Background: Extracorporeal membrane oxygenation (ECMO) is frequently used during lung transplantation. Unfractionated heparin (UFH) is mainly used as part of ECMO support for anticoagulation. One of the most common perioperative complications is bleeding, which high-dose UFH can aggravate. Methods: We retrospectively analyzed (n = 141) patients who underwent lung transplantation between 2020 and 2022. All subjects (n = 109) underwent central cannulated VA ECMO with successful intraoperative ECMO weaning. Patients on ECMO bridge, postoperative ECMO, heart-lung transplants and transplants without ECMO were excluded. The dose of UFH for the entire surgical procedure, blood loss and consumption of blood derivatives intraoperatively and 48 h after ICU admission were recorded. Surgical revision for postoperative bleeding were analyzed. Thrombotic complications, mortality and long-term survival were evaluated. Results: Lower doses of UFH administered for intraoperative ECMO anticoagulation contribute to a reduction in intraoperative blood derivates consumption and blood loss with no thrombotic complications related to the patient or the ECMO circuit. Lower doses of UFH may lead to a decreased incidence of surgical revision for hemothorax. Conclusion: Lower doses of UFH as part of intraoperative ECMO anticoagulation might reduce the incidence of complications and lead to better postoperative outcomes.

• MeSH
• antikoagulancia terapeutické užití   MeSH
• heparin terapeutické užití   MeSH
• lidé MeSH
• mimotělní membránová oxygenace * škodlivé účinky   MeSH
• pooperační krvácení MeSH
• retrospektivní studie MeSH
• transplantace plic * metody   MeSH
• trombóza * etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

Static ice storage has long been the standard-of-care for lung preservation, although freezing injury limits ischemic time (IT). Controlled hypothermic storage (CHS) at elevated temperature could safely extend IT. This retrospective analysis assesses feasibility and safety of CHS with IT > 15 hours. Three lung transplant (LuTx) centers (April-October 2023) included demographics, storage details, IT, and short-term outcome from 13 LuTx recipients (8 male, 59 years old). Donor lungs were preserved in a portable CHS device at 7 (5-9.3)°C. Indication was overnight bridging and/or long-distance transport. IT of second-implanted lung was 17.3 (15.1-22) hours. LuTx were successful, 4/13 exhibited primary graft dysfunction grade 3 within 72 hours and 0/13 at 72 hours. Post-LuTx mechanical ventilation was 29 (7-442) hours. Intensive care unit stay was 9 (5-28) and hospital stay 30 (16-90) days. Four patients needed postoperative extracorporeal membrane oxygenation (ECMO). One patient died (day 7) following malpositioning of an ECMO cannula. This multicenter experience demonstrates the possibility of safely extending IT > 15 hours by CHS.

• MeSH
• časové faktory MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• retrospektivní studie MeSH
• senioři MeSH
• studená ischemie MeSH
• studie proveditelnosti MeSH
• transplantace plic * metody   MeSH
• uchovávání orgánů * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

• MeSH
• dítě MeSH
• kontraindikace léčebného výkonu MeSH
• lidé MeSH
• pooperační komplikace imunologie   mikrobiologie   MeSH
• rejekce štěpu MeSH
• seznamy čekatelů MeSH
• transplantace plic * metody   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• antifibrotické látky terapeutické užití   MeSH
• idiopatická plicní fibróza * diagnóza   etiologie   terapie   MeSH
• lidé MeSH
• polymorfismus genetický MeSH
• transplantace plic metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Za 23 let trvání národního programu transplantace plic v České republice se uskutečnilo již přes 500 plicních transplantací, 4 retransplantace a jedna lobární retransplantace. Předmětem tohoto článku je kazuistika pacientky s cystickou fibrózou, která podstoupila první bilaterální transplantaci plic v lednu 2020. Z důvodu rozvoje chronické rejekce transplantovaného orgánu vyžadoval stav pacientky ECMO podporu a retransplantaci. Retransplantace proběhla v dubnu 2021 a vůbec poprvé tak byla v České republice provedena plicní retransplantace s „ECMO bridge to (re) transplantation“ podporou preoperačně z důvodu chronické dysfunkce plicního štěpu. Pacientka byla po 39 dnech od retransplantace ve stabilizovaném stavu dimitována. Při kontrole po 90 dnech od operace byla pacientka v celkově dobrém stavu a s uspokojivou funkcí plicního štěpu.

During the last 23 years of the National Lung Transplant Program in the Czech Republic, more than 500 lung transplantations, 4 retransplantations and one lobar retransplantation have been performed. We present the case report of a female patient with cystic fibrosis who underwent her first bilateral lung transplantation in January 2020. Due to a chronic lung allograft dysfunction, the patient required ECMO support and retransplantation. For the first time in the Czech Republic, a lung retransplantation with “ECMO bridge to (re)transplantation” preoperative support was performed in April 2021. The patient was discharged 39 days after retransplantation in a stable condition. At the day 90 follow-up visit, the patient was in a generally good condition with satisfying spirometric functions.

• Klíčová slova
• ECMO bridge,
• MeSH
• cystická fibróza chirurgie   MeSH
• dospělí MeSH
• lidé MeSH
• mimotělní membránová oxygenace * metody   MeSH
• reoperace MeSH
• transplantace plic * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• anastomóza chirurgická MeSH
• kontraindikace léčebného výkonu MeSH
• lidé MeSH
• seznamy čekatelů MeSH
• transplantace plic * metody   MeSH
• výběr pacientů MeSH
• Check Tag
• lidé MeSH

The past six decades have seen remarkable improvements in health outcomes for people with cystic fibrosis, which was once a fatal disease of infants and young children. However, although life expectancy for people with cystic fibrosis has increased substantially, the disease continues to limit survival and quality of life, and results in a large burden of care for people with cystic fibrosis and their families. Furthermore, epidemiological studies in the past two decades have shown that cystic fibrosis occurs and is more frequent than was previously thought in populations of non-European descent, and the disease is now recognised in many regions of the world. The Lancet Respiratory Medicine Commission on the future of cystic fibrosis care was established at a time of great change in the clinical care of people with the disease, with a growing population of adult patients, widespread genetic testing supporting the diagnosis of cystic fibrosis, and the development of therapies targeting defects in the cystic fibrosis transmembrane conductance regulator (CFTR), which are likely to affect the natural trajectory of the disease. The aim of the Commission was to bring to the attention of patients, health-care professionals, researchers, funders, service providers, and policy makers the various challenges associated with the changing landscape of cystic fibrosis care and the opportunities available for progress, providing a blueprint for the future of cystic fibrosis care. The discovery of the CFTR gene in the late 1980s triggered a surge of basic research that enhanced understanding of the pathophysiology and the genotype-phenotype relationships of this clinically variable disease. Until recently, available treatments could only control symptoms and restrict the complications of cystic fibrosis, but advances in CFTR modulator therapies to address the basic defect of cystic fibrosis have been remarkable and the field is evolving rapidly. However, CFTR modulators approved for use to date are highly expensive, which has prompted questions about the affordability of new treatments and served to emphasise the considerable gap in health outcomes for patients with cystic fibrosis between high-income countries, and low-income and middle-income countries (LMICs). Advances in clinical care have been multifaceted and include earlier diagnosis through the implementation of newborn screening programmes, formalised airway clearance therapy, and reduced malnutrition through the use of effective pancreatic enzyme replacement and a high-energy, high-protein diet. Centre-based care has become the norm in high-income countries, allowing patients to benefit from the skills of expert members of multidisciplinary teams. Pharmacological interventions to address respiratory manifestations now include drugs that target airway mucus and airway surface liquid hydration, and antimicrobial therapies such as antibiotic eradication treatment in early-stage infections and protocols for maintenance therapy of chronic infections. Despite the recent breakthrough with CFTR modulators for cystic fibrosis, the development of novel mucolytic, anti-inflammatory, and anti-infective therapies is likely to remain important, especially for patients with more advanced stages of lung disease. As the median age of patients with cystic fibrosis increases, with a rapid increase in the population of adults living with the disease, complications of cystic fibrosis are becoming increasingly common. Steps need to be taken to ensure that enough highly qualified professionals are present in cystic fibrosis centres to meet the needs of ageing patients, and new technologies need to be adopted to support communication between patients and health-care providers. In considering the future of cystic fibrosis care, the Commission focused on five key areas, which are discussed in this report: the changing epidemiology of cystic fibrosis (section 1); future challenges of clinical care and its delivery (section 2); the building of cystic fibrosis care globally (section 3); novel therapeutics (section 4); and patient engagement (section 5). In panel 1, we summarise key messages of the Commission. The challenges faced by all stakeholders in building and developing cystic fibrosis care globally are substantial, but many opportunities exist for improved care and health outcomes for patients in countries with established cystic fibrosis care programmes, and in LMICs where integrated multidisciplinary care is not available and resources are lacking at present. A concerted effort is needed to ensure that all patients with cystic fibrosis have access to high-quality health care in the future.

• MeSH
• celosvětové zdraví MeSH
• cystická fibróza genetika   terapie   MeSH
• genetická terapie metody   MeSH
• kvalita života * MeSH
• lidé MeSH
• poskytování zdravotní péče trendy   MeSH
• progrese nemoci * MeSH
• protein CFTR aplikace a dávkování   MeSH
• transplantace plic metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Research Support, N.I.H., Extramural MeSH
• Research Support, U.S. Gov't, P.H.S. MeSH

• MeSH
• biologické markery krev   MeSH
• hemostáza fyziologie   MeSH
• koagulopatie krev   komplikace   diagnóza   MeSH
• lidé MeSH
• mimotělní membránová oxygenace metody   MeSH
• pilotní projekty MeSH
• prospektivní studie MeSH
• transplantace plic metody   MeSH
• trombocyty fyziologie   MeSH
• trombóza krev   etiologie   prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Transplantácia pľúc je plne zavedená klinická metóda, ktorá zachraňuje a zlepšuje kvalitu života pacientom v konečnom štádiu pľúcneho ochorenia. V Českej republike sa trans-plantácia pľúc vykonáva od roku 1997. Počas tohto obdobia sa program transplantácie pľúc neustále vyvíja a mení. V tomto príspevku je uvedená svetová história transplantácie pľúc, ale aj vývoj transplantácie pľúc v Českej republike. V závere je objasnené pre akých pacientov je transplantácia pľúc určená, a opísaný zložitý proces protokolárnych vyšetrení pred zaradením na čakaciu listinu.

Lung transplantation is fully implemented clinical method, which saves and improves quality of life of patients in their final stage of lung disease. In the Czech Republic is the lung transplantation performed from 1997. During this period was the program of lung transplantation always evolving and changing. In this report is written world history of lung transplantation as well as evolution of lung transplantation in Czech Republic. In the end it's explained for which patients is the lung transplantation dedicated, and described difficult process of protocolar examinations before listing into the waiting list.

• MeSH
• příprava pacienta k transplantaci metody   MeSH
• programy řízené péče MeSH
• seznamy čekatelů MeSH
• transplantace orgánů MeSH
• transplantace plic dějiny   klasifikace   metody   normy   MeSH
• Geografické názvy
• Česká republika MeSH

Při narůstajících počtech transplantací plic v České republice vznikla potřeba zintenzivnit spolupráci pneumologů a hrudních chirurgů. III. chirurgická klinika v Motole získala statut Centra vysoce specializované péče v oblasti transplantační medicíny pro transplantace plic dospělých a dětí a v rámci povinnosti zabezpečit potransplantační péči se obrátila na Plicní kliniku FN Motol a Kliniku plicních nemocí a tuberkulózy FN Olomouc se Žádostí O spolupráci ve smyslu dlouhodobého sledování pacientů operovaných ve FN Motol. Péče o moravské pacienty se tedy postupně přesouvá do Olomouce. Během 2 let činnosti olomouckého centra bylo předáno 45 nemocných. Konstituovaná poradna pracuje 5 dní v týdnu a je zabezpečena čtyřmi lékari, dvěma psychology, edukační sestrou a koordinátorkou.

With increasing numbers of lung transplants in the Czech Republic, there was a need to intensify the cooperation of pneumologists and thoracic surgeons. The 3rd Department of Surgery of the Motol University Hospital was granted the status of a Center for Highly Specialized Care in Transplantation Medicine for Adult and Child Lung Transplantation and, under the obligation to provide post-transplantation care, contacted the Department of Pneumology, Motol University Hospital and the Department of Pulmonary Medicine, University Hospital Olomouc and asked them to cooperate in the long-term monitoring of patients operated in the Motol University Hospital. Care for patients from Moravia has gradually been moved to Olomouc. During the two-year existence of the Olomouc Center, 40 patients were handed over. The Center operates 5 days a week and the service is provided by four clinicians, two psychologists, a nurse and a coordinator.

• MeSH
• lidé MeSH
• pooperační komplikace MeSH
• pooperační péče statistika a číselné údaje   MeSH
• transplantace plic * dějiny   metody   statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH