Respiratory syncytial virus (RSV) causes seasonal acute respiratory illness significantly impacting vulnerable groups, including lung transplant recipients, who are at increased risk of hospitalization, acute rejection, and allograft dysfunction. The immunogenicity of the novel RSV prefusion F3 (RSVPreF3-AS01, Arexvy, GlaxoSmithKline) vaccine in immunocompromised patients remains largely unknown. In this study, we assessed both antibody-using and cellular immune responses 2 months after a single dose of the RSVPreF3-AS01 vaccine in 30 lung transplant recipients aged 60 years or older, who were at least 6 months posttransplant. The antibody response was assessed using enzyme-linked immunosorbent assay for detection of serum anti-RSV-F IgG specific antibodies, and the CD4+ T cell response was measured by flow cytometry intracellular cytokine secretion assay. Our findings show that all vaccinees exhibited a CD4+ T cell response 2 months postvaccination, whereas only 40% demonstrated an antibody response. These results suggest that some patients may derive clinical benefit from the vaccine through cellular immunity, even without an antibody response. Furthermore, the vaccine was well tolerated in this vulnerable population, with no major safety concerns observed.

• Klíčová slova
• RSV vaccine, T cell response, antibody response, immunogenicity, lung transplantation, respiratory syncytial virus,
• MeSH
• buněčná imunita MeSH
• CD4-pozitivní T-lymfocyty * imunologie   MeSH
• infekce respiračními syncytiálními viry * prevence a kontrola   imunologie   virologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lidský respirační syncytiální virus * imunologie   MeSH
• následné studie MeSH
• příjemce transplantátu MeSH
• prognóza MeSH
• protilátky virové imunologie   krev   MeSH
• respirační syncytiální viry * imunologie   MeSH
• senioři MeSH
• transplantace plic * škodlivé účinky   MeSH
• vakcíny proti respiračnímu syncyciálnímu viru * imunologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• protilátky virové MeSH
• vakcíny proti respiračnímu syncyciálnímu viru * MeSH

The maximal donor age for lung transplantation (LTx) remains controversial, despite favorable outcomes with donors ≥70 years. We report our experience with LTx from donors ≥80 years. Donor/recipient characteristics and short-term postoperative outcome were retrospectively analyzed across two centers between 2016 and 2023. Seventeen patients underwent single (n=2) or double (n=15) LTx from octo- or nonagenarian donors with a median age of 83 years (range 80-94). Most donors were non-smoking females with intracerebral bleeding. Last donor PaO2/FiO2 ratio was 440 mmHg. Three recipients developed PGD3 at 72 h. Median ICU and hospital stay were 11 and 29 days, respectively. Five patients showed minimal (A1) ACR at one month post-LTx. Two patients developed CLAD. One- and three-year survival rates were 84% and 70%. Our case series indicates that LTx from well-selected octo- and nonagenarian donors is a valuable option to expand the donor pool.

• Klíčová slova
• aging, donor age, lung transplantation,
• MeSH
• dárci tkání * MeSH
• lidé MeSH
• míra přežití trendy   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• transplantace plic * metody   MeSH
• věkové faktory MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

The preservation of donor lungs and the effort to safely extend ischemic time while maintaining function is an important topic that the transplant community has been addressing for a long time. Recent publications, mainly from the Toronto team, have fundamentally influenced the existing standard of optimal preservation conditions, and their results provide a scientific basis for the shift from ice preservation to con-trolled hypothermia. Optimal preservation conditions are a necessary prerequisite for the safe extension of ischemic time. This brings additional potential for the development of the field and the possibility to improve the availability of lung transplantations and their outcomes. This review summarizes the key findings in the area of donor lung preservation from the first experimental attempts conducted 30 years ago to recent studies and discusses the various aspects that the change in preservation standard has influenced or is likely to influence.

• Klíčová slova
• Lung transplantation, donor lung preservation, ischemic time,
• MeSH
• chlazení MeSH
• dárci tkání MeSH
• led MeSH
• lidé MeSH
• transplantace plic * MeSH
• uchovávání orgánů * metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• led MeSH

BACKGROUND: Pulmonary hernia is a rare condition characterized by the protrusion of lung tissue through a chest wall defect. Trauma and thoracic surgery are the most common causes of acquired lung hernias. We present an unusual case of (sequential) bilateral lung herniation with parenchymal infarction after bilateral lobar lung transplantation. CASE PRESENTATION: A 50-year-old female, wait-listed as high-urgency candidate, with a body mass index (BMI) of 29 kg/m2 underwent a bilateral lobar lung transplantation for pulmonary fibrosis through a clamshell thoracotomy approach. Due to a size mismatch, stapler resection of the segment 3 and the middle lobe of the right lung, as well as an upper left lobectomy was required. The chest was closed with 3 braided non-absorbable pericostal sutures on each side. Sternal osteosynthesis was performed with a titanium sternal splint along with 7 self-tapping screws with a length of 18 mm. On the posttransplant day (PTD) 18, patient's clinical condition deteriorated. Physical examination didn't reveal any palpable subcutaneous chest resistance. However, a computed tomography (CT) scan showed a herniation of the segment 6 of the right lung. During acute surgical revision, perioperative finding revealed posterior pericostal suture failure. Therefore, a stapler resection was performed due to the infarction of the herniated segment. On the PTD 36, herniation of the left lung parenchyma was detected by acute CT scan. The protruding vital parenchyma was surgically repositioned without necessity of resection. Two posterior pericostal sutures were broken, and distal part of sternal splint detached. Thoracotomy was closed using 5 braided non-absorbable sutures. Sternum was re-osteosynthesized with the STRATOS™ system. After 3 months of intensive postoperative care, the patient was transferred to the rehabilitation department. She was discharged on the PTD 99. After 20 months of follow-up, lung function remains stable without the need for oxygen support. CONCLUSION: Clamshell incision remains ultimate approach in thoracic surgery. However, pulmonary herniation after clamshell thoracotomy is a rare complication and may manifest as acute respiratory distress syndrome with an inflammatory response. In these cases, CT scan should be always considered, even if no palpable pathology of chest is present.

• Klíčová slova
• Clamshell thoracotomy, Lung hernia, Lung transplantation,
• MeSH
• hernie * etiologie   diagnóza   MeSH
• infarkt * etiologie   chirurgie   diagnóza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• plíce * krevní zásobení   chirurgie   diagnostické zobrazování   MeSH
• plicní nemoci * etiologie   chirurgie   MeSH
• počítačová rentgenová tomografie MeSH
• pooperační komplikace * etiologie   chirurgie   MeSH
• torakotomie * škodlivé účinky   metody   MeSH
• transplantace plic * škodlivé účinky   metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Scoliotic deformity represents a serious spinal disorder that influences the locomotive and cardiopulmonary systems. Some patients with severe scoliosis and end-stage lung disease are therefore denied lung transplantation. In patients with scoliosis considering lung transplantation, size match, straight back syndrome, delayed chest closure and bronchial stenosis are key issues clinicians should evaluate. Therefore, it is vital to determine donor-recipient size matches very precisely. Chest opening is a routine intraoperative primary therapeutic procedure after lung transplantation in unstable patients with oversized transplanted lungs. Postoperative bronchial stenosis occurs predominantly on the right side and is usually handled through interventional bronchoscopy and the insertion of stents. This report describes the complex case of a patient with scoliosis who underwent lobar transplantation in our center.

• Klíčová slova
• Bronchial stenosis, Delayed chest closure, Lung transplantation, Scoliosis, Straight back syndrome,
• MeSH
• bronchiální nemoci * chirurgie   etiologie   MeSH
• lidé MeSH
• skolióza * komplikace   chirurgie   MeSH
• stenóza chirurgie   MeSH
• sternum * chirurgie   MeSH
• transplantace plic * metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Acute cellular rejection (ACR) frequently occurs following lung transplantation (LuTx) and represents a risk factor for the development of chronic lung allograft dysfunction (CLAD) as well as long-term survival. The histopathological diagnosis of ACR carries a burden of interobserver variability. The widespread utilization and cost-effectiveness of immunohistochemistry (IHC) was proven beneficial in diagnosing rejection in human kidney transplantations and LuTx rat models. However, its potential for ACR detection in patients remains unexplored. We analyzed surface markers (CD3, CD4, CD8, CD20, CD68, CD47, PD-1, PD-L1, and CD31/PECAM-1) on lung tissue cryobiopsy samples collected within 6 months post-LuTx from 60 LuTx recipients, 48 of whom were diagnosed with ACR. Additionally, serum samples from 51 patients were analyzed using a multiplex bead-based Luminex assay. The cytokines and markers included PD-L1, IL2, TNFα, IFNγ, and Granzyme B. We observed a significant increase in PD-L1 tissue expression within the rejection group, suggesting a concerted effort to suppress immune responses, especially those mediated by T-cells. Furthermore, we noted significant differences in PECAM-1 levels between ACR/non-ACR. Additionally, peripheral blood C-reactive-protein levels tended to be higher in the ACR group, while Luminex serum analyses did not reveal any significant differences between groups. In conclusion, our findings suggest the potential value of PECAM-1 and PD-L1 markers in diagnosing ACR.

• Klíčová slova
• acute cellular rejection, checkpoint inhibitors, immunohistochemistry, luminex, lung transplantation,
• MeSH
• akutní nemoc MeSH
• antigeny CD274 * metabolismus   krev   MeSH
• antigeny CD31 * metabolismus   MeSH
• biologické markery * krev   metabolismus   MeSH
• dospělí MeSH
• imunohistochemie MeSH
• lidé středního věku MeSH
• lidé MeSH
• plíce patologie   MeSH
• rejekce štěpu * diagnóza   krev   MeSH
• senioři MeSH
• transplantace plic * škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antigeny CD274 * MeSH
• antigeny CD31 * MeSH
• biologické markery * MeSH
• CD274 protein, human MeSH Prohlížeč
• PECAM1 protein, human MeSH Prohlížeč

UNLABELLED: Primary graft failure occurs 15 to 30 % of the time after transplantation. Although there have been improvements in preserving the lungs in good condition, there have not been studies on the regulation of transcription factors. METHODS: We carried out an experimental study involving lung transplantation to indirectly evaluate reactive oxygen species (ROS) production and VEGF expression by competitive blockade of HIF-1alpha with chetomin. There were 5 groups: Group-1: Lung blocks were perfused with 0.9 % SSF, immediately harvested, and preserved. Group-2 (I-T): Immediate transplantation and then reperfusion for 1 h. Group-3 (I-R): Lung blocks were harvested and preserved in LPD solution for 6 h and reperfused for 1 h. Group-4 (DMSO): Lung blocks were treated for 4 h with DMSO, preserved for 6 h and transplanted to a receptor treated with DMSO. Group-5 (chetomin): Lung blocks were treated for 4 h with chetomin, preserved for 6 h and transplanted to a receptor treated with chetomin. ROS, mRNA, and protein levels of HIF-1alpha and EG-VEGF were determined. RESULTS: The DMSO and chetomin groups had significantly lower ROS levels. Compared with those in the I-R group, the chetomin group exhibited the lowest level of HIF-1alpha. CONCLUSIONS: Addition of chetomin to the donor and the receptor results in a significant reduction in HIF-1A, VEGF and ROS.

• MeSH
• disulfidy MeSH
• faktor 1 indukovatelný hypoxií - podjednotka alfa * metabolismus   MeSH
• indolové alkaloidy MeSH
• krysa rodu Rattus MeSH
• plíce metabolismus   účinky léků   MeSH
• potkani Sprague-Dawley MeSH
• reaktivní formy kyslíku * metabolismus   MeSH
• transplantace plic * MeSH
• vaskulární endoteliální růstový faktor A * metabolismus   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• chetomin MeSH Prohlížeč
• disulfidy MeSH
• faktor 1 indukovatelný hypoxií - podjednotka alfa * MeSH
• Hif1a protein, rat MeSH Prohlížeč
• indolové alkaloidy MeSH
• reaktivní formy kyslíku * MeSH
• vascular endothelial growth factor A, rat MeSH Prohlížeč
• vaskulární endoteliální růstový faktor A * MeSH

BACKGROUND: The pathology of primary hemostasis is a common complication of extracorporeal membrane oxygenation (ECMO) support. Scientific data describing its changes in patients on short-term ECMO support and the ability and speed of the restoration of its functions are limited. AIMS: The aim of this study was to describe the pathology of primary hemostasis induced by short-term ECMO support and its development over time using PFA-200, ROTEM platelet, and von Willebrand factor (vWF) analyses. METHODS: In patients undergoing lung transplantation surgery using intraoperative veno-arterial ECMO support, blood samples were analyzed using the following tests: PFA-200, ROTEM platelet tests, vWF antigen, ristocetin cofactor (RCo), and collagen-binding protein (CB) before, during, and after ECMO support. RESULTS: Blood samples from 32 patients were analyzed. All 3 PFA-200 tests (COL/EPI, COL/ADP, and COL/P2Y) showed significant deterioration during ECMO support with rapid restoration after ECMO cessation (p < 0.05), suggesting an ECMO-induced primary hemostasis disorder. A significant increase of vWF antigen after ECMO cessation (p < 0.05) was found with an increase of RCo and CB levels, although it was not significant (p > 0.05). CONCLUSIONS: Short-term ECMO support induces primary hemostasis pathology. It occurs immediately after initiation but is rapidly restored after ECMO cessation, which is detectable by PFA-200. Despite there being persistent platelet dysfunction after ECMO cessation, as seen with the ROTEM platelet results, the increased levels of vWF antigen might explain the normal results of primary hemostasis detected by PFA-200.

• Klíčová slova
• ECMO, ROTEM platelet, VWF, platelet function analyzer, primary hemostasis, shear stress,
• MeSH
• časové faktory MeSH
• dospělí MeSH
• hemostáza * fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mimotělní membránová oxygenace * metody   MeSH
• transplantace plic * MeSH
• von Willebrandův faktor metabolismus   analýza   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Názvy látek
• von Willebrandův faktor MeSH

Idiopathic pulmonary fibrosis (IPF) is a severe and currently incurable disease that is associated with irreversible fibrotic remodeling of the lung parenchyma. Pathological remodeling of the lung leads to damage of the alveolo-capillary barrier. There is a reduction in the diffusing capacity of the lungs for respiratory gases. Later, changes in the mechanical properties of lung tissue occur - their compliance decreases and respiratory work increases. Impaired respiratory gases exchange with restrictive ventilatory failure lead to tissue hypoxia and muscle weakness. Progressive respiratory insufficiency develops. The triggers of fibrotic remodeling of the lung are currently unknown, as are the pathomechanisms that keep this process active. IPF can only be slowed pharmacologically, not reversed. It is therefore very important to start its treatment as soon as possible. Early detection of IPF patients requires a multidisciplinary approach. Diagnosis, treatment initiation, and monitoring in specialized centers offer the best chance of slowing disease progression, enhancing quality of life, and extending patient survival. In addition to antifibrotic therapy, good lifestyle management, maintenance of physical fitness and treatment of associated chronic diseases such as diabetes and cardiac comorbidities are important. Lung transplantation is an option for some patients with IPF. This is a challenging treatment modality, requiring close collaboration with transplant centers and expert selection of suitable candidates, influenced, among other things, by the availability of suitable donor lungs. Our article aims to provide current information about IPF, focusing on its functional consequences and clinical manifestation. We discuss the molecular and cellular mechanisms potentially involved in IPF development, as well as the morphological changes observed in lung biopsies and high-resolution computed tomography (HRCT) images. Finally, we summarize the existing treatment options. Key words: Idiopathic pulmonary fibrosis, Lung biopsy, HRCT, Antifibrotic therapy, Lung transplantation.

• MeSH
• idiopatická plicní fibróza * terapie   diagnóza   patofyziologie   patologie   MeSH
• lidé MeSH
• plíce patologie   patofyziologie   MeSH
• transplantace plic MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Histologic evaluation of allograft biopsies after lung transplantation has several limitations, suggesting that molecular assessment using tissue transcriptomics could improve biopsy interpretation. This single-center, retrospective cohort study evaluated discrepancies between the histology of transbronchial biopsies (TBBs) with no rejection (NR) and T-cell mediated rejection (TCMR) by molecular diagnosis. The accuracy of diagnosis was assessed based on response to treatment. 54 TBBs from Prague Lung Transplant Program obtained between December 2015 and January 2020 were included. Patients with acute cellular rejection (ACR) grade ≥ 1 by histology received anti-rejection treatment. Response to therapy was defined as an increase in FEV1 of ≥ 10% 4 weeks post-biopsy compared to the pre-biopsy value. Among the 54 analyzed TBBs, 25 (46%) were concordant with histology, while 29 (54%) showed discrepancies. ACR grade 0 was found in 12 TBBs (22%) and grade A1 ≥ 1 in 42 TBBs (78%). Treatment response was present in 14% in the NR group and in 50% in the TCMR group (p = 0.024). Our findings suggest that low-grade acute cellular rejection is less likely to be associated with molecular TCMR, which might better identify lung transplant recipients who benefit from therapy.

• Klíčová slova
• acute cellular rejection, gene expression, histopathology, lung transplantation, molecular biology,
• MeSH
• biopsie MeSH
• dospělí MeSH
• imunosupresiva terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• plíce patologie   MeSH
• rejekce štěpu * diagnóza   patologie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• transplantace plic * MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Názvy látek
• imunosupresiva MeSH