DOCSLIB.ORG

Prophylactic Epinephrine for the Prevention Of

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Open access Protocol BMJ Open: first published as 10.1136/bmjopen-2018-024521 on 23 March 2019. Downloaded from Prophylactic epinephrine for the prevention of transbronchial lung biopsy-related bleeding in lung transplant recipients (PROPHET) study: a protocol for a multicentre randomised, double-blind, placebo-controlled trial Or Kalchiem-Dekel,1 Aldo Iacono,2 Edward M Pickering,1 Ashutosh Sachdeva,1 Nirav G Shah,1 Mark Sperry,1 Bich-Chieu Tran,1 Robert M Reed 1 To cite: Kalchiem-Dekel O, ABSTRACT Strengths and limitations of this study Iacono A, Pickering EM, et al. Introduction Transbronchial lung biopsy (TBLB) is Prophylactic epinephrine for frequently performed in single-lung and double-lung the prevention of transbronchial ► Randomised, double-blinded, placebo-controlled transplant recipients for evaluation of clinical and lung biopsy-related bleeding multicentre design to ensure unbiased treatment radiological findings as well as routine surveillance for in lung transplant recipients effect measure. acute cellular rejection. While rates of clinically significant (PROPHET) study: a protocol ► Comprehensive data are collected, including vid- for a multicentre randomised, TBLB-related haemorrhage are <1% for all comers, the eo-recording of bronchoscopic procedures, to allow double-blind, placebo- incidence in lung transplant recipients is reported to be independent evaluation by observers blinded to the controlled trial. BMJ Open higher, presumably due to persistent allograft inflammation individual participant data and study arm allocation. 2019;9:e024521. doi:10.1136/ and alterations in allograft blood flow. While routinely Study outcome to be evaluated comprehensively via bmjopen-2018-024521 ► performed by some bronchoscopists, the efficacy and several grading scales by both procedure performer ► Prepublication history for safety profile of prophylactic administration of topical and independent observers. this paper is available online. intrabronchial diluted epinephrine for the prevention of ► The target population of the study, while enriching To view these files, please visit TBLB-related haemorrhage has not been explored in a the outcome of interest, may limit generalisability of http://bmjopen.bmj.com/ the journal online (http:// dx. doi. prospective manner. the findings to other populations. org/ 10. 1136/ bmjopen- 2018- Methods and analysis In this randomised, double-blind, Data informing optimal dose of topical epinephrine 024521). ► placebo-controlled multicentre trial (PROPHET Study), and volume of instillation are lacking. Dose and vol- Received 31 May 2018 single-lung and double-lung transplant adult recipients ume used in this study are based on local expertise Revised 20 February 2019 from participating institutions who are scheduled for and may not necessarily represent optimal values. Accepted 21 February 2019 bronchoscopy with TBLB for clinical indications will be identified. Potential participants who meet inclusion and exclusion criteria and sign an informed consent will study will be published in peer-reviewed scientific journals be randomised to receive either diluted epinephrine or and presented at relevant academic conferences. on October 1, 2021 by guest. Protected copyright. placebo prior to performance of TBLB. The degree of TBLB- Trial registration number NCT03126968; Pre-results. related haemorrhage will be graded by the performing bronchoscopist as well as independent observers. The primary analysis will compare the rates of severe and very INTRODUCTION severe bleeding in participants treated with epinephrine or Flexible bronchoscopy with transbron- placebo. The study will also evaluate the safety profile of chial lung biopsy (TBLB) has become a prophylactic topical epinephrine including the occurrence central diagnostic modality for assessment © Author(s) (or their of serious cardiovascular and haemodynamic adverse of lung allograft function and specifically events. Additional secondary outcomes to be explored employer(s)) 2019. Re-use acute cellular rejection (ACR) following permitted under CC BY-NC. No include rates of non-severe TBLB-related haemorrhage, lung transplantation. Most lung transplant commercial re-use. See rights overall yield of the bronchoscopic procedure and non- and permissions. Published by serious cardiovascular and haemodynamic adverse effects. programmes now perform TBLB for allograft BMJ. Ethics and dissemination The study procedures were function surveillance, new onset symp- For numbered affiliations see reviewed and approved by institutional review boards in toms, ≥10% decrease in forced expiratory end of article. participating institutions. This study is being externally volume over 1 s, assessment of new findings Correspondence to monitored, and a data and safety monitoring committee on chest imaging or as a follow-up for acute 1 Dr Robert M Reed; has been assembled to monitor patient safety and to rejection or cytomegalovirus pneumonitis. rreed@ som. umaryland. edu evaluate the efficacy of the intervention. The results of this For ACR surveillance in lung and lung–heart Kalchiem-Dekel O, et al. BMJ Open 2019;9:e024521. doi:10.1136/bmjopen-2018-024521 1 Open access BMJ Open: first published as 10.1136/bmjopen-2018-024521 on 23 March 2019. Downloaded from transplant recipients, most transplant centres will obtain such as tranexamic acid.17 18 Dosing of topical epineph- at least 5 and up to 10 biopsies per procedure.2 3 The rine for treatment of airway bleeding lacks standardisa- frequency and period of time over which surveillance tion. Recommendations regarding epinephrine dilution biopsies are obtained is debatable and based on local range between 1:10 000 and 1:100 000 and recommended expertise within transplant institutions. volumes of instillation vary between 0.5 mL and 20 mL TBLB is generally safe, although severe and life-threat- in different publications.16 19–21 Our local practice for ening procedure-related complications are occasionally the initial treatment of endobronchial bleeding includes encountered. Most common among them are pneumo- administration of iced saline in aliquots of 2–10 mL thorax and haemorrhage. Large population-based studies followed by 1–2 mL aliquots of 1:10 000 topical epineph- have established the overall rate of TBLB-related haem- rine (0.1–0.2 mg) to a maximum of 6 mL (0.6 mg). orrhage, defined arbitrarily as recovery of ≥50 mL of Although adopted by some providers as means to bloody fluid, at 0.58%–0.73%.4 5 Death related to airway reduced TBLB-related haemorrhage, the use of prophy- bleeding in association with bronchoscopic procedures is lactic instillation of diluted epinephrine into the target exceedingly rare.5 6 Evidence suggests a higher propen- bronchus before attempting TBLB is not established in sity for TBLB-related bleeding in the lung and heart–lung the literature. The main body of evidence regarding the transplant population. In a population of lung–heart efficacy and safety of prophylactic topical epinephrine transplant patients, Scott et al2 recorded a 12.6% rate for the prevention of haemorrhage is derived from the of >100 mL procedure-related bleeding. In another surgical literature, specifically endoscopic endonasal and prospective study, Diette et al7 recorded higher rates sinus surgery, rhinoplasty and surgical management of of bronchoscopy-related haemorrhage, postprocedure burn injuries.22–25 haemoptysis and early termination of a procedure due The potential for endobronchially administered to bleeding in lung transplant patients when compared epinephrine to result in adverse haemodynamic effects with non-transplant controls. Possible reasons posited to is well recognised, and dosing recommendations have explain the greater propensity to bleed among lung trans- been made since the 1970s.26 Nevertheless, evidence of plant recipients include an already inflamed lung tissue such adverse effects is scarce. Janjua et al27 reported a case from infection, ACR or bronchiolitis obliterans, as well as of coronary vasospasm manifesting as chest pain, ST-seg- an increase in blood flow to the transplanted lung, partic- ment elevation and ectopy induced by topical adminis- ularly in recipients of single lung transplants.7 tration of 3 mL of 1:10 000 diluted epinephrine during Quantification of TBLB-related bleeding is difficult, bronchoscopy. In this case, epinephrine was adminis- subjective and prone to bias. Many investigators use tered into inflamed and friable airways of a lung cancer grading systems that rely on the amount of mixed blood patient for the treatment of established bleeding, poten- and bronchial wash fluid in the vacuum suction system tially augmenting the area of contact between epineph- 5 8–10 at the end of the procedure. This method may be rine and injured blood vessels. More recently, two cases http://bmjopen.bmj.com/ prone to measurement errors in estimation of the actual of ventricular fibrillation possibly induced by broncho- extent of blood loss during the procedure due to dilu- scopic administration of epinephrine for TBLB-related tion of blood with other airway secretions as well as fluids bleeding were reported.28–30 In both cases, arrhythmia administered via the bronchoscope channel. Pilarczyk et occurred with bronchoscopic instillation of epinephrine al11 suggested a grading system that classifies endobron- as a therapeutic measure in response to bleeding and via chial haemorrhage based on the most proximal bronchus a catheter that was positioned distally in the bronchial in
Recommended publications
  • Surgical Advances in Heart and Lung Transplantation

    Surgical Advances in Heart and Lung Transplantation

    Anesthesiology Clin N Am 22 (2004) 789–807 Surgical advances in heart and lung transplantation Eric E. Roselli, MD*, Nicholas G. Smedira, MD Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Desk F25, 9500 Euclid Avenue, Cleveland, OH 44195, USA The first heart transplants were performed in dogs by Alexis Carrel and Charles Guthrie in 1905, but it was not until the 1950s that attempts at human orthotopic heart transplant were reported. Several obstacles, including a clear definition of brain death, adequate organ preservation, control of rejection, and an easily reproducible method of implantation, slowed progress. Eventually, the first successful human to human orthotopic heart transplant was performed by Christian Barnard in South Africa in 1967 [1]. Poor healing of bronchial anastomoses hindered early progress in lung transplantation, first reported in 1963 [2]. The first successful transplant of heart and both lungs was accomplished at Stanford University School of Medicine (Stanford, CA) in 1981 [3]. The introduction of cyclosporine to immunosuppres- sion protocols, with lower doses of steroids, led to the first successful isolated lung transplant, performed at Toronto General Hospital in 1983 [4]. Since these early successes at thoracic transplantation, great progress has been made in the care of patients with end-stage heart and lung disease. Although only minor changes have occurred in surgical technique for heart and lung transplantation, the greatest changes have been in liberalizing donor criteria to expand the donor pool. This article focuses on more recent surgical advances in donor selection and management, procurement and implantation, and the impact these advances have had on patient outcome.
  • Clinical Policy: Lung Transplantation Reference Number: CP.MP.57 Coding Implications Last Review Date: 05/20 Revision Log

    Clinical Policy: Lung Transplantation Reference Number: CP.MP.57 Coding Implications Last Review Date: 05/20 Revision Log

    Clinical Policy: Lung Transplantation Reference Number: CP.MP.57 Coding Implications Last Review Date: 05/20 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description Medical necessity criteria for the review of lung transplantation requests. Policy/Criteria I. It is the policy of health plans affiliated with Centene Corporation® that lung transplant for members with chronic, end-stage lung disease who have failed maximal medical therapy is medically necessary when all of the following criteria are met: A. High (> 50%) risk of death from lung disease within 2 years if lung transplantation is not performed. B. High (> 80%) likelihood of surviving at least 90 days after lung transplantation. C. High (> 80%) likelihood of 5-year post-transplant survival from a general medical perspective provided that there is adequate graft function. D. Does not have ANY of the following absolute contraindications: 1. Malignancy, except for non-melanoma localized skin cancer that has been treated appropriately, low grade prostate cancer, a malignancy that has been completely resected, or a treated malignancy determined to have a small likelihood of recurrence and acceptable future risks; 2. Untreatable significant dysfunction of another major organ system unless combined organ transplantation can be performed; 3. Uncorrected atherosclerotic disease with suspected or confirmed end-organ ischemia or dysfunction and/or coronary artery disease not amenable to revascularization; 4. Acute medical instability, including, but not limited to, acute sepsis, acute viral respiratory infection, myocardial infarction, and liver failure; 5. Uncorrectable bleeding diathesis; 6. Chronic infection with highly virulent and/or resistant microbes that are poorly controlled pre-transplant; 7.
  • Lung Transplantation with the OCS (Organ Care System)

    Lung Transplantation with the OCS (Organ Care System)

    Lung Transplantation with the OCSTM (Organ Care System) Lung System Bringing Breathing Lung Preservation to Transplant Patients A Guide for You and Your Family DRAFT ABOUT THIS BOOKLET This booklet was created for patients like you who have been diagnosed with end-stage lung failure and are candidates for a lung transplant. It contains information that will help you and your family learn about options available to you for a transplant. This booklet includes information on your lungs, how they function, and respiratory failure. In addition, you will learn about a new way to preserve lungs before transplantation, called breathing lung preservation. Your doctor is the best person to explain your treatment options and their risks and to help you decide which option is right for you. The booklet explains: • Breathing lung preservation with the OCS™ Lung System • How the OCS™ Lung System works • Who is eligible for the OCS™ Lung System • Lung transplant complications • How the lungs function • What is respiratory failure and the treatment options • What to expect during your treatment • Summary of clinical data for the OCS™ Lung System • Contact Information Please read this booklet carefully and share it with your family and caregivers. For your convenience, a glossary is provided in the front of this booklet. Terms in the text in bold italics are explained in the glossary. If you have questions about the OCS™ Lung System that are not answered in this booklet, please ask your physician. This booklet is intended for general information only. It is not intended to tell you everything you need to know about a lung transplant.
  • Chronic Lung Allograft Dysfunction Post Lung Transplantation: a Review of Computed Tomography Quantitative Methods for Detection and Follow-Up

    Chronic Lung Allograft Dysfunction Post Lung Transplantation: a Review of Computed Tomography Quantitative Methods for Detection and Follow-Up

    Journal of Clinical Medicine Review Chronic Lung Allograft Dysfunction Post Lung Transplantation: A Review of Computed Tomography Quantitative Methods for Detection and Follow-Up Trieu-Nghi Hoang-Thi 1,2,3 , Guillaume Chassagnon 1, Thong Hua-Huy 3, Veronique Boussaud 4, Anh-Tuan Dinh-Xuan 3 and Marie-Pierre Revel 1,* 1 AP-HP.Centre, Hôpital Cochin, Department of Radiology, Université de Paris, 75014 Paris, France; [email protected] (T.-N.H.-T.); [email protected] (G.C.) 2 Department of Diagnostic Imaging, Vinmec Central Park Hospital, Ho Chi Minh City 70000, Vietnam 3 AP-HP.Centre, Hôpital Cochin, Department of Respiratory Physiology, Université de Paris, 75014 Paris, France; [email protected] (T.H.-H.); [email protected] (A.-T.D.-X.) 4 AP-HP.Centre, Hôpital Cochin, Department of Pneumology, Université de Paris, 75014 Paris, France; [email protected] * Correspondence: [email protected]; Tel.: +33-1-5841-2471 Abstract: Chronic lung allograft dysfunction (CLAD) remains the leading cause of morbidity and mortality after lung transplantation. The term encompasses both obstructive and restrictive pheno- types, as well as mixed and undefined phenotypes. Imaging, in addition to pulmonary function tests, plays a major role in identifying the CLAD phenotype and is essential for follow-up after Citation: Hoang-Thi, T.-N.; lung transplantation. Quantitative imaging allows for the performing of reader-independent precise Chassagnon, G.; Hua-Huy, T.; Boussaud, V.; Dinh-Xuan, A.-T.; evaluation of CT examinations. In this review article, we will discuss the role of quantitative imaging Revel, M.-P.
  • Islet Interleukin-1Β Immunoreactivity Is an Early Feature of Cystic Fibrosis That May Contribute to Β-Cell Failure

    Islet Interleukin-1Β Immunoreactivity Is an Early Feature of Cystic Fibrosis That May Contribute to Β-Cell Failure

    Diabetes Care 1 Islet Interleukin-1b Rebecca L. Hull,1 Ronald L. Gibson,2 Sharon McNamara,2 Gail H. Deutsch,3 Immunoreactivity Is an Early Corinne L. Fligner,3 Charles W. Frevert,1,4 Bonnie W. Ramsey,2 and Srinath Sanda5,6 Feature of Cystic Fibrosis That May Contribute to b-Cell Failure https://doi.org/10.2337/dc17-1387 OBJECTIVE Cystic fibrosis–related diabetes (CFRD) is a common complication of cystic fibrosis (CF), increasing patient morbidity and mortality. Poor understanding of CFRD path- ogenesis limits the development of targeted therapies to treat and/or prevent the disease. The aim of this study was to evaluate islet pathology, specifically, inflam- mation, amyloid deposition, and endocrine cell composition in subjects with CF with diabetes and with CF without diabetes. RESEARCH DESIGN AND METHODS A retrospective analysis of archived pancreas tissue collected at autopsy was con- ducted using pancreas tissue from subjects with CF and diabetes (CFRD) (n = 18) and PATHOPHYSIOLOGY/COMPLICATIONS CF without diabetes (CF-no DM) (n = 17). Two cohorts of control non-CF subjects were identified, each matched to CFRD and CF-no DM subjects for age, sex, and BMI (non-CF older, n = 20, and non-CF younger, n = 20), respectively. Immunohistochem- istry was performed to assess IL-1b and islet hormone (insulin, glucagon, somato- statin, and pancreatic polypeptide) immunoreactivity; histochemistry was performed 1Department of Medicine, University of Wash- to quantify amyloid deposition. ington, Seattle, WA 2Department of Pediatrics, University of Wash- RESULTS ington, Seattle, WA 3Department of Pathology, University of Wash- Islet IL-1b immunoreactivity was substantially increased in both CFRD and CF-no DM ington, Seattle, WA subjects compared with non-CF subjects and was common in young subjects with CF 4Department of Comparative Medicine, Univer- (£10 years of age).
  • Airway Versus Transbronchial Biopsy and BAL in Lung Transplant Recipients: Different but Complementary

    Airway Versus Transbronchial Biopsy and BAL in Lung Transplant Recipients: Different but Complementary

    Eur Respir J 1997; 10: 2876–2880 Copyright ERS Journals Ltd 1997 DOI: 10.1183/09031936.97.10122876 European Respiratory Journal Printed in UK - all rights reserved ISSN 0903 - 1936 Airway versus transbronchial biopsy and BAL in lung transplant recipients: different but complementary C. Ward, G.I. Snell, B. Orsida, L. Zheng, T.J. Williams, E.H. Walters Airway versus transbronchial biopsy and BAL in lung transplant recipients: different Dept of Respiratory Medicine, Alfred but complementary. C. Ward, G.I. Snell, B. Orsida, L. Zheng, T.J. Williams, E.H. Walters. Hospital and Monash University Medical ©ERS Journals Ltd 1997. School, Melbourne, Australia. ABSTRACT: Lung transplantation is now an established therapeutic intervention Correspondence: E.H Walters for end-stage cardiopulmonary disease in humans. Chronic rejection, in the form Dept of Respiratory Medicine of bronchiolitis obliterans syndrome (BOS), remains the commonest cause of mor- Alfred Hospital bidity and mortality in those surviving more than 3 months. The pathology of BOS Prahran involves airway changes. We have evaluated the potential for endobronchial biop- Melbourne sies (EBB) to complement existing sampling methods used in allograft monitoring Victoria 3181 and have compared the results of EBB findings with those of bronchoalveolar Australia lavage (BAL) and transbronchial biopsy (TBB) in 18 clinically stable patients. Keywords: Bronchoalveolar lavage We found that all the EBB had inflammatory cells present but that only five endobronchial biopsy TBB specimens had evidence of inflammation, with airway material being present lung transplant in 78% of the TBB. Paired BAL and EBB yielded different results, with no cor- transbronchial biopsy relations between total macrophages, lymphocytes, CD4+ cells or CD8+ cells.
  • Icd-9-Cm (2010)

    Icd-9-Cm (2010)

    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
  • FY 2009 Final Addenda ICD-9-CM Volume 3, Procedures Effective October 1, 2008

    FY 2009 Final Addenda ICD-9-CM Volume 3, Procedures Effective October 1, 2008

    FY 2009 Final Addenda ICD-9-CM Volume 3, Procedures Effective October 1, 2008 Tabular 00.3 Computer assisted surgery [CAS] Add inclusion term That without the use of robotic(s) technology Add exclusion term Excludes: robotic assisted procedures (17.41-17.49) New code 00.49 SuperSaturated oxygen therapy Aqueous oxygen (AO) therapy SSO2 SuperOxygenation infusion therapy Code also any: injection or infusion of thrombolytic agent (99.10) insertion of coronary artery stent(s) (36.06-36.07) intracoronary artery thrombolytic infusion (36.04) number of vascular stents inserted (00.45-00.48) number of vessels treated (00.40-00.43) open chest coronary artery angioplasty (36.03) other removal of coronary obstruction (36.09) percutaneous transluminal coronary angioplasty [PTCA] (00.66) procedure on vessel bifurcation (00.44) Excludes: other oxygen enrichment (93.96) other perfusion (39.97) New Code 00.58 Insertion of intra-aneurysm sac pressure monitoring device (intraoperative) Insertion of pressure sensor during endovascular repair of abdominal or thoracic aortic aneurysm(s) New code 00.59 Intravascular pressure measurement of coronary arteries Includes: fractional flow reserve (FFR) Code also any synchronous diagnostic or therapeutic procedures Excludes: intravascular pressure measurement of intrathoracic arteries (00.67) 00.66 Percutaneous transluminal coronary angioplasty [PTCA] or coronary atherectomy Add code also note Code also any: SuperSaturated oxygen therapy (00.49) 1 New code 00.67 Intravascular pressure measurement of intrathoracic
  • What Is Lung Transplantation?

    What Is Lung Transplantation?

    American Thoracic Society PATIENT EDUCATION | INFORMATION SERIES What is Lung Transplantation? Lung transplants are performed as a life saving treatment for people with end-stage lung disease. A lung transplant is a surgery to remove diseased lungs and replace them with lungs from a deceased donor with healthy lungs. There are only a few specialized centers around the world where lung transplants are performed. You will need to be referred to one of these centers to be considered for the surgery. Do I need a lung transplant? oxygen requirement, pulmonary function test results, distance Lung transplantation is an option for people with ‘end walked in 6 minutes and the type of lung disease you have. stage’ lung diseases such as chronic obstructive pulmonary Your transplant team may update your score over time if some disease (COPD), pulmonary fibrosis, cystic fibrosis (CF), of these factors change. pulmonary arterial hypertension (PAH), sarcoidosis, and Other factors used when matching donor lungs to a transplant other more rare lung diseases (See “Recipient Selection for recipient include: Lung Transplantation”). Lung transplantation should only be considered when you and your physician have exhausted all ■ where the donor is, other forms of available treatment. However, lung transplant ■ donor and recipient blood types, should be performed before you become too sick to tolerate the ■ surgery. Hence, the timing of evaluation and the surgery itself is antibodies you may have against certain donors’ blood very important. and tissues, ■ In order to qualify for surgery, you need to be evaluated at a donor lung size and your chest size (often related to lung transplant center.
  • Heart, Lung, and Heart-Lung Transplantation

    Heart, Lung, and Heart-Lung Transplantation

    Medical Coverage Policy Effective Date ............................................. 9/15/2021 Next Review Date ....................................... 9/15/2022 Coverage Policy Number .................................. 0129 Heart, Lung, and Heart-Lung Transplantation Table of Contents Related Coverage Resources Overview .............................................................. 1 Ventricular Assist Devices (VADs), Percutaneous Coverage Policy ................................................... 1 Cardiac Support Systems and Total Artificial General Background ............................................ 3 Heart Medicare Coverage Determinations .................. 16 Transplantation Donor Charges Coding/Billing Information .................................. 16 Laboratory Testing for Transplantation Rejection Extracorporeal Photopheresis References ........................................................ 17 INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary
  • Transplant Recipient Outcome in the Lung Allocation Score Era in Eurotransplant – a Historical Prospective Study

    Transplant Recipient Outcome in the Lung Allocation Score Era in Eurotransplant – a Historical Prospective Study

    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Erasmus University Digital Repository Transplant International ORIGINAL ARTICLE Impact of donor lung quality on post-transplant recipient outcome in the Lung Allocation Score era in Eurotransplant – a historical prospective study Jacqueline M. Smits1 , Jens Gottlieb2,3, Erik Verschuuren4, Patrick Evrard5, Rogier Hoek6, Christiane Knoop7,Gyorgy€ Lang8, Johanna M. Kwakkel-van Erp9, Robin Vos10 , Geert Verleden10, Benoit Rondelet11, Daniel Hoefer12, Frank Langer13, Rene Schramm14, Konrad Hoetzenecker8, Diana van Kessel15, Bart Luijk16, Leonard Seghers6, Tobias Deuse17, Roland Buhl18, Christian Witt19, Agita Strelniece1, Dave Green1, Erwin de Vries1, Guenter Laufer20 & Dirk Van Raemdonck21 1 Eurotransplant International Foundation, Leiden, The Netherlands SUMMARY 2 Department of Respiratory The aim of this study was to investigate whether there is an impact of Medicine, Hannover Medical School, donation rates on the quality of lungs used for transplantation and Hannover, Germany whether donor lung quality affects post-transplant outcome in the current 3 Biomedical Research in End-stage Lung Allocation Score era. All consecutive adult LTx performed in Euro- and Obstructive Disease (Breath), transplant (ET) between January 2012 and December 2016 were included German Centre for Lung Research = (DZL), Hannover, Germany (N 3053). Donors used for LTx in countries with high donation rate were younger (42% vs. 33% ≤45 years, P < 0.0001), were less often smok- 4 Department of Pulmonary < Medicine and Tuberculosis, ers (35% vs. 46%, P 0.0001), had more often clear chest X-rays (82% vs. University Medical Center 72%, P < 0.0001), had better donor oxygenation ratios (20% vs.
  • Annual Report 20 14 Eurotransplant International Foundation

    Annual Report 20 14 Eurotransplant International Foundation

    Annual Report 20 14 Eurotransplant International Foundation Edited by Undine Samuel Central office P.O. box 2304 2301 CH Leiden The Netherlands Tel. +31-71-579 57 00 Fax. +31-71-579 00 57 www.eurotransplant.org twitter.com/eurotransplant All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying or elswise, without prior permission. Eurotransplant | Annual Report 2014 1 CIP-GEGEVENS KONINKLIJKE BIBLIOTHEEK, DEN HAAG Annual Report/Eurotransplant International Foundation.–Leiden: Eurotransplant Foundation. -III., graf., tab. Published annually Annual report 2014 / ed. by Undine Samuel ISBN-EAN: 978-90-71658-33-4 Keyword: Eurotransplant Foundation; annual reports. 2 Eurotransplant | Annual Report 2014 Table of contents Foreword 5 1. Basic principles of the Eurotransplant community 9 2. Report of the Board and the central office 17 3. Transplant programs and their delegates in 2014 33 4. Eurotransplant: donation, waiting lists and transplants 41 5. Kidney: donation, waiting lists and transplants 65 6. Thoracic organs: donation, waiting lists and transplants 85 7. Liver and Intestine: donation, waiting lists and transplants 107 8. Pancreas and Islets: donation, waiting lists and transplants 121 9. Agreements between transplant programs within and outside Eurotransplant 135 10. Reporting of non-resident transplants in Eurotransplant 139 11. Histocompatibility Testing 141 12. Scientific Output in 2014 147 13. Eurotransplant personnel related statistics 151 14. Abbreviated financial statements 153 List of abbreviations 159 Eurotransplant | Annual Report 2014 3 4 Eurotransplant | Annual Report 2014 Foreword In 2014, Eurotransplant (ET) allocated 7.183 deceased donor organs from 2.041 donors to patients on the waiting list.