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Background: The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation is an uncommon strategy in Japan owing to the severe donor shortage and absence of urgent allocation policy. Moreover, the use of veno-venous (VV) ECMO for immunosuppressed patients is controversial; thus, applying ECMO to patients who await lung re-transplantation is challenging. Case presentation: A 16-year-old lung transplant recipient with grade 3 bronchiolitis obliterans syndrome was waitlisted for lung re-transplantation. Eleven months later, he fell into severe respiratory acidosis with hypercapnia, which were not resolved with mechanical ventilation. VV ECMO was introduced to minimize lung stress and strain. Tracheostomy was additionally performed on day 5 after the start of ECMO, and respiratory condition swiftly improved; hence, the weaning process from VV ECMO began on day 9. Rehabilitation became implementable, and bilateral re-lung transplantation was successfully performed 6 months after the ECMO treatment. No critical complication related to the precedent use of ECMO was noted. Conclusions: VV ECMO can be a feasible treatment option even for lung transplant candidates awaiting re-transplantation for a prolonged period. Introduction of ECMO and tracheostomy in the early deterioration stage may be crucial to successful subsequent patient management. [ABSTRACT FROM AUTHOR]

Background Sinusoidal obstruction syndrome (SOS) after liver transplantation (LT) is a rare and potentially lethal complication. We retrospectively reviewed the outcomes of patients with post-transplant SOS. Methods Between May 2001 and December 2019, of 332 patients who underwent LT, 5 (1.5%) developed SOS. The median age at LT was 1.7 years (range 0.1–66.5). SOS was histopathologically diagnosed and classified as early-onset (<1 month) or late-onset. Results The median time to diagnosis of SOS was one month after LT. All patients developed acute cellular rejection before SOS, and the cause of SOS was acute cellular rejection in four patients and unknown in one. The treatment of SOS included conversion to tacrolimus from cyclosporine, intrahepatic hepatic vein stent placement, strengthening of immunosuppression, and plasma exchange. The 5-year graft survival rates in patients with and without SOS were 53.0% and 92.5%, respectively (p < 0.001). Of three patients with early-onset SOS, two patients improved and are doing well, and one patient died of graft failure four months after LT. Conclusions The cause and treatment of post-transplant SOS are not yet defined. The poor outcomes in patients with early-onset SOS may be improved by strengthening of immunosuppression. Patients with late-onset SOS are ultimately treated by repeat LT. [ABSTRACT FROM AUTHOR]

Background: Chemotherapy with oxaliplatin is known to induce sinusoidal obstruction syndrome (SOS). In a previous single-center study, we reported that oxaliplatin-induced increase in splenic volume (SV) is strongly indicative of SOS, and that this increase in SV persisted for > 1 year after completing chemotherapy. The aim of this study was to confirm the oxaliplatin-induced SV change in a multicenter study in patients with stage III colon cancer in Japan. Methods: We enrolled 59 patients who underwent curative resection for stage III colon cancer in the FACOS study in a phase II multi-center clinical study. Participants received mFOLFOX6 or CAPOX as adjuvant chemotherapy. SV change was assessed three times by computed tomographic volumetry: before surgery, on completion of adjuvant chemotherapy, and 1 year after completing adjuvant chemotherapy. Results: SV on completing and 1 year after chemotherapy was significantly higher than that before surgery (P < 0.001). Oxaliplatin-induced SOS persisted for > 1 year after the completion of adjuvant chemotherapy in half of the patients. There was no difference in 3-year disease-free survival with respect to the presence or absence of increased SV. An increase in SV was observed in 72% of patients treated with mFOLFOX6 and 94% of patients treated with CAPOX (P = 0.13). Conclusion: This study can be verified the findings observed in our previous single-center study, oxaliplatin-based adjuvant chemotherapy was associated with an increase in SV. Furthermore, this increase can persist for > 1 year. The continuous presence of SOS may have a negative impact on prognosis in patients that develop recurrent disease. [ABSTRACT FROM AUTHOR]

Purpose Recent progress in the treatment of pulmonary arterial hypertension (PAH) such as high-dose epoprostenol and upfront combination therapy brought a marked improvement in prognosis of PAH. However, severely ill cases with PAH still need lung transplantation. Considering the first-come-first-served system and resulting long waiting period Japan, the timing of referral for lung transplantation is critical. Methods Consecutive 31 patients with PAH (including pulmonary veno-occlusive disease) referred to our hospital to be considered eligibility for lung transplantation were enrolled in this study. We retrospectively analyzed patients' characteristics at referral for lung transplantation and their clinical outcomes. Results Seventeen of 31 patients (55%) were female and average age at referral was 30.6±11.8 year-old. Twenty-six patients were idiopathic/heritable PAH, 4 were connective tissue disease associated PAH and 1 was pulmonary veno-occlusive disease. They were referred to our hospital 2127±1691 days after diagnosis. All but one patients were introduced parenteral prostanoid. Mean received dose of parenteral prostanoid was 98±56 ng/kg/min at referral. Although their mean pulmonary artery pressure was severely elevated (51.1±11.6 mmHg), cardiac index and six-minute walk distance were relatively maintained (3.63±0.98 L/min/m2 and 394±174m, respectively). Two patients were not registered as candidates for lung transplantation for medical or social reason. Three patients underwent successful lung transplantation, while eight patients died on the waiting list. Three-year survival after referral was 67% in total. Multivariate analysis revealed that heart rate (HR) and pulmonary vascular resistance (PVR) were independent predictors of all-cause mortality after referral (p=0.016 and p=0.016, respectively). Conclusion High HR and PVR are independent predictors of mortality in patients with PAH receiving parenteral prostanoid and awaiting lung transplantation. Although high-dose parenteral prostanoid improved hemodynamics in patients with PAH, the high output status and relatively maintained exercise capacity might have delayed referral for lung transplantation. [ABSTRACT FROM AUTHOR]