Lung and heart-lung transplantation for systemic sclerosis patients. A monocentric experience of 13 patients, review of the literature and position paper of a multidisciplinary Working Group

Systemic sclerosis per se should not be considered as an a priori contraindication for a pre-transplantation assessment in patients with advanced interstitial lung disease and/or pulmonary hypertension. For lung or heart-lung transplantation, a multidisciplinary approach, adapting the pre-transplant...

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Veröffentlicht in:La Presse médicale (1983) 2014-10, Vol.43 (10), p.e345-e363
Hauptverfasser: Launay, David, Savale, Laurent, Berezne, Alice, Le Pavec, Jérôme, Hachulla, Eric, Mouthon, Luc, Sitbon, Olivier, Lambert, Benoit, Gaudric, Marianne, Jais, Xavier, Stephan, Francois, Hatron, Pierre-Yves, Lamblin, Nicolas, Vignaux, Olivier, Cottin, Vincent, Farge, Dominique, Wallaert, Benoît, Guillevin, Loic, Simonneau, Gerald, Mercier, Olaf, Fadel, Elie, Dartevelle, Philippe, Humbert, Marc, Mussot, Sacha
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Sprache:eng
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Zusammenfassung:Systemic sclerosis per se should not be considered as an a priori contraindication for a pre-transplantation assessment in patients with advanced interstitial lung disease and/or pulmonary hypertension. For lung or heart-lung transplantation, a multidisciplinary approach, adapting the pre-transplant assessment to systemic sclerosis and optimizing systemic sclerosis patient management before, during and after surgery should improved the short- and long-term prognosis. Indications and contraindications for transplantation have to be adapted to the specificities of systemic sclerosis. A special focus on the digestive tract involvement and its thorough evaluation are mandatory before transplantation in systemic sclerosis. As the esophagus is almost always involved, isolated gastro-oesophageal reflux disease, pH metry and/or manometry abnormalities should not be a systematic per se contraindication for pre-transplantation assessment. Corticosteroids may be harmful in systemic sclerosis as they are associated with acute renal crisis. A low dose corticosteroids protocol for immunosuppression is therefore advisable in systemic sclerosis.
ISSN:0755-4982
2213-0276
DOI:10.1016/j.lpm.2014.01.020