Publications by authors named "Herve Mal"

Background: The waitlist deaths of transplantation candidates based on their time on the waiting list (TWL) have already been studied, but the short-term mortality and early complications of lung transplant (LT) recipients based on their TWL have not been specifically studied. The first aim of this study was to assess the relationship between increased TWL and short-term mortality in LT recipients.

Methods: In this observational, monocentric, retrospective study, all patients who underwent LT between January 2016 and August 2022 at Bichat Claude Bernard Hospital, Paris were analyzed.

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Background: The ISHLT guidelines recommend early referral to a lung transplantation (LTx) center for patients with interstitial lung disease (ILD) due to the unpredictable course. To our knowledge, no study has assessed the impact of forced vital capacity (FVC) reduction severity on LTx outcomes in ILD. This study aims to determine whether the severity of FVC reduction is associated with post-transplant outcomes in ILD.

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Secondary prophylaxis using inhaled colistin (IC) was implemented to prevent recurrences of Pseudomonas aeruginosa or extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) pneumonia during the postoperative intensive care unit (ICU) stay after lung transplantation (LT). We evaluated the risk of emergence of colistin resistance in the respiratory tract during secondary IC prophylaxis. We conducted a prospective, single-centre, observational study of all adult patients who underwent LT between 1 July 2018 and 30 June 2019.

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Unlabelled: Osteoporosis and fragility fractures are frequent complications of lung transplantation patients. Among 131 patients included, 35 (26.5%) patients had a diagnosis of fractures after transplantation.

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Background: Incidental lung cancer, in the field of lung transplantation (LTx), is more often related to malignancies diagnosed in explants or transplanted organs. Little is known about cancer diagnosed during the medical evaluation of potential LTx candidates. What are the clinical, and prognostic differences between lung cancers diagnosed before or after transplantation in LTx candidates?

Methods: We performed a retrospective, observational, single-center study to describe the characteristics of lung malignancies first discovered during the pre-transplant assessment and then identified in lung explants, over the same period.

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Idiopathic pulmonary fibrosis (IPF) is a lethal disease with limited therapeutic options. FGF21 (fibroblast growth factor 21), an endocrine fibroblast growth factor that acts through the FGFR1 (fibroblast growth factor receptor 1)/KLB (β-Klotho) pathway, mitigates liver fibrosis. We hypothesized that FGF21 could exert antifibrotic properties in the lung.

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Idiopathic pulmonary fibrosis (IPF) is a devastating lung disease with limited therapeutic options. Fibroblast growth factor receptor-4 (FGFR4) is a known receptor for several paracrine fibroblast growth factors (FGFs). FGFR4 is also the main receptor for FGF19, an endocrine FGF that was demonstrated by our group to have antifibrotic properties in the lung.

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Article Synopsis
  • The study examines lung transplantation (LT) outcomes in patients aged 65 and older compared to younger recipients, emphasizing that age shouldn't be a strict barrier for the procedure.
  • Researchers conducted a retrospective analysis of patients who underwent LT at Bichat Hospital, tracking 90-day mortality and other long-term health markers.
  • Results showed that while elderly patients had better short-term lung function post-transplant, their overall survival rates and mortality within the first year were similar to those of younger patients.
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In patients with pulmonary emphysema and mild to moderate airflow limitation, one does not expect the features marked exertional dyspnea and hypoxemia as well as a profound decrease in diffusing capacity of the lung for carbon monoxide (DLCO). Here we describe this phenotype and its prognosis. From our database, we retrospectively selected cases associating emphysema, exertional breathlessness, O requirement at least upon exercise, forced expiratory volume in 1 sec (FEV) ≥ 50% predicted, and DLCO ≤ 50% predicted, without associated combined pulmonary fibrosis and emphysema, right-to-left shunt, or severe pulmonary hypertension.

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Article Synopsis
  • A study was conducted to compare the outcomes of lung transplantation (LT) based on whether the surgery took place during the day or night.
  • The study included 253 patients between January 2015 and December 2020, with 66% undergoing surgery during the day and 34% at night.
  • Results showed that while mortality rates at 90 days and one year were similar for both groups, daytime procedures had a higher rate of one-year airway complications compared to nighttime surgeries.
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Background: Size matching between donors and recipients is a major issue in lung transplantation (LTx), especially in patients with restrictive lung disease (RLD). This study aims to evaluate computed tomography (CT) as an additional method for defining the total lung capacity (TLC) in patients with end-stage interstitial disease awaiting LTx.

Methods: Clinical data and CT scans from patients who underwent a first LTx from January 2014 to July 2018 in Bichat Hospital, Paris, were prospectively included in a database.

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Article Synopsis
  • - This study investigates two strategies for initiating venoarterial extracorporeal membrane oxygenation (VA-ECMO) during lung transplantation (LTx) for patients with severe lung diseases, comparing an 'on-demand' approach versus a 'systematic' pre-emptive method.
  • - The trial will include adult patients needing bilateral LTx, excluding those with severe pre-existing conditions, and aims to identify which initiation strategy results in more ventilator-free days post-surgery.
  • - Outcomes will be assessed not only on ventilator-free days but also on various health metrics, like vital status at different intervals, while following ethical standards for patient care and data sharing.
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Background: One of the major challenges in managing allergic bronchopulmonary aspergillosis remains consistent and reproducible assessment of response to treatment.

Research Question: What are the most relevant changes in CT scan parameters over time for assessing response to treatment?

Study Design And Methods: In this ancillary study of a randomized clinical trial (NebuLamB), patients with asthma with available CT scan and without exacerbation during a 4-month allergic bronchopulmonary aspergillosis exacerbation treatment period (corticosteroids and itraconazole) were included. Changed CT scan parameters were assessed by systematic analyses of CT scan findings at initiation and end of treatment.

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Background: Antifibrotic agents (AFAs) are now standard-of-care for idiopathic pulmonary fibrosis (IPF). Concerns have arisen about the safety of these drugs in patients undergoing lung transplantation (LTx).

Methods: We performed a multi-centre, nationwide, retrospective, observational study of French IPF patients undergoing LTx between 2011 and 2018 to determine whether maintaining AFAs in the peri-operative period leads to increased bronchial anastomoses issues, delay in skin healing and haemorrhagic complications.

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Matrix remodeling is a salient feature of idiopathic pulmonary fibrosis (IPF). Targeting cells driving matrix remodeling could be a promising avenue for IPF treatment. Analysis of transcriptomic database identified the mesenchymal transcription factor PRRX1 as upregulated in IPF.

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Article Synopsis
  • - The study investigates the risk factors and incidence of prolonged mechanical ventilation (PMV) after lung transplantation (LT) in patients at Bichat Claude Bernard Hospital from 2016 to 2020, finding that 28% required PMV for an average of 34 days.
  • - Significant independent risk factors for PMV include higher body mass index (BMI), diabetes in the recipient, ECMO support during surgery, and receiving more than 5 red blood cell transfusions.
  • - One-year survival rates show a concerning increase in mortality for patients on PMV (44%) compared to those without it (15%), highlighting the need to consider preoperative risk factors like BMI and diabetes in recipient selection.
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spp. are associated with respiratory infections in immunocompromised hosts. A link with bronchial complications after lung transplantation (LTx) has been suggested.

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Background: Calcineurin inhibitors (CNIs) remain the cornerstone of maintenance immunosuppression (IS) after lung transplantation (LTx), although CNI-related life-threatening toxic effects may occur. Belatacept, a novel immunosuppressant that blocks a T-cell co-stimulation pathway, is a non-nephrotoxic drug indicated as an alternative to CNIs in kidney Tx. In LTx, there are only a few reports of belatacept conversion as a CNI-free or CNI-sparing IS treatment.

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Article Synopsis
  • The study examined the presence and effects of culture-positive preservation fluid (PF) in lung transplant patients from 2015 to 2020, finding that 30.6% had PF that tested positive for microorganisms.
  • Common bacteria like Staphylococcus aureus and Escherichia coli were identified, and a significant portion of culture-positive samples were polymicrobial.
  • Patients with culture-positive PF experienced lower 30-day survival rates (85.5%) compared to those with culture-negative PF (94.7%), prompting the need for further research to understand the implications and management of culture-positive PF.
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Background: The outcomes of lung transplantation (LT) recipients who received a graft from a brain-dead donor after successful resuscitation from cardiac arrest (CA donors) have been poorly described. This study compared the one-year survival of LT recipients depending on the CA status of the donor.

Methods: This prospective observational single-centre study analysed all consecutive patients who underwent LT at Bichat Claude Bernard Hospital, Paris, between January 2016 and December 2020.

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High-density lipoproteins (HDLs), whose main role is the reverse transport of cholesterol, also have pleiotropic anti-inflammatory, antioxidant, anti-apoptotic and anti-infectious properties. During sepsis, HDL cholesterol (HDL-C) concentration is low, HDL particle functionality is altered, and these modifications are correlated with poor outcomes. Based on the protective effects of HDL, we hypothesized that HDL-C levels could be associated with lung transplantation (LT) outcome.

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Lung transplantation (LTx) is a steadily expanding field. The considerable developments have been driven over the years by indefatigable work conducted at LTx centers to improve donor and recipient selection, combined with multifaceted efforts to overcome challenges raised by the surgical procedure, perioperative care, and long-term medical complications. One consequence has been a pruning away of contraindications over time, which has, in some ways, complicated the patient selection process.

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Background: Airway complications are frequent after lung transplantation (LT), as they affect up to 23% of recipients. The implication of perioperative extracorporeal membrane oxygenation (ECMO) support and haemodynamic instability has never been specifically assessed. The first aim of this study was to explore the impact of perioperative ECMO support on bronchial anastomotic dehiscence (BAD) at Day 90 after LT.

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We aimed to describe the prevalence, risk factors, morbidity and mortality associated with the occurrence of bacteraemia during the postoperative ICU stay after lung transplantation (LT). We conducted a retrospective single-centre study that included all consecutive patients who underwent LT between January 2015 and October 2021. We analysed all the blood cultures drawn during the postoperative ICU stay, as well as samples from suspected infectious sources in case of bacteraemia.

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We evaluated the contribution of artificial intelligence in predicting the risk of acute cellular rejection (ACR) using early plasma levels of soluble CD31 (sCD31) in combination with recipient haematosis, which was measured by the ratio of arterial oxygen partial pressure to fractional oxygen inspired (PaO/FiO) and respiratory SOFA (Sequential Organ Failure Assessment) within 3 days of lung transplantation (LTx). CD31 is expressed on endothelial cells, leukocytes and platelets and acts as a "peace-maker" at the blood/vessel interface. Upon nonspecific activation, CD31 can be cleaved, released, and detected in the plasma (sCD31).

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