Background: In China, lung cancer mainly affects the elderly population. Surgery remains the stan... more Background: In China, lung cancer mainly affects the elderly population. Surgery remains the standard treatment for lung cancer in elderly patients, however, postoperative pulmonary complications (PPCs) are major contributors to morbidity and mortality following lung resection. This study aimed to identify perioperative predictors of PPCs among elderly patients undergoing pulmonary resection for lung cancer to provide evidence for better prevention and intervention for PPCs. Methods: A retrospective study was conducted with 456 patients (age >65 years) undergoing pulmonary resection for lung cancer in Yunnan, China from January 2016 to March 2019. Propensity score matching (PSM) was performed to compare preoperative data and clinical characteristics between the PPC and non-PPC groups, followed by binary logistic regression to evaluate predictors of PPCs. Results: Pulmonary complications occurred in 142/456 (31.1%) patients age >65 years, with pneumonia being the most common event (21.7%). Both PSM and binary logistic regression analysis identified American Society of Anesthesiologists (ASA) class <II [odds ratio (OR): 0.177, 95% confidence interval (CI): 0.037-0.854] and video-assisted thoracoscopic surgery (VATS) (OR: 0.576, 95% CI: 0.334-0.992) as protective factors for PPCs. Conclusions: PPCs following lung cancer resection in elderly patients were associated with a higher ASA classification and open thoracotomy. An adequate and comprehensive evaluation of the operative strategies and enhanced recovery methods should be implemented among elderly patients undergoing lung resection with an ASA class > II or those undergoing an open thoracotomy to help prevent the occurrence of PPCs.
Journal of Heart and Lung Transplantation, Apr 1, 2020
Estimated LW gain during the entire perfusion period significantly correlated with LW gain at the... more Estimated LW gain during the entire perfusion period significantly correlated with LW gain at the back table (n = 10, r = 0.95, p < 0.01, Fig. 1A). Furthermore, initial LW gain (0-60 min) had a significant correlation with back table LW gain, compared with LW gain after 60 min of EVLP (n = 10, r = 0.79, p < 0.01, Fig. 1B). Non-suitable group had significantly higher initial LW gain compared to suitable group (120 § 30 vs-17 § 56 g, p = 0.02, Fig. 1C). Unfavorable outcome group (defined as non-suitable or PGD grade 2-3) group had significantly higher initial LW gain compared to favorable outcome group (defined as PGD grade 0-1, 75 § 56 vs-32 § 58 g, p = 0.02, Fig. 1D). Conclusion: The data suggest that LW gain calculated by real-time LW measurement might be useful to assess pulmonary edema during EVLP. Initial LW gain at 0-60 min of EVLP might be a predictor of transplant suitability and clinical outcomes.
Advanced systemic sclerosis-associated interstitial lung disease (SSc-ILD) can be treated with lu... more Advanced systemic sclerosis-associated interstitial lung disease (SSc-ILD) can be treated with lung transplantation. There is limited data on lung transplantation outcomes in patients with SSc-ILD, in non-Western populations.We assessed survival data of patients with SSc-ILD, on the lung transplant (LT) waiting list, and evaluated post-transplant outcomes in patients from an Asian LT center. In this single-center retrospective study, 29 patients with SSc-ILD, registered for deceased LT at Kyoto University Hospital, between 2010 and 2022, were identified. We investigated post-transplant outcomes in recipients who underwent LT for SSc-ILD, between February 2002 and April 2022. Ten patients received deceased-donor LT (34%), two received living-donor LT (7%), seven died waiting for LT (24%), and ten survived on the waiting list (34%). Median duration from registration to deceaseddonor LT was 28.9 months and that from registration to living-donor LT or death was 6.5 months. Analysis of 15 recipients showed improved forced vital capacity with a median of 55.1% at baseline, 65.8% at 6 months, and 80.3% at 12 months post-transplant. The 5-year survival rate for posttransplant patients with SSc-ILD was 86.2%. The higher post-transplant survival rate at our institute than previously reported suggests that lung transplantation is acceptable in Asian patients with SSc-ILD. Abbreviations SSc Systemic sclerosis ePASP Estimated pulmonary artery systolic pressure CLAD Chronic lung allograft dysfunction IQR Interquartile range DLCO Diffusing capacity of the lung for carbon monoxide PFT Pulmonary function test results ILD Interstitial lung disease HRCT High-resolution computed tomography IPF Idiopathic pulmonary fibrosis PH Pulmonary hypertension ISHLT International society for heart and lung transplantation CTD Connective tissue disease Systemic sclerosis (SSc) is a chronic autoimmune disorder characterized by microangiopathy and fibrosis affecting the skin and visceral organs. Interstitial lung disease (ILD) is a major complication and the leading cause of death in SSc, accounting for 35% of SSc-related deaths 1. SSc-associated ILD (SSc-ILD) is a mortality risk factor
European Journal of Cardio-Thoracic Surgery, Apr 25, 2023
OBJECTIVES Polyglycolic acid (PGA) sheets are difficult to adapt to the central airway because of... more OBJECTIVES Polyglycolic acid (PGA) sheets are difficult to adapt to the central airway because of poor durability against high air pressure. Therefore, we developed a novel layered PGA material to cover the central airway and examined its morphologic traits and functional performance as a potential tracheal replacement. METHODS A critical-size defect in rat cervical tracheas was covered with the material. Morphologic changes were bronchoscopically and pathologically evaluated. Functional performance was evaluated by regenerated ciliary area, ciliary beat frequency and ciliary transport function determined by measuring the moving distance of microspheres dropped onto the trachea (µm/s). The evaluation time points were 2 weeks, 1 month, 2 months and 6 months after surgery (n = 5, respectively). RESULTS Forty rats underwent implantation, and all survived. Histological examination confirmed ciliated epithelization on the luminal surface after 2 weeks. Neovascularization was observed after 1 month, tracheal glands after 2 months and chondrocyte regeneration after 6 months. Although the material was gradually replaced by self-organization, tracheomalacia was not bronchoscopically observed at any time point. The area of regenerated cilia significantly increased between 2 weeks and 1 month (12.0% vs 30.0%; P = 0.0216). The median ciliary beat frequency significantly improved between 2 weeks and 6 months (7.12 vs 10.04 Hz; P = 0.0122). The median ciliary transport function was significantly improved between 2 weeks and 2 months (5.16 vs 13.49 µm/s; P = 0.0216). CONCLUSIONS The novel PGA material showed excellent biocompatibility and tracheal regeneration both morphologically and functionally 6 months after tracheal implantation.
We developed a novel wireless localization technique with radiofrequency identification( RFID) ma... more We developed a novel wireless localization technique with radiofrequency identification( RFID) markers to enable precise localization of deeply located small lung lesions. Electromagnetic navigational bronchoscopy was used to place RFID markers as close to tumors as possible. Without palpating the lung, operators located the marker using a detection probe, following tone changes in accordance with the marker-probe distance. In this section, we present a novel wireless localization technique using an RFID marker for accurate localization of small lung lesions.
European Journal of Cardio-Thoracic Surgery, Jun 9, 2022
OBJECTIVES Identifying the risks for chronic lung allograft dysfunction (CLAD) after lung transpl... more OBJECTIVES Identifying the risks for chronic lung allograft dysfunction (CLAD) after lung transplantation (LTx) is beneficial to the patient. We hypothesized that diabetes mellitus (DM) is relevant to CLAD development. Our study aimed to clarify if DM is a risk for poor post-LTx outcomes. METHODS The records of patients first undergoing LTx in our institution between 2010 and 2018 were reviewed retrospectively. Patient characteristics and postoperative outcomes were analysed. We established 6 months post-LTx as the landmark point for predicting overall survival (OS) and CLAD development. To identify perioperative DM, we evaluated the patient for DM at 6 months post-LTx. RESULTS A total of 172 patients were investigated. DM and CLAD occurred in 76 and 39 patients, respectively, and 40 died. At 6 months post-LTx, the unadjusted and adjusted hazard ratios of DM for OS were 3.36 [95% confidence interval (CI) = 1.67–6.73] and 2.78 (95% CI = 1.35–5.75), respectively. The unadjusted and adjusted hazard ratios of DM for CLAD-free survival were 2.20 (95% CI = 1.27–3.80) and 2.15 (95% CI = 1.24–3.74). The patients with DM were older and had a higher body mass index and more incidents of post-LTx malignant disease than the non-DM patients. The 5-year OS and CLAD-free survival rates of the patients with or without DM were 57.2% vs 86.5% and 50.1% vs 72.9%, respectively. CONCLUSIONS Perioperative DM was identified as an independent adverse factor for OS and CLAD-free survival. Perioperative management of DM should be emphasized in the clinical setting of LTx.
Journal of Heart and Lung Transplantation, Apr 1, 2019
Purpose: The impact of de novo donor-specific anti-HLA antibodies (DSA) on patients after lung tr... more Purpose: The impact of de novo donor-specific anti-HLA antibodies (DSA) on patients after lung transplantation remains controversial. We investigated various characteristics of de novo DSAs, such as timing of initial de novo DSA detection, its duration of existence, and its type of HLA classes, in living-donor lobar lung transplantation (LDLLT) and cadaveric lung transplantation (CLT) at a single institution in Japan. Methods: We performed 88 LDLLTs and 113 CLTs at Kyoto University between 2008 and 2018. We experienced the first case of antibody-mediated rejection in 2010 (Chen F, et al. Surg Today 2012 and Transplant Int 2014). Since July 2010, anti-HLA antibodies had been prospectively screened periodically, using LAB Screen Mixed (One Lambda, CA, USA). In addition, they were also investigated when recipients presented symptoms or abnormal findings. When anti-HLA antibodies were detected, their specificities were identified using LAB Screen Single Antigen (One Lambda, CA, USA). Patients' records were retrospectively reviewed. Patients, in whom anti-HLA antibodies were measured both preoperatively and postoperatively, were included in this study. Patients who had preformed DSA were excluded from this study. Results: 69 patients in LDLLT and 89 patients in CLT were included in this study. 20 patients (13%) had de novo DSAs. There were 3 patients in LDLLT (5%) and 17 patients in CLT (18%, p<0.01). In LDLLT, de novo DSAs were detected more than 10 months postoperatively in 2 patients (67%). Class II DSAs were seen in all patients and class I was not seen in any patients. These DSAs were against bilateral donors in all patients. DSAs did not vanish despite treatment. On the other hand, in CLT, de novo DSAs were detected within 1 month in 14 patients (82%). Class I DSAs were seen in 15 patients and class II were seen in 8 patients. DSAs vanished in 12 patients (71%). Conclusion: We found that de novo DSAs were significantly more frequently detected in LDLLT than in CLT. Types and existing duration of de novo DSA seemed different between LDLLT than CLT.
Background: In China, lung cancer mainly affects the elderly population. Surgery remains the stan... more Background: In China, lung cancer mainly affects the elderly population. Surgery remains the standard treatment for lung cancer in elderly patients, however, postoperative pulmonary complications (PPCs) are major contributors to morbidity and mortality following lung resection. This study aimed to identify perioperative predictors of PPCs among elderly patients undergoing pulmonary resection for lung cancer to provide evidence for better prevention and intervention for PPCs. Methods: A retrospective study was conducted with 456 patients (age >65 years) undergoing pulmonary resection for lung cancer in Yunnan, China from January 2016 to March 2019. Propensity score matching (PSM) was performed to compare preoperative data and clinical characteristics between the PPC and non-PPC groups, followed by binary logistic regression to evaluate predictors of PPCs. Results: Pulmonary complications occurred in 142/456 (31.1%) patients age >65 years, with pneumonia being the most common event (21.7%). Both PSM and binary logistic regression analysis identified American Society of Anesthesiologists (ASA) class <II [odds ratio (OR): 0.177, 95% confidence interval (CI): 0.037-0.854] and video-assisted thoracoscopic surgery (VATS) (OR: 0.576, 95% CI: 0.334-0.992) as protective factors for PPCs. Conclusions: PPCs following lung cancer resection in elderly patients were associated with a higher ASA classification and open thoracotomy. An adequate and comprehensive evaluation of the operative strategies and enhanced recovery methods should be implemented among elderly patients undergoing lung resection with an ASA class > II or those undergoing an open thoracotomy to help prevent the occurrence of PPCs.
Journal of Heart and Lung Transplantation, Apr 1, 2020
Estimated LW gain during the entire perfusion period significantly correlated with LW gain at the... more Estimated LW gain during the entire perfusion period significantly correlated with LW gain at the back table (n = 10, r = 0.95, p < 0.01, Fig. 1A). Furthermore, initial LW gain (0-60 min) had a significant correlation with back table LW gain, compared with LW gain after 60 min of EVLP (n = 10, r = 0.79, p < 0.01, Fig. 1B). Non-suitable group had significantly higher initial LW gain compared to suitable group (120 § 30 vs-17 § 56 g, p = 0.02, Fig. 1C). Unfavorable outcome group (defined as non-suitable or PGD grade 2-3) group had significantly higher initial LW gain compared to favorable outcome group (defined as PGD grade 0-1, 75 § 56 vs-32 § 58 g, p = 0.02, Fig. 1D). Conclusion: The data suggest that LW gain calculated by real-time LW measurement might be useful to assess pulmonary edema during EVLP. Initial LW gain at 0-60 min of EVLP might be a predictor of transplant suitability and clinical outcomes.
Advanced systemic sclerosis-associated interstitial lung disease (SSc-ILD) can be treated with lu... more Advanced systemic sclerosis-associated interstitial lung disease (SSc-ILD) can be treated with lung transplantation. There is limited data on lung transplantation outcomes in patients with SSc-ILD, in non-Western populations.We assessed survival data of patients with SSc-ILD, on the lung transplant (LT) waiting list, and evaluated post-transplant outcomes in patients from an Asian LT center. In this single-center retrospective study, 29 patients with SSc-ILD, registered for deceased LT at Kyoto University Hospital, between 2010 and 2022, were identified. We investigated post-transplant outcomes in recipients who underwent LT for SSc-ILD, between February 2002 and April 2022. Ten patients received deceased-donor LT (34%), two received living-donor LT (7%), seven died waiting for LT (24%), and ten survived on the waiting list (34%). Median duration from registration to deceaseddonor LT was 28.9 months and that from registration to living-donor LT or death was 6.5 months. Analysis of 15 recipients showed improved forced vital capacity with a median of 55.1% at baseline, 65.8% at 6 months, and 80.3% at 12 months post-transplant. The 5-year survival rate for posttransplant patients with SSc-ILD was 86.2%. The higher post-transplant survival rate at our institute than previously reported suggests that lung transplantation is acceptable in Asian patients with SSc-ILD. Abbreviations SSc Systemic sclerosis ePASP Estimated pulmonary artery systolic pressure CLAD Chronic lung allograft dysfunction IQR Interquartile range DLCO Diffusing capacity of the lung for carbon monoxide PFT Pulmonary function test results ILD Interstitial lung disease HRCT High-resolution computed tomography IPF Idiopathic pulmonary fibrosis PH Pulmonary hypertension ISHLT International society for heart and lung transplantation CTD Connective tissue disease Systemic sclerosis (SSc) is a chronic autoimmune disorder characterized by microangiopathy and fibrosis affecting the skin and visceral organs. Interstitial lung disease (ILD) is a major complication and the leading cause of death in SSc, accounting for 35% of SSc-related deaths 1. SSc-associated ILD (SSc-ILD) is a mortality risk factor
European Journal of Cardio-Thoracic Surgery, Apr 25, 2023
OBJECTIVES Polyglycolic acid (PGA) sheets are difficult to adapt to the central airway because of... more OBJECTIVES Polyglycolic acid (PGA) sheets are difficult to adapt to the central airway because of poor durability against high air pressure. Therefore, we developed a novel layered PGA material to cover the central airway and examined its morphologic traits and functional performance as a potential tracheal replacement. METHODS A critical-size defect in rat cervical tracheas was covered with the material. Morphologic changes were bronchoscopically and pathologically evaluated. Functional performance was evaluated by regenerated ciliary area, ciliary beat frequency and ciliary transport function determined by measuring the moving distance of microspheres dropped onto the trachea (µm/s). The evaluation time points were 2 weeks, 1 month, 2 months and 6 months after surgery (n = 5, respectively). RESULTS Forty rats underwent implantation, and all survived. Histological examination confirmed ciliated epithelization on the luminal surface after 2 weeks. Neovascularization was observed after 1 month, tracheal glands after 2 months and chondrocyte regeneration after 6 months. Although the material was gradually replaced by self-organization, tracheomalacia was not bronchoscopically observed at any time point. The area of regenerated cilia significantly increased between 2 weeks and 1 month (12.0% vs 30.0%; P = 0.0216). The median ciliary beat frequency significantly improved between 2 weeks and 6 months (7.12 vs 10.04 Hz; P = 0.0122). The median ciliary transport function was significantly improved between 2 weeks and 2 months (5.16 vs 13.49 µm/s; P = 0.0216). CONCLUSIONS The novel PGA material showed excellent biocompatibility and tracheal regeneration both morphologically and functionally 6 months after tracheal implantation.
We developed a novel wireless localization technique with radiofrequency identification( RFID) ma... more We developed a novel wireless localization technique with radiofrequency identification( RFID) markers to enable precise localization of deeply located small lung lesions. Electromagnetic navigational bronchoscopy was used to place RFID markers as close to tumors as possible. Without palpating the lung, operators located the marker using a detection probe, following tone changes in accordance with the marker-probe distance. In this section, we present a novel wireless localization technique using an RFID marker for accurate localization of small lung lesions.
European Journal of Cardio-Thoracic Surgery, Jun 9, 2022
OBJECTIVES Identifying the risks for chronic lung allograft dysfunction (CLAD) after lung transpl... more OBJECTIVES Identifying the risks for chronic lung allograft dysfunction (CLAD) after lung transplantation (LTx) is beneficial to the patient. We hypothesized that diabetes mellitus (DM) is relevant to CLAD development. Our study aimed to clarify if DM is a risk for poor post-LTx outcomes. METHODS The records of patients first undergoing LTx in our institution between 2010 and 2018 were reviewed retrospectively. Patient characteristics and postoperative outcomes were analysed. We established 6 months post-LTx as the landmark point for predicting overall survival (OS) and CLAD development. To identify perioperative DM, we evaluated the patient for DM at 6 months post-LTx. RESULTS A total of 172 patients were investigated. DM and CLAD occurred in 76 and 39 patients, respectively, and 40 died. At 6 months post-LTx, the unadjusted and adjusted hazard ratios of DM for OS were 3.36 [95% confidence interval (CI) = 1.67–6.73] and 2.78 (95% CI = 1.35–5.75), respectively. The unadjusted and adjusted hazard ratios of DM for CLAD-free survival were 2.20 (95% CI = 1.27–3.80) and 2.15 (95% CI = 1.24–3.74). The patients with DM were older and had a higher body mass index and more incidents of post-LTx malignant disease than the non-DM patients. The 5-year OS and CLAD-free survival rates of the patients with or without DM were 57.2% vs 86.5% and 50.1% vs 72.9%, respectively. CONCLUSIONS Perioperative DM was identified as an independent adverse factor for OS and CLAD-free survival. Perioperative management of DM should be emphasized in the clinical setting of LTx.
Journal of Heart and Lung Transplantation, Apr 1, 2019
Purpose: The impact of de novo donor-specific anti-HLA antibodies (DSA) on patients after lung tr... more Purpose: The impact of de novo donor-specific anti-HLA antibodies (DSA) on patients after lung transplantation remains controversial. We investigated various characteristics of de novo DSAs, such as timing of initial de novo DSA detection, its duration of existence, and its type of HLA classes, in living-donor lobar lung transplantation (LDLLT) and cadaveric lung transplantation (CLT) at a single institution in Japan. Methods: We performed 88 LDLLTs and 113 CLTs at Kyoto University between 2008 and 2018. We experienced the first case of antibody-mediated rejection in 2010 (Chen F, et al. Surg Today 2012 and Transplant Int 2014). Since July 2010, anti-HLA antibodies had been prospectively screened periodically, using LAB Screen Mixed (One Lambda, CA, USA). In addition, they were also investigated when recipients presented symptoms or abnormal findings. When anti-HLA antibodies were detected, their specificities were identified using LAB Screen Single Antigen (One Lambda, CA, USA). Patients' records were retrospectively reviewed. Patients, in whom anti-HLA antibodies were measured both preoperatively and postoperatively, were included in this study. Patients who had preformed DSA were excluded from this study. Results: 69 patients in LDLLT and 89 patients in CLT were included in this study. 20 patients (13%) had de novo DSAs. There were 3 patients in LDLLT (5%) and 17 patients in CLT (18%, p<0.01). In LDLLT, de novo DSAs were detected more than 10 months postoperatively in 2 patients (67%). Class II DSAs were seen in all patients and class I was not seen in any patients. These DSAs were against bilateral donors in all patients. DSAs did not vanish despite treatment. On the other hand, in CLT, de novo DSAs were detected within 1 month in 14 patients (82%). Class I DSAs were seen in 15 patients and class II were seen in 8 patients. DSAs vanished in 12 patients (71%). Conclusion: We found that de novo DSAs were significantly more frequently detected in LDLLT than in CLT. Types and existing duration of de novo DSA seemed different between LDLLT than CLT.
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Papers by Yojiro Yutaka