Imperial College London
Alternate

Claire L. Shovlin PhD FRCP

Faculty of Medicine, National Heart & Lung Institute

Professor of Practice (Clinical and Molecular Medicine)
 
 
 
//

Contact

 

c.shovlin Website

 
 
//

Location

 

534Block L Hammersmith HospitalHammersmith Campus

//

Summary

 

Publications

Citation

BibTex format

@article{Shovlin:2017:10.1136/bmjresp-2017-000198,
author = {Shovlin, CL and Buscarini, E and Hughes, JMB and Allison, DJ and Jackson, JE},
doi = {10.1136/bmjresp-2017-000198},
journal = {BMJ Open Respiratory Research},
title = {Long-term outcomes of patients with pulmonary arteriovenous malformations considered for lung transplantation, compared with similarly hypoxaemic cohorts},
url = {http://dx.doi.org/10.1136/bmjresp-2017-000198},
volume = {4},
year = {2017}
}
Download

RIS format (EndNote, RefMan)

TY  - JOUR
AB  - INTRODUCTION:Pulmonary  arteriovenous  malformations  (PAVMs) may not be amenable  to treatment   by   embolization   or   surgical   resection,   and many patients   are   left   with significant hypoxemia. Lung transplantation has been undertaken.There is no guidance on selection criteria.METHODS:To guidetransplantation listingassessments, the outcomes of the six patients who had been considered  for transplantation were  compared  to a  similarly hypoxemic  patient group recruited prospectively between2005-2016at thesame UK institution.RESULTS: Sixpatientshad  been formally  considered  for  lung  transplantation  purely  for  PAVMs. One underwent a single lung transplantation for diffuse PAVMs and died within 4 weeks of surgery. Theother  five  were  not  transplanted,  in four  cases at the patients’ request.Their  current  survival ranges from 16-27 (median 21) years post transplant assessment. Of 444 consecutive patients with PAVMs recruited between 2005-2016, 42 were similarly hypoxemic to the “transplant-considered”cohort (SaO2 <86.5%).  Hypoxemic cohorts maintained arterial oxygen content  through  secondary  erythrocytosis  and  higher  haemoglobin. The “transplant-considered” cohort had similar  CaO2to  the  hypoxemic  comparator  group,but higher  MRC  dyspnea  scores(p=0.023),higher  rates  of  cerebral  abscesses  (p=0.0043)  and  higher  rates  of  venous  thromboemboli (p=0.0009) that were evident before and after the decision to list for transplantation. CONCLUSIONS: The non-transplanted patients demonstrated marked longevity. Symptoms and co-morbidities  were  better  predictors  of  health  than  oxygen  measurements. While  a  case-by-case decision,  weighing  survival  estimates  and  quality  of  life  will  help  patients  in  their  decision  making, the data suggesta verystrong case must be made before lung transplantation is considered.
AU  - Shovlin,CL
AU  - Buscarini,E
AU  - Hughes,JMB
AU  - Allison,DJ
AU  - Jackson,JE
DO  - 10.1136/bmjresp-2017-000198
PY  - 2017///
SN  - 2052-4439
TI  - Long-term outcomes of patients with pulmonary arteriovenous malformations considered for lung transplantation, compared with similarly hypoxaemic cohorts
T2  - BMJ Open Respiratory Research
UR  - http://dx.doi.org/10.1136/bmjresp-2017-000198
UR  - http://hdl.handle.net/10044/1/48609
VL  - 4
ER  -
Download