The most critical complication to watch out for after receiving a lung transplant is Chronic Lung Allograft Dysfunction (CLAD). Once CLAD develops, there are no universally effective treatments available. Therefore, preventing this complication takes top priority for those who have undergone a lung transplant. One of the primary immunosuppressing medications used in lung transplant recipients is calcineurin inhibitors.

There are only two calcineurin inhibitors: cyclosporine and tacrolimus. Each has different formulations, such as once-daily slow-release tacrolimus, twice-daily immediate-release tacrolimus, and twice-daily cyclosporine. While these medications share the same goal of preventing rejection, it is unclear whether they are equally effective. CLAD encompasses a range of clinical manifestations that ultimately lead to the transplanted lung losing its normal function.

The presentation of CLAD can vary among patients, with some experiencing an obstructive ventilatory defect, others having a restrictive defect, and some exhibiting a combination of both. Unfortunately, once CLAD develops, lung function does not improve. In the absence of effective treatments, strategies to prevent CLAD are crucial.

A recent study published in the International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry data found a significant survival benefit between using tacrolimus versus cyclosporine after lung transplantation. Out of 22,222 individuals with data on chronic lung allograft dysfunction treatment, 88.6% received immediate-release tacrolimus. The participants taking immediate-release tacrolimus had a much lower rate of experiencing CLAD than those who took twice-daily cyclosporine.

Michael Combs, an assistant professor of pulmonary diseases and internal medicine at Michigan Medicine, led the research team conducting this study. Combs highlighted the positive findings for twice-daily immediate-release tacrolimus in this study, stating that it should reassure transplant patients and providers that using this formulation is the superior treatment to cyclosporine.

“This present study should reassure transplant patients and providers twice-daily tacrolimus — and not only once-daily tacrolimus — is the superior treatment to cyclosporine,” said Combs. “Importantly, in our study we found that twice-daily tacrolimus not only resulted in lower rates of CLAD relative to cyclosporine, but it was also associated with improved overall survival after lung transplantation. This is an important, patient-centered finding which has not been previously demonstrated.”

In conclusion, the most effective prevention method for complications post-lung transplant is using tacrolimus, regardless of its formulation. This treatment offers a significant advantage over cyclosporine in preventing CLAD and improving overall survival after lung transplantation. Future research will need to investigate whether once-daily medication regimens are superior to twice-daily formulations.

The Xpert MTB/RIF Ultra molecular diagnostic test for stool samples, previously recommended only for children, has shown potential as an additional tool for diagnosing tuberculosis (TB) in adults living with HIV. A study led by the Barcelona Institute for Global Health (ISGlobal), in collaboration with several institutions, has demonstrated that this test can be used to detect TB in people with advanced AIDS, where the risk of TB is higher.

Tuberculosis, caused by the bacterium Mycobacterium tuberculosis, remains a significant global health concern, with 1.25 million deaths reported in 2023, including 13% among people living with HIV. Current diagnostic strategies focus on sputum samples, but access to these diagnostics remains limited, and they are not effective for all individuals living with HIV.

The study, published in The Lancet Microbe, recruited 677 patients over 15 years old with HIV and suspected TB from medical centers in three African countries: Eswatini, Mozambique, and Uganda. Participants provided sputum, urine, stool, and blood samples. The results showed that the stool ultra test had a sensitivity of 23.7% and a specificity of 94.0%, compared with a microbiological reference standard consisting of three WHO-recommended tests: TB-LAM in urine, liquid culture, and Xpert Ultra from sputum.

In patients with CD4 counts below 200 cells/μl, sensitivity increased to 45.5%. This suggests that the stool ultra test can be used as a complementary tool for diagnosing TB in people living with HIV, especially in those with advanced AIDS, where the risk of TB is higher.

The study’s findings support the use of the Stool Ultra test as a valuable diagnostic tool in areas where access to standard tests is limited. The potential of this sample to confirm disease in cases where respiratory tests are negative offers hope for improving diagnosis and treatment outcomes in vulnerable populations.

The medical community has long believed that severely injured patients require high levels of supplemental oxygen to ensure brain and organ function. However, a groundbreaking study published in JAMA Network Open suggests that this approach may be overly cautious. Led by investigators at the University of Colorado School of Medicine, the Strategy to Avoid Excessive Oxygen (SAVE-O2) study aimed to determine whether targeting slightly lower levels of oxygen saturation could safely improve outcomes for adult trauma patients.

The research team, led by Adit Ginde, MD, MPH, professor of emergency medicine and lead investigator, enrolled nearly 13,000 patients at eight level 1 trauma centers across the US. They found that patients who received supplemental oxygen at a target range of 90-96% had similar or better outcomes compared to those receiving higher levels of oxygen. This approach, known as normoxemia, allowed medical staff to deliver less supplemental oxygen without negatively affecting mortality or time spent in hypoxemia.

“We saw strong evidence that patients did at least as well by being in this normoxemia range,” Dr. Ginde said. “We wanted to then see their clinical outcome, which we measured with supplemental oxygen-free days, a combination of survival and the time spent receiving supplemental oxygen. Overall, we saw a signal for improvement, especially when patients were not on the ventilator.”

The study’s findings have significant implications for trauma care in both military and civilian settings. The research team has already updated 10 relevant Joint Trauma System guidelines and received outstanding research accomplishment awards at the Military Health System Research Symposium.

The next step in this research is the development of an autonomous oxygen titration device, called O2Matic, which can measure oxygen levels and deliver it to patients as necessary. This device has been approved for use in Europe but not yet evaluated in the US, so Dr. Ginde and his team are leading a registration trial with the US FDA.

“This device has the potential to significantly improve how we give oxygen when it’s needed,” Dr. Ginde said. “We think this could be the future. Now that we’ve proven the normoxemia target is safe and desirable, the next step is figuring out how to implement it more efficiently and on a broader scale.”

The SAVE-O2 study’s findings offer hope for improved trauma care standards across the country. As research continues to evolve, one thing is clear – redefining oxygen standards could be a game-changer in saving lives.