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at 1 year and 54&#37; at 5 years&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The significant costs involved&#44; the intensive use of health-care resources and the need to carry out a rigorous lifestyle and prescription plan before and after LT&#44; make it really necessary to accurately select the most appropriate patients for this treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> Therefore&#44; the existence of a special lung transplant outpatient clinic&#44; in a non-transplant referring hospital&#44; is extremely helpful in order to achieve a systematic approach for LT candidates on the initial evaluation stage&#44; the monitoring of LT patients on waiting lists&#44; and also for post LT follow-up&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">To meet these demands&#44; the LT outpatient clinic at the Centro Hospitalar S&#227;o Jo&#227;o&#44; a tertiary hospital in the city of Porto&#44; Portugal&#44; was created 10 years ago&#46; The patients who are candidates for LT are first evaluated at the national lung transplantation centre in Lisbon &#40;Hospital Santa Marta &#8211; Centro Hospitalar Lisboa Central&#41; and if refused&#44; later presented for assessment at the Complexo Hospitalario Universitario de A Coru&#241;a&#44; in Spain&#46; Having reached this symbolic milestone of one decade&#44; an analysis of the patient data may be a useful learning opportunity&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Over the past ten years&#44; a total of 186 patients have been evaluated&#44; with an average age of 54&#46;1 years &#40;maximum of 70 years&#59; minimum of 20 years&#41; and a male gender predominance &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>126&#44; 67&#46;7&#37;&#41;&#46; 69 patients &#40;37&#46;1&#37;&#41; were referred for LT&#46; Most of the patients received a unilateral LT &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>44&#44; 63&#46;8&#37;&#41;&#46; Bilateral LT was done in 23 cases &#40;33&#46;3&#37;&#41; and 2 &#40;2&#46;9&#37;&#41; patients received a heart and lung transplant &#40;HLT&#41;&#46; None of the patients received a re-transplantation&#46; There were 40 LT performed at Complexo Hospitalario Universitario de A Coru&#241;a and 27 LT at Hospital Santa Marta &#8211; Centro Hospitalar Lisboa Central&#46; The 2 cases of HLT were performed at Royal Brompton &#38; Harefield NHS Trust&#44; London&#44; UK&#44; and Hospital Universitario Puerta de Hierro-Majadahonda&#44; Madrid&#44; Spain&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Of the other non-LT patients&#44; 24&#46;7&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>46&#41; died before LT &#40;either on the transplant list or during the initial assessment&#41;&#44; 14&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41; were discharged &#40;either due to active smoking&#44; transplant refusal&#44; absenteeism&#44; or lack of LT criteria&#41;&#44; 12&#46;4&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41; were refused by the transplant centre&#44; 8&#46;1&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; are actively on the LT list&#44; and 4&#46;3&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41; are on clinical surveillance&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The list of indications for LT is described in detail in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The main indications were COPD &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#44; 14&#46;5&#37;&#41;&#44; non-cystic fibrosis bronchiectasis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44; 11&#46;6&#37;&#41;&#44; silicosis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44; 11&#46;6&#37;&#41; and chronic hypersensitivity pneumonitis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44; 11&#46;6&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The median age at the time of LT was 47&#46;2 years old &#40;maximum of 68 and a minimum of 14 years&#41;&#46; Nine of the 69 LT patients &#40;13&#37;&#41; died during surgical procedure or shortly thereafter&#46; The remaining 19 deaths &#40;27&#46;5&#37;&#41; in the LT group happened later on&#46; The median survival of this group of patients has yet to be established&#44; but the survival at 1&#44; 3 and 5 years is 79&#46;4&#37;&#44; 70&#46;1&#37; and 62&#46;0&#37; respectively&#46; However&#44; if we remove from the equation the patients who died in the first year after LT&#44; because of the more abrupt decline in survival during this period&#44; the 3 and 5-year survival rates are higher&#44; 83&#46;3&#37; and 73&#46;7&#37; respectively&#46; The main causes of death were Chronic Lung Allograft Dysfunction &#40;CLAD&#41; &#8211; 9 cases &#40;32&#46;1&#37;&#41;&#44; and infection &#8211; 8 cases &#40;28&#46;6&#37;&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In terms of late complications in LT patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; the most commonly seen&#44; as expected&#44; was CLAD &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#44; 21&#46;7&#37;&#41;&#46; Malignancy was diagnosed in 7 &#40;10&#46;1&#37;&#41; patients with a higher incidence of skin cancer and lymphoproliferative disease&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The high mortality observed in patients who were not transplanted&#44; reflects the clinical severity of these end-stage lung disease cases&#46; LT is a game-changing opportunity&#44; although associated with risks&#44; such as mortality in the early post-transplant period and multiple complications later on&#46; These facts justify the need for having a structured approach to these patients&#44; making faster assessment possible&#44; facilitating the connection with the transplant centre and enabling a more thorough selection and follow-up of patients&#46; The existence of a LT outpatient clinic also manages to achieve a better control of the comorbidities and an improved adherence to pulmonary rehabilitation prior to LT&#44; which have a direct impact on the outcome after LT&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;11&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sarcoidosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;4&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lymphangioleiomyomatosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;4&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">UIP secondary to CTD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;4&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulmonary fibrosis secondary to infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fibrotic NSIP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bronchiolitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulmonary veno-occlusive disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Congenital heart defect with pulmonary hypertension&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Complication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of patients &#40;&#37; of total LT patients&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CLAD &#8211; &#40;BOS&#47;RAS&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;21&#46;7&#37;&#41; &#8211; &#40;14&#47;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Aspergillosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;2&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haemolytic uremic syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;2&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hodgkin lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PTLD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">End-stage renal disease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cutaneous Kaposi sarcoma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Squamous lung cancer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "Health-related quality of life after solid organ transplantation&#58; a prospective&#44; multiorgan cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Kugler"
                            1 => "J&#46; Gottlieb"
                            2 => "G&#46; Warnecke"
                            3 => "A&#46; Schwarz"
                            4 => "K&#46; Weissenborn"
                            5 => "H&#46; Barg-Hock"
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                    0 => array:2 [
                      "doi" => "10.1097/TP.0b013e31829853eb"
                      "Revista" => array:6 [
                        "tituloSerie" => "Transplantation"
                        "fecha" => "2013"
                        "volumen" => "96"
                        "paginaInicial" => "316"
                        "paginaFinal" => "323"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23715048"
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              "identificador" => "bib0030"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quality of life in lung transplantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;P&#46; Singer"
                            1 => "L&#46;G&#46; Singer"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0033-1348470"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Respir Crit Care Med"
                        "fecha" => "2013"
                        "volumen" => "34"
                        "paginaInicial" => "421"
                        "paginaFinal" => "430"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23821515"
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                ]
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              "identificador" => "bib0035"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Registry of the International Society for Heart and Lung Transplantation&#58; thirty third adult lung and heart-lung transplant report&#8212;2016&#59; focus theme&#58; primary diagnostic indications for transplant"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;D&#46; Yusen"
                            1 => "L&#46;B&#46; Edwards"
                            2 => "A&#46;I&#46; Dipchand"
                            3 => "S&#46;B&#46; Goldfarb"
                            4 => "A&#46;Y&#46; Kucheryavaya"
                            5 => "B&#46;J&#46; Levvey"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.healun.2016.09.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Heart Lung Transplant"
                        "fecha" => "2016"
                        "volumen" => "35"
                        "paginaInicial" => "1170"
                        "paginaFinal" => "1184"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27772669"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A consensus document for the selection of lung transplant candidates&#58; 2014&#8212;an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Weill"
                            1 => "C&#46; Benden"
                            2 => "P&#46;A&#46; Corris"
                            3 => "J&#46;H&#46; Dark"
                            4 => "R&#46;D&#46; Davis"
                            5 => "S&#46; Keshavjee"
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                      ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.healun.2014.06.014"
                      "Revista" => array:6 [
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                        "volumen" => "34"
                        "paginaInicial" => "1"
                        "paginaFinal" => "15"
                        "link" => array:1 [
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        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0055" class="elsevierStylePara elsevierViewall">We would like to thank the lung transplantation team in Hospital Santa Marta &#8211; Centro Hospitalar Lisboa Central and at the Complexo Hospitalario Universitario de A Coru&#241;a&#46;</p>"
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Research letter
Lung transplant outpatient clinic at Centro Hospitalar São João – 10 year review
D. Araújo
Corresponding author
d_araujo90@hotmail.com

Corresponding author.
, C. Damas
Serviço de Pneumologia, Centro Hospitalar São João, Porto, Portugal
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    "titulo" => "Lung transplant outpatient clinic at Centro Hospitalar S&#227;o Jo&#227;o &#8211; 10 year review"
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at 1 year and 54&#37; at 5 years&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The significant costs involved&#44; the intensive use of health-care resources and the need to carry out a rigorous lifestyle and prescription plan before and after LT&#44; make it really necessary to accurately select the most appropriate patients for this treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> Therefore&#44; the existence of a special lung transplant outpatient clinic&#44; in a non-transplant referring hospital&#44; is extremely helpful in order to achieve a systematic approach for LT candidates on the initial evaluation stage&#44; the monitoring of LT patients on waiting lists&#44; and also for post LT follow-up&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">To meet these demands&#44; the LT outpatient clinic at the Centro Hospitalar S&#227;o Jo&#227;o&#44; a tertiary hospital in the city of Porto&#44; Portugal&#44; was created 10 years ago&#46; The patients who are candidates for LT are first evaluated at the national lung transplantation centre in Lisbon &#40;Hospital Santa Marta &#8211; Centro Hospitalar Lisboa Central&#41; and if refused&#44; later presented for assessment at the Complexo Hospitalario Universitario de A Coru&#241;a&#44; in Spain&#46; Having reached this symbolic milestone of one decade&#44; an analysis of the patient data may be a useful learning opportunity&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Over the past ten years&#44; a total of 186 patients have been evaluated&#44; with an average age of 54&#46;1 years &#40;maximum of 70 years&#59; minimum of 20 years&#41; and a male gender predominance &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>126&#44; 67&#46;7&#37;&#41;&#46; 69 patients &#40;37&#46;1&#37;&#41; were referred for LT&#46; Most of the patients received a unilateral LT &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>44&#44; 63&#46;8&#37;&#41;&#46; Bilateral LT was done in 23 cases &#40;33&#46;3&#37;&#41; and 2 &#40;2&#46;9&#37;&#41; patients received a heart and lung transplant &#40;HLT&#41;&#46; None of the patients received a re-transplantation&#46; There were 40 LT performed at Complexo Hospitalario Universitario de A Coru&#241;a and 27 LT at Hospital Santa Marta &#8211; Centro Hospitalar Lisboa Central&#46; The 2 cases of HLT were performed at Royal Brompton &#38; Harefield NHS Trust&#44; London&#44; UK&#44; and Hospital Universitario Puerta de Hierro-Majadahonda&#44; Madrid&#44; Spain&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Of the other non-LT patients&#44; 24&#46;7&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>46&#41; died before LT &#40;either on the transplant list or during the initial assessment&#41;&#44; 14&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41; were discharged &#40;either due to active smoking&#44; transplant refusal&#44; absenteeism&#44; or lack of LT criteria&#41;&#44; 12&#46;4&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41; were refused by the transplant centre&#44; 8&#46;1&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41; are actively on the LT list&#44; and 4&#46;3&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41; are on clinical surveillance&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The list of indications for LT is described in detail in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The main indications were COPD &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#44; 14&#46;5&#37;&#41;&#44; non-cystic fibrosis bronchiectasis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44; 11&#46;6&#37;&#41;&#44; silicosis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44; 11&#46;6&#37;&#41; and chronic hypersensitivity pneumonitis &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#44; 11&#46;6&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The median age at the time of LT was 47&#46;2 years old &#40;maximum of 68 and a minimum of 14 years&#41;&#46; Nine of the 69 LT patients &#40;13&#37;&#41; died during surgical procedure or shortly thereafter&#46; The remaining 19 deaths &#40;27&#46;5&#37;&#41; in the LT group happened later on&#46; The median survival of this group of patients has yet to be established&#44; but the survival at 1&#44; 3 and 5 years is 79&#46;4&#37;&#44; 70&#46;1&#37; and 62&#46;0&#37; respectively&#46; However&#44; if we remove from the equation the patients who died in the first year after LT&#44; because of the more abrupt decline in survival during this period&#44; the 3 and 5-year survival rates are higher&#44; 83&#46;3&#37; and 73&#46;7&#37; respectively&#46; The main causes of death were Chronic Lung Allograft Dysfunction &#40;CLAD&#41; &#8211; 9 cases &#40;32&#46;1&#37;&#41;&#44; and infection &#8211; 8 cases &#40;28&#46;6&#37;&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In terms of late complications in LT patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; the most commonly seen&#44; as expected&#44; was CLAD &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#44; 21&#46;7&#37;&#41;&#46; Malignancy was diagnosed in 7 &#40;10&#46;1&#37;&#41; patients with a higher incidence of skin cancer and lymphoproliferative disease&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The high mortality observed in patients who were not transplanted&#44; reflects the clinical severity of these end-stage lung disease cases&#46; LT is a game-changing opportunity&#44; although associated with risks&#44; such as mortality in the early post-transplant period and multiple complications later on&#46; These facts justify the need for having a structured approach to these patients&#44; making faster assessment possible&#44; facilitating the connection with the transplant centre and enabling a more thorough selection and follow-up of patients&#46; The existence of a LT outpatient clinic also manages to achieve a better control of the comorbidities and an improved adherence to pulmonary rehabilitation prior to LT&#44; which have a direct impact on the outcome after LT&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Congenital heart defect with pulmonary hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">List of lung transplant indications&#46;</p>"
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      ]
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">LT &#8211; lung transplant&#59; CLAD &#8211; chronic lung allograft dysfunction&#59; BOS &#8211; bronchiolitis obliterans syndrome&#59; RAS &#8211; restrictive allograft syndrome&#59; PTLD &#8211; posttransplant lymphoproliferative disease&#59; CMV &#8211; cytomegalovirus&#46;</p>"
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Complication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of patients &#40;&#37; of total LT patients&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CLAD &#8211; &#40;BOS&#47;RAS&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;21&#46;7&#37;&#41; &#8211; &#40;14&#47;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Aspergillosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;2&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haemolytic uremic syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;2&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hodgkin lymphoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PTLD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">End-stage renal disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Colon adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cutaneous Kaposi sarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Squamous lung cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Squamous skin cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Basal cell carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CMV colitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pneumocystosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cryptococcal meningitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">List of late post-transplant complications&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:4 [
            0 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health-related quality of life after solid organ transplantation&#58; a prospective&#44; multiorgan cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Kugler"
                            1 => "J&#46; Gottlieb"
                            2 => "G&#46; Warnecke"
                            3 => "A&#46; Schwarz"
                            4 => "K&#46; Weissenborn"
                            5 => "H&#46; Barg-Hock"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/TP.0b013e31829853eb"
                      "Revista" => array:6 [
                        "tituloSerie" => "Transplantation"
                        "fecha" => "2013"
                        "volumen" => "96"
                        "paginaInicial" => "316"
                        "paginaFinal" => "323"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23715048"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quality of life in lung transplantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;P&#46; Singer"
                            1 => "L&#46;G&#46; Singer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0033-1348470"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Respir Crit Care Med"
                        "fecha" => "2013"
                        "volumen" => "34"
                        "paginaInicial" => "421"
                        "paginaFinal" => "430"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23821515"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Registry of the International Society for Heart and Lung Transplantation&#58; thirty third adult lung and heart-lung transplant report&#8212;2016&#59; focus theme&#58; primary diagnostic indications for transplant"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;D&#46; Yusen"
                            1 => "L&#46;B&#46; Edwards"
                            2 => "A&#46;I&#46; Dipchand"
                            3 => "S&#46;B&#46; Goldfarb"
                            4 => "A&#46;Y&#46; Kucheryavaya"
                            5 => "B&#46;J&#46; Levvey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.healun.2016.09.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Heart Lung Transplant"
                        "fecha" => "2016"
                        "volumen" => "35"
                        "paginaInicial" => "1170"
                        "paginaFinal" => "1184"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27772669"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A consensus document for the selection of lung transplant candidates&#58; 2014&#8212;an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Weill"
                            1 => "C&#46; Benden"
                            2 => "P&#46;A&#46; Corris"
                            3 => "J&#46;H&#46; Dark"
                            4 => "R&#46;D&#46; Davis"
                            5 => "S&#46; Keshavjee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.healun.2014.06.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Heart Lung Transplant"
                        "fecha" => "2015"
                        "volumen" => "34"
                        "paginaInicial" => "1"
                        "paginaFinal" => "15"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25085497"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack299848"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0055" class="elsevierStylePara elsevierViewall">We would like to thank the lung transplantation team in Hospital Santa Marta &#8211; Centro Hospitalar Lisboa Central and at the Complexo Hospitalario Universitario de A Coru&#241;a&#46;</p>"
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Article information
ISSN: 21735115
Original language: English
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Pulmonology

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