Publication: Osteoporosis en el trasplante pulmonar
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2018-04-17
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Universidad Complutense de Madrid
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Abstract
El trasplante pulmonar se ha consolidado progresivamente como alternativa terapéutica en los pacientes con enfermedades pulmonares en estadio terminal. Esto se ha objetivado a través del incremento en el número de trasplantados durante las últimas décadas. En España, los registros de la Organización Nacional de Trasplantes (ONT) y el Registro Español de trasplantes pulmonares reflejan la realización de más de 3.781 procedimientos en nuestro país desde 1993. Las mejoras en la técnica quirúrgica, el manejo peri-operatorio, la profilaxis antibiótica y la selección de donantes y receptores durante el periodo perioperatorio han permitido un incremento progresivo de la supervivencia de los receptores; sin embargo, nuevos retos surgen en el manejo de los pacientes a largo plazo. La osteoporosis pos-trasplante es una complicación bien conocida del trasplante de órganos. La combinación de alteraciones óseas, antes y después del mismo, parecen contribuir a su patogénesis, particularmente durante los primeros 12 meses en los que se experimenta una rápida pérdida de masa ósea. La elevada prevalencia de osteoporosis y el consiguiente riesgo de fractura de los pacientes candidatos a trasplante pulmonar, exigen el diseño de estrategias que permitan abordar de forma precoz la evaluación, seguimiento y tratamiento de la misma...
Lung transplant has become progressively a consolidated therapeutic alternative in patients with end-stage lung disease. This phenomenon could be observed on the increasing number of transplant patients within the last decades. In Spain, the National Transplant Organization (ONT) and the Spanish Registry of lung transplants summarize data from 3,781 adult lung transplants performed since 1993. Improvements in surgical technique, perioperative management, antibiotic prophylaxis, and selection of donors and recipients during the peri-operative period have led to perceptive improvements in the survival of the recipients, bringing new challenges of long term management. Osteoporosis is a well-known complication of solid organ transplantation. Particularly within the first 12 months after trasplantattion, when a rapid bone mass loss is experienced. The combination of bone alterations, before and after, seems to contribute to its pathogenesis. The high prevalence of osteoporosis and the increased risk of fracture among candidates for lung transplantation require the development of strategies to establish an early approach, follow-up and treatment of osteoporosis. The abscense of a gold standard in terms of prevention and treatment programs, as well as a lack of precision regarding the right moment for its implementation, has contributed to the emergence of a variety of protocols at local level that requires continuous evaluation to assess their effectiveness and potential improvements...
Lung transplant has become progressively a consolidated therapeutic alternative in patients with end-stage lung disease. This phenomenon could be observed on the increasing number of transplant patients within the last decades. In Spain, the National Transplant Organization (ONT) and the Spanish Registry of lung transplants summarize data from 3,781 adult lung transplants performed since 1993. Improvements in surgical technique, perioperative management, antibiotic prophylaxis, and selection of donors and recipients during the peri-operative period have led to perceptive improvements in the survival of the recipients, bringing new challenges of long term management. Osteoporosis is a well-known complication of solid organ transplantation. Particularly within the first 12 months after trasplantattion, when a rapid bone mass loss is experienced. The combination of bone alterations, before and after, seems to contribute to its pathogenesis. The high prevalence of osteoporosis and the increased risk of fracture among candidates for lung transplantation require the development of strategies to establish an early approach, follow-up and treatment of osteoporosis. The abscense of a gold standard in terms of prevention and treatment programs, as well as a lack of precision regarding the right moment for its implementation, has contributed to the emergence of a variety of protocols at local level that requires continuous evaluation to assess their effectiveness and potential improvements...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina Física y Rehabilitación (Hidrología Médica), leída el 09-07-2017