Background: Lung transplantation (LuTX) can be the last resort for patients with end-stage lung diseases. In the last decades, improvements were implemented in transplant medicine, from immunosuppression throughout preservation of the donor organ to enhance lung allograft survival. This retrospective study aims to illustrate the development of the LuTX-program at the University Hospital of Munich, LMU, Munich, Germany, since its launch in 1990 by depicting and comparing postoperative outcome. Methods: We analyzed all LuTX performed from 1990 to 2019. Data was collected on indication for transplantation (TX), date, type (double/single) and postoperative survival. Survival analysis and Kaplan-Meier estimator were used to identify factors that are detrimental to post-LuTX-outcome. Results: A total of 1,054 LuTX were performed over 30 years, comprising overall 1,024 patients (30 retransplantations). The best results regarding five-year survival rates (5-YSR) were observed in patients with lymphangioleiomyomatosis (LAM) and hypersensitivity pneumonitis (HP) (5-YSR: LAM: 78.6%, HP: 73.6%). We could show that besides that the type of LuTX played a crucial role in post-TX survival, depicting double superior to single LuTX (5-YSR: single: 47.2%, double: 64.5%). Additionally, cytomegalovirus (CMV) risk constellation (high/intermediate risk; P=0.02) and infection (P<0.001) were identified as risk factors for deteriorated survival. Conclusions: Data analysis demonstrates that the field of LuTX has undergone enormous progress over the years. Therapeutic advances and improvements in interdisciplinary cooperation, pre- and postoperative management, changes in immunosuppressive medication, diagnosis and treatment of allograft rejections have clearly improved lung allograft and patient survival.

Introduction Poor oral hygiene can cause infections and inflammatory diseases. Data on its impact on outcome after lung transplantation (LuTX) is scarce. Most transplant centers have individual standards regarding dental care as there is no clinical guideline. This study's objective was to assess LuTX-listed patient's dental status and determine its effect on postoperative outcome.Methods Two hundred patients having undergone LuTX from 2014 to 2019 were selected. Collected data comprised LuTX-indication, periodontal status, and number of carious teeth/fillings. A preoperative panoramic dental X-ray and a dentist's consultative clarification were mandatory.Results 63.5% had carious dental status, differing significantly regarding TX-indication (p < 0.001; ILD: 41.7% vs. CF: 3.1% of all patients with carious teeth). Mean age at the time of LuTX differed significantly within these groups. Neither preoperative carious dental status nor periodontitis or bone loss deteriorated post-LuTX survival significantly. No evidence was found that either resulted in a greater number of deaths related to an infectious etiology.Conclusion This study shows that carious dental status, periodontitis, and bone loss do not affect post-TX survival. However, literature indicates that they can cause systemic/pulmonary infections that deteriorate post-LuTX survival. Regarding the absence of standardized guidelines regarding dental care and LuTX, we strongly recommend emphasizing research in this field.

Background/Objectives: Chronic lung allograft dysfunction (CLAD) remains the leading cause of late graft failure after lung transplantation (LuTX). De novo donor-specific anti-HLA antibodies (dnDSA), especially HLA-DQ, have been implicated; we assessed associations between dnDSA (class and specificity) and CLAD after LuTX. Methods: We retrospectively analyzed all LuTX recipients transplanted from 2005–2018 at a single center (n = 585). dnDSA were measured by Luminex single-antigen bead assays (MFI > 1000) at 1, 3, 6, and 12 months and at least annually thereafter. CLAD was defined by ISHLT criteria; time-to-event comparisons used log-rank testing. Results: dnDSA developed in 151/585 recipients (25.8%), predominantly class II (129/585; 22.1%); class I dnDSA occurred in 52/585 (8.9%). CLAD occurred more frequently in dnDSA-positive than dnDSA-negative recipients (64/151; 42.4% vs. 109/434; 25.1%; p < 0.0001). Rejection-attributed death was higher in dnDSA-positive recipients (19/151; 11.3% vs. 25/434; 5.3%; p = 0.01). Both class I and class II dnDSA were associated with higher CLAD rates (log-rank p < 0.001 each). Locus-specific analyses identified HLA-DQ dnDSA as strongly associated with CLAD (p < 0.0001); DQ7 was the most frequent specificity (n = 44) and showed the strongest association (p < 0.0001). Conclusions: dnDSA after LuTX were associated with increased CLAD incidence and rejection-attributed mortality, with a prominent association for HLA-DQ—particularly DQ7.

Despite advances in immunosuppression and perioperative care, lung transplantation (LuTX) outcome continues to be limited by allograft rejection and infectious complications. Given the allograft's direct exposure to the environment, peri-transplant microbial presence and dynamics may critically shape outcomes, yet its impact remains incompletely understood. This study aimed to evaluate peri-transplant airway microbiological findings in lung transplant recipients and determine their associations with acute cellular rejection (ACR), chronic lung allograft dysfunction (CLAD), and survival. We retrospectively analyzed 345 LuTX recipients treated between 2014 and 2019 with follow-up through 2024. Standardized microbiological sampling was performed pre-, intra- and postoperatively. Associations with ACR, CLAD and survival were evaluated. Candida species (spp.) (22.6% and 18.3%, respectively) and Pseudomonas aeruginosa (10.7% and 7.2%) were most frequently detected in pre- and postoperative sputum samples. Donor lungs showed positive microbial samples in 62.3% of cases, predominantly with Candida spp. (31.3%) and Staphylococcus spp. (26.1%). Multivariate analysis identified donor-derived Escherichia coli as an independent predictor of ACR (P=0.01; odds ratio 3.2), CLAD [P=0.03; hazard ratio (HR) 2.6] and impaired survival (P<0.001; HR 3.2). Furthermore, donor-derived Achromobacter spp. (P=0.01; HR 13.6) and postoperative deep airway Candida detection (P=0.045; HR 1.9) predicted mortality. While Klebsiella was associated with adverse outcomes in univariate analysis, this did not remain significant after adjustment. Peri-transplant airway microbiota are significantly associated with graft rejection and survival after LuTX. Donor-derived E. coli and Achromobacter spp., as well as postoperative Candida detection, emerged as robust predictors of poor outcome. Systematic microbiological surveillance and tailored prophylaxis are essential to mitigate microbial-driven allograft dysfunction and improve long-term survival.

Objective: Oral infections and poor dental health may contribute to systemic complications after heart transplantation, yet data on their impact is limited. In the absence of standardized dental guidelines for transplant candidates, this study evaluated preoperative dental status and its association with post‐transplant outcomes. Methods: A retrospective analysis was conducted on 72 patients who underwent heart transplantation between 2014 and 2019. Collected data included transplantation indications, dental findings, and postoperative outcomes. All patients received a preoperative panoramic dental X‐ray and dental consultation. Results: Patients had an average of 23.88 teeth, and all presented with at least one dental filling. Periodontal abnormalities were present in 68%. While the decayed, missing, and filled teeth scores showed no significant association with post‐transplant mortality ( p = 0.076), both periodontal disease and carious lesions were significantly associated with sepsis ( p = 0.003). Sepsis, in turn, was significantly linked to increased mortality ( p = 0.001). Conclusions: Poor dental health was not directly associated with post‐transplant mortality but was linked to a higher sepsis risk, which negatively affected outcomes. These findings support the need for standardized dental care protocols for heart transplant candidates.

Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous autoimmune disease characterized by diverse clinical manifestations in the oral cavity, with a pathogenesis that remains incompletely understood. Aim of this study was to evaluate antinuclear antibodies (ANA) as well as vitamin status in blood samples collected from OLP patients. Fifty OLP patients and 25 healthy controls were included in the study. This study explores the correlation between OLP, elevated ANA titers and elevated Vitamin B6 levels, hypothesizing that a shared autoimmune mechanism or metabolic dysregulation may link these findings. Forty-seven patients (94%) with OLP and 11 patients (44%) in the healthy control group had increased ANA-titers (≥1:100) (p < 0.001). Vitamin B6 was increased in 24 patients (48%) in the OLP group while it was normal in the control group (p < 0.001). While ANA testing is not intended to diagnose OLP, the high prevalence observed in this cohort may reflect systemic immune activation or dysregulation in OLP patients. Elevated vitamin B6 (pyridoxine) levels were identified in a subset of OLP cases; however, it remains uncertain whether this finding reflects a contributory role in disease pathogenesis or an epiphenomenon.