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Jeon JH, Harano T, Rodman JCS, Sheth M, Wightman SC, Atay SM, Kim AW. Early outcomes of lung transplantation with lung allografts from coronavirus disease 2019 (COVID-19)-positive donors. J Thorac Cardiovasc Surg 2024; 167:1955-1964.e3. [PMID: 37625616 DOI: 10.1016/j.jtcvs.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/24/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) can be detected for extended periods of time with nucleic acid amplification test even after transmissibility becomes negligible. Lung allografts from COVID-19-positive donors have been used for transplantation in highly selected cases. This study aimed to clarify the early outcomes of lung transplantation with COVID-19-positive donors. METHODS The Organ Procurement and Transplantation Network/United Network for Organ Sharing database between April 2020 and June 2022 was retrospectively analyzed. RESULTS In the study period, 1297 COVID-19-positive donors were identified and the lungs were transplanted from 47 donors (3.6%). Of 47 donors, 44 donors were positive for COVID-19 NAT with nasopharyngeal swabs and the other 3 were positive with bronchoalveolar lavage. The COVID-19-positive lung donors were younger than the COVID-19-negative donors (28.4 ± 11.6 years vs 35.4 ± 13.6 years, P < .001). Recipients of the COVID-19-positive lungs (n = 47) were more likely have a greater lung allocation score (57.1 ± 22.9 vs 50.5 ± 19.7, P = .057) than recipients of COVID-19-negative lungs (n = 5501). The posttransplant length of hospital stay (39.8 ± 43.6 days vs 30.6 ± 34.5 days, P = .181), need for extracorporeal membrane oxygenation support at 72 hours after transplantation (2.6% [1/38] vs 10.4% [541/5184], P = .18), and 1-year overall survival rate (85.6% vs 87.1%, P = .63) were comparable between the 2 groups. CONCLUSIONS Carefully selected lung allografts from COVID-19-positive donors had comparable early posttransplant outcomes to lung allografts from COVID-19-negative donors.
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Affiliation(s)
- Jae Hyun Jeon
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Calif; Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Takashi Harano
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Calif.
| | - John C S Rodman
- Biostatistics, Epidemiology, and Research Design, Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, Calif
| | - Megha Sheth
- Keck School of Medicine of the University of Southern California, Los Angeles, Calif
| | - Sean C Wightman
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Calif
| | - Scott M Atay
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Calif
| | - Anthony W Kim
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Calif
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Pradère P, Le Pavec J, Bos S, Pozza A, Nair A, Meachery G, Lordan J, Humbert M, Mercier O, Fadel E, Savale L, Fisher AJ. Outcomes of listing for lung and heart-lung transplantation in pulmonary hypertension: comparative experience in France and the UK. ERJ Open Res 2024; 10:00521-2023. [PMID: 38259809 PMCID: PMC10801724 DOI: 10.1183/23120541.00521-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/17/2023] [Indexed: 01/24/2024] Open
Abstract
Background Lung or heart-lung transplantation (LT/HLT) for severe pulmonary hypertension (PH) as the primary disease indication carries a high risk of waiting list mortality and post-transplant complications. France and the UK both have coordinated PH patient services but with different referral pathways for accessing LT services. Methods We conducted a comparative analysis of adult PH patients listed for LT/HLT in the UK and France. Results We included 211 PH patients in France (2006-2018) and 170 in the UK (2010-2019). Cumulative incidence of transplant, delisting and waiting list death within 3 years were 81%, 4% and 11% in France versus 58%, 10% and 15% in the UK (p<0.001 for transplant and delisting; p=0.1 for death). Median non-priority waiting time was 45 days in France versus 165 days in the UK (p<0.001). High-priority listing occurred in 54% and 51% of transplanted patients respectively in France and the UK (p=0.8). Factors associated with achieving transplantation related to recipients' height, male sex, clinical severity and priority listing status. 1-year post-transplant survival was 78% in France and 72% in the UK (p= 0.04). Conclusion Access to transplantation for PH patients is better in France than in the UK where more patients were delisted due to clinical deterioration because of longer waiting time. High rates of priority listing occurred in both countries. Survival for those achieving transplantation was slightly better in France. Ensuring optimal outcomes after transplant listing for PH patients is challenging and may involve early listing of higher risk patients, increasing donor lung utilisation and improving allocation rules for these specific patients.
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Affiliation(s)
- Pauline Pradère
- Pneumology Department, Marie Lannelongue Hospital, Paris Saint Joseph Hospital, Le Plessis Robinson, France
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Jérome Le Pavec
- Pneumology Department, Marie Lannelongue Hospital, Paris Saint Joseph Hospital, Le Plessis Robinson, France
- Paris Saclay University, Faculty of Medical Sciences, Le Kremlin-Bicêtre, France
- INSERM UMR-S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Saskia Bos
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
- Institute of Transplantation, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andre Pozza
- Institute of Transplantation, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Arun Nair
- Institute of Transplantation, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gerard Meachery
- Institute of Transplantation, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - James Lordan
- Institute of Transplantation, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Marc Humbert
- Paris Saclay University, Faculty of Medical Sciences, Le Kremlin-Bicêtre, France
- INSERM UMR-S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis Robinson, France
- AP-HP, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Olaf Mercier
- Paris Saclay University, Faculty of Medical Sciences, Le Kremlin-Bicêtre, France
- INSERM UMR-S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Thoracic Surgery, Marie Lannelongue Hospital, Paris Saint Joseph Hospital, Le Plessis Robinson, France
| | - Elie Fadel
- Paris Saclay University, Faculty of Medical Sciences, Le Kremlin-Bicêtre, France
- INSERM UMR-S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Thoracic Surgery, Marie Lannelongue Hospital, Paris Saint Joseph Hospital, Le Plessis Robinson, France
| | - Laurent Savale
- Paris Saclay University, Faculty of Medical Sciences, Le Kremlin-Bicêtre, France
- INSERM UMR-S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Le Plessis Robinson, France
- AP-HP, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Andrew J. Fisher
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
- Institute of Transplantation, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Zhao Y, Dhru U, Fleischmann E, Mostafa E, Al-Suqi M, Conaway MR, Krupnick AS, Linden J, Rabin J, Lau CL. Regadenoson Reduces Soluble Receptor for Advanced Glycation End-Products in Lung Recipients. Ann Thorac Surg 2023; 116:1150-1158. [PMID: 36921749 DOI: 10.1016/j.athoracsur.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/21/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The selective adenosine A2A receptor (A2AR) agonist regadenoson reduces inflammation due to lung ischemia-reperfusion injury (IRI). The objective of this study was to investigate molecular and cellular mechanisms by which regadenoson reduces IRI in lung transplant recipients. METHODS Fourteen human lung transplant recipients were infused for 12 hours with regadenoson and 7 more served as untreated controls. Plasma levels of high mobility group box 1 and its soluble receptor for advanced glycation end-products (sRAGE) were measured by Luminex. Matrix metalloproteinase (MMP) 2 and 9 were measured by gelatin zymography. Tissue inhibitor of metalloproteinase 1 was measured by mass spectroscopy. A2AR expression on leukocytes was analyzed by flow cytometry. MMP-9-mediated cleavage of RAGE was evaluated using cultured macrophages in vitro. RESULTS Regadenoson treatment during lung transplantation significantly reduced levels of MMP-9 (P < .05), but not MMP-2, and elevated levels of tissue inhibitor of metalloproteinase 1 (P < .05), an endogenous selective inhibitor of MMP-9. Regadenoson infusion significantly reduced plasma levels of sRAGE (P < .05) during lung reperfusion compared with control subjects. A2AR expression was highest on invariant natural killer T cells and higher on monocytes than other circulating immune cells (P < .05). The shedding of RAGE from cultured monocytes/macrophages was increased by MMP-9 stimulation and reduced by an MMP inhibitor or by A2AR agonists, regadenoson or ATL146e. CONCLUSIONS In vivo and in vitro studies suggest that A2AR activation reduces sRAGE in part by inhibiting MMP-9 production by monocytes/macrophages. These results suggest a novel molecular mechanism by which A2AR agonists reduce primary graft dysfunction.
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Affiliation(s)
- Yunge Zhao
- Thoracic Division, Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland
| | - Urmil Dhru
- Thoracic Division, Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland
| | - Emily Fleischmann
- Thoracic Division, Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland
| | - Ezzat Mostafa
- Thoracic Division, Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland
| | - Manal Al-Suqi
- Thoracic Division, Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland
| | - Mark R Conaway
- Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Alexander S Krupnick
- Thoracic Division, Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland
| | - Joel Linden
- Thoracic Division, Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland; Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Joseph Rabin
- Thoracic Division, Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland
| | - Christine L Lau
- Thoracic Division, Department of Surgery, University of Maryland Baltimore, Baltimore, Maryland.
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Kambali S, Mantero AMA, Ghodsizad A, Loebe M, Mirsaeidi M. Improving survival outcome among elderly lung transplant recipients. Eur J Intern Med 2020; 74:121-124. [PMID: 32001096 DOI: 10.1016/j.ejim.2020.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Shweta Kambali
- Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | | | - Ali Ghodsizad
- Heart and Lung Transplant, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Matthias Loebe
- Heart and Lung Transplant, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
| | - Mehdi Mirsaeidi
- Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Section of Pulmonary Medicine, Miami Veterans Affairs Healthcare System, Miami, FL 33136, USA.
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Balsara KR, Krupnick AS, Bell JM, Khiabani A, Scavuzzo M, Hachem R, Trulock E, Witt C, Byers DE, Yusen R, Meyers B, Kozower B, Patterson GA, Puri V, Kreisel D. A single-center experience of 1500 lung transplant patients. J Thorac Cardiovasc Surg 2018; 156:894-905.e3. [PMID: 29891245 DOI: 10.1016/j.jtcvs.2018.03.112] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 02/28/2018] [Accepted: 03/03/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Over the past 30 years, lung transplantation has emerged as the definitive treatment for end-stage lung disease. In 2005, the lung allocation score (LAS) was introduced to allocate organs according to disease severity. The number of transplants performed annually in the United States continues to increase as centers have become more comfortable expanding donor and recipient criteria and have become more facile with the perioperative and long-term management of these patients. We report a single-center experience with lung transplants, looking at patients before and after the introduction of LAS. METHODS We retrospectively reviewed 1500 adult lung transplants at a single center performed between 1988 and 2016. Patients were separated into 2 groups, before and after the introduction of LAS: group 1 (April 1988 to April 2005; 792 patients) and group 2 (May 2005 to September 2016; 708 patients). RESULTS Differences in demographic data were noted over these periods, reflecting changes in allocation of organs. Group 1 patient average age was 48 ± 13 years, and 404 subjects (51%) were male. Disease processes included emphysema (52%; 412), cystic fibrosis (18.2%; 144), pulmonary fibrosis (16.1%; 128) and pulmonary vascular disease (7.2%; 57). Double lung transplant (77.7%; 615) was performed more frequently than single lung transplant (22.3%; 177). Group 2 average age was 50 ± 14 years, and 430 subjects (59%) were male. Disease processes included pulmonary fibrosis (46%; 335), emphysema (25.8%; 188), cystic fibrosis (17.7%; 127) and pulmonary vascular disease (1.6%; 11). Double lung transplant (96.2%; 681) was performed more frequently than single lung transplant (3.8%; 27). Overall incidence of grade 3 primary graft dysfunction (PGD) in group 1 was significantly lower at 22.1% (175) than in group 2 at 31.6% (230) (P < .001). Nonetheless, overall hospital mortality was not statistically different between the 2 groups (4.4% vs 3.5%; P < .4). Most notably, survival at 1 year was statistically different at 646 (81.6%) for group 1 and 665 (91.4%) for group 2 (P < .02). CONCLUSIONS Patient demographics over the study period have changed with an increased number of fibrotic patients transplanted. In addition, more aggressive strategies with donor/recipient selection appear to have resulted in a higher incidence of primary graft dysfunction. This does not, however, appear to affect patient survival on index hospitalization or at 1 year. In fact, we have observed a significant improvement in survival at 1 year in the more recent era. This observation suggests that continued expansion of possible donors and recipients, coupled with a more sophisticated understanding of primary graft dysfunction and long-term chronic rejection, can lead to increased transplant volume and prolonged survival.
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Affiliation(s)
- Keki R Balsara
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo.
| | - Alexander S Krupnick
- Division of Cardiothoracic Surgery, University of Virginia School of Medicine, Charlottesville, Va
| | - Jennifer M Bell
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Ali Khiabani
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Masina Scavuzzo
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Mo
| | - Ramsey Hachem
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Mo
| | - Elbert Trulock
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Mo
| | - Chad Witt
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Mo
| | - Derek E Byers
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Mo
| | - Roger Yusen
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Mo
| | - Bryan Meyers
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Benjamin Kozower
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo
| | - G Alexander Patterson
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Varun Puri
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo
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