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Wayda B, Weng Y, Zhang S, Luikart H, Pearson T, Nieto J, Nicely B, Geraghty PJ, Belcher J, Nguyen J, Neidlinger N, Groat T, Malinoski D, Zaroff JG, Khush KK. Prediction of Donor Heart Acceptance for Transplant and Its Clinical Implications: Results From The Donor Heart Study. Circ Heart Fail 2024; 17:e011360. [PMID: 39308397 DOI: 10.1161/circheartfailure.123.011360] [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: 10/27/2023] [Accepted: 07/24/2024] [Indexed: 10/17/2024]
Abstract
BACKGROUND Despite a shortage of potential donors for heart transplant in the United States, most potential donor hearts are discarded. We evaluated predictors of donor heart acceptance in the United States and applied machine learning methods to improve prediction. METHODS We included a nationwide (2005-2020) cohort of potential heart donors in the United States (n=73 948) from the Scientific Registry of Transplant Recipients and a more recent (2015-2020) rigorously phenotyped cohort of potential donors from DHS (Donor Heart Study; n=4130). We identified predictors of acceptance for heart transplant in both cohorts using multivariate logistic regression, incorporating time-interaction terms to characterize their varying effects over time. We fit models predicting acceptance for transplant in a 50% training subset of DHS using logistic regression, least absolute shrinkage and selection operator, and random forest algorithms and compared their performance in the remaining 50% (test) of the subset. RESULTS Predictors of donor heart acceptance were similar in the nationwide and DHS cohorts. Among these, older age (P value for time interaction, 0.0001) has become increasingly predictive of discard over time while other factors, including those related to drug use, infection, and mild cardiac diagnostic abnormalities, have become less influential (P value for time interaction, <0.05 for all). A random forest model (area under the curve, 0.908; accuracy, 0.831) outperformed other prediction algorithms in the test subset and was used as the basis of a novel web-based prediction tool. CONCLUSIONS Predictors of donor heart acceptance for transplantation have changed significantly over the last 2 decades, likely reflecting evolving evidence regarding their impact on posttransplant outcomes. Real-time prediction of donor heart acceptance, using our web-based tool, may improve efficiency during donor management and heart allocation.
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Affiliation(s)
- Brian Wayda
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine (B.W., H.L.)
| | - Yingjie Weng
- Quantitative Sciences Unit, Department of Medicine (Y.W., S.Z.), Stanford University School of Medicine, CA
| | - Shiqi Zhang
- Quantitative Sciences Unit, Department of Medicine (Y.W., S.Z.), Stanford University School of Medicine, CA
| | - Helen Luikart
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine (B.W., H.L.)
| | | | - Javier Nieto
- LifeGift Organ Procurement Organization, Houston, TX (J. Nieto)
| | | | | | | | - John Nguyen
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco (J. Nguyen)
| | - Nikole Neidlinger
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison (N.N.)
| | - Tahnee Groat
- Department of Surgery, Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health and Science University, Portland (T.G., D.M.)
| | - Darren Malinoski
- Department of Surgery, Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health and Science University, Portland (T.G., D.M.)
| | - Jonathan G Zaroff
- Division of Research, Kaiser Permanente Northern California, Oakland (J.Z.)
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Department of Medicine (K.K.K.), Stanford University School of Medicine, CA
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Liu CR, Heid CA, Hauptmann E, Ali M, Pruszynski J, Pillai A, Banga A, Wait MA, Huffman LC, Peltz M, Hackmann AE, Jessen ME, Ring WS, Murala JS. Donor substance use and lung transplantation: A single center experience. TRANSPLANTATION REPORTS 2022. [DOI: 10.1016/j.tpr.2022.100124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Celebi Sozener Z, Ozdel Ozturk B, Cerci P, Turk M, Gorgulu Akin B, Akdis M, Altiner S, Ozbey U, Ogulur I, Mitamura Y, Yilmaz I, Nadeau K, Ozdemir C, Mungan D, Akdis CA. Epithelial barrier hypothesis: Effect of the external exposome on the microbiome and epithelial barriers in allergic disease. Allergy 2022; 77:1418-1449. [PMID: 35108405 PMCID: PMC9306534 DOI: 10.1111/all.15240] [Citation(s) in RCA: 149] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 12/11/2022]
Abstract
Environmental exposure plays a major role in the development of allergic diseases. The exposome can be classified into internal (e.g., aging, hormones, and metabolic processes), specific external (e.g., chemical pollutants or lifestyle factors), and general external (e.g., broader socioeconomic and psychological contexts) domains, all of which are interrelated. All the factors we are exposed to, from the moment of conception to death, are part of the external exposome. Several hundreds of thousands of new chemicals have been introduced in modern life without our having a full understanding of their toxic health effects and ways to mitigate these effects. Climate change, air pollution, microplastics, tobacco smoke, changes and loss of biodiversity, alterations in dietary habits, and the microbiome due to modernization, urbanization, and globalization constitute our surrounding environment and external exposome. Some of these factors disrupt the epithelial barriers of the skin and mucosal surfaces, and these disruptions have been linked in the last few decades to the increasing prevalence and severity of allergic and inflammatory diseases such as atopic dermatitis, food allergy, allergic rhinitis, chronic rhinosinusitis, eosinophilic esophagitis, and asthma. The epithelial barrier hypothesis provides a mechanistic explanation of how these factors can explain the rapid increase in allergic and autoimmune diseases. In this review, we discuss factors affecting the planet's health in the context of the 'epithelial barrier hypothesis,' including climate change, pollution, changes and loss of biodiversity, and emphasize the changes in the external exposome in the last few decades and their effects on allergic diseases. In addition, the roles of increased dietary fatty acid consumption and environmental substances (detergents, airborne pollen, ozone, microplastics, nanoparticles, and tobacco) affecting epithelial barriers are discussed. Considering the emerging data from recent studies, we suggest stringent governmental regulations, global policy adjustments, patient education, and the establishment of individualized control measures to mitigate environmental threats and decrease allergic disease.
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Affiliation(s)
| | - Betul Ozdel Ozturk
- School of MedicineDepartment of Chest DiseasesDivision of Immunology and Allergic DiseasesAnkara UniversityAnkaraTurkey
| | - Pamir Cerci
- Clinic of Immunology and Allergic DiseasesEskisehir City HospitalEskisehirTurkey
| | - Murat Turk
- Clinic of Immunology and Allergic DiseasesKayseri City HospitalKayseriTurkey
| | - Begum Gorgulu Akin
- Clinic of Immunology and Allergic DiseasesAnkara City HospitalAnkaraTurkey
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
| | - Seda Altiner
- Clinic of Internal Medicine Division of Immunology and Allergic DiseasesKahramanmaras Necip Fazil City HospitalKahramanmarasTurkey
| | - Umus Ozbey
- Department of Nutrition and DietAnkara UniversityAnkaraTurkey
| | - Ismail Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
| | - Yasutaka Mitamura
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
| | - Insu Yilmaz
- Department of Chest DiseasesDivision of Immunology and Allergic DiseasesErciyes UniversityKayseriTurkey
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University School of MedicineDivision of Pulmonary and Critical Care MedicineDepartment of MedicineStanford UniversityStanfordCaliforniaUSA
| | - Cevdet Ozdemir
- Institute of Child HealthDepartment of Pediatric Basic SciencesIstanbul UniversityIstanbulTurkey
- Istanbul Faculty of MedicineDepartment of PediatricsDivision of Pediatric Allergy and ImmunologyIstanbul UniversityIstanbulTurkey
| | - Dilsad Mungan
- School of MedicineDepartment of Chest DiseasesDivision of Immunology and Allergic DiseasesAnkara UniversityAnkaraTurkey
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE)DavosSwitzerland
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Banga N, Mohanka M. Prevalence, Clinical Characteristics, and Outcomes Among Lung Transplant Recipients of Donors With Cocaine Use. Transplant Proc 2021; 53:3069-3074. [PMID: 34728078 DOI: 10.1016/j.transproceed.2021.08.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/30/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION There is limited data regarding lung transplant (LT) outcomes among recipients of donors with a history of cocaine use. We sought to assess the burden of cocaine abuse among LT donors, describe their characteristics, and evaluate the association with post-transplant outcomes. METHODS From the United Network for Organ Sharing database, we included adult patients (age ≥18 years) who underwent LT between 1996 and 2014 (N = 20,106; mean age 53.7 ± 13 years; male: 57%). Study groups were divided based on the donor history of recent cocaine abuse (last 6 months). Donor and recipient characteristics were compared between the 2 groups. With 1-year survival as the primary endpoint, multivariate logistic regression analysis was conducted to assess for an independent association with the donor history of cocaine use. RESULTS The overall frequency of donors with any history of cocaine use was 10.9% (n = 2189), although less than half were current users (n = 1001, 4.98%). Unadjusted 1-year survival was worse among recipients of donors with current cocaine use, although it did not achieve statistical significance (84.4% vs 82.2%; odds ratio 1.17, 95% confidence interval 0.99-1.38; P = .07). After adjusting for potential confounders, the current use of cocaine was not associated with 1-year survival (adjusted OR 1.06, 95% CI 0.95-1.18; P = .29). CONCLUSIONS A significant proportion of lung donors have a history of cocaine abuse. Although unadjusted early outcomes appear to worsen among recipients of active cocaine users, an independent association was not seen with 1-year survival. The current analysis supports the continued use of donors with a history of cocaine abuse, assuming they meet other criteria for organ quality.
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Affiliation(s)
- Natasha Banga
- Lung Transplant Program, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Manish Mohanka
- Lung Transplant Program, University of Texas Southwestern Medical Center, Dallas, Texas.
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Krishnan P, Saddoughi SASS. Procurement of lungs from brain-dead donors. Indian J Thorac Cardiovasc Surg 2021; 37:416-424. [PMID: 34629768 PMCID: PMC8464546 DOI: 10.1007/s12055-021-01140-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/31/2020] [Accepted: 01/06/2021] [Indexed: 10/21/2022] Open
Abstract
Lung transplantation is the procedure of choice in many patients with end-stage lung disease and is being performed more frequently around the world. However, there continues to be shortage of donor organs with the ever-expanding number of recipients on the waiting list, leading to liberalization of the lung donor selection criteria with increasing acceptance of marginal donors while striving for excellent results. This has placed an increasing emphasis on the technique of donor lung procurement and preservation from marginal donors. Good judgment and procurement techniques are necessary to obtain high-quality donor lungs for transplantation and optimize long-term results. This is a review of our current technique used for the procurement of the lungs from brain-dead donors.
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Affiliation(s)
- Prasad Krishnan
- Department of Cardiovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
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Baran DA, Lansinger J, Long A, Herre JM, Yehya A, Sawey EJ, Badiye AP, Old W, Copeland J, Stelling K, Copeland H. Intoxicated Donors and Heart Transplant Outcomes: Long-Term Safety. Circ Heart Fail 2021; 14:e007433. [PMID: 34315226 PMCID: PMC8366767 DOI: 10.1161/circheartfailure.120.007433] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Supplemental Digital Content is available in the text. Background: The opioid crisis has led to an increase in available donor hearts, although questions remain about the long-term outcomes associated with the use of these organs. Prior studies have relied on historical information without examining the toxicology results at the time of organ offer. The objectives of this study were to examine the long-term survival of heart transplants in the recent era, stratified by results of toxicological testing at the time of organ offer as well as comparing the toxicology at the time of donation with variables based on reported history. Methods: The United Network for Organ Sharing database was requested as well as the donor toxicology field. Between 2007 and 2017, 23 748 adult heart transplants were performed. United Network for Organ Sharing historical variables formed a United Network for Organ Sharing Toxicology Score and the measured toxicology results formed a Measured Toxicology Score. Survival was examined by the United Network for Organ Sharing Toxicology Score and Measured Toxicology Score, as well as Cox proportional hazards models incorporating a variety of risk factors. Results: The number and percent of donors with drug use has significantly increased over the study period (P<0.0001). Cox proportional hazards modeling of survival including toxicological and historical data did not demonstrate differences in post-transplant mortality. Combinations of drugs identified by toxicology were not associated with differences in survival. Lower donor age and ischemic time were significantly positively associated with survival (P<0.0001). Conclusions: Among donors accepted for transplantation, neither history nor toxicological evidence of drug use was associated with significant differences in survival. Increasing use of such donors may help alleviate the chronic donor shortage.
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Affiliation(s)
- David A Baran
- Division of Cardiology, Sentara Heart Hospital, Norfolk, VA (D.A.B., J.L., A.L., J.M.H., A.Y., E.J.S., A.P.B., W.O., K.S.)
| | - Justin Lansinger
- Division of Cardiology, Sentara Heart Hospital, Norfolk, VA (D.A.B., J.L., A.L., J.M.H., A.Y., E.J.S., A.P.B., W.O., K.S.)
| | - Ashleigh Long
- Division of Cardiology, Sentara Heart Hospital, Norfolk, VA (D.A.B., J.L., A.L., J.M.H., A.Y., E.J.S., A.P.B., W.O., K.S.)
| | - John M Herre
- Division of Cardiology, Sentara Heart Hospital, Norfolk, VA (D.A.B., J.L., A.L., J.M.H., A.Y., E.J.S., A.P.B., W.O., K.S.)
| | - Amin Yehya
- Division of Cardiology, Sentara Heart Hospital, Norfolk, VA (D.A.B., J.L., A.L., J.M.H., A.Y., E.J.S., A.P.B., W.O., K.S.)
| | - Edward J Sawey
- Division of Cardiology, Sentara Heart Hospital, Norfolk, VA (D.A.B., J.L., A.L., J.M.H., A.Y., E.J.S., A.P.B., W.O., K.S.)
| | - Amit P Badiye
- Division of Cardiology, Sentara Heart Hospital, Norfolk, VA (D.A.B., J.L., A.L., J.M.H., A.Y., E.J.S., A.P.B., W.O., K.S.)
| | - Wayne Old
- Division of Cardiology, Sentara Heart Hospital, Norfolk, VA (D.A.B., J.L., A.L., J.M.H., A.Y., E.J.S., A.P.B., W.O., K.S.)
| | | | - Kelly Stelling
- Division of Cardiology, Sentara Heart Hospital, Norfolk, VA (D.A.B., J.L., A.L., J.M.H., A.Y., E.J.S., A.P.B., W.O., K.S.)
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