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Abramov A, Fuller J, Su I, Flatley M, Abrams D, Stanifer BP, Agerstrand C, Brodie D, Sonett J, Azizi E, Lemaitre P. P94: COVID-19-related ARDS Supported with Extracorporeal Membrane Oxygenation: Using Machine Learning Models to Improve Care. ASAIO J 2022. [DOI: 10.1097/01.mat.0000841592.03089.c7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Leiva-Juárez MM, Urso A, Costa J, Stanifer BP, Sonett JR, Benvenuto L, Aversa M, Robbins H, Shah L, Arcasoy S, D’Ovidio F. Fundoplication after lung transplantation in patients with systemic sclerosis-related end-stage lung disease. J Scleroderma Relat Disord 2021; 6:247-255. [PMID: 35387211 PMCID: PMC8922666 DOI: 10.1177/23971983211016210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/19/2021] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Gastroesophageal reflux and aspiration are risk factors for chronic lung allograft dysfunction in lung transplant recipients. Patients with systemic sclerosis are at an increased risk of aspiration due to esophageal dysmotility and an ineffective lower esophageal sphincter. The aim of this study is to understand the effect of fundoplication on outcomes in systemic sclerosis recipients. METHODS Between 2001 and 2019, 168 systemic sclerosis patients were referred for lung transplantation-51 (30.3%) were listed and 36 (21.4%) were transplanted. Recipients were stratified whether they underwent a fundoplication (n = 10, 27.8%) or not (n = 26, 72.2%). Freedom from chronic lung allograft dysfunction and survival were analyzed using log-rank test. Multivariable analysis for known risk factors was performed using a Cox-proportional hazards model. RESULTS Median time to fundoplication after transplantation was 16.4 months (interquartile range: 9.6-25.1) and all were laparoscopic (Dor 50%, Nissen 40%, Toupet 10%). There were no differences in acute rejection ⩾ A1 (26.9% vs 30%), or primary graft dysfunction grades 2-3 at 72 h (42.3% vs 40%) between groups. Recipients with fundoplication had an increased freedom from chronic lung allograft dysfunction (p = 0.035) and overall survival (p = 0.01). Fundoplication was associated with a reduced risk of mortality adjusting for other comorbidities (hazard ratio = 0.13; 95% confidence interval = 0.02-0.65; p = 0.014). Double and single lung transplant did not have different post-transplant survival. CONCLUSION Fundoplication in systemic sclerosis lung transplant recipients is associated with greater freedom from chronic lung allograft dysfunction and overall survival. Screening for reflux and aspiration followed by early fundoplication may delay graft deterioration in this population.
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Affiliation(s)
- Miguel M Leiva-Juárez
- Department of Surgery, Section of
General Thoracic Surgery, Columbia University Irving Medical Center, New York, NY,
USA
| | - Andreacarola Urso
- Department of Surgery, Section of
General Thoracic Surgery, Columbia University Irving Medical Center, New York, NY,
USA
| | - Joseph Costa
- Department of Surgery, Section of
General Thoracic Surgery, Columbia University Irving Medical Center, New York, NY,
USA
| | - Bryan P Stanifer
- Department of Surgery, Section of
General Thoracic Surgery, Columbia University Irving Medical Center, New York, NY,
USA
| | - Joshua R Sonett
- Department of Surgery, Section of
General Thoracic Surgery, Columbia University Irving Medical Center, New York, NY,
USA
| | - Luke Benvenuto
- Department of Pulmonary, Allergy and
Critical Care Medicine, Columbia University Irving Medical Center, New York, NY,
USA
| | - Megan Aversa
- Department of Pulmonary, Allergy and
Critical Care Medicine, Columbia University Irving Medical Center, New York, NY,
USA
| | - Hilary Robbins
- Department of Pulmonary, Allergy and
Critical Care Medicine, Columbia University Irving Medical Center, New York, NY,
USA
| | - Lori Shah
- Department of Pulmonary, Allergy and
Critical Care Medicine, Columbia University Irving Medical Center, New York, NY,
USA
| | - Selim Arcasoy
- Department of Pulmonary, Allergy and
Critical Care Medicine, Columbia University Irving Medical Center, New York, NY,
USA
| | - Frank D’Ovidio
- Department of Surgery, Section of
General Thoracic Surgery, Columbia University Irving Medical Center, New York, NY,
USA
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Furfaro D, Rosenzweig EB, Shah L, Robbins H, Anderson M, Kim H, Abrams D, Agerstrand CL, Brodie D, Feldhaus D, Costa J, Lemaitre P, Stanifer BP, D'Ovidio F, Sonett JR, Arcasoy S, Benvenuto L. Lung transplantation disparities based on diagnosis for patients bridging to transplant on extracorporeal membrane oxygenation. J Heart Lung Transplant 2021; 40:1641-1648. [PMID: 34548196 DOI: 10.1016/j.healun.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/02/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is increasingly utilized as a bridge to lung transplantation, but ECMO status is not explicitly accounted for in the Lung Allocation Score (LAS). We hypothesized that among waitlist patients on ECMO, patients with pulmonary arterial hypertension (PAH) would have lower transplantation rates. METHODS Using United Network for Organ Sharing data, we conducted a retrospective cohort study of patients who were ≥12 years old, active on the lung transplant waitlist, and required ECMO support from June 1, 2015 through June 12, 2020. Multivariable competing risk analysis was used to examine waitlist outcomes. RESULTS 1064 waitlist subjects required ECMO support; 40 (3.8%) had obstructive lung disease (OLD), 97 (9.1%) had PAH,138 (13.0%) had cystic fibrosis (CF), and 789 (74.1%) had interstitial lung disease (ILD). Ultimately, 671 (63.1%) underwent transplant, while 334 (31.4%) died or were delisted. The transplant rate per person-years on the waitlist on ECMO was 15.41 for OLD, 6.05 for PAH, 15.66 for CF, and 15.62 for ILD. Compared to PAH patients, OLD, CF, and ILD patients were 78%, 69%, and 62% more likely to undergo transplant throughout the study period, respectively (adjusted SHRs 1.78 p = 0.007, 1.69 p = 0.002, and 1.62 p = 0.001). The median LAS at waitlist removal for transplantation, death, or delisting were 75.1 for OLD, 79.6 for PAH, 91.0 for CF, and 88.3 for ILD (p < 0.001). CONCLUSIONS Among patients bridging to transplant on ECMO, patients with PAH had a lower transplantation rate than patients with OLD, CF, and ILD.
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Affiliation(s)
- David Furfaro
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
| | - Erika B Rosenzweig
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Lori Shah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Hilary Robbins
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Michaela Anderson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Hanyoung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Darryl Abrams
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Cara L Agerstrand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Danielle Feldhaus
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Joseph Costa
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Philippe Lemaitre
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Bryan P Stanifer
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Frank D'Ovidio
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Joshua R Sonett
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Selim Arcasoy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Luke Benvenuto
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Leiva-Juarez MM, Benvenuto L, Costa J, Blackett JW, Aversa M, Robbins H, Shah L, Stanifer BP, Lemaître PH, Jodorkovsky D, Arcasoy S, Sonett JR, D'Ovidio F. Identification of Lung Transplant Recipients with a Survival Benefit after Fundoplication. Ann Thorac Surg 2021; 113:1801-1810. [PMID: 34280376 DOI: 10.1016/j.athoracsur.2021.05.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/02/2021] [Accepted: 05/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) and aspiration of enteric contents is associated with worse outcomes after lung transplant. The purpose of this study is to elucidate populations that benefit the most from fundoplication after lung transplant. METHODS Lung transplants from 2001-2019 (n=971) were retrospectively reviewed and stratified by a fundoplication before (n=128) or after (n=24) chronic lung allograft dysfunction (CLAD) development vs those who didn't. Patients with a fundoplication prior to CLAD were propensity-matched to those without a fundoplication. The primary outcome of interest was post-transplant survival. Time-to-event rates were calculated using a multivariable Cox proportional hazards model and Kaplan-Meier functions. RESULTS A fundoplication prior to CLAD improved post-transplant survival before and after propensity-matching, and remained a significant predictor after adjusting for baseline characteristics (HR:0.57, 95% CI:0.4-0.8, P=0.001). Recipients with a restrictive disorder (HR: 0.46, 95% CI:0.3-0.73, P=0.001), age <65 (HR:0.48, 95% CI:0.32-0.71, P<0.001), and both single (HR:0.47, 95% CI:0.28-0.79, P=0.005) or double (HR:0.55, 95% CI:0.32-0.93, P=0.027) lung transplants had a significant decrease in mortality after fundoplication. The effect was present after excluding early deaths and/or CLAD diagnoses. GERD diagnosed by pH, impedance or EGD was not associated with worse outcomes. Among patients with CLAD, a fundoplication was an independent predictor of post-CLAD survival (HR:0.27, 95% CI:0.12-0.61, P=0.002). CONCLUSIONS A fundoplication before or after CLAD development is an independent predictor of survival. Younger patients with restrictive disease, independent of the type of transplant, have a survival benefit. GERD diagnosed by conventional methods was not associated with worse survival.
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Affiliation(s)
- Miguel M Leiva-Juarez
- Division of Thoracic Surgery and Lung Transplant, Columbia University Medical Center, New York, New York
| | - Luke Benvenuto
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, New York
| | - Joseph Costa
- Division of Thoracic Surgery and Lung Transplant, Columbia University Medical Center, New York, New York
| | - John W Blackett
- Division of Gastroenterology, Columbia University Medical Center, New York, New York
| | - Meghan Aversa
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, New York
| | - Hilary Robbins
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, New York
| | - Lori Shah
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, New York
| | - Bryan P Stanifer
- Division of Thoracic Surgery and Lung Transplant, Columbia University Medical Center, New York, New York
| | - Phillippe H Lemaître
- Division of Thoracic Surgery and Lung Transplant, Columbia University Medical Center, New York, New York
| | - Daniela Jodorkovsky
- Division of Gastroenterology, Columbia University Medical Center, New York, New York
| | - Selim Arcasoy
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, New York
| | - Joshua R Sonett
- Division of Thoracic Surgery and Lung Transplant, Columbia University Medical Center, New York, New York
| | - Frank D'Ovidio
- Division of Thoracic Surgery and Lung Transplant, Columbia University Medical Center, New York, New York.
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Benvenuto L, Snyder ME, Aversa M, Patel S, Costa J, Shah L, Robbins H, D’Ovidio F, Sonett J, Stanifer BP, Lemaitre P, Arcasoy S, Anderson MR. Geographic Differences in Lung Transplant Volume and Donor Availability During the COVID-19 Pandemic. Transplantation 2021; 105:861-866. [PMID: 33760792 PMCID: PMC7993650 DOI: 10.1097/tp.0000000000003600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Regional variation in lung transplantation practices due to local coronavirus disease 2019 (COVID-19) prevalence may cause geographic disparities in access to lung transplantation. METHODS Using the United Network for Organ Sharing registry, we conducted a descriptive analysis of lung transplant volume, donor lung volume, new waitlist activations, and waiting list deaths at high-volume lung transplant centers during the first 3 months of the pandemic (March 1. 2020, to May 30, 2020) and we compared it to the same period in the preceding 5 years. RESULTS Lung transplant volume decreased by 10% nationally and by a median of 50% in high COVID-19 prevalence centers (range -87% to 80%) compared with a median increase of 10% (range -87% to 80%) in low prevalence centers (P-for-trend 0.006). Donation services areas with high COVID-19 prevalence experienced a greater decrease in organ availability (-28% range, -72% to -11%) compared with low prevalence areas (+7%, range -20% to + 55%, P-for-trend 0.001). Waiting list activations decreased at 18 of 22 centers. Waiting list deaths were similar to the preceding 5 years and independent of local COVID-19 prevalence (P-for-trend 0.36). CONCLUSIONS Regional variation in transplantation and donor availability in the early months of the pandemic varied by local COVID-19 activity.
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Affiliation(s)
- Luke Benvenuto
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Mark E. Snyder
- Division of Pulmonary, Critical Care, University of Pittsburgh, Pittsburgh, PA
| | - Meghan Aversa
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Shreena Patel
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Joseph Costa
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Lori Shah
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Hilary Robbins
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Frank D’Ovidio
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Joshua Sonett
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Bryan P. Stanifer
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Philippe Lemaitre
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Selim Arcasoy
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Michaela R. Anderson
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
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Aversa M, Benvenuto L, Anderson M, Shah L, Robbins H, Pereira M, Scheffert J, Carroll M, Hum J, Nolan M, Reilly G, Lemaitre P, Stanifer BP, D’Ovidio F, Sonett J, Arcasoy S. COVID-19 in lung transplant recipients: A single center case series from New York City. Am J Transplant 2020; 20:3072-3080. [PMID: 32881315 PMCID: PMC7436464 DOI: 10.1111/ajt.16241] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 01/25/2023]
Abstract
There are limited data describing COVID-19 in lung transplant recipients. We performed a single center, retrospective case series study of lung transplant patients followed by the Columbia Lung Transplant program who tested positive for SARS-CoV-2 between March 19 and May 19, 2020. Thirty-two lung transplant patients developed mild (16%), moderate (44%), or severe (41%) COVID-19. The median age of patients was 65 years, and the median time from lung transplant was 5.6 years. Symptoms included cough (66%), dyspnea (50%), fever (47%), and gastrointestinal upset (44%). Patients received hydroxychloroquine (84%), azithromycin (75%), augmented steroids (44%), tocilizumab (19%), and remdesivir (9%). Eleven patients (34%) died at a median time of 14 days from admission. Complications during admission included: acute kidney injury (63%), transaminitis (31%), shock (31%), acute respiratory distress syndrome (25%), neurological events (25%), arrhythmias (22%), and venous thromboembolism (9%). Compared to patients with moderate COVID-19, patients with severe COVID-19 had higher peak white blood cell counts (15.8 vs 7 × 103 /uL, P = .019), C-reactive protein (198 vs. 107 mg/L, P = .010) and D-dimer (8.6 vs. 2.1 ug/mL, P = .004) levels, and lower nadir lymphocyte counts (0.09 vs. 0.4 × 103 /uL, P = .006). COVID-19 is associated with severe illness and a high mortality rate in lung transplant recipients.
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Key Words
- clinical research/practice
- complication: infectious
- infection and infectious agents - viral
- lung failure/injury
- lung transplantation/pulmonology
- patient survival
- aki, acute kidney injury
- alt, alanine aminotransferase
- ards, acute respiratory distress syndrome
- ast, aspartate aminotransferase
- bid, bis in die
- bmi, body mass index
- bos, bronchiolitis obliterans syndrome
- c. albicans, candida albicans
- cf, cystic fibrosis
- ckd, chronic kidney disease
- copd, chronic obstructive pulmonary disease
- covid-19, coronavirus disease 2019
- crp, c-reactive protein
- e. faecalis, enterococcus faecalis
- egfr, estimated glomerular filtration rate
- esr, erythrocyte sedimentation rate
- gi, gastrointestinal
- icu, intensive care unit
- il-6, interleukin-6
- ild, interstitial lung disease
- iqr, interquartile range
- ishlt, international society of heart and lung transplantation
- iv, intravenous
- k. pneumoniae, klebsiella pneumoniae
- kg, kilogram
- ldh, lactate dehydrogenase
- m. morganii, morganella morganii
- mg, milligram
- mrsa, methicillin-resistant staphylococcus aureus
- mssa, methicillin-sensitive staphylococcus aureus
- p. aeruginosa, pseudomonas aerugoinosa
- pah, pulmonary arterial hypertension
- pcr, polymerase chain reaction
- pft, pulmonary function test
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- vte, venous thromboembolism
- wbc, white blood cell
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Affiliation(s)
- Meghan Aversa
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA,Correspondence Meghan Aversa
| | - Luke Benvenuto
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Michaela Anderson
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Lori Shah
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Hilary Robbins
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Marcus Pereira
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jenna Scheffert
- Department of Pharmacy, New York-Presbyterian Hospital, New York, New York, USA
| | - Maggie Carroll
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jamie Hum
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Margaret Nolan
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Genevieve Reilly
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Philippe Lemaitre
- Division of Thoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Bryan P. Stanifer
- Division of Thoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Frank D’Ovidio
- Division of Thoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Joshua Sonett
- Division of Thoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Selim Arcasoy
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
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Rudym D, Benvenuto L, Costa J, Aversa M, Robbins H, Shah L, Kim H, Stanifer BP, Sonett J, D'Ovidio F, Arcasoy SM. What Awaits on the Other Side: Post-Lung Transplant Morbidity and Mortality After Pre-Transplant Hospitalization. Ann Transplant 2020; 25:e922641. [PMID: 32807766 PMCID: PMC7453747 DOI: 10.12659/aot.922641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Morbidity and mortality rates after lung transplantation remain high compared to other solid organ transplants. In the lung allocation score era, patients given the highest priority on the waitlist are those with the greatest severity of illness, who often require preoperative hospitalization. Material/Methods To determine the association of pre-transplant hospitalization with post-transplant outcomes, we retrospectively evaluated 448 lung transplant recipients at our center between January 2010 and July 2017 (114 hospitalized; 334 outpatient). Results Survival was similar between the groups (hazard ratio 0.93 [95% CI 0.61 to 1.42], p=0.738). However, hospitalized patients had longer hospital and intensive care unit length of stay compared to outpatients – 25 vs. 18 days, (p<0.001) and 9.5 vs. 6 days, (p<0.001), respectively. Hospitalized patients had higher rates of Grade 3 primary graft dysfunction – 29.8% vs. 9.6%, p<0.001 – and remained mechanically ventilated longer – 6 vs. 3 days, p<0.001. A greater percentage of hospitalized patients needed a tracheostomy and a re-operation within 30 days – 39.5% vs. 15.3% (p<0.001) and 22.8% vs. 12.0% (p=0.005) – respectively. After discharge, 28% of hospitalized patients required acute rehabilitation compared with 12% of outpatients (p=0.001). Conclusions While pre-transplant hospitalization is not associated with mortality, it is associated with significant morbidity after transplant.
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Affiliation(s)
- Darya Rudym
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
| | - Luke Benvenuto
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
| | - Joseph Costa
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Meghan Aversa
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
| | - Hilary Robbins
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
| | - Lori Shah
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
| | - Hanyoung Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
| | - Bryan P Stanifer
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Joshua Sonett
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Frank D'Ovidio
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Selim M Arcasoy
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
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Chen LN, Spivack J, Cao T, Saqi A, Benvenuto LJ, Bulman WA, Mathew M, Stoopler MB, Arcasoy SM, Stanifer BP, Rizvi NA, Shu CA. Characteristics and outcomes of lung cancer in solid organ transplant recipients. Lung Cancer 2020; 146:297-302. [PMID: 32619780 DOI: 10.1016/j.lungcan.2020.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Lung cancer is the third most common malignancy that develops in patients following solid organ transplantation and is the leading cause of cancer deaths in the general population. The aims of this study are to examine the characteristics of patients who developed lung cancer following solid organ transplantation at our institution and to compare their outcomes to those of lung cancer patients without a history of transplant. MATERIALS AND METHODS We performed a single-institution retrospective study of 44 solid organ transplant recipients who developed lung cancer and compared their characteristics to a cohort of 74 lung cancer patients without a history of transplant. We performed propensity score weighted analyses to compare outcomes between the two groups, including a cox proportional hazards model of overall survival. RESULTS 52 % of post-transplant patients who developed lung cancer were diagnosed with stage III or IV disease. In the propensity score weighted analysis that accounted for age at diagnosis, sex, lung cancer stage at diagnosis, Charlson comorbidity index score, and ECOG performance score, post-transplant patients were more likely to have squamous cell histology (p < 0.01) and had worse overall survival compared to the non-transplant cohort (HR = 1.88, 95 % CI 1.13-3.12, p = 0.02). The difference in survival remained significant after accounting for differences in lung cancer histology and treatment (HR = 2.40, 95 % CI 1.27-3.78, p < 0.01). CONCLUSIONS When compared to non-transplant patients with lung cancer, post-transplant patients have worse overall survival after accounting for differences in age, sex, lung cancer stage, comorbidities, and performance status. This survival difference is not solely attributable to differences in tumor histology and treatments received. This may suggest that post-transplant malignancies are more aggressive and difficult to treat.
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Affiliation(s)
- Lanyi Nora Chen
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - John Spivack
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, United States.
| | - Thu Cao
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Surgery, Columbia University Medical Center, United States.
| | - Anjali Saqi
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Pathology, Columbia University Medical Center, United States.
| | - Luke J Benvenuto
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - William A Bulman
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - Matthen Mathew
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - Mark B Stoopler
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - Selim M Arcasoy
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - Bryan P Stanifer
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Surgery, Columbia University Medical Center, United States.
| | - Naiyer A Rizvi
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
| | - Catherine A Shu
- Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States; Department of Medicine, Columbia University Medical Center, United States.
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9
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Mehta CK, Stanifer BP, Fore-Kosterski S, Gillespie C, Yeldandi A, Meyerson S, Odell DD, DeCamp MM, Bharat A. Primary Spontaneous Pneumothorax in Menstruating Women Has High Recurrence. Ann Thorac Surg 2016; 102:1125-30. [PMID: 27345097 DOI: 10.1016/j.athoracsur.2016.04.069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Primary spontaneous pneumothorax (PSP) is treated on the basis of studies that have predominantly consisted of tall male subjects. Here, we determined recurrence of PSP in average-statured menstruating women and studied prevalence of catamenial pneumothorax (CP) in this population. METHODS Men and menstruating women, aged 18 to 55 years, without underlying lung disease or substance abuse were retrospectively studied between 2009 and 2015. A chest pathologist reviewed all specimens for thoracic endometriosis. Kaplan-Meier curves were constructed to determine recurrence. RESULTS The median age of women (n = 33) and men (n = 183) was 33.4 and 31.6 years, respectively. In women, 9 (27%) had left-sided and 24 (73%) had right-sided PSP, treated with tube thoracostomy. Recurrence occurred in 21 women (64%) with median follow-up of 14 months, and they were treated with thoracoscopic pleurodesis. Right PSP had higher recurrence (70%) than left PSP (56%, p = 0.02). Four women (12%) presented with recurrent tension pneumothorax within 6 months. Eight patients (24%) had PSP within 72 hours of menses, meeting clinical criteria of CP. All these were placed on hormonal suppression after initial episode but went on to experience recurrence that was treated with pleurodesis. Classical endometrial glands were not found in any biopsy specimens obtained during the thoracoscopy. In contrast to female subjects, only 8 average-statured men (4.4%) had recurrence (p < 0.001) with a median follow-up of 16 months. CONCLUSIONS PSP in healthy average-statured menstruating women has high recurrence compared with male counterparts. CP is a clinical diagnosis and often recurs despite hormonal suppression therapy.
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Affiliation(s)
- Christopher K Mehta
- Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois
| | - Bryan P Stanifer
- Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois
| | - Susan Fore-Kosterski
- Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois
| | - Colin Gillespie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern Memorial Hospital, Chicago, Illinois
| | - Anjana Yeldandi
- Department of Pathology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Shari Meyerson
- Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois
| | - David D Odell
- Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois
| | - Malcolm M DeCamp
- Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois
| | - Ankit Bharat
- Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois.
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