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Xu Q, Elrefaei M, Taupin JL, Hitchman KMK, Hiho S, Gareau AJ, Iasella CJ, Marrari M, Belousova N, Bettinotti M, Narula T, Alvarez F, Sanchez PG, Levvey B, Westall G, Snell G, Levine DJ, Zeevi A, Roux A. Chronic lung allograft dysfunction is associated with an increased number of non-HLA antibodies. J Heart Lung Transplant 2024; 43:663-672. [PMID: 38141896 DOI: 10.1016/j.healun.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/21/2023] [Accepted: 12/14/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Chronic lung allograft dysfunction (CLAD) is the major cause of adverse outcomes in lung transplant recipients. Multiple factors, such as infection, alloimmunity, and autoimmunity, may lead to CLAD. Here, we aim to examine the role of non-human leukocytes antigen (HLA) antibodies in CLAD in a large retrospective cohort. METHODS We analyzed non-HLA antibodies in the pre- and post-transplant sera of 226 (100 CLAD, 126 stable) lung transplant recipients from 5 centers, and we used a separate cohort to confirm our findings. RESULTS A panel of 18 non-HLA antibodies was selected for analysis based on their significantly higher positive rates in CLAD vs stable groups. The panel-18 non-HLA antibodies (n > 3) may be positive pre- or post-transplant; the risk for CLAD is higher in the latter. The presence of both non-HLA antibody and HLA donor-specific antibody (DSA) was associated with an augmented risk of CLAD (HR=25.09 [5.52-14.04], p < 0.001), which was higher than that for single-positive patients. In the independent confirmatory cohort of 61 (20 CLAD, 41 stable) lung transplant recipients, the risk for CLAD remained elevated in double-positive patients (HR=10.67 [0.98-115.68], p = 0.052). After adjusting for nonstandard immunosuppression, patients with double-positive DSA/Non-HLA antibodies had an elevated risk for graft loss (HR=2.53 [1.29-4.96], p = 0.007). CONCLUSIONS Circulating non-HLA antibodies (n > 3) were independently associated with a higher risk for CLAD. Furthermore, when non-HLA antibodies and DSA were detected concomitantly, the risk for CLAD and graft loss was significantly increased. These results show that humoral immunity to HLA and non-HLA antigens may contribute to CLAD development.
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Affiliation(s)
- Qingyong Xu
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Mohamed Elrefaei
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida
| | - Jean-Luc Taupin
- Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint Louis, Paris, France
| | - Kelley M K Hitchman
- Department of Pathology and Lab Medicine, University of Texas Health Science Center, San Antonio, Texas
| | - Steven Hiho
- Australian Red Cross Life Blood, Victorian and Immunogenetics, Melbourne, Victoria, Australia
| | - Alison J Gareau
- Immunogenetics Laboratory, Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Carlo J Iasella
- Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Marilyn Marrari
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Maria Bettinotti
- Immunogenetics Laboratory, Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Tathagat Narula
- Division of Lung Failure and Transplant, Mayo Clinic, Jacksonville, Florida
| | - Francisco Alvarez
- Division of Lung Failure and Transplant, Mayo Clinic, Jacksonville, Florida
| | - Pablo G Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Bronwyn Levvey
- Lung Transplant Service, Alfred Hospital, Melbourne, Victoria, Australia
| | - Glen Westall
- Lung Transplant Service, Alfred Hospital, Melbourne, Victoria, Australia
| | - Gregory Snell
- Lung Transplant Service, Alfred Hospital, Melbourne, Victoria, Australia
| | - Deborah J Levine
- Department of Medicine, Stanford University, Palo Alto, California
| | - Adriana Zeevi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Antoine Roux
- Department of Pneumology, Hôpital Foch, Suresnes, France
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Lindstedt S, Niroomand A, Snell G. The devil is in the details: A commentary on registry analyses of characteristics and outcomes of lung transplants using ex vivo lung perfusion. J Heart Lung Transplant 2024; 43:226-228. [PMID: 37820946 DOI: 10.1016/j.healun.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023] Open
Affiliation(s)
- Sandra Lindstedt
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, Lund, Sweden; Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden; Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Anna Niroomand
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden; Lund Stem Cell Center, Lund University, Lund, Sweden; Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Gregory Snell
- Lung Transplant Service, Alfred Hospital, Melbourne, Australia
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3
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Yeoh H, Shingles H, Levvey B, Snell G, Andrews M. The High Incidence of Non-Melanoma Skin Cancer-Related Death in Australian Lung Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1452] [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: 04/05/2023] Open
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4
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Levin K, Lavon B, Muchmore P, Westall G, Snell G. Identifying Imaging Biomarkers Before the Onset of Chronic Lung Allograft Dysfunction. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1432] [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: 04/05/2023] Open
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5
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Hiho S, Ennis S, Sullivan L, Westall G, Snell G, Levvey B. The Significant Impact of HLA Homozygosity on Sensitization, Chronic Lung Allograft Dysfunction and Overall Survival. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1604] [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: 04/05/2023] Open
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6
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Snell G, Holsworth L, Westall G, Punjabi N, Siddharthan T, Dusting J, Eikelis N, Fouras A, Kirkness J, Lui V, Pirakalathanan P. Novel Regional Ventilation Evaluation of Abnormalities of the Lung In Advanced Lung Disease (REVEAL Study). J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1456] [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: 04/05/2023] Open
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7
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Darley D, Nilsen K, Vazirani J, Borg B, Levvey B, Snell G, Plit M, Tonga K. Oscillometry Resistance Parameters Elucidate Obstructive Physiology in Chronic Lung Allograft Dysfunction Phenotypes: Results from a Multi-Centre Cross-Sectional Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1601] [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: 04/05/2023] Open
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8
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Mackova M, Gauthier P, Chang J, Snell G, Westall G, Juvet S, Havlin J, Halloran P, Halloran K. Molecular Features Associated with Baseline Lung Allograft Dysfunction. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.153] [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: 04/05/2023] Open
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9
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Parsons K, Snell G, Brooks A, Westall G, Cristiano Y, Levvey B, Sullivan L, Stankovic S. Donor-Derived Lymphocyte Chimerism is Associated with Protection from Chronic Lung Allograft Dysfunction. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.051] [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: 04/05/2023] Open
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10
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Varkey S, Westall G, Snell G, Nixon P, Sheldrake J, Rozen T, Bourne B, Harrison J, Buckland M, Marasco S, Nanjayya V. Can Pediatric Lung Transplantation be Safely Performed in an Adult Hospital - The ICU Experience. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.730] [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: 04/05/2023] Open
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11
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Vazirani J, Levvey B, Okahara S, Westall G, Snell G. Thoracic Epidural Anaesthesia Improves Outcomes Following Lung Transplant - A Single Centre Long Term Follow Up Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.735] [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: 04/05/2023] Open
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12
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Reilly E, Sullivan L, Snell G, Holsworth L, Levvey B, Westall G, Stankovic S. Bronchoalveolar Lavage Cytokine Profile at Two Weeks Post-Transplant is Associated with Chronic Lung Allograft Dysfunction. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1678] [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: 04/05/2023] Open
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13
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Koshy K, Prasad J, Vazirani J, Snell G. Case Report: Bilateral Lung Transplantation for Rapidly Progressive Undifferentiated Interstitial Lung Disease—A Cautionary Tale. Transplant Proc 2023; 55:703-705. [PMID: 36997380 DOI: 10.1016/j.transproceed.2023.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/30/2023]
Abstract
Interstitial lung disease is fast becoming one of the most common indications for lung transplantation (LTx); however, LTx for Goodpasture's syndrome with pulmonary involvement has not been previously described in the literature. In this report, we outline the case of a young male with undifferentiated rapidly progressive interstitial lung disease who ultimately received a bilateral sequential LTx after deterioration requiring extracorporeal membrane oxygenation. The original disease soon recurred in the graft, and unfortunately, the patient did not survive. The diagnosis of Goodpasture's syndrome was made postmortem and was not clearly evident on examination of the native explanted tissue, nor was there an elevated titer of antiglomerular basement membrane antibodies during his initial work-up. We hypothesize that the donor and recipient's HLA profile made him more susceptible to aggressive disease. In hindsight, active Goodpasture's disease would have been a contraindication to proceed to transplantation. This case is a cautionary reminder of the high stakes of performing LTx without a certain diagnosis.
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Darley DR, Nilsen K, Vazirani J, Borg BM, Levvey B, Snell G, Plit ML, Tonga KO. Airway oscillometry parameters in baseline lung allograft dysfunction: Associations from a multicenter study. J Heart Lung Transplant 2023; 42:767-777. [PMID: 36681528 DOI: 10.1016/j.healun.2022.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 07/31/2022] [Revised: 12/09/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Baseline lung allograft dysfunction (BLAD), the failure to achieve ≥80%-predicted spirometry after lung transplant (LTx), is associated with impaired survival. Physiologic abnormalities in BLAD are poorly understood. Airway oscillometry measures respiratory system mechanics and may provide insight into understanding the mechanisms of BLAD. OBJECTIVES This study aims to describe and measure the association between airway oscillometry parameters [Reactance (Xrs5, Ax), Resistance (Rrs5, Rrs5-19)] (1) stable LTx recipients, comparing those with normal spirometry and those with BLAD; and (2) in recipients with chronic lung allograft dysfunction (CLAD), comparing those with normal baseline spirometry and those with BLAD. METHODS A multi-center cross-sectional study was performed including bilateral LTx between January 2020 and June 2021. Participants performed concurrent airway oscillometry and spirometry. Multivariable logistic regression was performed to measure the association between oscillometry parameters and BLAD. RESULTS A total of 404 LTx recipients performed oscillometry and 253 were included for analysis. Stable allograft function was confirmed in 149 (50.2%) recipients (92 (61.7%) achieving normal spirometry and 57 (38.3%) with BLAD). Among stable LTx recipients, lower Xrs5 Z-Score (aOR 0.50 95% CI 0.37-0.76, p = 0.001) was independently associated with BLAD. CLAD was present in 104 (35.0%) recipients. Among recipients with CLAD, lower Xrs5 Z-Score (aOR 0.73 95% CI 0.56-0.95, p = 0.02) was associated with BLAD. CONCLUSIONS Oscillometry provides novel physiologic insights into mechanisms of BLAD. The independent association between Xrs5 and BLAD, in both stable recipients and those with CLAD suggests that respiratory mechanics, in particular abnormal elastance, is an important physiologic feature. Further longitudinal studies are needed to understand the trajectory of oscillometry parameters in relation to allograft outcomes.
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Affiliation(s)
- David Ross Darley
- Lung Transplant Unit, St Vincent's Hospital Sydney, Darlinghurst NSW, Australia; School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, UNSW Medicine & Health, UNSW Sydney, Australia.
| | - Kris Nilsen
- Lung Transplant Service, The Alfred Hospital, Melbourne, Australia
| | - Jaideep Vazirani
- Lung Transplant Service, The Alfred Hospital, Melbourne, Australia
| | - Brigitte M Borg
- Respiratory Medicine, The Alfred Hospital, Melbourne, Australia
| | - Bronwyn Levvey
- Lung Transplant Service, The Alfred Hospital, Melbourne, Australia
| | - G Snell
- Lung Transplant Service, The Alfred Hospital, Melbourne, Australia
| | - Marshall Lawrence Plit
- Lung Transplant Unit, St Vincent's Hospital Sydney, Darlinghurst NSW, Australia; School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, UNSW Medicine & Health, UNSW Sydney, Australia
| | - Katrina O Tonga
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, UNSW Medicine & Health, UNSW Sydney, Australia; Thoracic Medicine Department, St Vincent's Hospital Darlinghurst, Sydney, Australia; Northern Clinical School, Sydney Medical School, Faculty of Medicine & Health, University of Sydney, Sydney, Australia
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15
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Ivulich S, Paraskeva M, Paul E, Kirkpatrick C, Dooley M, Snell G. Rescue Everolimus Post Lung Transplantation is Not Associated With an Increased Incidence of CLAD or CLAD-Related Mortality. Transpl Int 2023; 36:10581. [PMID: 36824294 PMCID: PMC9942680 DOI: 10.3389/ti.2023.10581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
Everolimus (EVE) has been used as a calcineurin inhibitor (CNI) minimization/ elimination agent or to augment immunosuppression in lung transplant recipients (LTR) with CNI-induced nephrotoxicity or neurotoxicity. The long-term evidence for survival and progression to chronic lung allograft dysfunction (CLAD) is lacking. The primary aim was to compare survival outcomes of LTR starting EVE-based immunosuppression with those remaining on CNI-based regimens. The secondary outcomes being time to CLAD, incidence of CLAD and the emergence of obstructive (BOS) or restrictive (RAS) phenotypes. Single center retrospective study of 91 LTR starting EVE-based immunosuppression matched 1:1 with LTR remaining on CNI-based immunosuppression. On multivariate analysis, compared to those remaining on CNI-based immunosuppression, starting EVE was not associated with poorer survival [HR 1.04, 95% CI: 0.67-1.61, p = 0.853], or a statistically significant faster time to CLAD [HR 1.34, 95% CI: 0.87-2.04, p = 0.182]. There was no difference in the emergence of CLAD (EVE, [n = 57, 62.6%] vs. CNI-based [n = 52, 57.1%], p = 0.41), or the incidence of BOS (p = 0.60) or RAS (p = 0.16) between the two groups. Introduction of EVE-based immunosuppression does not increase the risk of death or accelerate the progression to CLAD compared to CNI-based immunosuppression.
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Affiliation(s)
- Steven Ivulich
- The Alfred Hospital, Melbourne, VIC, Australia.,Centre for Medication Use and Safety, Monash University, Melbourne, VIC, Australia
| | | | - Eldho Paul
- Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Carl Kirkpatrick
- Centre for Medication Use and Safety, Monash University, Melbourne, VIC, Australia
| | - Michael Dooley
- The Alfred Hospital, Melbourne, VIC, Australia.,Centre for Medication Use and Safety, Monash University, Melbourne, VIC, Australia
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Otto M, McGiffin D, Whitford H, Kure C, Snell G, Diehl A, Orosz J, Burrell AJC. Survival and left ventricular dysfunction post lung transplantation for pulmonary arterial hypertension. J Crit Care 2022; 72:154120. [PMID: 35914371 DOI: 10.1016/j.jcrc.2022.154120] [Citation(s) in RCA: 2] [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: 03/24/2022] [Revised: 07/17/2022] [Accepted: 07/17/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Bilateral lung transplantation for end-stage pulmonary arterial hypertension (PAH) is traditionally associated with higher early post-transplant mortality when compared with other indications. Changes in perioperative management, including the growing use of perioperative extracorporeal membrane oxygenation (ECMO) and an increased awareness of postoperative left ventricular dysfunction (LVD), have resulted in outcomes that are uncertain. MATERIALS AND METHODS We conducted a single-center, retrospective observational study at a lung transplantation center in Melbourne, Australia, from 2006 to 2019. ECMO use was categorized as preoperative, prophylactic, or rescue. Postoperative LVD was defined as a reduction in left ventricular function on echocardiography or using strict clinical criteria. RESULTS 50 patients underwent lung transplantation for PAH. 12-month survival was 48/50 (96%). ECMO was used in 26 (52%) patients, and the use of prophylactic VA-ECMO increased over the study period. Postoperative LVD was diagnosed in 21 (42%) patients. 12-month survival and left ventricular function was no different between LVD and non-LVD groups. CONCLUSIONS This study showed that high survival rates can be achieved following lung transplantation for PAH. We found that ECMO utilization was common, and indications have changed over time. LVD was common but did not impact 12-month survival.
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Affiliation(s)
- Madeleine Otto
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, Australia.
| | - David McGiffin
- Department of Cardiothoracic Surgery and Transplantation, The Alfred Hospital, 55 Commercial Road, Melbourne, Australia.
| | - Helen Whitford
- Lung Transplant Service, Department of Respiratory Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, Australia.
| | - Christina Kure
- Department of Cardiothoracic Surgery and Transplantation, The Alfred Hospital, 55 Commercial Road, Melbourne, Australia.
| | - Gregory Snell
- Lung Transplant Service, Department of Respiratory Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, Australia.
| | - Arne Diehl
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Australia.
| | - Judit Orosz
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, Australia.
| | - Aidan J C Burrell
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Australia.
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Westall G, Barnes H, Fuller L, Harris J, Emsley C, Snell G, Levvey B, Winton-Brown T. Composite Lung Transplant Suitability Score (CLaSS): A Novel Predictor of Survival Following Lung Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.340] [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: 10/18/2022] Open
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18
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Darley D, Nilsen K, Vazirani J, Borg B, Levvey B, Snell G, Plit M, Tonga K. Donor Age and Recipient-Donor Sex and Height Mismatch Are Associated with Abnormal Pulmonary Reactance (X5) in Stable Recipients After Bilateral Lung Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1623] [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: 10/18/2022] Open
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Abstract
Lung transplantation (LTx) has evolved significantly since its inception and the improvement in LTx outcomes over the last three decades has predominantly been driven by advances in immunosuppression management. Despite the lack of new classes of immunosuppression medications, immunosuppressive strategies have evolved significantly from a universal method to a more targeted approach, reflecting a greater understanding of the need for individualized therapy and careful consideration of all factors that are influenced by immunosuppression choice. This has become increasingly important as the demographics of lung transplant recipients have changed over time, with older and more medically complex candidates being accepted and undergoing LTx. Furthermore, improved survival post lung transplant has translated into more immunosuppression related comorbidities long-term, predominantly chronic kidney disease (CKD) and malignancy, which has required further nuanced management approaches. This review provides an update on current traditional lung transplant immunosuppression strategies, with modifications based on pre-existing recipient factors and comorbidities, peri-operative challenges and long term complications, balanced against the perpetual challenge of chronic lung allograft dysfunction (CLAD). As we continue to explore and understand the complexity of LTx immunology and the interplay of different factors, immunosuppression strategies will require ongoing critical evaluation and personalization in order to continue to improve lung transplant outcomes.
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Affiliation(s)
- Sakhee Kotecha
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia
| | - Steven Ivulich
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia
| | - Gregory Snell
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Australia
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Sim JPS, Darley DR, Nilsen K, Shirol R, Borg BM, Vazirani J, Levvey B, Snell G, Plit M, Tonga KO. Airway oscillometry after single lung transplantation is characterised by abnormal respiratory reactance. Transplantation 2021. [DOI: 10.1183/13993003.congress-2021.pa3497] [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: 11/05/2022]
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Darley D, Sim J, Nilsen K, Shirol R, Borg B, Vazirani J, Levvey B, Snell G, Plit M, Tonga K. Characterisation of Baseline and Chronic Lung Allograft Dysfunction by Airway Oscillometry: Results of a Multi-Centre Cross-Sectional Study. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1881] [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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22
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Levvey B, Okahara S, McDonald M, D'Costa R, Opdam H, Pilcher D, Snell G. Development of a Prediction Model for Donation after Circulatory Death Lung Donor Progression. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.918] [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: 11/27/2022] Open
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23
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Tarrant B, Quinn E, Robinson R, Poulsen M, Fuller L, Snell G, Thompson B, Button B, Holland A. Postoperative, Inpatient Rehabilitation after Lung Transplant Evaluation (PIRATE): A Feasibility Randomized Controlled Trial. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.480] [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: 11/28/2022] Open
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Emsley C, King S, Nyulasi I, Snell G. A GLIMmer of insight into lung transplant nutrition: Enhanced detection of malnutrition in lung transplant patients using the GLIM criteria. Clin Nutr 2021; 40:2521-2526. [PMID: 33932798 DOI: 10.1016/j.clnu.2021.02.047] [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: 01/23/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS The Global Leadership Initiative on Malnutrition (GLIM) is a novel framework for diagnosing malnutrition and requires evaluation in wide-ranging clinical settings. This study aimed to assess the prevalence of malnutrition and its phenotypic characteristics among lung transplantation (LTx) candidates comparing GLIM to International Classification of Diseases, 10th Revision (ICD-10) criteria. METHODS A retrospective analysis was conducted of all adult patients assessed for LTx in a one-year period. Phenotypic criteria included body mass index (BMI), unintentional loss of weight (LOW) over a 12-month period and fat-free mass index (FFMI) using bioelectrical impedance analysis (BIA). Systemic inflammation associated with severe end-stage lung disease met GLIM's etiological criterion. Diagnosis of malnutrition, and its severity, were classified according to each of GLIM and ICD-10. RESULTS Of 130 patients, 112 (86%) had all data to classify malnutrition. Malnutrition prevalence according to GLIM was 59%, which was markedly greater than using ICD-10 criteria (26%). Half of the LTx patients were moderately malnourished using GLIM, compared to 19% using ICD-10. A similar proportion were severely malnourished using GLIM (9%) and ICD-10 (7%). Fat-free mass (FFM) depletion (47% of all patients) was a major contributor to GLIM-malnutrition. Over 60% of LTx patients with GLIM-malnutrition were not detected as malnourished using ICD-10 criteria. CONCLUSION Malnutrition diagnosis using GLIM was higher than using ICD-10 in LTx patients, primarily attributable to the incorporation of quantitative evaluation of FFM depletion. This highlights the utility of the GLIM framework and the importance of including body composition in malnutrition assessment.
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Affiliation(s)
- Christie Emsley
- Nutrition Department, The Alfred Hospital, 55 Commercial Rd Melbourne, Victoria, 3004, Australia.
| | - Susannah King
- Nutrition Department, The Alfred Hospital, 55 Commercial Rd Melbourne, Victoria, 3004, Australia; Department of Dietetics, Nutrition and Sport, LaTrobe University, Bundoora, Victoria, 3068, Australia.
| | - Ibolya Nyulasi
- Nutrition Department, The Alfred Hospital, 55 Commercial Rd Melbourne, Victoria, 3004, Australia; Department of Dietetics, Nutrition and Sport, LaTrobe University, Bundoora, Victoria, 3068, Australia; Department of Medicine, Central Clinical School, Monash University, 99 Commercial Rd, Melbourne, Victoria 3004, Australia.
| | - Gregory Snell
- Lung Transplant Service, The Alfred Hospital, 55 Commercial Rd Melbourne, Victoria, 3004, Australia.
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Kennedy J, Walker A, Ellender CM, Steinfort K, Martin C, Smith C, Snell G, Whitford H. Outcomes Of Non-Cystic Fibrosis Related Bronchiectasis Post Lung Transplantation. Intern Med J 2021; 52:995-1001. [PMID: 33656222 DOI: 10.1111/imj.15256] [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: 09/16/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lung transplantation is a recognised treatment for end-stage lung disease due to bronchiectasis. Non-CF bronchiectasis and CF are often combined into one cohort, however outcomes for non-CF bronchiectasis patients varies between centres, and in comparison to those for CF. AIMS To compare lung transplantation mortality and morbidity of bronchiectasis (non-CF) patients to those with CF and other indications. METHODS Retrospective analysis of patients undergoing lung transplantation between 01 January 2008-31 December 2013. Time to and cause of lung allograft loss was censored on 01 April 2018. A case-note review was conducted on a sub-group of 78 patients, to analyse hospital admissions as a marker of morbidity. RESULTS 341 patients underwent lung transplantation, 22 (6%) had bronchiectasis compared to 69 (20%) with CF. The 5-year survival for the bronchiectasis group was 32%, compared to CF 69%, obstructive lung disease (OLD) 64%, pulmonary hypertension 62% and ILD 55% (p = 0.008). Lung allograft loss due to CLAD with predominant infection was significantly higher in the bronchiectasis group at 2 years. The rate of acute admissions was 2.24 higher in the bronchiectasis group when compared to OLD (p = 0.01). Patients with bronchiectasis spent 45.81 days in hospital per person year after transplantation compared with 18.21 days for CF. CONCLUSIONS Bronchiectasis patients in this study had a lower 5-year survival and poorer outcomes in comparison to other indications including CF. Bronchiectasis should be considered a separate entity to CF in survival analysis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jessica Kennedy
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Australia.,School of Medicine, Dentistry and Health Science, Melbourne University, Melbourne, Australia.,Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Australia
| | - Anne Walker
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Australia.,Department of Thoracic Medicine, Royal Adelaide Hospital, South Australia, Australia
| | - Claire M Ellender
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Australia.,Department of Respiratory & Sleep Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Kate Steinfort
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Catherine Martin
- Pubic Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Catherine Smith
- Pubic Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Gregory Snell
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Helen Whitford
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Australia
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Abstract
BACKGROUND General practitioners are increasingly likely to encounter elderly patients who are receiving immunosuppressants for the management of autoimmune diseases or solid organ transplants. OBJECTIVE The aim of this article is to provide an overview of the long-term management of the elderly patient treated with immunosuppressants. Recommendations for monitoring, preventing and managing adverse effects of immunosuppressants are summarised. DISCUSSION Elderly patients prescribed immunosuppressants may present a number of unique challenges. Immunosenescence, altered pharmacokinetics and the presence of multiple comorbidities can all affect response to immunosuppressants. Through close collaboration with tertiary care providers and regular screening, the general physician is well placed to recognise medication-related complications.
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Affiliation(s)
- Steven Ivulich
- BPharm, Lead Pharmacist, Cardio-Respiratory Services, Alfred Hospital, Vic
| | - Gregory Snell
- MBBS, FRACP, MD, OAM, Head @ Lung Transplant Service, Alfred Hospital, Vic
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Levvey B, Okahara S, McDonald M, D’Costa R, Opdam H, Pilcher D, Snell G. PREDICTING TIME TO DEATH AFTER WITHDRAWAL IN CONTROLLED DONATION AFTER CIRCULATORY DEATH (DCD) DONORS: A COMPARISON OF 100 DCD LUNG TRANSPLANT (LTX) DONORS VERSUS 59 POTENTIAL DCD DONORS THAT DID NOT PROGRESS. Transplantation 2020. [DOI: 10.1097/01.tp.0000698556.30053.87] [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]
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28
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Halloran K, Parkes MD, Timofte I, Snell G, Westall G, Havlin J, Lischke R, Hachem R, Kreisel D, Levine D, Kubisa B, Piotrowska M, Juvet S, Keshavjee S, Jaksch P, Klepetko W, Hirji A, Weinkauf J, Halloran PF. Molecular T-cell‒mediated rejection in transbronchial and mucosal lung transplant biopsies is associated with future risk of graft loss. J Heart Lung Transplant 2020; 39:1327-1337. [PMID: 32943286 DOI: 10.1016/j.healun.2020.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/08/2020] [Revised: 08/18/2020] [Accepted: 08/23/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND We previously developed molecular assessment systems for lung transplant transbronchial biopsies (TBBs) with high surfactant and bronchial mucosal biopsies, identifying T-cell‒mediated rejection (TCMR) on the basis of the expression of rejection-associated transcripts, but the relationship of rejection to graft loss is unknown. This study aimed to develop molecular assessments for TBBs and mucosal biopsies and to establish the impact of molecular TCMR on graft survival. METHODS We used microarrays and machine learning to assign TCMR scores to an expanded cohort of 457 TBBs (367 high surfactant plus 90 low surfactant) and 314 mucosal biopsies. We tested the score agreement between TBB-TBB, mucosal-mucosal, and TBB-mucosal biopsy pairs in the same patient. We also assessed the association of molecular TCMR scores with graft loss (death or retransplantation) and compared it with the prognostic associations for histology and donor-specific antibodies. RESULTS The molecular TCMR scores assigned in all the TBBs performed similarly to those in high-surfactant TBBs, indicating that variation in alveolation in TBBs does not prevent the detection of TCMR. Mucosal biopsy pieces showed less piece-to-piece variation than TBBs. TCMR scores in TBBs agreed with those in mucosal biopsies. In both TBBs and mucosal biopsies, molecular TCMR was associated with graft loss, whereas histologic rejection and donor-specific antibodies were not. CONCLUSIONS Molecular TCMR can be detected in TBBs regardless of surfactant and in mucosal biopsies, which show less variability in the sampled tissue than TBBs. On the basis of these findings, molecular TCMR appears to be an important predictor of the risk of future graft failure. TRIAL REGISTRATION ClinicalTrials.gov NCT02812290.
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Affiliation(s)
- Kieran Halloran
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michael D Parkes
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Irina Timofte
- Division of Pulmonary and Critical Care, Department of Medicine, University of Maryland, Baltimore, Maryland
| | - Gregory Snell
- Lung Transplant Service, Alfred Hospital, Monash University, Melbourne, Australia
| | - Glen Westall
- Lung Transplant Service, Alfred Hospital, Monash University, Melbourne, Australia
| | - Jan Havlin
- 3rd Department of Surgery, University Hospital Motol, Prague, Czech Republic
| | - Robert Lischke
- 3rd Department of Surgery, University Hospital Motol, Prague, Czech Republic
| | | | - Daniel Kreisel
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Deborah Levine
- Pulmonary Disease and Critical Care Medicine, University of Texas San Antonio, San Antonio, Texas
| | - Bartosz Kubisa
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland
| | - Maria Piotrowska
- Department of Thoracic Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland
| | - Stephen Juvet
- Toronto Lung Transplant Program, University of Toronto, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Toronto Lung Transplant Program, University of Toronto, Toronto, Ontario, Canada
| | - Peter Jaksch
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Alim Hirji
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Justin Weinkauf
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Philip F Halloran
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Ivulich S, Paraskeva M, Hopkins R, Snell G. The Successful Evolution of Everolimus Based Immunosuppression (IS) in a Large Lung Transplant (LTx) Cohort: 14 Years Experience. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.727] [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: 10/24/2022] Open
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30
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Emsley C, King S, Snell G. Incorporating Body Composition into Lung Transplant Assessment Enhances the Detection of Malnutrition. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.456] [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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31
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Snell G, Hiho S, Levvey B, Sullivan L, Westall G. Consequences of donor-derived passengers (pathogens, cells, biological molecules and proteins) on clinical outcomes. J Heart Lung Transplant 2019; 38:902-906. [PMID: 31307786 DOI: 10.1016/j.healun.2019.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/15/2019] [Accepted: 06/15/2019] [Indexed: 12/12/2022] Open
Abstract
It is recognized that donor factors contribute to lung transplant outcomes. Recent observations and studies have started to elucidate potential mechanisms behind explaining these observations. This perspective piece summarizes evolving lung transplant literature on the subject, focusing on donor "passenger" organisms, cells, hormones, and proteins transferred to the recipient. Many extrinsic and intrinsic donor features or properties have important consequences for subsequent allograft function in the recipient. Potentially, a better understanding of these features may provide useful novel therapeutic targets to enhance allograft outcomes.
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Affiliation(s)
- Gregory Snell
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Victoria, Australia.
| | - Steven Hiho
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Victoria, Australia; Victorian Transplantation and Immunogenetics Service, Australian Red Cross Blood Service, Melbourne, Victoria, Australia
| | - Bronwyn Levvey
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Lucy Sullivan
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Victoria, Australia; Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Glen Westall
- Lung Transplant Service, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
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Glanville AR, Verleden GM, Todd JL, Benden C, Calabrese F, Gottlieb J, Hachem RR, Levine D, Meloni F, Palmer SM, Roman A, Sato M, Singer LG, Tokman S, Verleden SE, von der Thüsen J, Vos R, Snell G. Chronic lung allograft dysfunction: Definition and update of restrictive allograft syndrome-A consensus report from the Pulmonary Council of the ISHLT. J Heart Lung Transplant 2019; 38:483-492. [PMID: 31027539 DOI: 10.1016/j.healun.2019.03.008] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 02/07/2023] Open
Affiliation(s)
- Allan R Glanville
- Lung Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - Jamie L Todd
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, North Carolina, USA
| | | | - Fiorella Calabrese
- Department of Cardiothoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Member of the German Center for Lung Research, Hannover, Germany
| | - Ramsey R Hachem
- Division of Pulmonary & Critical Care, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Deborah Levine
- Pulmonary Disease and Critical Care Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Federica Meloni
- Department of Respiratory Diseases Policlinico San Matteo Foundation & University of Pavia, Pavia, Italy
| | - Scott M Palmer
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, North Carolina, USA
| | - Antonio Roman
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Masaaki Sato
- Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Lianne G Singer
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sofya Tokman
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | | | - Jan von der Thüsen
- Department of Pathology, University Medical Center, Rotterdam, The Netherlands
| | - Robin Vos
- University Hospital Gasthuisberg, Leuven, Belgium
| | - Gregory Snell
- Lung Transplant Service, The Alfred Hospital, Melbourne, Victoria, Australia
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Sullivan L, Shaw E, Snell G, Brooks A, Westall G. A Longitudinal Study of γδ T Cell Subsets Post Lung Transplant: Potential Players in CMV Immunity. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.629] [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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34
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Van Raemdonck D, Keshavjee S, Levvey B, Cherikh W, Snell G, Erasmus M, Simon A, Glanville A, Clark S, D'Ovidio F, Catarino P, McCurry K, Hertz M, Venkateswaran R, Hopkins P, Inci I, Walia R, Kreisel D, Mascaro J, Dilling D, Camp P, Mason D, Musk M, Burch M, Fisher A, Yusen R, Stehlik J, Cypel M. 5-Year Results from the ISHLT DCD Lung Transplant Registry Confirm Excellent Recipient Survival from Donation after Circulatory Death Donors. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.241] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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35
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Tarrant BJ, Snell G, Ivulich S, Button B, Thompson B, Holland A. Dornase alfa during lower respiratory tract infection post-lung transplantation: a randomized controlled trial. Transpl Int 2019; 32:603-613. [DOI: 10.1111/tri.13400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/09/2018] [Accepted: 01/07/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Gregory Snell
- Alfred Health; Melbourne Vic. Australia
- Monash University; Melbourne Vic. Australia
| | - Steven Ivulich
- Alfred Health; Melbourne Vic. Australia
- Monash University; Melbourne Vic. Australia
| | - Brenda Button
- Alfred Health; Melbourne Vic. Australia
- Monash University; Melbourne Vic. Australia
| | - Bruce Thompson
- Alfred Health; Melbourne Vic. Australia
- Monash University; Melbourne Vic. Australia
| | - Anne Holland
- Alfred Health; Melbourne Vic. Australia
- La Trobe University; Melbourne Vic. Australia
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Levvey B, Keshavjee S, Cypel M, Robinson A, Erasmus M, Glanville A, Hopkins P, Musk M, Hertz M, McCurry K, Van Raemdonck D, Snell G. Influence of lung donor agonal and warm ischemic times on early mortality: Analyses from the ISHLT DCD Lung Transplant Registry. J Heart Lung Transplant 2019; 38:26-34. [DOI: 10.1016/j.healun.2018.08.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 08/02/2018] [Accepted: 08/04/2018] [Indexed: 11/30/2022] Open
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Halloran K, Parkes M, Chang J, Famulski K, Reeve J, Hachem R, Juvet S, Keshavjee S, Kreisel D, Snell G, Trulock E, Timofte I, Westall G, Halloran P. Molecular Detection of Rejection-like Changes in Proximal Bronchial Mucosal Lung Transplant Biopsies: Initial Findings of the INTERLUNG Study. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.183] [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: 10/17/2022] Open
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38
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Mackintosh J, Munsif M, Thomson C, Musk M, Snell G, Glanville A, Chambers D, Hopkins P. Anastomotic Outcomes in Idiopathic Pulmonary Fibrosis Patients Receiving Anti-Fibrotic Therapy: Experience of the Australian Lung Transplant Collaborative. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.208] [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: 11/16/2022] Open
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Levin K, Paraskeva M, Westall G, Levvey B, Snell G. Standardizing and Improving the Classification for Causes of Death Post Lung Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1160] [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: 10/17/2022] Open
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Halloran K, Parkes M, Chang J, Famulski K, Reeve J, Hachem R, Jaksch P, Juvet S, Keshavjee S, Klepetko W, Kreisel D, Loupy A, Roux A, Trulock E, Snell G, Timofte I, Westall G, Halloran P. Molecular Diagnosis of Rejection Phenotypes in Lung Transplant Biopsies: Initial Findings of the INTERLUNG Study. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.182] [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: 10/17/2022] Open
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41
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Van Raemdonck D, Keshavjee S, Levvey B, Snell G, Erasmus M, Cherikh W, Kucheryavaya A, Stehlik J, McCurry K, Glanville A, D'Ovidio F, Hertz M, Inci I, Hopkins P, Walia R, Patterson G, Yusen R, Mason D, Musk M, Dilling D, Camp P, Cypel M. The ISHLT 2017 Updated DCD Registry Report. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.317] [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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42
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Levvey B, Levin K, Paraskeva M, Westall G, Snell G. Donation after Brain Death versus Donation after Circulatory Death: Lung Donor Management Issues. Semin Respir Crit Care Med 2018; 39:138-147. [DOI: 10.1055/s-0037-1615820] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AbstractLung transplantation (LTx) has traditionally been limited by a lack of suitable donor lungs. With the recognition that lungs are more robust than initially thought, the size of the donor pool of available lungs has increased dramatically in the past decade. Donation after brain death (DBD) and donation after circulatory death (DCD) lungs, both ideal and extended are now routinely utilized. DBD lungs can be damaged. There are important differences in the public's understanding, legal and consent processes, intensive care unit strategies, lung pathophysiology, logistics, and potential-to-actual donor conversion rates between DBD and DCD. Notwithstanding, the short- and long-term outcomes of LTx from any of these DBD versus DCD donor scenarios are now similar, robust, and continue to improve. Large audits suggest there remains a large untapped pool of DCD (but not DBD) lungs that may yet further dramatically increase lung transplant numbers. Donor scoring systems that might predict the donor conversion rates and lung quality, the role of ex vivo lung perfusion as an assessment and lung resuscitation tool, as well as the potential of donor lung quality biomarkers all have immense promise for the clinical field.
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Affiliation(s)
- Bronwyn Levvey
- Lung Transplant Service, Alfred Hospital, Monash University, Melbourne, Australia
| | - Kovi Levin
- Lung Transplant Service, Alfred Hospital, Monash University, Melbourne, Australia
| | - Miranda Paraskeva
- Lung Transplant Service, Alfred Hospital, Monash University, Melbourne, Australia
| | - Glen Westall
- Lung Transplant Service, Alfred Hospital, Monash University, Melbourne, Australia
| | - Gregory Snell
- Lung Transplant Service, Alfred Hospital, Monash University, Melbourne, Australia
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Fernando H, Noaman S, Snell G, Dart A, Shaw J, Chan W. Incidence and Predictors of Coronary Artery Disease in Patients Evaluated for Lung Transplantation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.620] [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: 11/16/2022]
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Ivulich S, Dooley M, Kirkpatrick C, Snell G. Clinical Challenges of Tacrolimus for Maintenance Immunosuppression Post–Lung Transplantation. Transplant Proc 2017; 49:2153-2160. [DOI: 10.1016/j.transproceed.2017.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/30/2017] [Indexed: 12/25/2022]
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45
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Yo S, Fuller L, Martin C, Naughton M, Snell G, Dabscheck E. Prevalence and Associations of Insomnia in Lung Transplant Recipients: A Cross-Sectional Study. Chest 2017. [DOI: 10.1016/j.chest.2017.08.1142] [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: 12/01/2022] Open
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46
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Snell G, Reed A, Stern M, Hadjiliadis D. The evolution of lung transplantation for cystic fibrosis: A 2017 update. J Cyst Fibros 2017; 16:553-564. [DOI: 10.1016/j.jcf.2017.06.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 06/29/2017] [Accepted: 06/29/2017] [Indexed: 02/08/2023]
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47
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Kotecha S, Buchan C, Parker K, Toghill J, Paul E, Miller B, Naughton M, Snell G, Dabscheck E. Domiciliary non-invasive ventilation post lung transplantation. Respirology 2017; 23:96-99. [PMID: 28840631 DOI: 10.1111/resp.13160] [Citation(s) in RCA: 2] [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: 02/06/2017] [Revised: 06/19/2017] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The benefits of domiciliary non-invasive ventilation (NIV) post lung transplantation (LTx) have not previously been described. This was a single-centre retrospective audit of patients requiring domiciliary NIV post-LTx. Our aim was to describe indications for NIV and outcomes in chronic lung allograft dysfunction (CLAD) and diaphragmatic palsy. METHODS All patients requiring domiciliary NIV post-LTx between 2010 and June 2016 were assessed. NIV indications, respiratory function and patient outcomes were collected. RESULTS Out of 488 LTx recipients, 20 patients were identified as requiring NIV over the 6.5-year study period. The most common indications for NIV were CLAD and diaphragmatic palsy. Hypercapnia improved significantly with NIV. Patient outcomes were poor with nine (45%) patients dying, four (20%) undergoing redo-LTx, four (20%) continuing domiciliary NIV and only three (15%) patients weaned off NIV. CONCLUSION This is the first case series to describe the use of domiciliary NIV post-LTx. Patients commenced on NIV post-LTx had severely impaired lung function and severe hypercapnia. Patients with diaphragmatic palsy often recovered. The mortality rate was high in chronic allograft dysfunction.
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Affiliation(s)
- Sakhee Kotecha
- Department of Lung Transplantation and General Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Catherine Buchan
- Department of Lung Transplantation and General Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Kerry Parker
- Department of Lung Transplantation and General Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Jo Toghill
- Department of Lung Transplantation and General Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Eldho Paul
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Clinical Haematology, Alfred Hospital, Melbourne, VIC, Australia
| | - Belinda Miller
- Department of Lung Transplantation and General Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Matthew Naughton
- Department of Lung Transplantation and General Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Gregory Snell
- Department of Lung Transplantation and General Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Eli Dabscheck
- Department of Lung Transplantation and General Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
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48
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Degen DA, Janardan J, Barraclough KA, Schneider HG, Barber T, Barton H, Snell G, Levvey B, Walker RG. Predictive performance of different kidney function estimation equations in lung transplant patients. Clin Biochem 2017; 50:385-393. [DOI: 10.1016/j.clinbiochem.2017.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/09/2017] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
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49
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Morrissey O, Westall G, Ffrench R, Edgell T, Cristiano Y, Phan T, Levvey B, Snell G, de Silva H. Cytokine Profiles of Aspergillus Isolation in Lung Transplant Recipients (LTR). J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.248] [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: 11/29/2022] Open
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50
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Fuller L, El-Ansary D, Button B, Corbett M, Snell G, Marasco S, Holland A. Upper Limb Rehabilitation After Lung Transplantation: A Randomised Controlled Trial. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.462] [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: 10/19/2022] Open
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