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Alghubari A, Cheah R, Z Shah S, Naser ARN, Lee AS, DeVault KR, Houghton LA. The impact of lung transplantation on esophageal motility and inter-relationships with reflux and lung mechanics in patients with restrictive and obstructive respiratory disease. Neurogastroenterol Motil 2024:e14788. [PMID: 38523356 DOI: 10.1111/nmo.14788] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND For many patients with lung disease the only proven intervention to improve survival and quality of life is lung transplantation (LTx). Esophageal dysmotility and gastroesophageal reflux (GER) are common in patients with respiratory disease, and often associate with worse prognosis following LTx. Which, if any patients, should be excluded from LTx based on esophageal concerns remains unclear. Our aim was to understand the effect of LTx on esophageal motility diagnosis and examine how this and the other physiological and mechanical factors relate to GER and clearance of boluses swallowed. METHODS We prospectively recruited 62 patients with restrictive (RLD) and obstructive (OLD) lung disease (aged 33-75 years; 42 men) who underwent high resolution impedance manometry and 24-h pH-impedance before and after LTx. KEY RESULTS RLD patients with normal motility were more likely to remain normal (p = 0.02), or if having abnormal motility to change to normal (p = 0.07) post-LTx than OLD patients. Esophageal length (EL) was greater in OLD than RLD patients' pre-LTx (p < 0.001), reducing only in OLD patients' post-LTx (p = 0.02). Reduced EL post-LTx associated with greater contractile reserve (r = 0.735; p = 0.01) and increased likelihood of motility normalization (p = 0.10). Clearance of reflux improved (p = 0.01) and associated with increased mean nocturnal baseline impedance (p < 0.001) in RLD but not OLD. Peristaltic breaks and thoraco-abdominal pressure gradient impact both esophageal clearance of reflux and boluses swallowed (p < 0.05). CONCLUSIONS AND INFERENCES RLD patients are more likely to show improvement in esophageal motility than OLD patients post-LTx. However, the effect on GER is more difficult to predict and requires other GI, anatomical and pulmonary factors to be taken into consideration.
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Affiliation(s)
- Ali Alghubari
- Division of Gastroenterology and Surgical Sciences, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Ramsah Cheah
- Division of Gastroenterology and Surgical Sciences, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Sadia Z Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Abdel-Rahman N Naser
- Department of Surgery, University of Florida College of Medicine, Jacksonville, Florida, USA
| | | | - Kenneth R DeVault
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Lesley A Houghton
- Division of Gastroenterology and Surgical Sciences, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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2
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El-Sayed Ahmed MM, Shah SZ, Zhang N, Jarmi T, Jacob S, Makey IA, Thomas M, Sareyyupoglu B, Landolfo KP, Erasmus DB, Pham SM. Survival Outcomes of Lung Transplant Recipients From Donors With Abnormal Kidney Function. Ann Thorac Surg 2023; 116:1071-1078. [PMID: 36404446 DOI: 10.1016/j.athoracsur.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/08/2022] [Revised: 09/19/2022] [Accepted: 10/17/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recovering lungs with pulmonary edema due to abnormal kidney function is considered one of the expanded selection criteria for lung transplant. The aim of this study is to assess lung transplant recipients' survival from donors with abnormal kidney function and to determine differences in lung recovery rates from donors with and donors without abnormal kidney function. METHODS We reviewed the United Network for Organ Sharing registry for first-time adult lung transplant donors and recipients from June 2005 to March 2017. Donor kidney function was categorized into three groups based on estimated glomerular filtration rate: group I, greater than 60 mL/min; group II, 15 to 59 mL/min; and group III, less than 15 mL/min. Recipient survival was stratified based on estimated glomerular filtration rate using Kaplan-Meier. A multivariate Cox Regression model with known risk factors that affect survival was used to compare survival among groups. Comparison of lung recovery among the three groups was also performed. RESULTS Lung recovery rates were 29.7% (15,670 of 52,747), 19.4% (3879 of 20,040), and 18.1% (704 of 3898) for groups I, II, and III, respectively. The 1-, 3-, and 5-year recipient survival rates were 86.2%, 69.2%, and 55.7% for group I; 84.9%, 66.9%, and 53.8% for group II; and 85.5%, 65.3%, and 50.3% for group III, respectively (adjusted P = .25; multivariate Cox regression method). When group I was used as reference, the adjusted hazard ratio for group II was 1.04 (95% CI, 0.98-1.10) and for group III, it was 1.08 (95% CI, 0.96-1.23), after adjusting with the multivariate Cox regression model. CONCLUSIONS There was no significant difference in lung recipient survival. The lung recovery rate from donors with abnormal kidney function was lower compared with that of donors with normal kidney function.
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Affiliation(s)
- Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida; Department of Surgery, Zagazig University Faculty of Medicine, Zagazig, Egypt.
| | - Sadia Z Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida
| | - Nan Zhang
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, Arizona
| | - Tambi Jarmi
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida
| | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Ian A Makey
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Kevin P Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - David B Erasmus
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
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3
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Wahab A, Hanson AC, Peters S, Villavicencio MA, Saddoughi SA, Shah SZ, Spencer PJ, Kennedy CC, Pennington KM. Expanded extracorporeal membrane oxygenation bridge to heart and lung transplant candidate selection does not impact outcomes compared to traditional candidate selection criteria. J Thorac Dis 2023; 15:3421-3430. [PMID: 37426137 PMCID: PMC10323592 DOI: 10.21037/jtd-23-13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/21/2023] [Indexed: 07/11/2023]
Abstract
Extracorporeal membrane oxygenation is used as a bridge to transplant (ECMO-BTT) in selected patients. The objective of this study was to determine whether 1-year post-transplant and post-ECMO survival are impacted by traditional compared to expanded selection criteria. We performed a retrospective study of patients >17 years who received ECMO as bridge to transplant (BTT) or bridge to transplant decision for lung or combined heart and lung transplantation at the Mayo Clinic Florida and Rochester. Institutional protocol excludes patients >55 years, maintained on steroids, unable to participate in physical therapy, with body mass index >30 or <18.5 kg/m2, non-pulmonary end-organ dysfunction, or unmanageable infections from ECMO-BTT. For this study, adherence to this protocol was considered traditional whereas exceptions to the protocol were considered expanded selection criteria. A total of 45 patients received ECMO as bridge therapy. Out of those 29 patients (64%) received ECMO as bridge to transplant and 16 patients (36%) as bridge to transplant decision. The traditional criteria cohort consisted of 15 (33%) patients and expanded criteria cohort consisted of 30 (67%) patients. In the traditional cohort, 9 (60%) of 15 patients were successfully transplanted compared to 16 (53%) of 30 patients in the expanded criteria cohort. No difference in being delisted or dying on the waitlist (OR: 0.58, CI: 0.13-2.58), surviving to 1-year post-transplant (OR: 0.53, CI: 0.03-9.71) or 1-year post-ECMO (OR: 0.77, CI: 0.0.23-2.56) was observed between the traditional criteria and expanded criteria cohorts. At our institution, we did not see differences in odds of 1-year post-transplant and post-ECMO survival between those who met traditional criteria compared to those who did not. Multicenter, prospective studies are needed to evaluate the impact of ECMO-BTT selection criteria.
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Affiliation(s)
- Abdul Wahab
- Department of Internal Medicine, Mayo Clinic Health Systems-Mankato, Mankato, MN, USA
| | | | - Steve Peters
- Department of Internal Medicine, Division of Pulmonary/Critical Care and Lung Transplant Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Sahar A. Saddoughi
- Department of Surgery, Division of Cardiac Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Surgery, Division of Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sadia Z. Shah
- Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Philip J. Spencer
- Department of Surgery, Division of Cardiac Surgery, Mayo Clinic, Rochester, MN, USA
| | - Cassie C. Kennedy
- Department of Internal Medicine, Division of Pulmonary/Critical Care and Lung Transplant Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kelly M. Pennington
- Department of Internal Medicine, Division of Pulmonary/Critical Care and Lung Transplant Medicine, Mayo Clinic, Rochester, MN, USA
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4
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Shah SZ, Alvarez FG, Sanghavi DK, Moreno Franco P, Isha S, Marquez CP, Libertin C, Guru PK, Sareyyupoglu B, Pham SM. Coronavirus Disease 2019 Causing Infection of Transplanted Lung Allograft: A Pitfall of Prolonged Shedding of Severe Acute Respiratory Syndrome Coronavirus-2 Pretransplant. Mayo Clin Proc Innov Qual Outcomes 2023; 7:93-98. [PMID: 36644594 PMCID: PMC9829600 DOI: 10.1016/j.mayocpiqo.2023.01.001] [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: 10/20/2022] [Revised: 12/25/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) pandemic has led to considerable morbidity and mortality across the world. Lung transplant is a viable option for a few with COVID-19-related lung disease. Whom and when to transplant has been the major question impacting the transplant community given the novelty of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe a pitfall of presumed prolonged shedding of SARS-CoV-2 in a patient with COVID-19 associated acute respiratory distress syndrome leading to COVID-19 pneumonia after lung transplant. This raises concerns that replication-competent SARS-CoV-2 virus can persist for months post-infection and can lead to re-infection of grafts in the future.
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Key Words
- BAL, bronchoalveolar lavage
- BSL-3, Biosafety level-3
- COVID-19, coronavirus disease 2019
- CP, convalescent plasma
- CT, computed tomography
- LT, lung transplant
- NPS, nasopharyngeal swab
- RT-PCR, reverse transcriptase–polymerase chain reaction
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- VV-ECMO, veno-venous extracorporeal membrane oxygenation
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Affiliation(s)
- Sadia Z. Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, FL,Correspondence: Address to Sadia Z. Shah, Department of Transplantation, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224
| | | | | | | | - Shahin Isha
- Department of Critical Care, Mayo Clinic, Jacksonville, FL
| | | | - Claudia Libertin
- Division of Infectious Disease, Department of Medicine, and Mayo Clinic, Jacksonville, FL
| | - Pramod K. Guru
- Department of Critical Care, Mayo Clinic, Jacksonville, FL
| | | | - Si M. Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL
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5
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Shah SZ, Abdelmoneim Y, Pham SM, Elrefaei M. Association between SARS-CoV-2 infection and de novo HLA donor specific antibody production in lung transplant recipients: Single-center study. Hum Immunol 2022; 83:749-754. [PMID: 35987702 PMCID: PMC9376302 DOI: 10.1016/j.humimm.2022.07.007] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 07/08/2022] [Accepted: 07/18/2022] [Indexed: 11/04/2022]
Abstract
The COVID-19 pandemic has led to significant morbidity and mortality in lung transplant recipients. Respiratory viral infections may be associated with de-novo HLA donor-specific antibody production and impact lung transplant outcome. Since one of the immunomodulation strategies post-SARS-CoV-2 infection in lung transplant recipients include decreasing or holding anti-metabolites, concerns have been raised for higher incidence of de-novo HLA donor specific antibody production in lung transplant recipients. We performed a retrospective chart review of 24 consecutive lung transplant recipients diagnosed with COVID-19 to investigate this concern. We observed no significant differences in the CPRA or MFI levels of HLA class I and II antibodies pre- COVID-19 compared to 1 and 6 months post-COVID-19 diagnosis in 11/24 (45.8 %) LTR (p = 0.98 and p = 0.63 respectively). HLA class I and II DSA were detected in 5/24 LTR pre-COVID-19 diagnosis and persisted with no significant differences in the median MFI levels at 1 and 6 months post-COVID-19 diagnosis (p = 0.89). De-novo HLA class I and II DSA were detected in 1/24 (4.2 %) LTR at one month post-COVID-19 diagnosis and persisted with no significant differences in the median MFI levels at 1 and 6 months post-COVID-19 diagnosis (p = 0.54). Our results suggest that there was no significant association between SARS-CoV-2 infection and immunomodulation on pre-existing or de novo HLA donor specific antibodies.
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Affiliation(s)
- Sadia Z Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, United States
| | - Yousif Abdelmoneim
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, United States
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Mohamed Elrefaei
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, United States.
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6
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Sanghavi DK, Bhakta S, Wadei HM, Bosch W, Cowart JB, Carter RE, Shah SZ, Pollock BD, Neville MR, Oman SP, Speicher L, Siegel J, Scindia AD, Libertin CR, Kunze KL, Johnson PW, Matson MW, Franco PM. Low antispike antibody levels correlate with poor outcomes in COVID-19 breakthrough hospitalizations. J Intern Med 2022; 292:127-135. [PMID: 35194861 PMCID: PMC9115098 DOI: 10.1111/joim.13471] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While COVID-19 immunization programs attempted to reach targeted rates, cases rose significantly since the emergence of the delta variant. This retrospective cohort study describes the correlation between antispike antibodies and outcomes of hospitalized, breakthrough cases during the delta variant surge. METHODS All patients with positive SARS-CoV-2 polymerase chain reaction hospitalized at Mayo Clinic Florida from 19 June 2021 to 11 November 2021 were considered for analysis. Cases were analyzed by vaccination status. Breakthrough cases were then analyzed by low and high antibody titers against SARS-CoV-2 spike protein, with a cut-off value of ≥132 U/ml. Outcomes included hospital length of stay (LOS), need for intensive care unit (ICU), mechanical ventilation, and mortality. We used 1:1 nearest neighbor propensity score matching without replacement to assess for confounders. RESULTS Among 627 hospitalized patients with COVID-19, vaccine breakthrough cases were older with more comorbidities compared to unvaccinated. After propensity score matching, the unvaccinated patients had higher mortality (27 [28.4%] vs. 12 [12.6%], p = 0.002) and LOS (7 [1.0-57.0] vs. 5 [1.0-31.0] days, p = 0.011). In breakthrough cases, low-titer patients were more likely to be solid organ transplant recipients (16 [34.0%] vs. 9 [12.3%], p = 0.006), with higher need for ICU care (24 [51.1%] vs. 22 [11.0%], p = 0.034), longer hospital LOS (median 6 vs. 5 days, p = 0.013), and higher mortality (10 [21.3%] vs. 5 [6.8%], p = 0.025) than high-titer patients. CONCLUSIONS Hospitalized breakthrough cases were more likely to have underlying risk factors than unvaccinated patients. Low-spike antibody titers may serve as an indicator for poor prognosis in breakthrough cases admitted to the hospital.
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Affiliation(s)
- Devang K Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Shivang Bhakta
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Hani M Wadei
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Wendelyn Bosch
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Jennifer B Cowart
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Sadia Z Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Benjamin D Pollock
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Matthew R Neville
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Sven P Oman
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Leigh Speicher
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Jason Siegel
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA.,Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Ameya D Scindia
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Claudia R Libertin
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Katie L Kunze
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Patrick W Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Mark W Matson
- Center for Digital Health-Data & Analytics, Mayo Clinic, Rochester, Minnesota, USA
| | - Pablo Moreno Franco
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA.,Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA.,Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
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7
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Martin AK, Shah SZ, Guru PK, Chaudhary S, Franco PM, Makey I, Fritz AV, Pham SM, Thomas M. Multidisciplinary Approach for Lung Transplantation due to COVID-19. Mayo Clin Proc Innov Qual Outcomes 2022; 6:200-208. [PMID: 35281693 PMCID: PMC8904149 DOI: 10.1016/j.mayocpiqo.2022.02.003] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), a novel etiology of end-stage lung disease, has resulted in major disruptions to the process of health care delivery worldwide. These disruptions have led to team-based innovations globally, resulting in a broad range of new processes in cardiopulmonary perioperative management. A key intersection of multidisciplinary teamwork and COVID-19 is found in lung transplantation, in which diverse teams collaborate throughout the perioperative period to achieve optimal outcomes. In this article, we describe the multidisciplinary approach taken by Mayo clinic in Florida to manage patients with COVID-19 presenting for lung transplantation.
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Key Words
- ARDS, acute respiratory distress syndrome
- CAD, coronary artery disease
- COVID-19, coronavirus disease 2019
- ECMO, extracorporeal membrane oxygenation
- ESLD, end-stage lung disease
- ICU, intensive care unit
- MCF, Mayo clinic in Florida
- MDT, multidisciplinary team
- OR, operating room
- PCR, polymerase chain reaction
- POD, postoperative day
- PPE, personal protective equipment
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- VA, veno-arterial
- VV, veno-venous
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Affiliation(s)
- Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic in Florida, Jacksonville, FL
| | - Sadia Z Shah
- Department of Transplantation, Mayo Clinic in Florida, Jacksonville, FL
| | - Pramod K Guru
- Department of Critical Care, Mayo Clinic in Florida, Jacksonville, FL
| | - Sanjay Chaudhary
- Department of Critical Care, Mayo Clinic in Florida, Jacksonville, FL
| | | | - Ian Makey
- Department of Cardiothoracic Surgery, Mayo Clinic in Florida, Jacksonville, FL
| | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic in Florida, Jacksonville, FL
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic in Florida, Jacksonville, FL
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic in Florida, Jacksonville, FL
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8
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Bhakta S, Sanghavi DK, Johnson PW, Kunze KL, Neville MR, Wadei HM, Bosch W, Carter RE, Shah SZ, Pollock BD, Oman SP, Speicher L, Siegel J, Libertin CR, Matson MW, Franco PM, Cowart JB. Clinical and Laboratory Profiles of SARS-CoV-2 Delta Variant Compared to Pre-Delta Variants. Int J Infect Dis 2022; 120:88-95. [PMID: 35487339 PMCID: PMC9040426 DOI: 10.1016/j.ijid.2022.04.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 03/03/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The emergence of SARS-CoV-2 variants of concern has led to significant phenotypical changes in transmissibility, virulence, and public health measures. Our study used clinical data to compare characteristics between a Delta variant wave and a pre-Delta variant wave of hospitalized patients. METHODS This single-center retrospective study defined a wave as an increasing number of COVID-19 hospitalizations, which peaked and later decreased. Data from the United States Department of Health and Human Services was used to identify the waves' primary variant. Wave 1 (08/08/20-04/01/21) was characterized by heterogeneous variants, while Wave 2 (06/26/21-10/18/21) was predominantly Delta variant. Descriptive statistics, regression techniques, and machine learning approaches supported the comparisons between waves. RESULTS From the cohort(n=1318), Wave 2 patients(n=665) were more likely to be younger, have fewer comorbidities, require more ICU care, and show an inflammatory profile with higher C-reactive protein, lactate dehydrogenase, ferritin, fibrinogen, prothrombin time, activated thromboplastin time, and INR compared to Wave 1. The gradient boosting model showed an area under the ROC curve of 0.854(sensitivity 86.4%;specificity 61.5%;positive predictive value 73.8%; negative predictive value 78.3%). CONCLUSIONS Clinical and laboratory characteristics can be used to estimate the COVID-19 variant regardless of genomic testing availability. This finding has implications for variant-driven treatment protocols and further research.
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Affiliation(s)
- Shivang Bhakta
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA.
| | - Devang K Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Patrick W Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Katie L Kunze
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona, USA
| | - Matthew R Neville
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Hani M Wadei
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Wendelyn Bosch
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Sadia Z Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Benjamin D Pollock
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Sven P Oman
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Leigh Speicher
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Jason Siegel
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA; Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Claudia R Libertin
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Mark W Matson
- Center for Digital Health - Data & Analytics, Mayo Clinic, Rochester, Minnesota, USA
| | - Pablo Moreno Franco
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA; Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Jennifer B Cowart
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
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9
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Bosch W, Cowart JB, Bhakta S, Carter RE, Wadei HM, Shah SZ, Sanghavi DK, Pollock BD, Neville MR, Oman SP, Speicher L, Scindia AD, Matson MW, Moreno Franco P. Coronavirus Disease 2019 Vaccine-Breakthrough Infections Requiring Hospitalization in Mayo Clinic Florida Through August 2021. Clin Infect Dis 2021; 75:e892-e894. [PMID: 34726700 PMCID: PMC8689905 DOI: 10.1093/cid/ciab932] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 09/04/2021] [Indexed: 01/19/2023] Open
Abstract
We characterized coronavirus disease 2019 (COVID-19) breakthrough cases admitted to a single center in Florida. With the emergence of delta variant, an increased number of hospitalizations was seen due to breakthrough infections. These patients were older and more likely to have comorbidities. Preventive measures should be maintained even after vaccination.
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Affiliation(s)
- Wendelyn Bosch
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | - Jennifer B Cowart
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Shivang Bhakta
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Hani M Wadei
- Division of Nephrology, Mayo Clinic, Jacksonville, Florida, USA
| | - Sadia Z Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Devang K Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Benjamin D Pollock
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Matthew R Neville
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Sven P Oman
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Leigh Speicher
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida, USAand
| | - Ameya D Scindia
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Mark W Matson
- Center for Digital Health, Data and Analytics, Mayo Clinic, Rochester, Minnesota, USA
| | - Pablo Moreno Franco
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA,Department of Transplantation, Mayo Clinic, Jacksonville, Florida, USA,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA,Correspondence: P. Moreno Franco, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 ()
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Shah SZ, Bryce AH. On the Road Back to Normalcy: Following Science Over Noise in SARS-CoV-2. Mayo Clin Proc 2021; 96:2736-2742. [PMID: 34736604 PMCID: PMC8479550 DOI: 10.1016/j.mayocp.2021.09.011] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Sadia Z Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, FL
| | - Alan H Bryce
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ. https://twitter.com/AlanBryce9
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Wadei HM, Gonwa TA, Leoni JC, Shah SZ, Aslam N, Speicher LL. COVID-19 infection in solid organ transplant recipients after SARS-CoV-2 vaccination. Am J Transplant 2021; 21:3496-3499. [PMID: 33890410 PMCID: PMC8251487 DOI: 10.1111/ajt.16618] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Hani M. Wadei
- Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA,Correspondence: Hani M. Wadei
| | - Thomas A. Gonwa
- Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA
| | - Juan C. Leoni
- Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA
| | - Sadia Z. Shah
- Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA
| | - Nabeel Aslam
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Leigh L. Speicher
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Martínez MDP, Alvarez FG, Mallea JM, Shah SZ, Pham SM, El-Sayed Ahmed MM, Jacob S, Janik AB, Haddad T, Erasmus DB, Narula T. Negative pressure ventilation as a bridge to lung transplant. Oxf Med Case Reports 2020; 2020:omaa056. [PMID: 32793360 PMCID: PMC7416820 DOI: 10.1093/omcr/omaa056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 03/04/2020] [Accepted: 06/12/2020] [Indexed: 11/23/2022] Open
Abstract
Recent years have witnessed evolution of lung allocation strategies to prioritize sicker recipients. In the pre-transplant period, this has translated into increased utilization of invasive extracorporeal or mechanical ventilatory support as a bridge to lung transplantation. The morbidity associated with these strategies warrants consideration to less invasive respiratory support modalities. Herein, we present a case highlighting successful bridge to lung transplantation with a relatively non-invasive negative pressure ventilator.
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Affiliation(s)
| | | | - Jorge M Mallea
- Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Sadia Z Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL 32224 USA
| | | | - Samuel Jacob
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Anthony B Janik
- Department of Respiratory Therapy, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Tarik Haddad
- Department of Transplantation, Mayo Clinic, Jacksonville, FL 32224 USA
| | - David B Erasmus
- Department of Transplantation, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Tathagat Narula
- Department of Transplantation, Mayo Clinic, Jacksonville, FL 32224 USA
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Shah SZ, Pouch SM, Keller BC, Pope-Harman A, Tumin D. Outcomes from bacteremic donors in lung transplantation. J Heart Lung Transplant 2017; 37:S1053-2498(17)31925-3. [PMID: 28823392 DOI: 10.1016/j.healun.2017.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sadia Z Shah
- Division of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic Hospital, Phoenix, Arizona, USA.
| | - Stephanie M Pouch
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brian C Keller
- Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Amy Pope-Harman
- Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Dmitry Tumin
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Ouellette DR, Shah SZ. Comparison of outcomes from sepsis between patients with and without pre-existing left ventricular dysfunction: a case-control analysis. Crit Care 2014; 18:R79. [PMID: 24758343 PMCID: PMC4057360 DOI: 10.1186/cc13840] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 03/11/2014] [Indexed: 12/29/2022]
Abstract
Introduction The aim of this study was to determine if there are differences between patients with pre-existing left ventricular dysfunction and those with normal antecedent left ventricular function during a sepsis episode in terms of in-hospital mortality and mortality risk factors when treated in accordance with a sepsis treatment algorithm. Methods We performed a retrospective case-control analysis of patients selected from a quality improvement database of 1,717 patients hospitalized with sepsis between 1 January 2005 and 30 June 2010. In this study, 197 patients with pre-existing left ventricular systolic dysfunction and sepsis were compared to 197 case-matched patients with normal prior cardiac function and sepsis. Results In-hospital mortality rates (P = 0.117) and intubation rates at 24 hours (P = 0.687) were not significantly different between cases and controls. There was no correlation between the amount of intravenous fluid administered over the first 24 hours and the PaO2/FiO2 ratio at 24 hours in either cases or controls (r2 = 0.019 and r2 = 0.001, respectively). Mortality risk factors for cases included intubation status (P = 0.016, OR = 0.356 for no intubation), compliance with a sepsis bundle (P = 0.008, OR = 3.516 for failed compliance), a source of infection other than the lung (P = 0.019, OR = 2.782), and the initial mixed venous oxygen saturation (P = 0.004, OR = 0.997). Risk factors for controls were the initial platelet count (P = 0.028, OR = 0.997) and the serum lactate level (P = 0.048, OR = 1.104). Patients with pre-existing left ventricular dysfunction who died had a lower initial mean mixed venous oxygen saturation than those who survived (61 ± 18% versus 70 ± 16%, P = 0.002). Conclusions Clinical outcomes were not different between septic patients with pre-existing left ventricular dysfunction and those with no cardiac disease. There was no correlation between fluid administration and oxygenation at 24 hours in either cohort. The mortality risk factor profile of patients with pre-existing left ventricular dysfunction was different when compared with control patients, and may be related to oxygen delivery determinants.
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Abstract
This study reviews the results of Surface Replacement Trapeziometacarpal (SR TMC, Avanta, San Diego, CA) total joint arthroplasty. Fifty patients (62 joints) were included in the study. Forty-three patients (54 joints) were seen at final follow up. Seven patients (eight joints) were interviewed over the phone. Seven patients were revised to trapeziectomy and ligament reconstruction with tendon interposition, five for aseptic loosening and two for dislocation. At final follow up, the mean Quick DASH score was 30.4 and the Sollerman Score was 77.3. Radiological review of the surviving 55 joints showed subsidence of four trapezial components in asymptomatic patients. Cumulative survival rate was 91% at 3 years. Eighty-five percent of the patients were satisfied with the outcome of their treatment.
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Affiliation(s)
- A Pendse
- Rotherham District General Hospital NHS Foundation Trust, Rotherham, South Yorkshire, UK
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