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Zou Y, Laothamatas K, Sonett J, Lemaitre P, Stanifer B, Magda G, Grewal H, Shah L, Robbins H, Patel S, Miller A, Anderson M, Costa J, D'Ovidio F, Arcasoy S, Benvenuto L. Effect of Age and Transplant Type on Survival and Hospital-Free Days in COPD Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1462] [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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Greissman S, Laothamatas K, Costa J, D'Ovidio F, Grewal H, Lemaitre P, Magda G, Miller A, Patel S, Robbins H, Shah L, Sonnett J, Stanifer B, Arcasoy S, Benvenuto L. Comparison of Post-Transplant Survival Between Lung-Kidney and Lung Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1463] [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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Greissman S, Laothamatas K, Costa J, D'Ovidio F, Grewal H, Lemaitre P, Magda G, Miller A, Patel S, Robbins H, Shah L, Sonett J, Stanifer B, Arcasoy S, Benvenuto L. Lung Transplant Waitlist Outcomes Before and after 2021 LAS Revision. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1445] [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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Benvenuto L, Grewal H, Laothamatas K, Anderson M, Snyder M, Greissman S, Costa J, Shah L, Robbins H, Magda G, Sonett J, Lemaitre P, D'Ovidio F, Arcasoy S. Rapidly Declining Rates of Single Lung Transplant for COPD and ILD in the U.S. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1457] [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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Greissman S, Anderson M, Dimango A, Grewal H, Magda G, Robbins H, Shah L, Costa J, Stanifer B, D'-Ovidio F, Juarez ML, Lemaitre P, Sonett J, Arcasoy S, Benvenuto L. Lung transplant waitlist outcomes among ABO blood groups vary based on disease severity. J Heart Lung Transplant 2023; 42:480-487. [PMID: 36464610 PMCID: PMC10123800 DOI: 10.1016/j.healun.2022.10.024] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/06/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Blood group O candidates have lower lung transplantation rates despite having the most common blood group. We postulated that waitlist outcomes among these candidates and those with other blood types vary with disease severity and lung allocation score (LAS). METHODS We performed a retrospective cohort study of 32,772 waitlist candidates using the United Network of Organ Sharing registry from May 2005 to 2020. After identifying an interaction between blood group and LAS, we evaluated the association between blood group and waitlist outcomes within LAS quartiles using unadjusted and adjusted competing risk models. RESULTS In the lowest LAS quartile, blood group O had a 20% reduced transplantation rate (SHR: 0.80, 95%CI: 0.75-0.85) and higher waitlist death/removal (1.33, 95%CI: 1.15-1.55) compared with group A. Blood group AB had a 52% higher transplantation rate (SHR: 1.52, 95%CI: 1.34-1.73) in the lowest LAS quartile compared with group A. In the highest LAS quartile, there was no difference in transplantation rates between groups O and A. In contrast, group B had a 19% reduced transplantation rate (SHR, 0.81 95%CI: 0.73-0.89) and AB had a 28% reduced transplantation rate (SHR: 0.72, 95%CI: 0.61-0.86) in the highest LAS quartile. Additionally, groups B and AB had increased risk of waitlist death/removal in the highest LAS quartile compared with A (SHR: 1.27, 95%CI: 1.08-1.48; SHR: 1.31, 95%CI: 1.00-1.72). CONCLUSIONS Waitlist outcomes among ABO blood groups vary depending on illness severity, which is represented by LAS. Blood group O has lower transplantation rates at low LAS while groups B and AB have lower transplantation rates at high LAS.
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Affiliation(s)
- Samantha Greissman
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Michaela Anderson
- Division of Pulmonary and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Angela Dimango
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
| | - Harpreet Grewal
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
| | - Gabriela Magda
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
| | - Hilary Robbins
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
| | - Lori Shah
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
| | - Joseph Costa
- Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Bryan Stanifer
- Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Frank D'-Ovidio
- Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Miguel Leiva Juarez
- Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Philippe Lemaitre
- Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Joshua Sonett
- Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Selim Arcasoy
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
| | - Luke Benvenuto
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York.
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Blackett JW, Benvenuto L, Leiva-Juarez MM, D'Ovidio F, Arcasoy S, Jodorkovsky D. Risk Factors and Outcomes for Gastroparesis After Lung Transplantation. Dig Dis Sci 2022; 67:2385-2394. [PMID: 34524597 DOI: 10.1007/s10620-021-07249-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gastroparesis is common after lung transplantation and is associated with worse transplant outcomes, including the development of chronic lung allograft dysfunction (CLAD). This study sought to identify the prevalence, risk factors, and outcomes associated with a new diagnosis of gastroparesis after lung transplantation. METHODS This was a single-center retrospective study of patients who underwent lung transplantation in 2008-2018. The primary outcome was a new diagnosis of gastroparesis within 3 years of transplant. Secondary outcomes included a new diagnosis of gastroesophageal reflux and the association between gastroparesis and both post-transplant survival and CLAD-free survival. Multivariable logistic regression was used to compare diagnosis of gastroparesis and gastroesophageal reflux, while multivariable Cox proportional hazards models were used to analyze gastroparesis and post-transplant outcomes. RESULTS Of 616 patients with no prior history of gastroparesis, 107 (17.4%) were diagnosed with delayed gastric emptying within 3 years of transplant. On multivariable logistic regression, black race (OR 2.16, 95% CI 1.18-3.98, p = 0.013) was significantly associated with a new diagnosis of gastroparesis. Age, sex, history of diabetes, connective tissue disease, type of transplant, diagnosis group, renal function, and body mass index were not predictive of gastroparesis post-transplant. Gastroparesis was significantly associated with CLAD (HR 1.76, 95% CI 1.20-2.59, p = 0.004), but not with overall mortality (HR 1.16, p = 0.43). CONCLUSION While gastroparesis is common after lung transplantation, it remains difficult to predict which patients will develop these complications post-transplant. Black patients were more likely to be diagnosed with gastroparesis after adjusting for relevant confounders. Gastroparesis is associated with increased risk of CLAD, and further studies are needed to assess whether early detection and treatment can reduce the incidence of CLAD.
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Affiliation(s)
- John W Blackett
- Division of Digestive and Liver Diseases, Department of Medicine, New York Presbyterian Columbia University Medical Center, 622 West 168th Street, New York, NY, USA.
| | - Luke Benvenuto
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, New York Presbyterian Columbia University Medical Center, New York, NY, USA
| | - Miguel M Leiva-Juarez
- Division of Cardiac, Vascular, and Thoracic Surgery, Department of Surgery, New York Presbyterian Columbia University Medical Center, New York, NY, USA
| | - Frank D'Ovidio
- Division of Cardiac, Vascular, and Thoracic Surgery, Department of Surgery, New York Presbyterian Columbia University Medical Center, New York, NY, USA
| | - Selim Arcasoy
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, New York Presbyterian Columbia University Medical Center, New York, NY, USA
| | - Daniela Jodorkovsky
- Division of Digestive and Liver Diseases, Department of Medicine, New York Presbyterian Columbia University Medical Center, 622 West 168th Street, New York, NY, USA
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Leiva-Juarez M, Briganti D, Urso A, Russum S, Benvenuto L, Robbins H, Shah L, Costa J, Gomez EA, Arcasoy S, Sonett J, D'Ovidio F. Large Airway Bronchial Wash Lipidomics as Novel Biomarkers for Chronic Lung Allograft Dysfunction. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.244] [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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8
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Kahn P, Siegelin M, Carroll M, D'ovidio F, Arcasoy S. Bronchoscopic Lobar Lavage in the Treatment of a Single Lung Transplant Recipient With Pulmonary Alveolar Proteinosis: A Case Report. Transplant Proc 2022; 54:169-172. [PMID: 34973839 DOI: 10.1016/j.transproceed.2021.11.023] [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] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/20/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022]
Abstract
Pulmonary alveolar proteinosis is a rare disorder that results from impaired clearance of surfactant. There are few case reports in lung transplant recipients. We report the case of a 57-year-old man with chronic hypersensitivity pneumonitis who underwent left single lung transplantation. Approximately 1 year after transplant, he was diagnosed as having pulmonary alveolar proteinosis by surgical lung biopsy. He was successfully treated with bronchoscopic lobar lavage of his allograft but later was diagnosed as having peritoneal mesothelioma. We highlight the challenges in the diagnosis, discuss potential etiologies, and describe a unique therapy of this rare disorder in lung transplant recipients.
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Affiliation(s)
- Phoebe Kahn
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York.
| | - Markus Siegelin
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Maggie Carroll
- Lung Transplant Program, Columbia University Irving Medical Center, New York, New York
| | - Frank D'ovidio
- Lung Transplant Program, Columbia University Irving Medical Center, New York, New York; Section of Thoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Selim Arcasoy
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York; Lung Transplant Program, Columbia University Irving Medical Center, New York, New York
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Henthorne K, Basile M, Marziliano A, Wong K, Polo J, Tsang D, LaVecchia G, Frantzen T, Hajizadeh N, Arcasoy S, Kim H, Wang J. 75: Access to education and support for adults with cystic fibrosis by virtual support group with a focus on readiness for lung transplant. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01500-9] [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: 10/20/2022]
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Leiva-Juárez MM, Urso A, Costa J, Stanifer BP, Sonett JR, Benvenuto L, Aversa M, Robbins H, Shah L, Arcasoy S, D’Ovidio F. Fundoplication after lung transplantation in patients with systemic sclerosis-related end-stage lung disease. J Scleroderma Relat Disord 2021; 6:247-255. [PMID: 35387211 PMCID: PMC8922666 DOI: 10.1177/23971983211016210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/19/2021] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Gastroesophageal reflux and aspiration are risk factors for chronic lung allograft dysfunction in lung transplant recipients. Patients with systemic sclerosis are at an increased risk of aspiration due to esophageal dysmotility and an ineffective lower esophageal sphincter. The aim of this study is to understand the effect of fundoplication on outcomes in systemic sclerosis recipients. METHODS Between 2001 and 2019, 168 systemic sclerosis patients were referred for lung transplantation-51 (30.3%) were listed and 36 (21.4%) were transplanted. Recipients were stratified whether they underwent a fundoplication (n = 10, 27.8%) or not (n = 26, 72.2%). Freedom from chronic lung allograft dysfunction and survival were analyzed using log-rank test. Multivariable analysis for known risk factors was performed using a Cox-proportional hazards model. RESULTS Median time to fundoplication after transplantation was 16.4 months (interquartile range: 9.6-25.1) and all were laparoscopic (Dor 50%, Nissen 40%, Toupet 10%). There were no differences in acute rejection ⩾ A1 (26.9% vs 30%), or primary graft dysfunction grades 2-3 at 72 h (42.3% vs 40%) between groups. Recipients with fundoplication had an increased freedom from chronic lung allograft dysfunction (p = 0.035) and overall survival (p = 0.01). Fundoplication was associated with a reduced risk of mortality adjusting for other comorbidities (hazard ratio = 0.13; 95% confidence interval = 0.02-0.65; p = 0.014). Double and single lung transplant did not have different post-transplant survival. CONCLUSION Fundoplication in systemic sclerosis lung transplant recipients is associated with greater freedom from chronic lung allograft dysfunction and overall survival. Screening for reflux and aspiration followed by early fundoplication may delay graft deterioration in this population.
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Affiliation(s)
- Miguel M Leiva-Juárez
- Department of Surgery, Section of
General Thoracic Surgery, Columbia University Irving Medical Center, New York, NY,
USA
| | - Andreacarola Urso
- Department of Surgery, Section of
General Thoracic Surgery, Columbia University Irving Medical Center, New York, NY,
USA
| | - Joseph Costa
- Department of Surgery, Section of
General Thoracic Surgery, Columbia University Irving Medical Center, New York, NY,
USA
| | - Bryan P Stanifer
- Department of Surgery, Section of
General Thoracic Surgery, Columbia University Irving Medical Center, New York, NY,
USA
| | - Joshua R Sonett
- Department of Surgery, Section of
General Thoracic Surgery, Columbia University Irving Medical Center, New York, NY,
USA
| | - Luke Benvenuto
- Department of Pulmonary, Allergy and
Critical Care Medicine, Columbia University Irving Medical Center, New York, NY,
USA
| | - Megan Aversa
- Department of Pulmonary, Allergy and
Critical Care Medicine, Columbia University Irving Medical Center, New York, NY,
USA
| | - Hilary Robbins
- Department of Pulmonary, Allergy and
Critical Care Medicine, Columbia University Irving Medical Center, New York, NY,
USA
| | - Lori Shah
- Department of Pulmonary, Allergy and
Critical Care Medicine, Columbia University Irving Medical Center, New York, NY,
USA
| | - Selim Arcasoy
- Department of Pulmonary, Allergy and
Critical Care Medicine, Columbia University Irving Medical Center, New York, NY,
USA
| | - Frank D’Ovidio
- Department of Surgery, Section of
General Thoracic Surgery, Columbia University Irving Medical Center, New York, NY,
USA
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11
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Furfaro D, Rosenzweig EB, Shah L, Robbins H, Anderson M, Kim H, Abrams D, Agerstrand CL, Brodie D, Feldhaus D, Costa J, Lemaitre P, Stanifer BP, D'Ovidio F, Sonett JR, Arcasoy S, Benvenuto L. Lung transplantation disparities based on diagnosis for patients bridging to transplant on extracorporeal membrane oxygenation. J Heart Lung Transplant 2021; 40:1641-1648. [PMID: 34548196 DOI: 10.1016/j.healun.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/02/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is increasingly utilized as a bridge to lung transplantation, but ECMO status is not explicitly accounted for in the Lung Allocation Score (LAS). We hypothesized that among waitlist patients on ECMO, patients with pulmonary arterial hypertension (PAH) would have lower transplantation rates. METHODS Using United Network for Organ Sharing data, we conducted a retrospective cohort study of patients who were ≥12 years old, active on the lung transplant waitlist, and required ECMO support from June 1, 2015 through June 12, 2020. Multivariable competing risk analysis was used to examine waitlist outcomes. RESULTS 1064 waitlist subjects required ECMO support; 40 (3.8%) had obstructive lung disease (OLD), 97 (9.1%) had PAH,138 (13.0%) had cystic fibrosis (CF), and 789 (74.1%) had interstitial lung disease (ILD). Ultimately, 671 (63.1%) underwent transplant, while 334 (31.4%) died or were delisted. The transplant rate per person-years on the waitlist on ECMO was 15.41 for OLD, 6.05 for PAH, 15.66 for CF, and 15.62 for ILD. Compared to PAH patients, OLD, CF, and ILD patients were 78%, 69%, and 62% more likely to undergo transplant throughout the study period, respectively (adjusted SHRs 1.78 p = 0.007, 1.69 p = 0.002, and 1.62 p = 0.001). The median LAS at waitlist removal for transplantation, death, or delisting were 75.1 for OLD, 79.6 for PAH, 91.0 for CF, and 88.3 for ILD (p < 0.001). CONCLUSIONS Among patients bridging to transplant on ECMO, patients with PAH had a lower transplantation rate than patients with OLD, CF, and ILD.
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Affiliation(s)
- David Furfaro
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
| | - Erika B Rosenzweig
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Lori Shah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Hilary Robbins
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Michaela Anderson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Hanyoung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Darryl Abrams
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Cara L Agerstrand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Danielle Feldhaus
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Joseph Costa
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Philippe Lemaitre
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Bryan P Stanifer
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Frank D'Ovidio
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Joshua R Sonett
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Selim Arcasoy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Luke Benvenuto
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Leiva-Juarez MM, Benvenuto L, Costa J, Blackett JW, Aversa M, Robbins H, Shah L, Stanifer BP, Lemaître PH, Jodorkovsky D, Arcasoy S, Sonett JR, D'Ovidio F. Identification of Lung Transplant Recipients with a Survival Benefit after Fundoplication. Ann Thorac Surg 2021; 113:1801-1810. [PMID: 34280376 DOI: 10.1016/j.athoracsur.2021.05.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/02/2021] [Accepted: 05/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) and aspiration of enteric contents is associated with worse outcomes after lung transplant. The purpose of this study is to elucidate populations that benefit the most from fundoplication after lung transplant. METHODS Lung transplants from 2001-2019 (n=971) were retrospectively reviewed and stratified by a fundoplication before (n=128) or after (n=24) chronic lung allograft dysfunction (CLAD) development vs those who didn't. Patients with a fundoplication prior to CLAD were propensity-matched to those without a fundoplication. The primary outcome of interest was post-transplant survival. Time-to-event rates were calculated using a multivariable Cox proportional hazards model and Kaplan-Meier functions. RESULTS A fundoplication prior to CLAD improved post-transplant survival before and after propensity-matching, and remained a significant predictor after adjusting for baseline characteristics (HR:0.57, 95% CI:0.4-0.8, P=0.001). Recipients with a restrictive disorder (HR: 0.46, 95% CI:0.3-0.73, P=0.001), age <65 (HR:0.48, 95% CI:0.32-0.71, P<0.001), and both single (HR:0.47, 95% CI:0.28-0.79, P=0.005) or double (HR:0.55, 95% CI:0.32-0.93, P=0.027) lung transplants had a significant decrease in mortality after fundoplication. The effect was present after excluding early deaths and/or CLAD diagnoses. GERD diagnosed by pH, impedance or EGD was not associated with worse outcomes. Among patients with CLAD, a fundoplication was an independent predictor of post-CLAD survival (HR:0.27, 95% CI:0.12-0.61, P=0.002). CONCLUSIONS A fundoplication before or after CLAD development is an independent predictor of survival. Younger patients with restrictive disease, independent of the type of transplant, have a survival benefit. GERD diagnosed by conventional methods was not associated with worse survival.
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Affiliation(s)
- Miguel M Leiva-Juarez
- Division of Thoracic Surgery and Lung Transplant, Columbia University Medical Center, New York, New York
| | - Luke Benvenuto
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, New York
| | - Joseph Costa
- Division of Thoracic Surgery and Lung Transplant, Columbia University Medical Center, New York, New York
| | - John W Blackett
- Division of Gastroenterology, Columbia University Medical Center, New York, New York
| | - Meghan Aversa
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, New York
| | - Hilary Robbins
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, New York
| | - Lori Shah
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, New York
| | - Bryan P Stanifer
- Division of Thoracic Surgery and Lung Transplant, Columbia University Medical Center, New York, New York
| | - Phillippe H Lemaître
- Division of Thoracic Surgery and Lung Transplant, Columbia University Medical Center, New York, New York
| | - Daniela Jodorkovsky
- Division of Gastroenterology, Columbia University Medical Center, New York, New York
| | - Selim Arcasoy
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, New York
| | - Joshua R Sonett
- Division of Thoracic Surgery and Lung Transplant, Columbia University Medical Center, New York, New York
| | - Frank D'Ovidio
- Division of Thoracic Surgery and Lung Transplant, Columbia University Medical Center, New York, New York.
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13
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Burack D, Pereira MR, Tsapepas DS, Harren P, Farr MA, Arcasoy S, Cohen DJ, Mohan S, Emond JC, Hod EA, Verna EC. Prevalence and predictors of SARS-CoV-2 antibodies among solid organ transplant recipients with confirmed infection. Am J Transplant 2021; 21:2254-2261. [PMID: 33590675 PMCID: PMC8014874 DOI: 10.1111/ajt.16541] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [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: 09/11/2020] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 01/25/2023]
Abstract
It remains uncertain whether immunocompromised patients including solid organ transplant (SOT) recipients will have a robust antibody response to SARS-CoV-2 infection. We enrolled all adult SOT recipients at our center with confirmed SARS-CoV-2 infection who underwent antibody testing with a single commercially available anti-nucleocapsid antibody test at least 7 days after diagnosis in a retrospective cohort. Seventy SOT recipients were studied (56% kidney, 19% lung, 14% liver ± kidney, and 11% heart ± kidney recipients). Thirty-six (51%) had positive anti-nucleocapsid antibody testing, and 34 (49%) were negative. Recipients of a kidney allograft were less likely to have positive antibody testing compared to those who did not receive a kidney (p = .04). In the final multivariable model, the years from transplant to diagnosis (OR 1.26, p = .002) and baseline immunosuppression with more than two agents (OR 0.26, p = .03) were significantly associated with the antibody test result, controlling for kidney transplantation. In conclusion, among SOT recipients with confirmed infection, only 51% of patients had detectable anti-nucleocapsid antibodies, and transplant-related variables including the level and nature of immunosuppression were important predictors. These findings raise the concern that SOT recipients with COVID-19 may be less likely to form SARS-CoV-2 antibodies.
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Affiliation(s)
- Daniel Burack
- Department of Medicine, Columbia University College of Physicians & Surgeons, New York, New York,Correspondence Elizabeth C. Verna, Center for Liver Disease and Transplantation, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Marcus R. Pereira
- Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians & Surgeons, New York, New York
| | - Demetra S. Tsapepas
- Department of Surgery, Columbia University College of Physicians & Surgeons, New York, New York
| | - Patricia Harren
- Department of Surgery, Columbia University College of Physicians & Surgeons, New York, New York
| | - Maryjane A. Farr
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, New York
| | - Selim Arcasoy
- Department of Medicine, Division of Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians & Surgeons, New York, New York
| | - David J. Cohen
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, New York
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, New York
| | - Jean C. Emond
- Department of Surgery, Columbia University College of Physicians & Surgeons, New York, New York,Center for Liver Disease and Transplantation, Columbia University College of Physicians & Surgeons, New York, New York
| | - Eldad A. Hod
- Department of Pathology, Columbia University College of Physicians & Surgeons, New York, New York
| | - Elizabeth C. Verna
- Center for Liver Disease and Transplantation, Columbia University College of Physicians & Surgeons, New York, New York,Department of Medicine, Division of Digestive and Liver Diseases, Columbia University College of Physicians & Surgeons, New York, New York
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14
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Urso A, Leiva-Juárez MM, Briganti DF, Aramini B, Benvenuto L, Costa J, Nandakumar R, Gomez EA, Robbins HY, Shah L, Aversa M, Sonnet JR, Arcasoy S, Cremers S, D'Ovidio F. Aspiration of conjugated bile acids predicts adverse lung transplant outcomes and correlates with airway lipid and cytokine dysregulation. J Heart Lung Transplant 2021; 40:998-1008. [PMID: 34183226 DOI: 10.1016/j.healun.2021.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/08/2021] [Accepted: 05/20/2021] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Duodeno-gastroesophageal reflux aspiration is associated with chronic lung allograft dysfunction (CLAD). Reflux aspirate can contain bile acids (BA), functional molecules in the gastro-intestinal tract with emulsifying properties. We sought to determine and quantify the various BA species in airways of the lung transplant recipients to better understand the various effects of aspirated BA that contribute to post-transplantation outcomes. METHODS Bronchial washings (BW) were prospectively collected from lung transplant recipients and subsequently assayed by liquid chromatography-mass spectrometry for 13 BA and 25 lipid families. Patients were monitored for CLAD, rejection, inflammation and airway infections. RESULTS Detectable BA were present in 45/50 patients (90%) at 3 months after transplant. Elevated BA and predominance of conjugated species were independent predictors of CLAD (hazard ratio 7.9; 95% confidence interval 2.7-23.6; p < 0.001 and 7.3; 2.4-22; p < 0.001, respectively) and mortality (hazard ratio 4.4; 1.5-12.7; p = 0.007 and 4.8; 1.4-15.8; p = 0.01, respectively). High BA associated with increased positive bacterial cultures (60% vs 25%, p = 0.02). Primary conjugated species independently correlated with the rate of bacterial cultures during the first-year post-transplant (Beta coefficient: 0.77; 0.28-1.26; p = 0.003) and changes in airway lipidome and cytokines. CONCLUSIONS Higher BA levels and predominance of conjugated BA are independent predictors of chronic lung allograft dysfunction, mortality and bacterial infections. Primary conjugated BA are related to distinct changes in airway lipidome and inflammatory cytokines. This elucidates novel evidence into the mechanism following BA aspiration and proposes novel markers for prediction of adverse post-transplant outcomes.
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Affiliation(s)
- Andreacarola Urso
- Department of Surgery, Division of Cardiac ,Thoracic, & Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Miguel M Leiva-Juárez
- Department of Surgery, Division of Cardiac ,Thoracic, & Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Domenica F Briganti
- Department of Surgery, Division of Cardiac ,Thoracic, & Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Beatrice Aramini
- Department of Surgery, Division of Cardiac ,Thoracic, & Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Luke Benvenuto
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY
| | - Joseph Costa
- Department of Surgery, Division of Cardiac ,Thoracic, & Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Renu Nandakumar
- Department of Pathology, Columbia University Irving Medical Center, New York, NY
| | - Estela Area Gomez
- Department of Pathology, Columbia University Irving Medical Center, New York, NY
| | - Hilary Y Robbins
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY
| | - Lori Shah
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY
| | - Meghan Aversa
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY
| | - Joshua R Sonnet
- Department of Surgery, Division of Cardiac ,Thoracic, & Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Selim Arcasoy
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY
| | - Serge Cremers
- Department of Pathology, Columbia University Irving Medical Center, New York, NY
| | - Frank D'Ovidio
- Department of Surgery, Division of Cardiac ,Thoracic, & Vascular Surgery, Columbia University Irving Medical Center, New York, NY.
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15
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Pereira MR, Arcasoy S, Farr MA, Mohan S, Emond JC, Tsapepas DS, Shi Q, Purpura L, Uhlemann AC, Zucker J, Verna EC. Outcomes of COVID-19 in solid organ transplant recipients: A matched cohort study. Transpl Infect Dis 2021; 23:e13637. [PMID: 33993630 PMCID: PMC8209880 DOI: 10.1111/tid.13637] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/30/2021] [Indexed: 12/15/2022]
Abstract
Whether solid organ transplant (SOT) recipients are at increased risk of poor outcomes due to COVID‐19 in comparison to the general population remains uncertain. In this study, we compared outcomes of SOT recipients and non‐SOT patients hospitalized with COVID‐19 in a propensity score matched analysis based on age, race, ethnicity, BMI, diabetes, and hypertension. After propensity matching, 117 SOT recipients and 350 non‐SOT patients were evaluated. The median age of SOT recipients was 61 years, with a median time from transplant of 5.68 years. The most common transplanted organs were kidney (48%), followed by lung (21%), heart (19%), and liver (10%). Overall, SOT recipients were more likely to receive COVID‐19 specific therapies and to require ICU admission. However, mortality (23.08% in SOT recipients vs. 23.14% in controls, P = .21) and highest level of supplemental oxygen (P = .32) required during hospitalization did not significantly differ between groups. In this propensity matched cohort study, SOT recipients hospitalized with COVID‐19 had similar overall outcomes as non‐SOT recipients, suggesting that chronic immunosuppression may not be an independent risk factor for poor outcomes in COVID‐19.
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Affiliation(s)
- Marcus R Pereira
- Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Selim Arcasoy
- Lung Transplant Program, Division of Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Maryjane A Farr
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY, USA.,Columbia University College of Physicians and Surgeons, The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jean C Emond
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Demetra S Tsapepas
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Qiuhu Shi
- Department of Public Health, School of Health Sciences and Practice, New York Medical College, New York, NY, USA
| | - Lawrence Purpura
- Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Anne-Catrin Uhlemann
- Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Jason Zucker
- Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Elizabeth C Verna
- Department of Medicine, Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, NY, USA
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16
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Hage CA, Klesney-Tait J, Wille K, Arcasoy S, Yung G, Hertz M, Chan KM, Morrell M, Goldberg H, Vedantham S, Derfler MC, Commean P, Berman K, Spitznagel E, Atkinson J, Despotis G. Extracorporeal photopheresis to attenuate decline in lung function due to refractory obstructive allograft dysfunction. Transfus Med 2021; 31:292-302. [PMID: 33955079 PMCID: PMC8453798 DOI: 10.1111/tme.12779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/18/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND This study was designed to prospectively evaluate the efficacy of extracorporeal photopheresis (ECP) to attenuate the rate of decline of FEV1 in lung transplant recipients with refractory bronchiolitis obliterans. Due to an observed higher than expected early mortality, a preliminary analysis was performed. STUDY DESIGN AND METHODS Subjects from 10 lung transplant centres were assigned to ECP treatment or to observation based on spirometric criteria, with potential crossover for those under observation. The primary endpoint of this study was to assess response to ECP (i.e., greater than a 50% decrease in the rate of FEV1 decline) before and 6 months after initiation of ECP. Mortality was also evaluated 6 and 12 months after enrolment as a secondary endpoint. RESULTS Of 44 enrolled subjects, 31 were assigned to ECP treatment while 13 were initially assigned to observation on a non-random basis using specific spirometric inclusion criteria (seven of the observation patients subsequently crossed over to receive ECP). Of evaluable patients, 95% of patients initially assigned to treatment responded to ECP with rates of FEV1 decline that were reduced by 93% in evaluable ECP-treated patients. Mortality rates (percentages) at 6 and 12 months after enrolment was 32% and 41%, respectively. The most common (92%) primary cause of death was respiratory or graft failure. Significantly (p = 0.002) higher rates of FEV1 decline were observed in the non-survivors (-212 ± 177 ml/month) when compared to the survivors (-95 ± 117 ml/month) 12 months after enrolment. In addition, 18 patients with bronchiolitis obliterans syndrome (BOS) diagnosis within 6 months of enrolment had lost 38% of their baseline lung function at BOS diagnosis and 50% of their lung function at enrolment. CONCLUSIONS These analyses suggest that earlier detection and treatment of BOS should be considered to appreciate improved outcomes with ECP.
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Affiliation(s)
| | - Chadi A Hage
- Department of Medicine, Division of Pulmonology, Indiana University, Bloomington, Indiana, USA
| | - Julia Klesney-Tait
- Department of Medicine, Division of Pulmonology, University of Iowa, Iowa City, Iowa, USA
| | - Keith Wille
- Department of Medicine, Division of Pulmonology, University of Alabama, Tuscaloosa, Alabama, USA
| | - Selim Arcasoy
- Department of Medicine, Division of Pulmonology, Columbia University of Alabama, Orange Beach, Alabama, USA
| | - Gordon Yung
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - Marshall Hertz
- Department of Medicine, Division of Pulmonology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kevin M Chan
- Department of Medicine, Division of Pulmonology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matt Morrell
- Department of Medicine, Division of Pulmonology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hilary Goldberg
- Harvard Medical School, Department of Medicine, Division of Pulmonology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Suresh Vedantham
- Clinical Coordinating Center, Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, Missouri, USA
| | - Mary Clare Derfler
- Clinical Coordinating Center, Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, Missouri, USA
| | - Paul Commean
- Data Coordinating Center, Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, Missouri, USA
| | - Keith Berman
- Health Research Associates, Mountlake Terrace, Washington, USA
| | - Ed Spitznagel
- Department of Mathematics, Washington University, St. Louis, Missouri, USA
| | - Jeff Atkinson
- Department of Internal Medicine, Division of Pulmonary Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - George Despotis
- Department of Pathology & Immunology, Division of Laboratory & Genomic Medicine, Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
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17
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Benvenuto L, Snyder ME, Aversa M, Patel S, Costa J, Shah L, Robbins H, D’Ovidio F, Sonett J, Stanifer BP, Lemaitre P, Arcasoy S, Anderson MR. Geographic Differences in Lung Transplant Volume and Donor Availability During the COVID-19 Pandemic. Transplantation 2021; 105:861-866. [PMID: 33760792 PMCID: PMC7993650 DOI: 10.1097/tp.0000000000003600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Regional variation in lung transplantation practices due to local coronavirus disease 2019 (COVID-19) prevalence may cause geographic disparities in access to lung transplantation. METHODS Using the United Network for Organ Sharing registry, we conducted a descriptive analysis of lung transplant volume, donor lung volume, new waitlist activations, and waiting list deaths at high-volume lung transplant centers during the first 3 months of the pandemic (March 1. 2020, to May 30, 2020) and we compared it to the same period in the preceding 5 years. RESULTS Lung transplant volume decreased by 10% nationally and by a median of 50% in high COVID-19 prevalence centers (range -87% to 80%) compared with a median increase of 10% (range -87% to 80%) in low prevalence centers (P-for-trend 0.006). Donation services areas with high COVID-19 prevalence experienced a greater decrease in organ availability (-28% range, -72% to -11%) compared with low prevalence areas (+7%, range -20% to + 55%, P-for-trend 0.001). Waiting list activations decreased at 18 of 22 centers. Waiting list deaths were similar to the preceding 5 years and independent of local COVID-19 prevalence (P-for-trend 0.36). CONCLUSIONS Regional variation in transplantation and donor availability in the early months of the pandemic varied by local COVID-19 activity.
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Affiliation(s)
- Luke Benvenuto
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Mark E. Snyder
- Division of Pulmonary, Critical Care, University of Pittsburgh, Pittsburgh, PA
| | - Meghan Aversa
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Shreena Patel
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Joseph Costa
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Lori Shah
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Hilary Robbins
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Frank D’Ovidio
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Joshua Sonett
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Bryan P. Stanifer
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Philippe Lemaitre
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Selim Arcasoy
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
| | - Michaela R. Anderson
- Division of Pulmonary, Allergy, Critical Care, Columbia University Irving Medical Center, New York, NY
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18
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Leiva-Juarez M, Benvenuto L, Costa J, Urso A, Stanifer B, Lemaitre P, Sonett J, Aversa M, Robbins H, Shah L, Arcasoy S, D'Ovidio F. Histologic Phenotypes and Outcomes in Single vs Double Lung Transplantation among Recipients with Interstitial Lung Disease. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.910] [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: 10/21/2022] Open
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19
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Pereira MR, Aversa MM, Farr MA, Miko BA, Aaron JG, Mohan S, Cohen DJ, Husain SA, Ratner LE, Arcasoy S, Uriel N, Zheng EX, Fox AN, Tsapepas DS, Emond JC, Verna EC. Tocilizumab for severe COVID-19 in solid organ transplant recipients: a matched cohort study. Am J Transplant 2020; 20:3198-3205. [PMID: 32946668 PMCID: PMC7537322 DOI: 10.1111/ajt.16314] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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: 06/24/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 01/25/2023]
Abstract
The safety and efficacy of tocilizumab for the treatment of severe respiratory symptoms due to COVID-19 remain uncertain, in particular among solid organ transplant (SOT) recipients. Thus, we evaluated the clinical characteristics and outcomes of 29 hospitalized SOT recipients who received tocilizumab for severe COVID-19, compared to a matched control group who did not. Among a total of 117 total SOT recipients hospitalized with COVID-19, 29 (24.8%) received tocilizumab. The 90-day mortality was significantly higher among patients who received tocilizumab (41%) compared to those who did not (20%, P = .03). When compared to control patients matched by age, hypertension, chronic kidney disease, and administration of high dose corticosteroids, there was no significant difference in mortality (41% vs 28%, P = .27), hospital discharge (52% vs 72%, P = .26), or secondary infections (34% vs 24%, P = .55). Among patients who received tocilizumab, there was also no difference in mortality based on the level of oxygen support (intubated vs not intubated) at the time of tocilizumab initiation. In this matched cohort study, tocilizumab appeared to be safe but was not associated with decreased 90-day mortality. Larger randomized studies are needed to identify whether there are subsets of SOT recipients who may benefit from tocilizumab for treatment of COVID-19.
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Affiliation(s)
- Marcus R. Pereira
- Department of MedicineDivision of Infectious DiseaseColumbia University College of Physicians & SurgeonsNew YorkNY
| | - Meghan M. Aversa
- Lung Transplant ProgramDivision of Division of Pulmonary, Allergy and Critical Care MedicineColumbia University College of Physicians & SurgeonsNew YorkNY
| | - Maryjane A. Farr
- Department of MedicineDivision of CardiologyColumbia University College of Physicians & SurgeonsNew YorkNY
| | - Benjamin A. Miko
- Department of MedicineDivision of Infectious DiseaseColumbia University College of Physicians & SurgeonsNew YorkNY
| | - Justin G. Aaron
- Department of MedicineDivision of Infectious DiseaseColumbia University College of Physicians & SurgeonsNew YorkNY
| | - Sumit Mohan
- Department of MedicineDivision of NephrologyColumbia University College of Physicians & SurgeonsNew YorkNY,The Columbia University Renal Epidemiology (CURE) GroupNew YorkNY,Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkNY
| | - David J. Cohen
- Department of MedicineDivision of NephrologyColumbia University College of Physicians & SurgeonsNew YorkNY
| | - Syed A. Husain
- Department of MedicineDivision of NephrologyColumbia University College of Physicians & SurgeonsNew YorkNY
| | - Lloyd E. Ratner
- Department of MedicineDivision of NephrologyColumbia University College of Physicians & SurgeonsNew YorkNY
| | - Selim Arcasoy
- Lung Transplant ProgramDivision of Division of Pulmonary, Allergy and Critical Care MedicineColumbia University College of Physicians & SurgeonsNew YorkNY
| | - Nir Uriel
- Department of MedicineDivision of CardiologyColumbia University College of Physicians & SurgeonsNew YorkNY
| | - Elizabeth X. Zheng
- Department of MedicineDivision of Digestive & Liver DiseasesColumbia University College of Physicians & SurgeonsNew YorkNY
| | - Alyson N. Fox
- Department of MedicineDivision of Digestive & Liver DiseasesColumbia University College of Physicians & SurgeonsNew YorkNY
| | - Demetra S. Tsapepas
- Department of SurgeryColumbia University College of Physicians & SurgeonsNew YorkNY
| | - Jean C. Emond
- Department of SurgeryColumbia University College of Physicians & SurgeonsNew YorkNY
| | - Elizabeth C. Verna
- Department of MedicineDivision of Digestive & Liver DiseasesColumbia University College of Physicians & SurgeonsNew YorkNY
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20
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Aversa M, Benvenuto L, Anderson M, Shah L, Robbins H, Pereira M, Scheffert J, Carroll M, Hum J, Nolan M, Reilly G, Lemaitre P, Stanifer BP, D’Ovidio F, Sonett J, Arcasoy S. COVID-19 in lung transplant recipients: A single center case series from New York City. Am J Transplant 2020; 20:3072-3080. [PMID: 32881315 PMCID: PMC7436464 DOI: 10.1111/ajt.16241] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 01/25/2023]
Abstract
There are limited data describing COVID-19 in lung transplant recipients. We performed a single center, retrospective case series study of lung transplant patients followed by the Columbia Lung Transplant program who tested positive for SARS-CoV-2 between March 19 and May 19, 2020. Thirty-two lung transplant patients developed mild (16%), moderate (44%), or severe (41%) COVID-19. The median age of patients was 65 years, and the median time from lung transplant was 5.6 years. Symptoms included cough (66%), dyspnea (50%), fever (47%), and gastrointestinal upset (44%). Patients received hydroxychloroquine (84%), azithromycin (75%), augmented steroids (44%), tocilizumab (19%), and remdesivir (9%). Eleven patients (34%) died at a median time of 14 days from admission. Complications during admission included: acute kidney injury (63%), transaminitis (31%), shock (31%), acute respiratory distress syndrome (25%), neurological events (25%), arrhythmias (22%), and venous thromboembolism (9%). Compared to patients with moderate COVID-19, patients with severe COVID-19 had higher peak white blood cell counts (15.8 vs 7 × 103 /uL, P = .019), C-reactive protein (198 vs. 107 mg/L, P = .010) and D-dimer (8.6 vs. 2.1 ug/mL, P = .004) levels, and lower nadir lymphocyte counts (0.09 vs. 0.4 × 103 /uL, P = .006). COVID-19 is associated with severe illness and a high mortality rate in lung transplant recipients.
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Key Words
- clinical research/practice
- complication: infectious
- infection and infectious agents - viral
- lung failure/injury
- lung transplantation/pulmonology
- patient survival
- aki, acute kidney injury
- alt, alanine aminotransferase
- ards, acute respiratory distress syndrome
- ast, aspartate aminotransferase
- bid, bis in die
- bmi, body mass index
- bos, bronchiolitis obliterans syndrome
- c. albicans, candida albicans
- cf, cystic fibrosis
- ckd, chronic kidney disease
- copd, chronic obstructive pulmonary disease
- covid-19, coronavirus disease 2019
- crp, c-reactive protein
- e. faecalis, enterococcus faecalis
- egfr, estimated glomerular filtration rate
- esr, erythrocyte sedimentation rate
- gi, gastrointestinal
- icu, intensive care unit
- il-6, interleukin-6
- ild, interstitial lung disease
- iqr, interquartile range
- ishlt, international society of heart and lung transplantation
- iv, intravenous
- k. pneumoniae, klebsiella pneumoniae
- kg, kilogram
- ldh, lactate dehydrogenase
- m. morganii, morganella morganii
- mg, milligram
- mrsa, methicillin-resistant staphylococcus aureus
- mssa, methicillin-sensitive staphylococcus aureus
- p. aeruginosa, pseudomonas aerugoinosa
- pah, pulmonary arterial hypertension
- pcr, polymerase chain reaction
- pft, pulmonary function test
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- vte, venous thromboembolism
- wbc, white blood cell
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Affiliation(s)
- Meghan Aversa
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA,Correspondence Meghan Aversa
| | - Luke Benvenuto
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Michaela Anderson
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Lori Shah
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Hilary Robbins
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Marcus Pereira
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jenna Scheffert
- Department of Pharmacy, New York-Presbyterian Hospital, New York, New York, USA
| | - Maggie Carroll
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jamie Hum
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Margaret Nolan
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Genevieve Reilly
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Philippe Lemaitre
- Division of Thoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Bryan P. Stanifer
- Division of Thoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Frank D’Ovidio
- Division of Thoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Joshua Sonett
- Division of Thoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Selim Arcasoy
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA
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21
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Pereira MR, Mohan S, Cohen DJ, Husain SA, Dube GK, Ratner LE, Arcasoy S, Aversa MM, Benvenuto LJ, Dadhania DM, Kapur S, Dove LM, Brown RS, Rosenblatt RE, Samstein B, Uriel N, Farr MA, Satlin M, Small CB, Walsh TJ, Kodiyanplakkal RP, Miko BA, Aaron JG, Tsapepas DS, Emond JC, Verna EC. COVID-19 in solid organ transplant recipients: Initial report from the US epicenter. Am J Transplant 2020; 20:1800-1808. [PMID: 32330343 PMCID: PMC7264777 DOI: 10.1111/ajt.15941] [Citation(s) in RCA: 629] [Impact Index Per Article: 157.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 01/25/2023]
Abstract
Solid organ transplant recipients may be at a high risk for SARS-CoV-2 infection and poor associated outcomes. We herein report our initial experience with solid organ transplant recipients with SARS-CoV-2 infection at two centers during the first 3 weeks of the outbreak in New York City. Baseline characteristics, clinical presentation, antiviral and immunosuppressive management were compared between patients with mild/moderate and severe disease (defined as ICU admission, intubation or death). Ninety patients were analyzed with a median age of 57 years. Forty-six were kidney recipients, 17 lung, 13 liver, 9 heart, and 5 dual-organ transplants. The most common presenting symptoms were fever (70%), cough (59%), and dyspnea (43%). Twenty-two (24%) had mild, 41 (46%) moderate, and 27 (30%) severe disease. Among the 68 hospitalized patients, 12% required non-rebreather and 35% required intubation. 91% received hydroxychloroquine, 66% azithromycin, 3% remdesivir, 21% tocilizumab, and 24% bolus steroids. Sixteen patients died (18% overall, 24% of hospitalized, 52% of ICU) and 37 (54%) were discharged. In this initial cohort, transplant recipients with COVID-19 appear to have more severe outcomes, although testing limitations likely led to undercounting of mild/asymptomatic cases. As this outbreak unfolds, COVID-19 has the potential to severely impact solid organ transplant recipients.
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Affiliation(s)
- Marcus R. Pereira
- Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians & Surgeons, New York, New York, USA,Correspondence Marcus R. Pereira
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, New York, USA,The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - David J. Cohen
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Syed A. Husain
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, New York, USA,The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA
| | - Geoffrey K. Dube
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Lloyd E. Ratner
- Department of Surgery, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Selim Arcasoy
- Lung Transplant Program, Division of Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Meghan M. Aversa
- Lung Transplant Program, Division of Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Luke J. Benvenuto
- Lung Transplant Program, Division of Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Darshana M. Dadhania
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, New York, USA
| | - Sandip Kapur
- Department of Surgery, Division of Transplant Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Lorna M. Dove
- Department of Medicine, Division of Digestive & Liver Diseases, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Robert S. Brown
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Russell E. Rosenblatt
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Benjamin Samstein
- Department of Surgery, Division of Transplant Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Maryjane A. Farr
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Michael Satlin
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | - Catherine B. Small
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | - Thomas J. Walsh
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | - Rosy P. Kodiyanplakkal
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| | - Benjamin A. Miko
- Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Justin G. Aaron
- Department of Medicine, Division of Infectious Disease, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Demetra S. Tsapepas
- Department of Surgery, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Jean C. Emond
- Department of Surgery, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Elizabeth C. Verna
- Department of Medicine, Division of Digestive & Liver Diseases, Columbia University College of Physicians & Surgeons, New York, New York, USA
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22
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Anderson MR, Easthausen I, Gallagher G, Udupa J, Tong Y, Torigian D, Diamond JM, Porteous MK, Palmer SM, Snyder LD, Benvenuto L, Aversa M, Arcasoy S, Greenland JR, Hays SR, Kukreja J, Cantu E, Kim JS, Gallagher D, Baldwin MR, Barr RG, Lederer DJ, Christie JD, Singer JP. Skeletal muscle adiposity and outcomes in candidates for lung transplantation: a lung transplant body composition cohort study. Thorax 2020; 75:801-804. [PMID: 32482837 DOI: 10.1136/thoraxjnl-2019-214461] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 12/16/2019] [Revised: 04/25/2020] [Accepted: 05/07/2020] [Indexed: 01/08/2023]
Abstract
CT measurement of body composition may improve lung transplant candidate selection. We assessed whether skeletal muscle adipose deposition on abdominal and thigh CT scans was associated with 6 min walk distance (6MWD) and wait-list survival in lung transplant candidates. Each ½-SD decrease in abdominal muscle attenuation (indicating greater lipid content) was associated with 14 m decrease in 6MWD (95% CI -20 to -8) and 20% increased risk of death or delisting (95% CI 10% to 40%). Each ½-standard deviation decrease in thigh muscle attenuation was associated with 15 m decrease in 6MWD (95% CI -21 to -10). CT imaging may improve candidate risk stratification.
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Affiliation(s)
| | - Imaani Easthausen
- Population Health Sciences, Weill Cornell Medical College, New York, New York, USA
| | - Grace Gallagher
- Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jayaram Udupa
- Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yubing Tong
- Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Drew Torigian
- Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joshua Matthew Diamond
- Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary Katherine Porteous
- Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott M Palmer
- Medicine, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Luke Benvenuto
- Medicine, Columbia University Medical Center, New York, New York, USA
| | - Meghan Aversa
- Medicine, Columbia University Medical Center, New York, New York, USA
| | - Selim Arcasoy
- Medicine, Columbia University Medical Center, New York, New York, USA
| | - John R Greenland
- Medicine, VA Medical Center, San Francisco, California, USA.,Medicine, University of California, San Francisco, California, USA
| | - Steven R Hays
- Medicine, University of California, San Francisco, California, USA
| | - Jasleen Kukreja
- Surgery, University of California, San Francisco, California, USA
| | - Edward Cantu
- Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Shinn Kim
- Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Dympna Gallagher
- Medicine, Columbia University Medical Center, New York, New York, USA
| | - Matthew R Baldwin
- Medicine, Columbia University Medical Center, New York, New York, USA
| | - R Graham Barr
- Medicine, Columbia University Medical Center, New York, New York, USA
| | - David J Lederer
- Medicine, Columbia University Medical Center, New York, New York, USA.,Regeneron Pharmaceuticals Inc, Tarrytown, New York, USA
| | - Jason D Christie
- Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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23
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Snyder ME, Finlayson MO, Connors TJ, Dogra P, Senda T, Bush E, Carpenter D, Marboe C, Benvenuto L, Shah L, Robbins H, Hook JL, Sykes M, D'Ovidio F, Bacchetta M, Sonett JR, Lederer DJ, Arcasoy S, Sims PA, Farber DL. Generation and persistence of human tissue-resident memory T cells in lung transplantation. Sci Immunol 2020; 4:4/33/eaav5581. [PMID: 30850393 DOI: 10.1126/sciimmunol.aav5581] [Citation(s) in RCA: 172] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/28/2019] [Indexed: 12/20/2022]
Abstract
Tissue-resident memory T cells (TRM) maintain immunity in diverse sites as determined in mouse models, whereas their establishment and role in human tissues have been difficult to assess. Here, we investigated human lung TRM generation, maintenance, and function in airway samples obtained longitudinally from human leukocyte antigen (HLA)-disparate lung transplant recipients, where donor and recipient T cells could be localized and tracked over time. Donor T cells persist specifically in the lungs (and not blood) of transplant recipients and express high levels of TRM signature markers including CD69, CD103, and CD49a, whereas lung-infiltrating recipient T cells gradually acquire TRM phenotypes over months in vivo. Single-cell transcriptome profiling of airway T cells reveals that donor T cells comprise two TRM-like subsets with varying levels of expression of TRM-associated genes, whereas recipient T cells comprised non-TRM and similar TRM-like subpopulations, suggesting de novo TRM generation. Transplant recipients exhibiting higher frequencies of persisting donor TRM experienced fewer adverse clinical events such as primary graft dysfunction and acute cellular rejection compared with recipients with low donor TRM persistence, suggesting that monitoring TRM dynamics could be clinically informative. Together, our results provide spatial and temporal insights into how human TRM develop, function, persist, and affect tissue integrity within the complexities of lung transplantation.
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Affiliation(s)
- Mark E Snyder
- Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA.,Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY 10032, USA
| | - Michael O Finlayson
- Department of Systems Biology, Columbia University Medical Center, New York, NY 10032, USA
| | - Thomas J Connors
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY 10032, USA.,Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Pranay Dogra
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY 10032, USA.,Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY 10032, USA
| | - Takashi Senda
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY 10032, USA.,Department of Surgery, Columbia University Medical Center, New York, NY 10032, USA
| | - Erin Bush
- Department of Systems Biology, Columbia University Medical Center, New York, NY 10032, USA
| | - Dustin Carpenter
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY 10032, USA.,Department of Surgery, Columbia University Medical Center, New York, NY 10032, USA
| | - Charles Marboe
- Department of Pathology, Columbia University Medical Center, New York, NY 10032, USA
| | - Luke Benvenuto
- Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA
| | - Lori Shah
- Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA
| | - Hilary Robbins
- Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA
| | - Jaime L Hook
- Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA
| | - Megan Sykes
- Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA.,Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY 10032, USA.,Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY 10032, USA
| | - Frank D'Ovidio
- Department of Surgery, Columbia University Medical Center, New York, NY 10032, USA
| | - Matthew Bacchetta
- Department of Surgery, Columbia University Medical Center, New York, NY 10032, USA
| | - Joshua R Sonett
- Department of Surgery, Columbia University Medical Center, New York, NY 10032, USA
| | - David J Lederer
- Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Selim Arcasoy
- Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA.,Department of Pediatrics, Columbia University Medical Center, New York, NY 10032, USA
| | - Peter A Sims
- Department of Systems Biology, Columbia University Medical Center, New York, NY 10032, USA
| | - Donna L Farber
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY 10032, USA. .,Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY 10032, USA.,Department of Surgery, Columbia University Medical Center, New York, NY 10032, USA
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24
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Maheshwari J, Kolaitis N, Anderson M, Benvenuto L, Gao Y, Katz P, Wolters P, Golden J, Kukreja J, Hays S, Greenland J, Shah R, Leard L, Trinh B, Oyster M, Covinsky K, Calabrese D, Venado A, Patel P, Huang C, Glidden D, Kleinhenz M, Sutter N, Tietje-Ulrich G, Brown M, Arcasoy S, Christie J, Diamond J, Singer J. Sarcopenia is Associated with Frailty in Lung Transplant Candidates. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.514] [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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25
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D'Ovidio F, Floros J, Aramini B, Lederer D, DiAngelo SL, Arcasoy S, Sonett JR, Robbins H, Shah L, Costa J, Urso A. Donor surfactant protein A2 polymorphism and lung transplant survival. Eur Respir J 2020; 55:13993003.00618-2019. [PMID: 31831583 DOI: 10.1183/13993003.00618-2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 11/21/2019] [Indexed: 11/05/2022]
Abstract
PURPOSE Gene polymorphisms of surfactant proteins, key players in lung innate immunity, have been associated with various lung diseases. The aim of this study was to investigate the potential association between variations within the surfactant protein (SP)-A gene of the donor lung allograft and recipient post-transplant outcome. METHODS Lung-transplant patients (n=192) were prospectively followed-up with pulmonary function tests, bronchoscopies with bronchoalveolar lavage and biopsies. Donor lungs were assayed for SP-A1 (6An) and SP-A2 (1An) gene polymorphism using the pyrosequencing method. Unadjusted and adjusted stratified Cox survival models are reported. RESULTS SP-A1 and SP-A2 genotype frequency and lung transplant recipient and donor characteristics as well as cause of death are noted. Recipients were grouped per donor SP-A2 variants. Individuals that received lungs from donors with the SP-A2 1A0 (n=102) versus 1A1 variant (n=68) or SP-A2 genotype 1A01A0 (n=54) versus 1A0A1 (n=38) had greater survival at 1 year (log-rank p<0.025). No significant association was noted for SP-A1 variants. Stratified adjusted survival models for 1-year survival and diagnosis showed a reduced survival for 1A1 variant and the 1A01A1 genotype. Furthermore, when survival was conditional on 1-year survival no significance was observed, indicating that the survival difference was due to the first year's outcome associated with the 1A1 variant. CONCLUSION Donor lung SP-A gene polymorphisms are associated with post-transplant clinical outcome. Lungs from donors with the SP-A2 variant 1A1 had a reduced survival at 1 year. The observed donor genetic differences, via innate immunity relate to the post-transplant clinical outcome.
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Affiliation(s)
- Frank D'Ovidio
- Division of Thoracic Surgery, Lung Transplant Program, Columbia University Medical Center, New York, NY, USA
| | - Joanna Floros
- Center for Host Defense, Inflammation, and Lung Disease (CHILD) Research Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Beatrice Aramini
- Division of Thoracic Surgery, Lung Transplant Program, Columbia University Medical Center, New York, NY, USA
| | - David Lederer
- Division of Thoracic Surgery, Lung Transplant Program, Columbia University Medical Center, New York, NY, USA
| | - Susan L DiAngelo
- Center for Host Defense, Inflammation, and Lung Disease (CHILD) Research Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Selim Arcasoy
- Division of Thoracic Surgery, Lung Transplant Program, Columbia University Medical Center, New York, NY, USA
| | - Joshua R Sonett
- Division of Thoracic Surgery, Lung Transplant Program, Columbia University Medical Center, New York, NY, USA
| | - Hillary Robbins
- Division of Thoracic Surgery, Lung Transplant Program, Columbia University Medical Center, New York, NY, USA
| | - Lory Shah
- Division of Thoracic Surgery, Lung Transplant Program, Columbia University Medical Center, New York, NY, USA
| | - Joseph Costa
- Division of Thoracic Surgery, Lung Transplant Program, Columbia University Medical Center, New York, NY, USA
| | - Andreacarola Urso
- Division of Thoracic Surgery, Lung Transplant Program, Columbia University Medical Center, New York, NY, USA
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26
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Farr M, Truby LK, Lindower J, Jorde U, Taylor S, Chen L, Gass A, Stevens G, Reyentovich A, Mancini D, Arcasoy S, Delair S, Pinney S. Potential for donation after circulatory death heart transplantation in the United States: Retrospective analysis of a limited UNOS dataset. Am J Transplant 2020; 20:525-529. [PMID: 31529766 DOI: 10.1111/ajt.15597] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 03/27/2019] [Revised: 08/05/2019] [Accepted: 08/28/2019] [Indexed: 01/25/2023]
Abstract
Donation after Circulatory Death (DCD) is an alternative to Donation after Brain death (DBD), and is a growing strategy for organ procurement in the United States(US). The purpose of this analysis was to review the number and quality of hearts in one United Network for Organ Sharing (UNOS) Region that were not utilized as a potential consequence of nonheart DCD donation. We retrospectively identified all successful US DCD solid organ donors from 1/2011 to 3/1/2017, defined an ideal heart donor by age and left ventricular ejection fraction (LVEF), and then reviewed the donor charts of unused hearts in New York and Vermont (UNOS Region 9). Of 8302 successful DCD donors across the United States, 5033 (61%) were between 18 and 49 years of age, and 872 had a screening echocardiogram, with 573 (66%) measuring an EF >50%. Of these 573 potential donors, 44 (7.7%) were from Region 9. Detailed donor chart review identified 36 ideal heart donors, 24 (66.7%) with anoxic brain injury. Trends in Region 9 DCD donation increased from 4 unused hearts in 2011, to 13 in 2016. In the context of severe organ scarcity, these data indicate that implementation of DCD heart transplantation in the United States would improve overall donation rates and provide a pathway to utilize these ideal donor hearts.
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Affiliation(s)
- Maryjane Farr
- Heart and Lung Transplant Programs, Columbia University Irving Medical Center, New York, New York, USA
| | - Lauren K Truby
- Duke University Medical Center, Durham, North Carolina, USA
| | - Joel Lindower
- New York Cardiothoracic Transplant Consortium, Albany, New York, USA
| | - Ulrich Jorde
- Heart Transplant Program, Montefiore Medical Center, Bronx, New York, USA
| | - Samantha Taylor
- New York Cardiothoracic Transplant Consortium, Albany, New York, USA
| | - Leway Chen
- Heart Transplant Program, University of Rochester Medical Center, Rochester, New York, USA
| | - Alan Gass
- Heart Transplant Program, Westchester Medical Center, Valhalla, New York, USA
| | - Gerin Stevens
- Heart Transplant Program, Northwell Health, Manhasset, New York, USA
| | - Alex Reyentovich
- Heart Transplant Program, New York University, New York, New York, USA
| | - Donna Mancini
- United Network for Organ Sharing/Organ Procurement Transplant Network, Thoracic Committee, Region 9, Richmond, Virginia, USA.,Heart Transplant Program, Mt. Sinai Medical Center, New York, New York, USA
| | - Selim Arcasoy
- Heart and Lung Transplant Programs, Columbia University Irving Medical Center, New York, New York, USA
| | - Samantha Delair
- New York Cardiothoracic Transplant Consortium, Albany, New York, USA
| | - Sean Pinney
- Heart Transplant Program, Mt. Sinai Medical Center, New York, New York, USA
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27
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Anderson MR, Kolaitis NA, Gao Y, Kukreja J, Greenland J, Hays S, Wolters P, Golden J, Diamond J, Palmer S, Arcasoy S, Udupa J, Christie JD, Lederer DJ, Singer JP. A nonlinear relationship between visceral adipose tissue and frailty in adult lung transplant candidates. Am J Transplant 2019; 19:3155-3161. [PMID: 31278829 PMCID: PMC7863776 DOI: 10.1111/ajt.15525] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 02/20/2019] [Revised: 06/12/2019] [Accepted: 06/22/2019] [Indexed: 01/25/2023]
Abstract
Frailty is a state of decreased physiologic reserve associated with poor outcomes before and after lung transplantation. Obesity, particularly central obesity characterized by excess proinflammatory visceral adipose tissue (VAT), is associated with incident frailty in middle-aged and older adults. The association between VAT and frailty in advanced lung disease, however, is unknown. In two, nonoverlapping multicenter cohorts of adults listed for lung transplantation, we measured VAT area on bioelectrical impedance assay (BIA) in one cohort and cross-sectional VAT and subcutaneous adipose tissue (SAT) areas on abdominal computed tomography (CT) in the other. We identified a nonlinear relationship between greater VAT by BIA and frailty. In fully adjusted piecewise regression models, every 20 cm2 increase in VAT area was associated with 50% increased odds of frailty in subjects with high VAT (95% CI 1.2-1.9, P < .001), and 10% decreased odds of frailty (95% CI 0.7-1.04, P = .12) in subjects with low VAT. Compared to frail subjects with low VAT, those with high VAT were more likely to have low grip strength and less likely to have weight loss, suggesting that mechanisms of frailty may differ by VAT. Further investigation of mechanisms linking VAT and frailty may identify new targets for prevention and treatment.
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Affiliation(s)
| | - Nicholas A. Kolaitis
- Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Ying Gao
- Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Jasleen Kukreja
- Department of Medicine, University of California at San Francisco, San Francisco, California
| | - John Greenland
- Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Steven Hays
- Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Paul Wolters
- Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Jeff Golden
- Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Joshua Diamond
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott Palmer
- Department of Medicine, Duke University, Durham, North Carolina
| | - Selim Arcasoy
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Jayaram Udupa
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason D. Christie
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J. Lederer
- Department of Medicine, Columbia University Medical Center, New York, New York,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Jonathan P. Singer
- Department of Medicine, University of California at San Francisco, San Francisco, California
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28
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Urso A, Briganti F, Nandakumar R, Benvenuto L, Costa J, Robbins H, Shah L, Sonett J, Cremers S, Arcasoy S, D’Ovidio F. Bile acid aspiration associated to early CLAD development and dysregulation of airway lipids. Transplantation 2019. [DOI: 10.1183/13993003.congress-2019.pa3358] [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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29
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Anderson MR, Edwin EA, Diamond JM, Ferrante A, Sonett J, D’Ovidio F, Arcasoy S, Cantu E, Christie JD, Lederer DJ. Aryl-Hydrocarbon Receptor Repressor Gene in Primary Graft Dysfunction after Lung Transplantation. Am J Respir Cell Mol Biol 2019; 61:268-271. [PMID: 31368810 PMCID: PMC6670041 DOI: 10.1165/rcmb.2018-0404le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
| | | | | | | | - Joshua Sonett
- Columbia University Medical CenterNew York, New Yorkand
| | | | - Selim Arcasoy
- Columbia University Medical CenterNew York, New Yorkand
| | - Edward Cantu
- University of PennsylvaniaPhiladelphia, Pennsylvania
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30
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Anderson ME, Rodic N, Subtil A, Queen D, Arcasoy S, Niedt GW, Heald PW, Geskin LJ. Multifocal pleomorphic dermal sarcoma and the role of inflammation and immunosuppression in a lung transplant patient: a case report. J Med Case Rep 2019; 13:169. [PMID: 31142349 PMCID: PMC6542061 DOI: 10.1186/s13256-019-2093-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/07/2018] [Accepted: 04/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background Pleomorphic dermal sarcoma is the cutaneous variant of undifferentiated pleomorphic sarcoma. It is a rare malignancy of unclear histogenesis; it is a diagnosis of exclusion that requires extensive use of immunohistochemistry to rule out other malignancies. Pleomorphic dermal sarcoma typically presents as a solitary tumor in sun-exposed areas and may have unpredictable clinical behavior, with some tumors associated with metastasis and death. Case presentation We present an unusual case of multifocal pleomorphic dermal sarcoma arising in the areas of alpha-1-antitrypsin deficiency panniculitis in a lung transplant patient. Our patient was a 58-year-old white woman whose initial presentation was consistent with alpha-1-antitrypsin deficiency panniculitis. She then developed extensive multifocal, bleeding, and ulcerated nodules in the areas of the panniculitis. A skin biopsy was consistent with a diagnosis of pleomorphic dermal sarcoma. Her immunosuppressive regimen was decreased, and she was treated with liposomal doxorubicin 40 mg/m2 every 3 weeks with some initial improvement in the size of her tumors. However, soon after beginning therapy, she developed pneumonia and septic shock and ultimately died from multi-organ failure. Conclusions We hypothesize that chronic, multifocal inflammation in the skin in the setting of immunosuppression led to simultaneous, malignant transformation in numerous skin lesions. We discuss the challenges of diagnosing pleomorphic dermal sarcoma, therapeutic options, and stress the need for multidisciplinary management of these cases.
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Affiliation(s)
- Mary E Anderson
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nemanja Rodic
- Department of Dermatology, Yale-New Haven Hospital, New Haven, CT, USA
| | - Antonio Subtil
- Department of Dermatology, Yale-New Haven Hospital, New Haven, CT, USA
| | - Dawn Queen
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Selim Arcasoy
- Department of Dermatology, Columbia University Irving Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 12th floor, New York, NY, 10032, USA
| | - George W Niedt
- Department of Dermatology, Columbia University Irving Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 12th floor, New York, NY, 10032, USA
| | - Peter W Heald
- Department of Dermatology, Yale-New Haven Hospital, New Haven, CT, USA
| | - Larisa J Geskin
- Department of Dermatology, Columbia University Irving Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 12th floor, New York, NY, 10032, USA.
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Snyder M, Weisberg S, Connors T, Benvenuto L, Shah L, Robbins H, Hook J, D'Ovidio F, Sonett J, Arcasoy S, Farber D. Persisting Donor Alveolar Macrophages Have Increased Expression of Scavenger Receptor CD206 Compared to Graft-Infiltrating Recipient-Derived Macrophages Following Lung Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.378] [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: 11/15/2022] Open
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Mecadon K, Scheffert J, Shah L, Robbins H, Aversa M, Arcasoy S, Benvenuto L. Time to Therapeutic Tacrolimus Serum Concentrations and the Impact on Early Acute Cellular Rejection in Adult Lung Transplant Recipients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1024] [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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Benvenuto L, Aversa M, Shah L, Carroll M, D'Ovidio F, Stanifer B, Sonett J, Robbins H, Arcasoy S. Single Lung Transplant Compared with Double Lung Transplant in Older Adults with Interstitial Lung Disease. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.456] [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: 11/28/2022] Open
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Piloni D, Costa J, Urso A, Gomez AN, Shah L, Robbins HY, Benvenuto L, Sonett JR, Arcasoy S, D'Ovidio F. Donor lung pathological abnormalities and recipient outcomes. Transplantation 2018. [DOI: 10.1183/13993003.congress-2018.pa2592] [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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Urso A, Briganti D, Costa J, Nandakumar R, Robbins H, Shah L, Sonett J, Cremers S, Arcasoy S, D'Ovidio F. Bile Acid Aspiration is Associated with Airway Infections: A Targeted Metabolomic Approach. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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36
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Snyder M, Connors T, Benvenuto L, Shah L, Robbins H, Hook J, D'Ovidio F, Bacchetta M, Sonett J, Arcasoy S, Farber D. Impact of Primary Graft Dysfunction on Allograft T Cell Chimerism Following Lung Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.186] [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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37
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Costa J, Shah L, Robbins H, Raza K, Sreekandth S, Arcasoy S, Sonett JR, D'Ovidio F. Use of Lung Allografts From Donation After Cardiac Death Donors: A Single-Center Experience. Ann Thorac Surg 2017; 105:271-278. [PMID: 29128047 DOI: 10.1016/j.athoracsur.2017.07.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 06/26/2017] [Accepted: 07/17/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Lung transplantation remains the only treatment for end-stage lung disease. Availability of suitable lungs does not parallel this growing trend. Centers using donation after cardiac death (DCD) donor lungs report comparable outcomes with those from brain-dead donors. Donor assessment protocols and consistent surgical teams have been advocated when considering using the use of DCD donors. We present our experience using lungs from Maastricht category III DCD donors. METHODS Starting 2007 to July 2016, 73 DCD donors were assessed, 44 provided suitable lungs that resulted in 46 transplants. A 2012 to October 2016 comparative cohort of 379 brain-dead donors were assessed. Recipient and donor characteristics and primary graft dysfunction (PGD) and survival were monitored. RESULTS Seventy-three DCD (40% dry run rate) donors assessed yielded 46 transplants (23 double, 6 right, and 17 left). Comparative cohort of 379 brain-dead donors yielded 237 transplants (112 double, 43 right, and 82 left). One- and 3-year recipient survival was 91% and 78% for recipients of DCD lungs and 91% and 75% for recipients of lungs from brain-dead donors, respectively. PGD 2 and 3 in DCD recipients at 72 hours was 4 of 46 (9%) and 6 of 46 (13%), respectively. Comparatively, brain-dead donor recipient cohort at 72 hours with PGD 2 and 3 was 23 of 237 (10%) and 41 of 237 (17%), respectively. CONCLUSIONS Our experience reaffirms the use of lungs from DCD donors as a viable source with favorable outcomes. Recipients from DCD donors showed equivalent PGD rate at 72 hours and survival compared with recipients from brain-dead donors.
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Affiliation(s)
- Joseph Costa
- Department of Surgery, General Thoracic Surgery Section, Columbia University Medical Center, New York
| | - Lori Shah
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, New York
| | - Hilary Robbins
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, New York
| | - Kashif Raza
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, New York
| | - Sowmya Sreekandth
- Department of Surgery, General Thoracic Surgery Section, Columbia University Medical Center, New York
| | - Selim Arcasoy
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, New York
| | - Joshua R Sonett
- Department of Surgery, General Thoracic Surgery Section, Columbia University Medical Center, New York
| | - Frank D'Ovidio
- Department of Surgery, General Thoracic Surgery Section, Columbia University Medical Center, New York.
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38
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Diamond JM, Arcasoy S, Kennedy CC, Eberlein M, Singer JP, Patterson GM, Edelman JD, Dhillon G, Pena T, Kawut SM, Lee JC, Girgis R, Dark J, Thabut G. Report of the International Society for Heart and Lung Transplantation Working Group on Primary Lung Graft Dysfunction, part II: Epidemiology, risk factors, and outcomes—A 2016 Consensus Group statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2017; 36:1104-1113. [DOI: 10.1016/j.healun.2017.07.020] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 11/28/2022] Open
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39
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Diamond JM, Cantu E, Porteous M, Suzuki Y, Meyer KC, Lederer D, Milewski RK, Arcasoy S, D’Ovidio F, Bacchetta M, Sonett JR, Singh G, Costa J, Tobias JW, Rodriguez H, Van Deerlin VM, Olthoff KM, Shaked A, Chang BL, Christie JD. Peripheral Blood Gene Expression Changes Associated With Primary Graft Dysfunction After Lung Transplantation. Am J Transplant 2017; 17:1770-1777. [PMID: 28117940 PMCID: PMC5489369 DOI: 10.1111/ajt.14209] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 11/18/2016] [Revised: 12/27/2016] [Accepted: 01/14/2017] [Indexed: 01/25/2023]
Abstract
Recipient responses to primary graft dysfunction (PGD) after lung transplantation may have important implications to the fate of the allograft. We therefore evaluated longitudinal differences in peripheral blood gene expression in subjects with PGD. RNA expression was measured throughout the first transplant year in 106 subjects enrolled in the Clinical Trials in Organ Transplantation-03 study using a panel of 100 hypothesis-driven genes. PGD was defined as grade 3 in the first 72 posttransplant hours. Eighteen genes were differentially expressed over the first year based on PGD development, with significant representation from innate and adaptive immunity genes, with most differences identified very early after transplant. Sixteen genes were overexpressed in the blood of patients with PGD compared to those without PGD within 7 days of allograft reperfusion, with most transcripts encoding innate immune/inflammasome-related proteins, including genes previously associated with PGD. Thirteen genes were underexpressed in patients with PGD compared to those without PGD within 7 days of transplant, highlighted by T cell and adaptive immune regulation genes. Differences in gene expression present within 2 h of reperfusion and persist for days after transplant. Future investigation will focus on the long-term implications of these gene expression differences on the outcome of the allograft.
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Affiliation(s)
- Joshua M. Diamond
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Edward Cantu
- Division of Cardiovascular Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Mary Porteous
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Yoshikazu Suzuki
- Division of Cardiovascular Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Keith C. Meyer
- Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - David Lederer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Rita K. Milewski
- Division of Cardiovascular Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Selim Arcasoy
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Frank D’Ovidio
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Matthew Bacchetta
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Joshua R. Sonett
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Gopal Singh
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Joseph Costa
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - John W. Tobias
- Penn Molecular Profiling Facility, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hetty Rodriguez
- Penn Molecular Profiling Facility, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Vivianna M. Van Deerlin
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Kim M. Olthoff
- Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Abraham Shaked
- Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Bao-Li Chang
- Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA,The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jason D. Christie
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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40
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Diamond JM, Arcasoy S, McDonnough JA, Sonett JR, Bacchetta M, D'Ovidio F, Cantu E, Bermudez CA, McBurnie A, Rushefski M, Kalman LH, Oyster M, D'Errico C, Suzuki Y, Giles JT, Ferrante A, Lippel M, Singh G, Lederer DJ, Christie JD. Adipose Gene Expression Profile Changes With Lung Allograft Reperfusion. Am J Transplant 2017; 17:239-245. [PMID: 27421969 PMCID: PMC5195853 DOI: 10.1111/ajt.13964] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/10/2016] [Accepted: 06/29/2016] [Indexed: 01/25/2023]
Abstract
Obesity is a risk factor for primary graft dysfunction (PGD), a form of lung injury resulting from ischemia-reperfusion after lung transplantation, but the impact of ischemia-reperfusion on adipose tissue is unknown. We evaluated differential gene expression in thoracic visceral adipose tissue (VAT) before and after lung reperfusion. Total RNA was isolated from thoracic VAT sampled from six subjects enrolled in the Lung Transplant Body Composition study before and after allograft reperfusion and quantified using the Human Gene 2.0 ST array. Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed enrichment for genes involved in complement and coagulation cascades and Jak-STAT signaling pathways. Overall, 72 genes were upregulated and 56 genes were downregulated in the postreperfusion time compared with baseline. Long pentraxin-3, a gene and plasma protein previously associated with PGD, was the most upregulated gene (19.5-fold increase, p = 0.04). Fibronectin leucine-rich transmembrane protein-3, a gene associated with cell adhesion and receptor signaling, was the most downregulated gene (4.3-fold decrease, p = 0.04). Ischemia-reperfusion has a demonstrable impact on gene expression in visceral adipose tissue in our pilot study of nonobese, non-PGD lung transplant recipients. Future evaluation will focus on differential adipose tissue gene expression and the development of PGD after transplant.
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Affiliation(s)
- Joshua M. Diamond
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Selim Arcasoy
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jamiela A. McDonnough
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Joshua R. Sonett
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Matthew Bacchetta
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Frank D'Ovidio
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Edward Cantu
- Division of Cardiovascular Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Christian A. Bermudez
- Division of Cardiovascular Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Amika McBurnie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Melanie Rushefski
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Laurel H. Kalman
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Michelle Oyster
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Carly D'Errico
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Yoshikazu Suzuki
- Division of Cardiovascular Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jon T. Giles
- Division of Rheumatology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Anthony Ferrante
- Department of Medicine, Naomi Berrie Diabetes Center, Columbia University, New York, New York
| | - Matthew Lippel
- Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Gopal Singh
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - David J. Lederer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jason D. Christie
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Kodiyanplakkal RP, Kates O, Miko B, Chiasson MA, Kubin C, Arcasoy S, Pereira MR. Incidence of Infection Following Transplantation in Single- vs Double- Lung Transplant Recipients. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Olivia Kates
- Medicine, Columbia University Medical Center, New York, NY
| | - Benjamin Miko
- Division of Infectious Diseases, Columbia University Medical Center, New York, NY
| | | | - Christine Kubin
- Division of Infectious Diseases, Columbia University Medical Center, New York, NY
| | - Selim Arcasoy
- Pulmonary and Critical Care, Columbia University Medical Center, New York, NY
| | - Marcus R. Pereira
- Division of Infectious Diseases, Columbia University Medical Center, New York, NY
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42
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Costa J, Sreekanth S, Shah L, Robbins H, Raza K, Arcasoy S, Sonett J, D'Ovidio F. P-257ORGAN DONORS FROM ASPHYXIATION ARE VALUABLE SOURCE OF LUNG ALLOGRAFTS. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Costa J, Sreekanth S, Kossar A, Raza K, Lederer DJ, Robbins H, Shah L, Sonett JR, Arcasoy S, D'Ovidio F. Donor lung assessment using selective pulmonary vein gases. Eur J Cardiothorac Surg 2016; 50:826-831. [PMID: 27242362 DOI: 10.1093/ejcts/ezw179] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 12/03/2015] [Accepted: 04/26/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Standard donor lung assessment relies on imaging, challenge gases and subjective interpretation of bronchoscopic findings, palpation and visual assessment. Central gases may not accurately represent true quality of the lungs. We report our experience using selective pulmonary vein gases to corroborate the subjective judgement. METHODS Starting, January 2012, donor lungs have been assessed by intraoperative bronchoscopy, palpation and visual judgement of lung collapse upon temporary disconnection from ventilator, central gases from the aorta and selective pulmonary vein gases. Partial pressure of oxygen (pO2) <300 mmHg on FiO2 of 1.0 was considered low. The results of the chest X-ray and last pO2 in the intensive care unit were also collected. Post-transplant primary graft dysfunction and survival were monitored. RESULTS To date, 259 consecutive brain-dead donors have been assessed and 157 transplants performed. Last pO2 in the intensive care unit was poorly correlated with intraoperative central pO2 (Spearman's rank correlation rs = 0.29). Right inferior pulmonary vein pO2 was associated (Mann-Whitney, P < 0.001) with findings at bronchoscopy [clean: median pO2 443 mmHg (25th-75th percentile range 349-512) and purulent: 264 mmHg (178-408)]; palpation [good: 463 mmHg (401-517) and poor: 264 mmHg (158-434)] and visual assessment of lung collapse [good lung collapse: 429 mmHg (320-501) and poor lung collapse: 205 mmHg (118-348)]. Left inferior pulmonary pO2 was associated (P < 0.001) with findings at bronchoscopy [clean: 419 mmHg (371-504) and purulent: 254 mmHg (206-367)]; palpation [good: 444 mmHg (400-517) and poor 282 mmHg (211-419)] and visual assessment of lung collapse [good: 420 mmHg (349-496) and poor: 246 mmHg (129-330)]. At 72 h, pulmonary graft dysfunction 2 was in 21/157 (13%) and pulmonary graft dysfunction 3 in 17/157 (11%). Ninety-day and 1-year mortalities were 6/157 (4%) and 13/157 (8%), respectively. CONCLUSIONS Selective pulmonary vein gases provide corroborative objective support to the findings at bronchoscopy, palpation and visual assessment. Central gases do not always reflect true function of the lungs, having high false-positive rate towards the individual lower lobe gas exchange. Objective measures of donor lung function may optimize donor surgeon assessment, allowing for low pulmonary graft dysfunction rates and low 90-day and 1-year mortality.
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Affiliation(s)
- Joseph Costa
- Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Sowmyashree Sreekanth
- Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Alex Kossar
- Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Kashif Raza
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
| | - David J Lederer
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
| | - Hilary Robbins
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
| | - Lori Shah
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
| | - Joshua R Sonett
- Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Selim Arcasoy
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
| | - Frank D'Ovidio
- Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA
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44
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Costa J, Sreekanth S, Kossar A, Raza K, Robbins H, Shah L, Sonett JR, Arcasoy S, D'Ovidio F. Donors with a prior history of cardiac surgery are a viable source of lung allografts. Eur J Cardiothorac Surg 2016; 50:822-825. [PMID: 27147626 DOI: 10.1093/ejcts/ezw157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 12/07/2015] [Accepted: 04/11/2016] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES End-stage lung disease continues to rise despite the lack of suitable lung donors, limiting the numbers of lung transplants performed each year. Expanded donor criteria, use of donation after cardiac death donors and the advent of ex vivo lung perfusion have resulted only in a slight increase in donor lung utilization. Organ donors with prior cardiac surgery (DPCS) present risks and technical challenges; however, they may be a potential source of suitable lung allografts with an experienced procurement surgeon. We present our experience having evaluated potential lung donors with a prior history of cardiac surgery, resulting in successful transplant outcomes. METHODS This is a single-institution retrospective review of brain-dead organ donors that were evaluated for lung donation in the period 2012-15. Donor and recipient characteristics were collected. Post-lung transplant survival was recorded. RESULTS From 2012 to 2015, 259 donors were evaluated, 12 with a prior history of cardiac surgery of which 4 had coronary artery bypass, 3 had aortic root replacement, 2 had aortic valve replacement, 1 pulmonary embolectomy, 1 two-time reoperative valve replacement and 1 paediatric congenital ventricular septal defect repair. DPCS, 6/12 (50% dry run) provided suitable allografts generating six single-lung transplants (three right and three left, 1 donor provided twin single-lung transplants) and one double-lung transplant. Interval between cardiac surgery and procurement for those rejected was median 5840 (IQR 2350-8640) days and interval for the donors that provided allografts was median 438 (IQR 336-1095) days (Mann-Whitney, P = 0.07). Recipient 1-year survival from DPCS is 100%. Recipient 1-year survival was 92% in allografts explanted from donors with no prior cardiac surgery (2012-13). CONCLUSION To date, this is the largest single-centre experience using lung allografts from brain-dead DPCS. Our experience shows despite predicted technical difficulties, with good communication between thoracic and abdominal teams, successful transplant outcomes are possible, when surgeons with experience in reoperative cases are sent for lung procurements.
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Affiliation(s)
- Joseph Costa
- Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Sowmyashree Sreekanth
- Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Alex Kossar
- Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Kashif Raza
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
| | - Hilary Robbins
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
| | - Lori Shah
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
| | - Joshua R Sonett
- Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Selim Arcasoy
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA
| | - Frank D'Ovidio
- Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA
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Cantu E, Diamond J, Nellen J, Beduhn B, Suzuki Y, Borders C, Lasky J, Schaufler C, Shah R, Porteous M, Lederer D, Kawut S, Arcasoy S, Palmer S, Snyder L, Hartwig M, Lama V, Crespo M, Wille K, Orens J, Shah P, Weinacker A, Ware L, Bellamy S, Christie J. Redefining Primary Graft Dysfunction after Lung Transplantation. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.244] [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: 10/22/2022] Open
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Ramphal K, Cantu E, Porteous M, Oyster M, Kawut S, Lederer D, Shah R, Arcasoy S, Snyder L, Hartwig M, Palmer S, Wille K, Ware L, Shah P, Crespo M, Hage C, Weinacker A, Lama V, Suzuki Y, Orens J, Christie J, Diamond J. Soluble CD14 and LBP as Markers for Primary Graft Dysfunction. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.897] [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: 10/21/2022] Open
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47
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Briganti D, Kim C, Aramini B, Chan R, Zhou B, Sreekanth S, Raza K, Robbins H, Shah L, Arcasoy S, Sonett J, Meloni F, Paolo GD, D’Ovidio. Bronchial & Alveolar Lipidomic Profile as a Marker of the Immunological and Functional Status of the Lung Allograft. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.639] [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: 10/21/2022] Open
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Diamond JM, Porteous MK, Roberts LJ, Wickersham N, Rushefski M, Kawut SM, Shah RJ, Cantu E, Lederer DJ, Chatterjee S, Lama VN, Bhorade S, Crespo M, McDyer J, Wille K, Orens J, Weinacker A, Arcasoy S, Shah PD, Wilkes DS, Hage C, Palmer SM, Snyder L, Calfee CS, Ware LB, Christie JD. The relationship between plasma lipid peroxidation products and primary graft dysfunction after lung transplantation is modified by donor smoking and reperfusion hyperoxia. J Heart Lung Transplant 2016; 35:500-507. [PMID: 26856667 DOI: 10.1016/j.healun.2015.12.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 09/01/2015] [Revised: 10/16/2015] [Accepted: 12/21/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Donor smoking history and higher fraction of inspired oxygen (FIO2) at reperfusion are associated with primary graft dysfunction (PGD) after lung transplantation. We hypothesized that oxidative injury biomarkers would be elevated in PGD, with higher levels associated with donor exposure to cigarette smoke and recipient hyperoxia at reperfusion. METHODS We performed a nested case-control study of 72 lung transplant recipients from the Lung Transplant Outcomes Group cohort. Using mass spectroscopy, F2-isoprostanes and isofurans were measured in plasma collected after transplantation. Cases were defined in 2 ways: grade 3 PGD present at day 2 or day 3 after reperfusion (severe PGD) or any grade 3 PGD (any PGD). RESULTS There were 31 severe PGD cases with 41 controls and 35 any PGD cases with 37 controls. Plasma F2-isoprostane levels were higher in severe PGD cases compared with controls (28.6 pg/ml vs 19.8 pg/ml, p = 0.03). Plasma F2-isoprostane levels were higher in severe PGD cases compared with controls (29.6 pg/ml vs 19.0 pg/ml, p = 0.03) among patients reperfused with FIO2 >40%. Among recipients of lungs from donors with smoke exposure, plasma F2-isoprostane (38.2 pg/ml vs 22.5 pg/ml, p = 0.046) and isofuran (66.9 pg/ml vs 34.6 pg/ml, p = 0.046) levels were higher in severe PGD compared with control subjects. CONCLUSIONS Plasma levels of lipid peroxidation products are higher in patients with severe PGD, in recipients of lungs from donors with smoke exposure, and in recipients exposed to higher Fio2 at reperfusion. Oxidative injury is an important mechanism of PGD and may be magnified by donor exposure to cigarette smoke and hyperoxia at reperfusion.
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Affiliation(s)
- Joshua M Diamond
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Mary K Porteous
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - L Jackson Roberts
- Departments of Medicine and Pharmacology, Vanderbilt University, Nashville, Tennessee
| | - Nancy Wickersham
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, Tennessee
| | - Melanie Rushefski
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Steven M Kawut
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Philadelphia, PA.,Penn Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Rupal J Shah
- Department of Medicine, University of California, San Francisco, California
| | - Edward Cantu
- Division of Cardiovascular Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - David J Lederer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Shampa Chatterjee
- Department of Physiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Philadelphia, PA
| | - Vibha N Lama
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sangeeta Bhorade
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
| | - Maria Crespo
- Division of Pulmonary, Allergy, and Critical Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John McDyer
- Division of Pulmonary, Allergy, and Critical Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Keith Wille
- Division of Pulmonary and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jonathan Orens
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Johns Hopkins University Hospital, Baltimore, Maryland
| | - Ann Weinacker
- Division of Pulmonary and Critical Care Medicine, Stanford University, Palo Alto, California
| | - Selim Arcasoy
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Pali D Shah
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Johns Hopkins University Hospital, Baltimore, Maryland
| | - David S Wilkes
- Division of Pulmonary, Allergy, Critical Care, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Chadi Hage
- Division of Pulmonary, Allergy, Critical Care, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Scott M Palmer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Raleigh-Durham, North Carolina
| | - Laurie Snyder
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Raleigh-Durham, North Carolina
| | - Carolyn S Calfee
- Department of Medicine, University of California, San Francisco, California.,Departments of Medicine and Anesthesia, University of California, San Francisco, California
| | - Lorraine B Ware
- Departments of Medicine and Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, Tennessee
| | - Jason D Christie
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Philadelphia, PA
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Gottlieb J, Zamora MR, Hodges T, Musk AW, Sommerwerk U, Dilling D, Arcasoy S, DeVincenzo J, Karsten V, Shah S, Bettencourt BR, Cehelsky J, Nochur S, Gollob J, Vaishnaw A, Simon AR, Glanville AR. ALN-RSV01 for prevention of bronchiolitis obliterans syndrome after respiratory syncytial virus infection in lung transplant recipients. J Heart Lung Transplant 2015; 35:213-21. [PMID: 26452996 DOI: 10.1016/j.healun.2015.08.012] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [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: 04/03/2015] [Revised: 07/20/2015] [Accepted: 08/22/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infection in lung transplant (LTx) patients is associated with an increased incidence of bronchiolitis obliterans syndrome (BOS). ALN-RSV01 is a small interfering RNA targeting RSV replication that was shown in an earlier Phase 2a trial to be safe and to reduce the incidence of BOS when compared with placebo. METHODS We performed a Phase 2b randomized, double-blind, placebo-controlled trial in RSV-infected LTx patients to examine the impact of ALN-RSV01 on the incidence of new or progressive BOS. Subjects were randomized (1:1) to receive aerosolized ALN-RSV01 or placebo daily for 5 days. RESULTS Of 3,985 symptomatic patients screened, 218 were RSV-positive locally, of whom 87 were randomized to receive ALN-RSV01 or placebo (modified intention-to-treat [mITT] cohort). RSV infection was confirmed by central laboratory in 77 patients (ALN-RSV01, n = 44; placebo, n = 33), which comprised the primary analysis cohort (central mITT [mITTc]). ALN-RSV01 was found to be safe and well-tolerated. At Day 180, in ALN-RSV01-treated patients, compared with placebo, in the mITTc cohort there was a trend toward a decrease in new or progressive BOS (13.6% vs 30.3%, p = 0.058), which was significant in the per-protocol cohort (p = 0.025). Treatment effect was enhanced when ALN-RSV01 was started <5 days from symptom onset, and was observed even without ribavirin treatment. There was no significant impact on viral parameters or symptom scores. CONCLUSIONS These results confirm findings of the earlier Phase 2a trial and provide further support that ALN-RSV01 reduces the risk of BOS after RSV in LTx recipients.
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Affiliation(s)
- Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Biomedical Research in End stage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Germany.
| | - Martin R Zamora
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado at Denver Health Sciences Center, Aurora, Colorado
| | - Tony Hodges
- Center for Thoracic Transplantation at the Heart & Lung Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - A W Musk
- Department of Respiratory Medicine, Royal Perth Hospital, Perth, Australia
| | - Urte Sommerwerk
- Department of Pneumology, Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitaetsklinikum Essen GmbH, Essen, Germany
| | - Daniel Dilling
- Departemnt of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Selim Arcasoy
- Department of Medicine, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY
| | - John DeVincenzo
- Department of Pediatrics, University of Tennessee Center for Health Sciences, Memphis, Tennessee
| | | | - Shaily Shah
- Alnylam Pharmaceuticals, Cambridge, Massachusetts
| | | | | | - Sara Nochur
- Alnylam Pharmaceuticals, Cambridge, Massachusetts
| | - Jared Gollob
- Alnylam Pharmaceuticals, Cambridge, Massachusetts
| | | | - Amy R Simon
- Alnylam Pharmaceuticals, Cambridge, Massachusetts
| | - Allan R Glanville
- Lung Transplant Unit, St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
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50
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Costa J, Singh G, Sreekanh S, Raza K, Lederer D, Robbins H, Shah L, Sonett J, Arcasoy S, D'Ovidio F. F-075DONOR LUNG ASSESSMENT USING SELECTIVE PULMONARY VEIN GASES. Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.75] [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: 11/12/2022] Open
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