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Copeland H, Hayanga JA, Neyrinck A, MacDonald P, Dellgren G, Bertolotti A, Khuu T, Burrows F, Copeland JG, Gooch D, Hackmann A, Hormuth D, Kirk C, Linacre V, Lyster H, Marasco S, McGiffin D, Nair P, Rahmel A, Sasevich M, Schweiger M, Siddique A, Snyder TJ, Stansfield W, Tsui S, Orr Y, Uber P, Venkateswaran R, Kukreja J, Mulligan M. Donor heart and lung procurement: A consensus statement. J Heart Lung Transplant 2020; 39:501-517. [DOI: 10.1016/j.healun.2020.03.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 01/02/2023] Open
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DePasquale E, Smith J, Fuentes J, Khuu T, Deng M. Use of dd-cfDNA in Multiorgan Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.734] [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: 10/27/2022] Open
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Lum C, Ragalie W, Chand R, Salimbangon A, Chang A, Khuu T, Cadeiras M, Deng M, Vucicevic D, Pandya K, Ardehali A, Ardehali A, DePasquale E. Survival for Combined Heart-Lung Transplant (HLT) Recipients over the Past 30 Years. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1073] [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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Khuu T, Chand R, Lum C, Salimbangon A, Chang A, Ross D, Ardehali A, DePasquale E. Utilization of PHS Increased Risk Donors in Lung Transplant Reduces Median Waitlist Time without Reducing Survival. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.246] [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: 10/27/2022] Open
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Khuu T, Kamath M, Moore M, Salimbangon A, Daun T, Chang A, Sweet L, DePasquale E, Nsair A, Ardehali R, Baas A, Deng M, Cadeiras M, Ardehali A. Past is Not Prologue - Immune Function Assay Results as a Predictor of Malignancy Post-Heart Transplant (HT). J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.074] [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: 11/24/2022] Open
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Salimbangon A, Vucicevic D, Lum C, Chang A, Khuu T, Moore M, Chand R, Cadeiras M, Kwon M, Deng M, Kamath M, DePasquale E. Is There a Mortality “Weekend Effect” in Cardiac Transplantation - A Single Center Experience? J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1011] [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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DePasquale E, Lum C, Chand R, Ragalie W, Chang A, Salimbangon A, Deng M, Cadeiras M, Khuu T, Vucicevic D, Pandya K, Ardehali A. Use of Donor HCV NAT Positive Hearts: Expanding the Donor Pool? J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.103] [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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Chand R, Lum C, Chang A, Salimbangon A, Deng M, Cadeiras M, Khuu T, Pandya K, Vucicevic D, Ardehali A, DePasquale E. Is There a Mortality “Weekend Effect” in Cardiac Transplantation? J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1008] [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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Bakir M, Jackson NJ, Han SX, Bui A, Chang E, Liem DA, Ardehali A, Ardehali R, Baas AS, Press MC, Cruz D, Deng MC, DePasquale EC, Fonarow GC, Khuu T, Kwon MH, Kubak BM, Nsair A, Phung JL, Reed EF, Schaenman JM, Shemin RJ, Zhang QJ, Tseng CH, Cadeiras M. Clinical phenomapping and outcomes after heart transplantation. J Heart Lung Transplant 2018; 37:956-966. [PMID: 29802085 PMCID: PMC6064662 DOI: 10.1016/j.healun.2018.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 05/09/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Survival after heart transplantation (HTx) is limited by complications related to alloreactivity, immune suppression, and adverse effects of pharmacologic therapies. We hypothesize that time-dependent phenomapping of clinical and molecular data sets is a valuable approach to clinical assessments and guiding medical management to improve outcomes. METHODS We analyzed clinical, therapeutic, biomarker, and outcome data from 94 adult HTx patients and 1,557 clinical encounters performed between January 2010 and April 2013. Multivariate analyses were used to evaluate the association between immunosuppression therapy, biomarkers, and the combined clinical end point of death, allograft loss, retransplantation, and rejection. Data were analyzed by K-means clustering (K = 2) to identify patterns of similar combined immunosuppression management, and percentile slopes were computed to examine the changes in dosages over time. Findings were correlated with clinical parameters, human leucocyte antigen antibody titers, and peripheral blood mononuclear cell gene expression of the AlloMap (CareDx, Inc., Brisbane, CA) test genes. An intragraft, heart tissue gene coexpression network analysis was performed. RESULTS Unsupervised cluster analysis of immunosuppressive therapies identified 2 groups, 1 characterized by a steeper immunosuppression minimization, associated with a higher likelihood for the combined end point, and the other by a less pronounced change. A time-dependent phenomap suggested that patients in the group with higher event rates had increased human leukocyte antigen class I and II antibody titers, higher expression of the FLT3 AlloMap gene, and lower expression of the MARCH8 and WDR40A AlloMap genes. Intramyocardial biomarker-related coexpression network analysis of the FLT3 gene showed an immune system-related network underlying this biomarker. CONCLUSIONS Time-dependent precision phenotyping is a mechanistically insightful, data-driven approach to characterize patterns of clinical care and identify ways to improve clinical management and outcomes.
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Affiliation(s)
- Maral Bakir
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | | | | | | | - Eleanor Chang
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - David A Liem
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Abbas Ardehali
- Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | - Reza Ardehali
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Arnold S Baas
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | | | - Daniel Cruz
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Mario C Deng
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Eugene C DePasquale
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Gregg C Fonarow
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Tam Khuu
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Murray H Kwon
- Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | - Bernard M Kubak
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Ali Nsair
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Jennifer L Phung
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | | | - Joanna M Schaenman
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine
| | - Richard J Shemin
- Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | | | | | - Martin Cadeiras
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine.
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Meguerdijian R, Chang A, Moreno E, Salimbangon A, Kamath M, Khuu T, Kwon M, Moore M, Nsair A, Pandya K, Vucicevic D, Ardehali A, Deng M, DePasquale E. Improving Utility of MELD-XI Prognostication in Heart Transplant. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Kamath M, Salimbangon A, Chang A, Moreno E, Cadeiras M, Deng M, Khuu T, Nsair A, Ardehali A, Kwon M, Depasquale E. LVAD Patients with CKD: Are Two Organs Better than One? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Kamath M, Bassi N, Wilson J, Bellam N, Khuu T, Iyengar A, Vucicevic D, Deng M, Ardehali A, Depasquale E. Survival in Re-Do Heart Transplant: Does Dual Organ Allocation Make a Difference? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Khuu T, DePasquale E, Salimbangon A, Chang A, Moreno E, Rourke D, Creaser J, Vandenbogaart E, Kwon M, Ardehali A, Nsair A. Reduced Readmissions with Enoxaparin Bridging for Subtherapeutic INR in MCS. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Bakir M, Jackson N, Han S, Chang E, Tseng C, Khuu T, Bui A, Zhang J, Reed E, Deng M, Cadeiras M. Dynamic Phenomapping and HLA Class I and II Antibodies for Heart Transplant Outcomes. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1078] [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: 11/16/2022] Open
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15
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Stockwell E, Khuu T, Kowalski L. Abdominopelvic Dissemination of Leiomyomas Following Minimally Invasive Surgery and Tissue Morcellation – a Case Series. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.206] [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]
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Bakir M, Jackson N, Han S, Tseng C, Chang E, Khuu T, Bui A, Zhang Q, Reed E, Liem D, Kubak B, Schaenman J, Ardehali A, Ardehali R, Baas A, Nsair A, Cruz D, Kwon M, DePasquale E, Deng M, Cadeiras M. Cluster Analysis and Dynamic Phenomapping to Guide Clinical Management After Heart Transplantation. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Khuu T, Chen B, Cadeiras M. Close to the Heart: Increasing Geographic Distance from Transplanting Center Associated with Increased Incidence of Graft Failure and Mortality Following Heart Transplant. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.291] [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: 11/26/2022] Open
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Bakir M, Henriquez-Ticas D, Chang E, Maque J, Chittoor J, Starling C, Bondar G, Wisniewski N, Adigopula S, Khuu T, Reed E, Zhang J, Cadeiras M, Deng M. Time Course of Immunosuppression Minimization and HLA Class I and Class II Antibody Emergence in Heart Transplantation. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.352] [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: 10/23/2022] Open
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Khuu T, Cadeiras M, Wisniewski N, Reed EF, Deng MC. Reduced HLA Class II antibody response to proteasome inhibition in heart transplantation. J Heart Lung Transplant 2015; 34:863-5. [PMID: 25816969 DOI: 10.1016/j.healun.2015.01.982] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 01/13/2015] [Accepted: 01/31/2015] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | | | - Elaine F Reed
- UCLA Pathology & Laboratory Medicine Immunogenetics Center, University of California, Los Angeles, Los Angeles, California
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Zhang Q, McNamara J, Cadeiras M, Khuu T, Baas A, Depasquale E, Halnon N, Perens G, Carlos J, Nsair A, Shemin R, Murray K, Ardehali A, Deng M, Reed E. Incidence and Importance of Donor-Specific HLA Antibody in Heart Transplant Recipients. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.095] [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: 11/30/2022] Open
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Chang E, Cadeiras M, Chan C, Bondar G, Wisniewski N, Bakir M, Chittoor J, Khuu T, Deng M. Differential Mitochondrial Gene Expression in Patients Undergoing MCSD Implantation. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.610] [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: 10/25/2022] Open
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DePasquale E, Cheng R, Nsair A, Baas A, Cadeiras M, Cruz D, Khuu T, Deng M, Laks H, Ardehali A. Cardiac Retransplantation: How Far Have We Come? J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.211] [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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Khuu T, Cheng R, Cadeiras M, Allareddy M, Baas A, Cruz D, Depasquale E, Hickey A, Kubak B, Nsair A, Holt C, Fishbein M, Kwon M, Ardehali A, Shemin R, Reed E, Deng M. Comparing Bortezomib to Traditional Therapies for Antibody-Mediated Rejection (AMR): Out with the Old? J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.229] [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: 10/27/2022] Open
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DePasquale E, Cheng R, Baas A, Cadeiras M, Cruz D, Kwon M, Khuu T, Nsair A, Deng M. Outcomes of Heart Transplant (HT) Recipients Bridged with ECMO. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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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DePasquale E, Cheng R, Ardehali A, Baas A, Cadeiras M, Cruz D, Khuu T, Nsair A, Jacoby D, Deng M. Outcomes of Adult Heart (HT) Versus Heart-Kidney (H+K) Transplant: Influence of CKD (Chronic Kidney Disease) Stage. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.325] [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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Khuu T, Cadeiras M, Wisniewski N, Allareddy M, Baas A, Cheng R, Cruz D, Depasquale E, Hickey A, Kubak B, Nsair A, Rajalingam R, Khuu W, Ren A, Holt C, Fishbein M, Kwon M, Ardehali A, Shemin R, Reed E, Deng M. Reduced HLA Class II Antibody Response to Proteasome Inhibition. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.239] [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: 11/30/2022] Open
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DePasquale E, Cheng R, Ardehali A, Baas A, Cadeiras M, Cruz D, Khuu T, Nsair A, Jacoby D, Deng M. Influence of Pre-Transplant Chronic Kidney Disease (CKD) on Adult Heart Transplant (HT) Outcomes. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.390] [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: 10/27/2022] Open
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Cheng R, Depasquale E, Allareddy M, Cadeiras M, Khuu T, Baas A, Nsair A, Cruz D, Deng M. Post-Heart Transplant (HT) Survival for Adult Congenital Heart Disease (ACHD). J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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DePasquale E, Cheng R, Ardehali A, Baas A, Cadeiras M, Cruz D, Khuu T, Nsair A, Deng M. Outcomes in Patients with Ischemic Cardiomyopathy (ICM) Post-Heart Transplant (HT) by Era. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.233] [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: 10/27/2022] Open
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DePasquale E, Cheng R, Ardehali A, Baas A, Cadeiras M, Cruz D, Khuu T, Nsair A, Deng M. Does Gender Influence Survival of Heart Transplant (HT) Recipients Bridged with LVAD Support? J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.414] [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: 10/27/2022] Open
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32
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DePasquale EC, Cheng R, Allareddy M, Baas A, Cadeiras M, Cruz D, Khuu T, Nsair A, Deng M. SURVIVAL OF HEART TRANSPLANT RECIPIENTS BRIDGED WITH LVAD SUPPORT BY GENDER. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60662-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Shayani S, Palmer J, Stiller T, Liu X, Thomas SH, Khuu T, Parker PM, Khaled SK, Forman SJ, Nakamura R. Thrombotic microangiopathy associated with sirolimus level after allogeneic hematopoietic cell transplantation with tacrolimus/sirolimus-based graft-versus-host disease prophylaxis. Biol Blood Marrow Transplant 2012; 19:298-304. [PMID: 23078784 DOI: 10.1016/j.bbmt.2012.10.006] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 10/10/2012] [Indexed: 11/12/2022]
Abstract
Posttransplantation thrombotic microangiopathy (TMA) is a multifactorial complication of allogeneic hematopoietic cell transplantation (allo-HCT) whose incidence is increased with the use of a sirolimus plus tacrolimus (SIR/TAC) regimen for acute graft-versus-host disease (aGVHD) prophylaxis. We evaluated the incidence and possible risk factors for TMA in a case series of 177 patients who received allo-HCT using SIR/TAC-based GVHD prophylaxis. The patients received either a sibling donor graft (n = 82) or a matched unrelated donor graft (n = 95). Within the first 100 days post-HCT, 30 patients (17%) were diagnosed with TMA, and an additional 9 patients (5%) were classified as probable TMA cases. The median time to onset of TMA was 4.6 weeks (range, 1.6-10.6 weeks). Thirty-four patients developed both TMA and aGVHD, with the majority (81%) developing aGVHD first. Multivariate analysis identified the following factors as associated with increased risk of TMA: day 14 serum sirolimus level ≥9.9 ng/mL (hazard ratio [HR], 2.19; 95% confidence interval [CI], 1.13-4.27; P = .02), presence of previous aGVHD grade II-IV (HR, 3.04; 95% CI, 1.38-6.71; P < .01), and fully myeloablative conditioning (HR, 3.47; 95% CI, 1.60-7.53; P < .01). These risk factors for TMA suggest that when using a SIR/TAC regimen for GVHD prophylaxis, careful monitoring and adjustment of the sirolimus dosage is critical, particularly in patients with active aGVHD.
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Affiliation(s)
- Sepideh Shayani
- Pharmacy Department, City of Hope, Duarte, California 91010, USA
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Shayani S, Palmer J, Stiller T, Rodriguez R, Khuu T, Parker P, Snyder D, Pullarkat V, Rosenthal J, Nademanee A, Senitzer D, Forman S, Khaled S, Nakamura R. Thrombotic Microangiopathy With Tacrolimus/Sirolimus-Based GVHD Prophylaxis Regimen in Patients Undergoing Hematopoietic Stem Cell Transplant. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.425] [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: 11/24/2022]
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Khuu T, Bagdasarian G, Leung J, Nguyen N, Lam LD, Han EE, Ambrose PJ. Estimating aminoglycoside clearance and creatinine clearance in underweight patients. Am J Health Syst Pharm 2010; 67:274-9. [DOI: 10.2146/ajhp090251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Tam Khuu
- City of Hope (COH), Duarte, CA; at the time of this study she was a student, School of Pharmacy, University of California, San Francisco (UCSF), San Francisco
| | - Gurgen Bagdasarian
- Walgreen’s Co., Southern California North District, Glendale; at the time of this study he was a student, School of Pharmacy, UCSF
| | - Jennifer Leung
- Santa Clara Valley Health and Hospital Systems, San Jose, CA; at the time of this study she was a student, School of Pharmacy, UCSF
| | - Nancy Nguyen
- COH; at the time of this study she was a student, School of Pharmacy, UCSF
| | - Lee D. Lam
- Department of Pharmacy Services, Cedars-Sinai Medical Center, Los Angeles, CA, and Assistant Clinical Professor, Department of Clinical Pharmacy, School of Pharmacy, UCSF
| | - Emily E. Han
- Department of Clinical Pharmacy, School of Pharmacy, University of Southern California, Los Angeles, and Clinical Pharmacist, Department of Pharmacy Services, University of Southern California University Hospital, Los Angeles
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