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Testelmans D, Schoovaerts K, Belge C, Verleden SE, Vos R, Verleden GM, Buyse B. Sleep-disordered breathing after lung transplantation: An observational cohort study. Am J Transplant 2021; 21:281-290. [PMID: 32519458 DOI: 10.1111/ajt.16130] [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: 04/10/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 01/25/2023]
Abstract
Data concerning sleep-disordered breathing (SDB) after lung transplantation (LTX) are scarce. This study aims to analyze prevalence, associated factors, and impact on survival of moderate to severe SDB in a large cohort of consecutive LTX patients (n = 219). Patients underwent a diagnostic polysomnography 1 year after LTX. Moderate to severe SDB was present in 57.5% of patients, with the highest prevalence in chronic obstructive pulmonary disease/emphysema (71.1%) and pulmonary fibrosis (65.1%). SDB patients were older, mostly male, and had higher body mass index and neck circumference. Nocturnal diastolic and 24-hour blood pressures were higher in SDB patients. In 45 patients, polysomnography was also performed pre-LTX. Compared to pre-LTX, mean apnea/hypopnea index (AHI) increased significantly after LTX. A significant correlation was seen between lung function parameters and AHI, suggesting a role of decreased caudal traction on the pharynx. Presence of SDB had no impact on mortality or prevalence of chronic lung allograft dysfunction. However, survival was better in continuous positive airway pressure (CPAP) compliant SDB patients compared to SDB patients without CPAP treatment. These findings may be pertinent for systematic screening of SDB after LTX.
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Affiliation(s)
- Dries Testelmans
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Kathleen Schoovaerts
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Catharina Belge
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Laboratory of Respiratory diseases and Thoracic Surgery (BREATHE) Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Geert M Verleden
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
| | - Bertien Buyse
- Clinical Department of Respiratory Diseases, UZ Leuven - BREATHE, department CHROMETA, KU Leuven, Leuven, Belgium
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Schenkel FA, Barr ML, McCloskey CC, Possemato T, O'Conner J, Sadeghi R, Bembi M, Duong M, Patel J, Hackmann AE, Ganesh S. Use of a Bluetooth tablet-based technology to improve outcomes in lung transplantation: A pilot study. Am J Transplant 2020; 20:3649-3657. [PMID: 32558226 PMCID: PMC7754459 DOI: 10.1111/ajt.16154] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 10/25/2019] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 01/25/2023]
Abstract
The impact of remote patient monitoring platforms to support the postoperative care of solid organ transplant recipients is evolving. In an observational pilot study, 28 lung transplant recipients were enrolled in a novel postdischarge home monitoring program and compared to 28 matched controls during a 2-year period. Primary endpoints included hospital readmissions and total days readmitted. Secondary endpoints were survival and inflation-adjusted hospital readmission charges. In univariate analyses, monitoring was associated with reduced readmissions (incidence rate ratio [IRR]: 0.56; 95% confidence interval [CI]: 0.41-0.76; P < .001), days readmitted (IRR: 0.46; 95% CI: 0.42-0.51; P < .001), and hospital charges (IRR: 0.52; 95% CI: 0.51-0.54; P < .001). Multivariate analyses also showed that remote monitoring was associated with lower incidence of readmission (IRR: 0.38; 95% CI: 0.23-0.63; P < .001), days readmitted (IRR: 0.14; 95% CI: 0.05-0.37; P < .001), and readmission charges (IRR: 0.11; 95% CI: 0.03-0.46; P = .002). There were 2 deaths among monitored patients compared to 6 for controls; however, this difference was not significant. This pilot study in lung transplant recipients suggests that supplementing postdischarge care with remote monitoring may be useful in preventing readmissions, reducing subsequent inpatient days, and controlling hospital charges. A multicenter, randomized control trial should be conducted to validate these findings.
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Affiliation(s)
- Felicia A. Schenkel
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Mark L. Barr
- Division of Cardiothoracic SurgeryDepartment of SurgeryUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Tammie Possemato
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jeremy O'Conner
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Roya Sadeghi
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Maria Bembi
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Marian Duong
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jaynita Patel
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Amy E. Hackmann
- Division of Cardiothoracic SurgeryDepartment of SurgeryUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Sivagini Ganesh
- Division of Pulmonary and Critical Care MedicineDepartment of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Blau JE, Abegg MR, Flegel WA, Zhao X, Harlan DM, Rother KI. Long-term immunosuppression after solitary islet transplantation is associated with preserved C-peptide secretion for more than a decade. Am J Transplant 2015; 15:2995-3001. [PMID: 26184712 PMCID: PMC5158099 DOI: 10.1111/ajt.13383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 05/12/2015] [Accepted: 05/13/2015] [Indexed: 01/25/2023]
Abstract
We report on two patients with type 1 diabetes (T1D) after solitary islet transplantation in 2001. They received steroid-sparing immunosuppression (daclizumab, sirolimus, and tacrolimus according to the Edmonton protocol). Both patients became insulin independent for 2 years: Patient A, a 42-year-old female with a 12-year history of T1D, received two islet infusions; patient B, a 53-year-old female with a 40-year T1D history, received one islet infusion. Pretransplant, both had undetectable C-peptide concentrations and frequent and severe hypoglycemia. Pretransplant, hemoglobin A1c (HbA1c) was 7.8% and 8.8% and insulin requirements were 0.47 and 0.33 units/kg/day, respectively. Posttransplant, C-peptide levels remained detectable while immunosuppression was continued, but decreased over time. Insulin was re-started 2 years posttransplant in both patients. Since patient A's glycemia and insulin requirements trended toward pretransplant levels, immunosuppression was discontinued after 13 years. This resulted in a sudden cessation of C-peptide secretion. Patient B continues on immunosuppression, has better HbA1c, and half the insulin requirement compared to pretransplant. Both patients no longer experience severe hypoglycemia. Herein, we document blood glucose concentrations over time (>30 000 measurements per patient) and β cell function based on C-peptide secretion. Despite renewed insulin dependence, both patients express satisfaction with having undergone the procedure.
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Affiliation(s)
- J. E. Blau
- Diabetes, Endocrinology, and Obesity Branch, NIDDK National Institutes of Health, Bethesda, MD
| | - M. R. Abegg
- Diabetes, Endocrinology, and Obesity Branch, NIDDK National Institutes of Health, Bethesda, MD
| | - W. A. Flegel
- Department of Transfusion Medicine, NIH Clinical Center National Institutes of Health, Bethesda, MD
| | - X. Zhao
- Diabetes, Endocrinology, and Obesity Branch, NIDDK National Institutes of Health, Bethesda, MD
| | - D. M. Harlan
- Division of Diabetes, Endocrinology, and Nutrition Diabetes Center of Excellence, Department of Internal Medicine, University of Massachusetts Medical School, North Worcester, MA
| | - K. I. Rother
- Diabetes, Endocrinology, and Obesity Branch, NIDDK National Institutes of Health, Bethesda, MD,Corresponding author: Kristina I. Rother,
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Pantin JM, Hoyt RF, Aras O, Sato N, Chen MY, Hunt T, Clevenger R, Eclarinal P, Adler S, Choyke P, Childs RW. Optimization of intrabone delivery of hematopoietic progenitor cells in a swine model using cell radiolabeling with [89]zirconium. Am J Transplant 2015; 15:606-17. [PMID: 25656824 PMCID: PMC8391069 DOI: 10.1111/ajt.13007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 06/27/2014] [Revised: 08/15/2014] [Accepted: 08/28/2014] [Indexed: 01/25/2023]
Abstract
Intrabone (IB) hematopoietic cell transplantation (HCT) of umbilical cord blood in humans remains experimental and the technique has not been optimized. It is unknown whether hematopoietic progenitor cells (HPCs) injected IB are initially retained in the marrow or rapidly enter into the venous circulation before homing to the marrow. To develop an IB-injection technique that maximizes HPC marrow-retention, we tracked radiolabeled human HPCs following IB-injection into swine. We developed a method to radionuclide-label HPCs using a long-lived positron emitter (89) Zr and protamine sulfate that resulted in cellular-retention of low-dose radioactivity. This approach achieved radioactivity levels sufficient for detection by positron emission tomography with both high sensitivity and spatial resolution when fused with computed tomography. We found that conditions utilized in pilot IB-HCT clinical trials conducted by others led to both rapid drainage into the central venous circulation and cellular extravasation into surrounding muscle and soft tissues. By optimizing the needle design, using continuous real-time intra-marrow pressure monitoring, and by reducing the infusion-volume and infusion-rate, we overcame this limitation and achieved high retention of HPCs in the marrow. This method of IB cellular delivery is readily applicable in the clinic and could be utilized in future investigational IB-HCT trials aimed at maximizing marrow retention of HPCs.
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Affiliation(s)
- J. M. Pantin
- Division of Hematology and Medical Oncology, Georgia Regents University, Augusta, GA
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - R. F. Hoyt
- Laboratory of Animal Medicine and Surgery, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
- Laboratory Animal Sciences Program, Leidos Biomedical Research, Inc., Frederick National Laboratory, Frederick
| | - O. Aras
- Imaging Sciences Training Program, Diagnostic Radiology Department, Warren Magnuson Clinical Center, National Institutes of Health, Bethesda, MD
| | - N. Sato
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - M. Y. Chen
- Advanced Cardiovascular Imaging Laboratory, Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - T. Hunt
- Laboratory of Animal Medicine and Surgery, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - R. Clevenger
- Laboratory of Animal Medicine and Surgery, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | - S. Adler
- Leidos Biomedical Research, Inc., Reston, VA
| | - P. Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - R. W. Childs
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
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