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Shtraichman O, Heching M, Bakal I, Rosengarten D, Shitenberg D, Shostak Y, Barac YD, Peysakhovich Y, Kramer MR. A single center Israeli experience in pregnancy post lung transplantation: Feasibility of successful two or more full-term pregnancies in individual lung transplant recipients. Clin Transplant 2023; 37:e15133. [PMID: 37725339 DOI: 10.1111/ctr.15133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Female lung transplant recipients (LTRs) of reproductive age are increasingly considering pregnancy due to advances in post-transplant management and improved survival. We report our experience with pregnancy in LTRs, with an emphasis on two or more successful full-term pregnancies in individual transplant recipients. METHODS We conducted a retrospective analysis of pregnancies in LTRs at our transplant center and collected maternal and fetal outcomes. RESULTS In our patient cohort, eight female LTRs conceived a total of 17 pregnancies, resulting in 13 newborns, 12 at full term, and 11 with a birth weight > 2.5 kg. Three of the LTRs had two or more successful full-term pregnancies. LTRs required a significant tacrolimus dose increase to maintain target trough levels during pregnancy. Six recipients are currently clinically stable and active, three with lung function comparable to pre-pregnancy values, and three with evidence of chronic lung allograft dysfunction (CLAD), but stable lung function. Two of the eight LTRs died subsequent to childbirth secondary to chronic respiratory failure due to CLAD, at a mean of 11 years post-transplantation and a mean of 4.5 years after childbirth. CONCLUSION Pregnancy following lung transplantation is feasible and can be achieved with acceptable maternal and newborn outcomes. Importantly, LTRs can successfully have two or more full-term pregnancies.
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Affiliation(s)
- Osnat Shtraichman
- Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Heching
- Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilana Bakal
- Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Rosengarten
- Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit Shitenberg
- Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Shostak
- Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron D Barac
- Thoracic Surgery Department, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yury Peysakhovich
- Thoracic Surgery Department, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai R Kramer
- Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shostak Y, Kramer MR, Edni O, Glusman Bendersky A, Shafran N, Bakal I, Heching M, Rosengarten D, Shitenberg D, Amor SM, Ben Zvi H, Pertzov B, Cohen H, Rotem S, Elia U, Chitlaru T, Erez N, Peysakhovich Y, D. Barac Y, Shlomai A, Bar-Haim E, Shtraichman O. Immunogenicity of a Third Dose of BNT162b2 Vaccine among Lung Transplant Recipients—A Prospective Cohort Study. Vaccines (Basel) 2023; 11:vaccines11040799. [PMID: 37112711 PMCID: PMC10141618 DOI: 10.3390/vaccines11040799] [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: 02/27/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
Two doses of mRNA SARS-CoV-2 vaccines elicit an attenuated humoral immune response among immunocompromised patients. Our study aimed to assess the immunogenicity of a third dose of the BNT162b2 vaccine among lung transplant recipients (LTRs). We prospectively evaluated the humoral response by measuring anti-spike SARS-CoV-2 and neutralizing antibodies in 139 vaccinated LTRs ~4–6 weeks following the third vaccine dose. The t-cell response was evaluated by IFNγ assay. The primary outcome was the seropositivity rate following the third vaccine dose. Secondary outcomes included: positive neutralizing antibody and cellular immune response rate, adverse events, and COVID-19 infections. Results were compared to a control group of 41 healthcare workers. Among LTRs, 42.4% had a seropositive antibody titer, and 17.2% had a positive t-cell response. Seropositivity was associated with younger age (t = 3.736, p < 0.001), higher GFR (t = 2.355, p = 0.011), and longer duration from transplantation (t = −1.992, p = 0.024). Antibody titer positively correlated with neutralizing antibodies (r = 0.955, p < 0.001). The current study may suggest the enhancement of immunogenicity by using booster doses. Since monoclonal antibodies have limited effectiveness against prevalent sub-variants and LTRs are prone to severe COVID-19 morbidity, vaccination remains crucial for this vulnerable population.
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Affiliation(s)
- Yael Shostak
- Department of Medicine D, Beilinson Hospital, Petah Tikva 4941492, Israel
- Pulmonary Institute, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Mordechai R. Kramer
- Pulmonary Institute, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Omer Edni
- Department of Medicine D, Beilinson Hospital, Petah Tikva 4941492, Israel
| | | | - Noa Shafran
- Department of Medicine D, Beilinson Hospital, Petah Tikva 4941492, Israel
| | - Ilana Bakal
- Pulmonary Institute, Rabin Medical Center, Petach Tikva 4941492, Israel
| | - Moshe Heching
- Pulmonary Institute, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dror Rosengarten
- Pulmonary Institute, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dorit Shitenberg
- Pulmonary Institute, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shay M. Amor
- Pulmonary Institute, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Haim Ben Zvi
- Clinical Microbiology Laboratory, Beilinson Hospital, Petah Tikva 4941492, Israel
| | - Barak Pertzov
- Pulmonary Institute, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hila Cohen
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
| | - Shahar Rotem
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
| | - Uri Elia
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
| | - Theodor Chitlaru
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
| | - Noam Erez
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
| | - Yuri Peysakhovich
- Cardiothoracic Surgery Department, Rabin Medical Center, Petach Tikva 4941492, Israel
| | - Yaron D. Barac
- Cardiothoracic Surgery Department, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Amir Shlomai
- Department of Medicine D, Beilinson Hospital, Petah Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Erez Bar-Haim
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
| | - Osnat Shtraichman
- Pulmonary Institute, Rabin Medical Center, Petach Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Shostak Y, Kramer M, Bakal I, Edni O, Gluzman A, Shafran N, Rosengarten D, Shitenberg D, Heching M, Amor S, Zvi HB, Pertzov B, Israeli M, Peysakhovich Y, Barac Y, Shtraichman O. No Association Between BNT162B2 Vaccine and Graft Rejection Among Lung Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.713] [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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Shitenberg D, Pertzov B, Heching M, Shostak Y, Shtraichman O, Rosengarten D, Yeshurun M, Peysakhovich Y, Barac Y, Kramer MR. Lung Transplantation for Graft-Versus-Host Disease after Allogeneic Hematopoietic Stem Cell Transplantation: A Single-center Experience. Isr Med Assoc J 2023; 25:227-232. [PMID: 36946670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Late-onset pulmonary complications can occur following hematological stem cell transplantation (HSCT). In allogeneic HSCT these complications are often associated with chronic graft-versus-host disease (GVHD). Lung transplantation (LTx) often remains the only viable therapeutic option in these patients. OBJECTIVES To describe our experience with LTx due to GVHD after HSCT and to compare the long-term survival of this group of patients to the overall survival of our cohort of LTx recipients for other indications. METHODS We retrospectively retrieved all data on patients who had undergone LTx for end-stage lung disease as a sequela of allogeneic HSCT, between 1997 and 2021, at Rabin Medical Center in Israel. RESULTS A total of 15 of 850 patients (1.7%) from our cohort of LTx recipients fulfilled the criteria of LTx as a sequela of late pulmonary complication after allogeneic HSCT. The median age at the time of HSCT was 33 years (median 15-53, range 3-60). The median time between HSCT and first signs of chronic pulmonary GVHD was 24 months (interquartile range [IQR] 12-80). The median time from HSCT to LTx was 96 months (IQR 63-120). Multivariate analysis showed that patients transplanted due to GVHD had similar survival compared to patients who were transplanted for other indications. CONCLUSIONS LTx for GVHD after allogeneic HSCT constitutes an important treatment strategy. The overall survival appears to be comparable to patients after LTx for other indications.
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Affiliation(s)
- Dorit Shitenberg
- Pulmonary Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Pertzov
- Pulmonary Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Heching
- Pulmonary Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Shostak
- Pulmonary Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Shtraichman
- Pulmonary Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Rosengarten
- Pulmonary Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Yeshurun
- Department of Hematology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yury Peysakhovich
- Department of Thoracic and Cardiovascular Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Barac
- Department of Thoracic and Cardiovascular Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai R Kramer
- Pulmonary Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shtraichman O, Diamond JM. CXCL9 and CXCL10 plasma levels: Potential keys to unlocking CLAD risk. Am J Transplant 2022; 22:2133-2134. [PMID: 35778933 DOI: 10.1111/ajt.17135] [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] [Received: 06/13/2022] [Accepted: 06/27/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Osnat Shtraichman
- Pulmonary Institute, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv, Israel
| | - Joshua M Diamond
- Division of Pulmonary, Allergy & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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6
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Pertzov B, Shmueli E, Ben Zvi H, Massarweh A, Barkan T, Ness A, Shostak Y, Freidkin L, Shtraichman O, Kramer MR. Humoral response among patients with interstitial lung disease vaccinated with the BNT162b2 SARS-Cov-2 vaccine: a prospective cohort study. Respir Res 2022; 23:226. [PMID: 36045374 PMCID: PMC9433517 DOI: 10.1186/s12931-022-02155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 08/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with interstitial lung disease (ILD) are at high risk of severe COVID-19 infection. Additionally, their anti-inflammatory and antifibrotic treatment may cause immunosuppression. Nevertheless, their ability to mount an adequate immune response to messenger RNA SARS-CoV-2 vaccines was not evaluated. Therefore, we aimed to evaluate the humoral response after the BNT162b2 vaccine among idiopathic pulmonary fibrosis (IPF) patients treated with antifibrotic therapy and among non-IPF ILD patients treated with anti-inflammatory therapy. METHODS We conducted an observational prospective cohort study to evaluate the level of anti-spike (S-IgG) antibodies after two doses of the BNT162b2 vaccine in patients with ILD. The cohort included 40 patients with idiopathic pulmonary fibrosis (IPF) treated with anti-fibrotic therapy and 29 patients with non-IPF ILD treated with anti-inflammatory therapy. For S-IgG titer measurement, one serology test was drawn from all patients 4-6 months after the second vaccine dose. In addition a control group matched for age and sex was created from a healthy control cohort of 107 patients. The study was conducted in Rabin Medical Center (Israel) between June and August 2021. RESULTS All patients in the anti-fibrotic arm were seropositive (40/40), corresponding to the matched control group (P = 1.0). The anti-fibrotic arm had a significantly lower median antibody titer in comparison to the matched control group (361.10 [IQR, 207-811] AU/ml vs. 820.75 [IQR, 459-1313] AU/ml; P < 0.001). Only 48.3% (14/29) of patients in the anti-inflammatory arm were seropositive in comparison to 100% (29/29) in the healthy control group (P < 0.001). The anti-inflammatory arm had a significantly lower median antibody titer in comparison to the healthy control group (39.6 [IQR, 4.25-165] AU/ml vs. 970.1 [IQR, 505-1926] AU/ml; P < 0.001). CONCLUSION IPF patients treated with antifibrotic therapy mount an adequate immune response after 2 doses of the BNT162b2 vaccine, and maintain a 100% seropositivity rate 4-6 months after vaccination. However, their antibody titer was reduced in comparison to a healthy control group. Among patients with non-IPF ILD treated with anti-inflammatory therapy, 48% were seronegative 4-6 months after the second vaccine dose. Moreover, treatment with rituximab caused significant immunosuppression, even in comparison to other anti-inflammatory treatments.
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Affiliation(s)
- Barak Pertzov
- Pulmonary Division, Rabin Medical Center, Beilinson Campus, 49100, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Einat Shmueli
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Ben Zvi
- Microbiology Laboratory, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Massarweh
- Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Barkan
- Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Ness
- Internal Medicine E, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Shostak
- Pulmonary Division, Rabin Medical Center, Beilinson Campus, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lev Freidkin
- Pulmonary Division, Rabin Medical Center, Beilinson Campus, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Shtraichman
- Pulmonary Division, Rabin Medical Center, Beilinson Campus, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai R Kramer
- Pulmonary Division, Rabin Medical Center, Beilinson Campus, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Izhakian S, Frajman A, Freidkin L, Shtraichman O, Rosengarten D, Pertzov B, Barac YD, Kramer MR. Prognostic Significance of the N-Terminal Pro-B-Type Natriuretic Peptide in Lung Transplant Candidates on the Waiting List. Diagnostics (Basel) 2022; 12:diagnostics12092112. [PMID: 36140513 PMCID: PMC9497763 DOI: 10.3390/diagnostics12092112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/14/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
We investigated the prognostic significance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in lung transplant candidates, in a retrospective single-center study. Data regarding various baseline characteristics and all-cause mortality were collected for 205 lung transplant candidates placed on waitlist for transplantation from November 2017 to December 2019. Associations of NT-proBNP levels with baseline characteristics and mortality were analyzed. Results showed NT-proBNP values correlated positively with age, forced vital capacity, mean pulmonary artery pressure (MPAP), and pulmonary capillary wedge pressure; and negatively with diffusing lung capacity for carbon monoxide and cardiac index. The optimal cut-off of NT-proBNP for predicting MPAP levels > 35 mmHg was 251 pg/mL; with 58.1% sensitivity, 85.7% specificity, 45.0% positive predictive value, and 91.0% negative predictive value. During a median follow-up period of 2.2 years, 97 patients underwent lung transplantation, 42 died waiting for donation, and 66 were alive and still waiting for transplantations. On multivariate analysis, higher NT-proBNP levels were strongly associated with increased mortality among waitlisted lung transplant candidates (HR 1.49, 95% CI 1.10−2.03, p = 0.01). In conclusion NT-proBNP can predict mortality among waitlisted lung transplant candidates. Lower levels of NT-proBNP can preclude severe pulmonary artery hypertension. Assessment of NT-proBNP may improve risk stratification among lung transplant candidates.
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Affiliation(s)
- Shimon Izhakian
- Pulmonary Institute, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-3-9377221
| | - Assaf Frajman
- Pulmonary Institute, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 6997801, Israel
| | - Lev Freidkin
- Pulmonary Institute, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 6997801, Israel
| | - Osnat Shtraichman
- Pulmonary Institute, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 6997801, Israel
| | - Dror Rosengarten
- Pulmonary Institute, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 6997801, Israel
| | - Barak Pertzov
- Pulmonary Institute, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 6997801, Israel
| | - Yaron D. Barac
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 6997801, Israel
- Division of Cardiovascular and Thoracic Surgery, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Mordechai Reuven Kramer
- Pulmonary Institute, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 6997801, Israel
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8
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Izhakian S, Frajman A, Mekiten O, Heching M, Pertzov B, Shtraichman O, Gershman E, Rozengarten D, Gorelik O, Kramer MR. Nontuberculous Mycobacterial Pulmonary Infection Among Lung Transplant Recipients. EXP CLIN TRANSPLANT 2021; 19:1076-1081. [PMID: 34641777 DOI: 10.6002/ect.2021.0177] [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] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Data are limited regarding the clinical significance of nontuberculous mycobacteria pulmonary infections among lung transplant recipients. We investigated the incidence and characteristics of pulmonary nontuberculous mycobacteria infection in ourlung transplant patient population. MATERIALS AND METHODS We obtaineddata of the patients who underwent lung transplant in our center from January 1997 to March 2019. RESULTS Of 690 patients, nontuberculous mycobacteria were identified in 58 patients (8.4%) over a median follow-up of 3 years. Types of species were as follows: Mycobacterium simiae (n = 24), avium complex (n = 12), abscessus (n = 9), fortuitum (n = 6), chelonae (n = 2), szulgai (n = 1), kansasii (n = 1), lentiflavum (n = 1), and undefined mycobacteria (n = 2). When we compared infections in the early versus late period posttransplant (before and after 6 months), infections with Mycobacterium simiae (16 vs 8 incidents) and Mycobacterium fortuitum (5 vs 1 incident) were more often observed within the early period, whereas most Mycobacterium abscessus (7 vs 1 incident) and Mycobacterium avium complex (9 vs 3 incidents) were observed in the later period. The median forced expiratory volume in 1 second overtime did not differ significantly between patients with and without nontuberculous mycobacteria infection (P = .29). Nontuberculous mycobacteria acquisition was significantly associated with decreased survival (relative risk of 2.41, 95% CI, 1.70-3.43; P ⟨ .001). CONCLUSIONS The nontuberculous mycobacteria species isolated varied according to the time elapsed since transplant. Among lung transplant recipients, nontuberculous mycobacteria infection was associated with increased mortality but not with lung dysfunction.
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Affiliation(s)
- Shimon Izhakian
- From the Pulmonary Institute, Rabin Medical Center, Petah Tikva, Zerifin, Israel.,From the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Zerifin, Israel
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9
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Crespo MM, Lease ED, Sole A, Sandorfi N, Snyder LD, Berry GJ, Pavec JL, Venado AE, Cifrian JM, Goldberg H, Dilling DF, Gries C, Nair A, Willie K, Meyer KC, Shah RJ, Tokman S, Holm A, Patterson CM, McWilliams T, Shtraichman O, Bemiss B, Salgado J, Farver C, Strah H, Wassilew K, Kaza V, Howsare M, Murray M, Bhorade S, Budev M. ISHLT consensus document on lung transplantation in patients with connective tissue disease: Part I: Epidemiology, assessment of extrapulmonary conditions, candidate evaluation, selection criteria, and pathology statements. J Heart Lung Transplant 2021; 40:1251-1266. [PMID: 34417111 DOI: 10.1016/j.healun.2021.07.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 12/16/2022] Open
Abstract
Patients with connective tissue disease (CTD) and advanced lung disease are often considered suboptimal candidates for lung transplantation (LTx) due to their underlying medical complexity and potential surgical risk. There is substantial variability across LTx centers regarding the evaluation and listing of these patients. The International Society for Heart and Lung Transplantation-supported consensus document on lung transplantation in patients with CTD standardization aims to clarify definitions of each disease state included under the term CTD, to describe the extrapulmonary manifestations of each disease requiring consideration before transplantation, and to outline the absolute contraindications to transplantation allowing risk stratification during the evaluation and selection of candidates for LTx.
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Affiliation(s)
- Maria M Crespo
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania,.
| | - Erika D Lease
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Amparo Sole
- Lung Transplant Unit, University Hospital la Fe, Universitat de Valencia, Valencia, Spain
| | - Nora Sandorfi
- Division of Rheumatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laurie D Snyder
- Division of Pulmonary and Critical Care Medicine, Duke University, Durham, North Carolina
| | - Gerald J Berry
- Department of Pathology, Stanford University Health Care, Stanford, California
| | - Jérôme Le Pavec
- Department of Pulmonology, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Aida E Venado
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco Medical Center, San Francisco, California
| | - Jose M Cifrian
- Department of Pulmonary, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Hilary Goldberg
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel F Dilling
- Division of Pulmonary and Critical Care Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | | | - Arun Nair
- Institute of Transplantation,Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Keith Willie
- Department of Pulmonology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Keith C Meyer
- Division of Pulmonary, University of Wisconsin, Madison, Wisconsin
| | - Rupal J Shah
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco Medical Center, San Francisco, California
| | - Sofya Tokman
- Division of Pulmonary and Critical Care, St Joseph Hospital, Phoenix, Arizona
| | - Are Holm
- Oslo University Hospital, Oslo, Norway
| | | | | | | | - Brad Bemiss
- Division of Pulmonary and Critical Care Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | - Juan Salgado
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carol Farver
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
| | - Heather Strah
- Division of Pulmonary and Critical Care, University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | - Molly Howsare
- Division of Pulmonary and Critical Care, Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | | | - Marie Budev
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
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Shostak Y, Shafran N, Heching M, Rosengarten D, Shtraichman O, Shitenberg D, Amor SM, Yahav D, Ben Zvi H, Pertzov B, Kramer MR. Early humoral response among lung transplant recipients vaccinated with BNT162b2 vaccine. Lancet Respir Med 2021; 9:e52-e53. [PMID: 33964244 PMCID: PMC8099313 DOI: 10.1016/s2213-2600(21)00184-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/31/2021] [Accepted: 04/07/2021] [Indexed: 01/26/2023]
Affiliation(s)
- Yael Shostak
- Department of Medicine D, Rabin Medical Center, Petach Tikva, Israel; Pulmonary Division, Rabin Medical Center, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Noa Shafran
- Department of Medicine D, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Heching
- Pulmonary Division, Rabin Medical Center, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Rosengarten
- Pulmonary Division, Rabin Medical Center, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Shtraichman
- Pulmonary Division, Rabin Medical Center, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit Shitenberg
- Pulmonary Division, Rabin Medical Center, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai M Amor
- Pulmonary Division, Rabin Medical Center, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Rabin Medical Center, Petach Tikva, Israel
| | - Haim Ben Zvi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Microbiology Laboratory, Rabin Medical Center, Petach Tikva, Israel
| | - Barak Pertzov
- Pulmonary Division, Rabin Medical Center, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai R Kramer
- Pulmonary Division, Rabin Medical Center, Petach Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Shtraichman O, Crespo M, Dibardino D, Bermudez C, Courtwright A. Early Post-Transplant Persistent Pneumothorax, Dehiscence or No Dehiscence? J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.2045] [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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12
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Wand O, Fox BD, Shtraichman O, Moreh-Rahav O, Kramer MR. Non-tuberculous, adenosine deaminase-positive lymphocytic pleural effusion: Consider immunoglobulin G4-related disease. Sarcoidosis Vasc Diffuse Lung Dis 2020; 37:225-230. [PMID: 33093787 PMCID: PMC7569552 DOI: 10.36141/svdld.v37i2.9098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 05/20/2020] [Indexed: 12/20/2022]
Abstract
Objective: Immunoglobulin G4-related disease (IgG4-RD) is a recently described systemic disorder. Pleural effusion is considered an uncommon manifestation of the disease. We describe a case series of patients with IgG4-RD and clinically significant pleural effusions. Methods: A retrospective analysis of patients with histologically proven IgG4-RD treated for pleural effusion in our clinic. Results: We identified 4 male patients with pleural effusion caused by IgG4-RD. The effusions were lymphocytic exudates, with especially high protein concentrations. All patients had hyperglobulinemia, elevated serum immunoglobulin G (IgG) levels and elevated levels subclasses IgG1 and IgG4. In two patients, levels of adenosine deaminase (ADA) were measured in the effusion and were elevated (309 and 108 IU/L). Tuberculosis was excluded in both cases by pleural biopsy. Involvement of other organs by IgG4-RD was the rule, especially thoracic lymphadenopathy which was prominent in all patients. In all cases, effusion responded to corticosteroids therapy. One patient developed radiological findings compatible with rounded atelectasis during remission. Conclusions: IgG4-RD may cause an ADA-positive, lymphocytic exudate with a high protein concentration, characteristics resembling tuberculous effusion. Thoracic lymphadenopathy, hyperglobulinemia, and an increased total IgG, IgG1, IgG4 may suggest the diagnosis. Not previously described, IgG4-RD pleural inflammation may result in rounded atelectasis. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 225-230)
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Affiliation(s)
- Ori Wand
- Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tiqwa, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel.,Pulmonary Division, Meir Medical Center, Kfar-Sava, Israel
| | - Benjamin D Fox
- Sackler Faculty of Medicine, Tel Aviv University, Israel.,Pulmonary Institute, Assaf Harofeh Medical Center, Tzrifin, Israel
| | - Osnat Shtraichman
- Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tiqwa, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Osnat Moreh-Rahav
- Sackler Faculty of Medicine, Tel Aviv University, Israel.,Radiology Department, Edith Wolfson Medical Center, Holon, Israel
| | - Mordechai R Kramer
- Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tiqwa, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
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13
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Gershman E, Zer A, Pertzov B, Shtraichman O, Shitenberg D, Heching M, Rosengarten D, Kramer M. Characteristics of lung cancer in idiopathic pulmonary fibrosis with single lung transplant versus non-transplanted patients: a retrospective observational study. BMJ Open Respir Res 2020; 7:7/1/e000566. [PMID: 32565443 PMCID: PMC7311020 DOI: 10.1136/bmjresp-2020-000566] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/01/2020] [Accepted: 05/22/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients with idiopathic pulmonary fibrosis (IPF) have significantly higher incidence of lung cancer (LC) relative to the general population. There is a further increase in LC incidence in patients with IPF subsequent to lung transplant, specifically in patients with IPF undergoing single lung transplant. OBJECTIVES To examine the incidence and characteristics of LC in patients with IPF during follow-up and after lung transplantation (LTX). METHODS We conducted a retrospective analysis of all patients with IPF diagnosed with LC in Rabin Medical Center, Israel, over an 11-year period. We compared the characteristics of transplanted patients with IPF diagnosed with LC to patients with IPF who did not undergo lung transplant. Data were accessed from database registries using the words 'fibrosis', 'lung-cancer' and 'lung-transplantation'. Demographic parameters included age, gender and smoking history (pack years). Clinical-pathological parameters included lapse in time from IPF diagnosis to LC, type of malignancy, affected pulmonary lobe, and stage at diagnosis, oncological treatment and survival. RESULTS Between 2008 and 2018, 205 patients with IPF underwent lung transplantation at our medical centre. Double LTX was performed in 83 and single LTX in 122 cases. Subsequently, 15 (12.3%) single LTX patients were diagnosed with LC during the study period. During the same period, of 497 non-transplanted patients with IPF followed in our centre, 45 (9.1%) were diagnosed with LC. In all 15 transplanted patients with IPF, LC was diagnosed exclusively in the native fibrotic lung. LC incidence was higher in the transplanted as compared with the non-transplanted group, but this difference did not reach statistical significance (OR=0.7, 95% CI 0.38 to 1.32, p=0.28). At LC diagnosis, the non-transplanted group was older than the transplanted group with average age of 67.7 versus 60.8 years, respectively (p=0.006). Both groups showed male predominance. In both groups, LC was primarily peripheral, lower lobe predominant and most frequently squamous cell carcinoma. The median survival time after LC diagnosis was 4 months in the transplanted group and 11 months in the non-transplanted group (p=0.19). Multivariate analysis showed improved survival in the non-transplanted group among those patients who received oncological treatment. CONCLUSION Chest CT should be performed regularly in order to evaluate IPF patients for potential LC. Single lung transplant IPF patients face an increased risk of post-transplant LC in the native fibrotic lung. Where practicable, IPF patients should be prioritised for double lung transplant.
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Affiliation(s)
- Evgeni Gershman
- Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alona Zer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Davidoff Oncology Institute, Rabin Medical Center, Petah Tikva, Israel
| | - Barak Pertzov
- Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Shtraichman
- Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit Shitenberg
- Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Heching
- Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Rosengarten
- Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Kramer
- Pulmonary Institute, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Abstract
Introduction: Lung transplantation remains an important treatment for patients with end stage lung disease. Chronic lung allograft dysfunction (CLAD) remains the greatest limiting factor for long term survival. As the diagnosis of CLAD is based on pulmonary function tests, significant lung injury is required before a diagnosis is feasible, likely when irreversible damage has already occurred. Therefore, research is ongoing for early CLAD recognition, with biomarkers making up a substantial amount of this research.Areas covered: The purpose of this review is to describe available biomarkers, focusing on those which aid in predicting CLAD and distinguishing between different CLAD phenotypes. We describe biomarkers presenting in bronchial alveolar lavage (BAL) as well as circulating in peripheral blood, both of which offer an appealing alternative to lung biopsy.Expert opinion: Development of CLAD involves complex, multiple immune and nonimmune mechanisms. Therefore, evaluation of potential CLAD biomarkers serves a dual purpose: clinically, the goal remains early detection and identification of patients at increased risk. Simultaneously, biomarkers offer insight into the different mechanisms involved in the pathophysiology of CLAD, leading to the development of possible interventions. The ultimate goal is the development of both preventive and early intervention strategies for CLAD to improve the overall survival of our lung transplant recipients.
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Affiliation(s)
- Osnat Shtraichman
- Division of Pulmonary, Allergy & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Pulmonary institute, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv, Israel
| | - Joshua M Diamond
- Division of Pulmonary, Allergy & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Abstract
Lung transplantation is an established therapeutic option for selected patients with advanced lung diseases. As early outcomes after lung transplantation have improved, chronic medical illnesses have emerged as significant obstacles to long-term survival. Among them is post-transplant malignancy, currently representing the 2nd most common cause of death 5–10 years after transplantation. Chronic immunosuppressive therapy and resulting impairment of anti-tumor immune surveillance is thought to have a central role in cancer development after solid organ transplantation (SOT). Lung transplant recipients receive more immunosuppression than other SOT populations, likely contributing to even higher risk of cancer among this group. The most common cancers in lung transplant recipients are non-melanoma skin cancers, followed by lung cancer and post-transplant lymphoproliferative disorder (PTLD). The purpose of this review is to outline the common malignancies following lung transplant, their risk factors, prognosis and current means for both prevention and treatment.
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Affiliation(s)
- Osnat Shtraichman
- Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Pulmonary Institute, Rabin Medical Center, Affiliated with Sackler School of Medicine Tel Aviv University, Petach Tikva, Israel
| | - Vivek N Ahya
- Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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16
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Unterman A, Izhakian S, Geffen Y, Rosengarten D, Shtraichman O, Pertzov B, Vainshelboim B, Alon H, Raviv Y, Kramer MR. Routine comprehensive Aspergillus screening of bronchoalveolar lavage samples in lung transplant recipients. Clin Transplant 2020; 34:e13811. [DOI: 10.1111/ctr.13811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 12/08/2019] [Accepted: 01/23/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Avraham Unterman
- Pulmonary Division Rabin Medical Center and Sackler Faculty of Medicine Tel Aviv University Petah Tikva Israel
| | - Shimon Izhakian
- Pulmonary Division Rabin Medical Center and Sackler Faculty of Medicine Tel Aviv University Petah Tikva Israel
| | - Yuval Geffen
- Clinical Microbiology Laboratory Rambam Health Care Campus Haifa Israel
| | - Dror Rosengarten
- Pulmonary Division Rabin Medical Center and Sackler Faculty of Medicine Tel Aviv University Petah Tikva Israel
| | - Osnat Shtraichman
- Pulmonary Division Rabin Medical Center and Sackler Faculty of Medicine Tel Aviv University Petah Tikva Israel
| | - Barak Pertzov
- Pulmonary Division Rabin Medical Center and Sackler Faculty of Medicine Tel Aviv University Petah Tikva Israel
| | - Baruch Vainshelboim
- Pulmonary Division Rabin Medical Center and Sackler Faculty of Medicine Tel Aviv University Petah Tikva Israel
| | - Hagar Alon
- Pulmonary Division Rabin Medical Center and Sackler Faculty of Medicine Tel Aviv University Petah Tikva Israel
| | - Yael Raviv
- Pulmonary Institute Soroka Medical Center and Ben‐Gurion University Beer‐Sheva Israel
| | - Mordechai R. Kramer
- Pulmonary Division Rabin Medical Center and Sackler Faculty of Medicine Tel Aviv University Petah Tikva Israel
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17
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Heching M, Rosengarten D, Shitenberg D, yael shostak, Shtraichman O, Kramer M. LUNG TRANSPLANT IN SIBLINGS: ANALYSIS OF 44 SIBLINGS. Chest 2019. [DOI: 10.1016/j.chest.2019.08.917] [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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18
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Pertzov B, Unterman A, Shtraichman O, Shitenberg D, Rosengarten D, Kramer MR. Efficacy and safety of mepolizumab in a real-world cohort of patients with severe eosinophilic asthma. J Asthma 2019; 58:79-84. [PMID: 31479312 DOI: 10.1080/02770903.2019.1658208] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The interleukin 5 (IL-5) pathway is an important component in the pathophysiology of severe eosinophilic asthma. Mepolizumab is a monoclonal antibody that targets the IL-5 pathway. Clinical trials showed efficacy of Mepolizumab in patients with severe eosinophilic asthma. However, reports on experience with treatment in a real-world cohort are limited. OBJECTIVES Evaluation of the efficacy and safety of Mepolizumab for treatment of severe eosinophilic asthma in a real-world cohort of patients. METHODS A clinical prospective observational trial included all patients >18 years treated with Mepolizumab between March 2016 to March 2019 at Rabin Medical Center. The composite primary outcome measures evaluated: increase in FEV1 by≥ 200 ml and/or decrease in exacerbation rate of ≥50% and/or cessation of oral corticosteroids (OCS) treatment or ≥50% decrease in dosage. Also evaluated: blood eosinophil count, adverse events and quality of life. RESULTS Of 61 patients, 50 (82.0%) achieved the primary outcome. The number of patients who suffered from frequent exacerbations decreased from 52 (85.2%) to 8 (13.1%) (p < 0.001). Twenty-two patients (68%) stopped OCS treatment or received >50% reduced dosage (p < 0.001). Mean FEV1 increased from 1.72 ± 0.78 liters to 1.87 ± 0.85 liters (p = 0.043). Response to therapy was seen within six months. Forty-nine patients (80%) reported an improvement in quality of life (p < 0.001). Only minor adverse events were reported. CONCLUSION Treatment with mepolizumab was well tolerated and significantly lowered the exacerbation rate and OCS dependence in a real-world cohort of severe eosinophilic asthma patients. Response to therapy was within six months and treatment effect was sustained over time.
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Affiliation(s)
- Barak Pertzov
- Pulmonary Division, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avraham Unterman
- Pulmonary Division, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Shtraichman
- Pulmonary Division, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit Shitenberg
- Pulmonary Division, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Rosengarten
- Pulmonary Division, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Reuven Kramer
- Pulmonary Division, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Moore A, Kramer MR, Silvern D, Shtraichman O, Allen AM. Endobronchial brachytherapy-A novel approach for the management of airway amyloidosis. Brachytherapy 2018; 17:966-972. [PMID: 30082189 DOI: 10.1016/j.brachy.2018.07.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/14/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Airway amyloidosis is an uncommon condition and may have variable clinical course. There is no proven systemic therapy, and the management mainly relies on local invasive treatments. Several reports have found external beam radiotherapy to produce durable responses. The optimal dose and fractionation has not been determined. Endobronchial brachytherapy (EBB) has never been reported to affect this disease. METHODS The study includes a retrospective chart review of all patients with airway amyloidosis treated with EBB at the Davidoff Cancer Center. Data include symptoms, radiotherapy method and dose, treatment outcomes, and toxicities. RESULTS Three patients were included. Patients were either symptomatic with extensive airway involvement or have undergone multiple local procedures with rapid recurrence of the amyloid deposits. Two patients had upper and 1 patient had lower airway involvement. Two were treated with external beam radiotherapy and EBB and 1 was treated with EBB only. All patients achieved rapid improvement of symptoms with visible improvement in followup bronchoscopies. EBB doses ranged from 7.5 to 10 Gy. Of the seven lesions treated with EBB, only one lesion recurred 6 months from treatment. No major toxicities were reported. CONCLUSIONS EBB is effective and safe for the management of airway amyloidosis and can offer long-term control. This is the first report of EBB for this indication. EBB should be further explored as means of minimizing the irradiated lung volume.
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Affiliation(s)
- Assaf Moore
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai R Kramer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Institute of Pulmonary Medicine, Rabin Medical Center, Petach Tiqva, Israel
| | - David Silvern
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel
| | - Osnat Shtraichman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Institute of Pulmonary Medicine, Rabin Medical Center, Petach Tiqva, Israel
| | - Aaron M Allen
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel; The Institute of Pulmonary Medicine, Rabin Medical Center, Petach Tiqva, Israel.
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20
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Shitenberg D, Rozengarten D, Shostak Y, Shtraichman O, Bakal I, Kramer M. Outcomes of Lung Transplantation Following Hematopoietic Stem Cell Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.643] [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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21
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Gershman E, Ridman E, Fridel L, Shtraichman O, Pertzov B, Rosengarten D, Rahman NA, Shitenberg D, Kramer MR. Efficacy and safety of trans-bronchial cryo in comparison with forceps biopsy in lung allograft recipients: Analysis of 402 procedures. Clin Transplant 2018; 32:e13221. [PMID: 29436115 DOI: 10.1111/ctr.13221] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Trans-bronchial forceps biopsy (TBFB) is the gold standard to establish the presence of allograft rejection or infection after lung transplantation. We aimed to analyze the diagnostic yield and safety of trans-bronchial cryobiopsy (TBCB) in lung allografts. METHODS Retrospective analysis of 402 TBB procedures in 362 lung recipients was performed between 2011 and 2016. Half of the cases (201) were performed by TBCB and the other half by TBFB. One hundred random slides of TBB specimens from lung allografts were reviewed for artifacts, bleeding, and histological evidence. RESULTS Both TBB groups were comparable in age, gender distribution, and time following transplantation. Acute rejection was diagnosed in 21.9% of the TBCB group vs 14.9% in the TBFB group (P = .09) and only 2 cases (1%) of nondiagnostic tissue in TBCB group and 4 cases (2%) in TBFB group (P = .685). Complications of pneumothorax and bleeding occurred in 9 (4.5%) vs 8 (4%) and 5 (2.5%) vs 4 (2%) in TBCB vs TBFB groups, respectively. The TBCB specimens were larger than TBFB (average 16.6 vs 6.6 mm2 ; P < .001). Crush and bleeding artifacts were seen in 11 (22%) and 23 (46%) of TBFB, respectively, yet none in TBCB group (P < .001). CONCLUSION Trans-bronchial cryobiopsy is safe and effective for diagnosis of lung allograft rejection.
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Affiliation(s)
- Evgeni Gershman
- Rabin Medical Center, Pulmonary Institute, Belinson Campus, Petah Tikva, Israel.,Sackler School of Medicine, Medical Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Elena Ridman
- Rabin Medical Center, Pulmonary Institute, Belinson Campus, Petah Tikva, Israel
| | - Ludmila Fridel
- Rabin Medical Center, Pathology Institute, Belinson Campus, Petah Tikva, Israel
| | - Osnat Shtraichman
- Rabin Medical Center, Pulmonary Institute, Belinson Campus, Petah Tikva, Israel.,Sackler School of Medicine, Medical Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Barak Pertzov
- Rabin Medical Center, Pulmonary Institute, Belinson Campus, Petah Tikva, Israel.,Sackler School of Medicine, Medical Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Dror Rosengarten
- Rabin Medical Center, Pulmonary Institute, Belinson Campus, Petah Tikva, Israel.,Sackler School of Medicine, Medical Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Nader Abdel Rahman
- Rabin Medical Center, Pulmonary Institute, Belinson Campus, Petah Tikva, Israel.,Sackler School of Medicine, Medical Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Dorit Shitenberg
- Rabin Medical Center, Pulmonary Institute, Belinson Campus, Petah Tikva, Israel.,Sackler School of Medicine, Medical Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai R Kramer
- Rabin Medical Center, Pulmonary Institute, Belinson Campus, Petah Tikva, Israel.,Sackler School of Medicine, Medical Faculty, Tel Aviv University, Tel Aviv, Israel
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22
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Shtraichman O, Kramer MR. [ARTIFICIAL STONE SILICOSIS: THE ISRAEL EPIDEMIC, CURRENT VIEW]. Harefuah 2017; 156:517-521. [PMID: 28853529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Silicosis is a fibrotic occupational pulmonary disease that results from over-exposure to crystalline silica-containing dust. Silicosis is a progressive disease which can often lead to advanced respiratory failure, the need for lung transplantation or death. There are a number of silicosis associated diseases which constitute diagnostic challenges, as well as contribute to further morbidity. Although preventable through appropriate workplace precautions, silicosis not only remains an endemic disease worldwide, it has also manifested a resurgence of epidemic disease in recent years, as seen in the inclining prevalence of disease in Israel. This review aims to present the silicosis epidemic in Israel, its causes and the ways to prevent further outbreaks of disease. We describe clinical and radiological imaging features, associated diseases and differential diagnosis for the purpose of raising awareness of the disease among medical professionals thus promoting early detection and diagnosis.
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Affiliation(s)
- Osnat Shtraichman
- Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai R Kramer
- Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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23
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Shtraichman O, Bakal I, Rosengarten D, Shitenberg D, Shostak Y, Kramer M. Fertility, Pregnancy and Child Birth in Women Post Lung Transplantation (a Single Center Experience). J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1182] [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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Rosengarten D, Fox BD, Fireman E, Blanc PD, Rusanov V, Fruchter O, Raviv Y, Shtraichman O, Saute M, Kramer MR. Survival following lung transplantation for artificial stone silicosis relative to idiopathic pulmonary fibrosis. Am J Ind Med 2017; 60:248-254. [PMID: 28145560 DOI: 10.1002/ajim.22687] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Silicosis is a progressive lung disease resulting from the inhalation of respirable crystalline silica. Lung transplantation is the only treatment for end-stage silicosis. The aim of this study was to analyze the survival experience following lung transplantation among patients with silicosis. METHODS We reviewed data for all patients who underwent lung transplantation for silicosis and a matched group undergoing lung transplantation for idiopathic pulmonary fibrosis (IPF) at a single medical center between March 2006 and the end of December 2013. Survival was followed through 2015. RESULTS A total of 17 lung transplantations were performed for silicosis among 342 lung transplantations (4.9%) during the study period. We observed non-statistically significant survival advantage (hazard ratio 0.6; 95%CI 0.24-1.55) for those undergoing lung transplantation for silicosis relative to IPF patients undergoing lung transplantation during the same period. CONCLUSIONS Within the limits of a small sample, survival in silicosis patients following lung transplantation was not reduced compared to IPF. Am. J. Ind. Med. 60:248-254, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Dror Rosengarten
- Institute of Pulmonology; Rabin Medical Center; Beilinson Campus; Petah Tiqwa Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Benjamin D. Fox
- Institute of Pulmonology; Rabin Medical Center; Beilinson Campus; Petah Tiqwa Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Elizabeth Fireman
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- The Institute of Pulmonary and Allergic Diseases; Tel-Aviv Sourasky Medical Center; Tel-Aviv Israel
| | - Paul D. Blanc
- Division of Occupational and Environmental Medicine; Department of Medicine and Cardiovascular Research Institute; University of California; San Francisco California
| | - Victoria Rusanov
- Institute of Pulmonology; Rabin Medical Center; Beilinson Campus; Petah Tiqwa Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Oren Fruchter
- Institute of Pulmonology; Rabin Medical Center; Beilinson Campus; Petah Tiqwa Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Yael Raviv
- Institute of Pulmonology; Rabin Medical Center; Beilinson Campus; Petah Tiqwa Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Osnat Shtraichman
- Institute of Pulmonology; Rabin Medical Center; Beilinson Campus; Petah Tiqwa Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Milton Saute
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Cardiothoracic Surgery; Rabin Medical Center; Beilinson Campus; Petah Tiqwa Israel
| | - Mordechai R. Kramer
- Institute of Pulmonology; Rabin Medical Center; Beilinson Campus; Petah Tiqwa Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Fox BD, Shtraichman O, Langleben D, Shimony A, Kramer MR. Combination Therapy for Pulmonary Arterial Hypertension: A Systematic Review and Meta-analysis. Can J Cardiol 2016; 32:1520-1530. [PMID: 27378592 DOI: 10.1016/j.cjca.2016.03.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 03/08/2016] [Accepted: 03/08/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Combination therapy (CT) for patients with pulmonary arterial hypertension (PAH) has been recommended for many years, despite weak evidence of efficacy over monotherapy (MT). A previous meta-analysis comparing CT vs MT with pulmonary vasodilators failed to demonstrate a clear reduction in clinical worsening events. METHODS We searched for relevant articles in PubMed, EMBASE, the Cochrane Database, and clinicaltrials.gov; we also manually searched review articles and conference abstracts from 1980-December 2015. Target articles were double-blinded studies of 2 or more pulmonary vasodilators given in combination vs monotherapy for treatment of patients with PAH. The principal outcome of interest was "combined clinical worsening" (CCW) events (including but not limited to death or hospitalization). Data on physiological outcomes were also explored. Meta-analysis was performed using the DerSimonian and Laird random-effects model. RESULTS We extracted data from 18 randomized controlled trials (RCTs) (N = 4162). CT was associated with a significant 38% reduction of risk of CCW (15 RCTs: n = 3906; risk ratio [RR], 0.62; 95% confidence interval [CI], 0.50-0.77). This reduction in risk was driven by a reduction in nonfatal end points (12 RCTs: n = 2611; RR, 0.56; 95% CI, 0.40-0.78) and not by a reduction of mortality (12 RCTs: n = 2717; RR, 0.79; 95% CI, 0.53-1.17). CT was also associated with improvement in 6-minute walking distance (10 RCTs: n = 1553; weighted mean difference [WMD], +23.0 m; 95% CI, 15.9-30.1), improved functional class (9 RCTs: n = 1737; RR, 1.26; 95% CI, 1.05-1.51), and beneficial effects on pulmonary hemodynamics such as cardiac index (WMD, +0.35 L/min/m; 95% CI, 0.14-0.56). CONCLUSIONS In this highly comprehensive meta-analysis, CT reduces the risk of CCW events in patients with PAH and brings physiological improvement.
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Affiliation(s)
- Benjamin D Fox
- Pulmonary Institute, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | | | - David Langleben
- Cardiology Department, Jewish General Hospital, Montreal, Québec, Canada
| | - Avi Shimony
- Cardiology Department, Soroka Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University, Beer Shiva, Israel
| | - Mordechai R Kramer
- Pulmonary Institute, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shtraichman O, Blanc PD, Ollech JE, Fridel L, Fuks L, Fireman E, Kramer MR. Outbreak of autoimmune disease in silicosis linked to artificial stone. Occup Med (Lond) 2015; 65:444-50. [DOI: 10.1093/occmed/kqv073] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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