Thomas Kaleekal - Academia.edu (original) (raw)

Papers by Thomas Kaleekal

Research paper thumbnail of Repair of Tracheal Dehiscence after Heart-Lung Transplant complicated by SARS-CoV-2 Infection

Annals of Thoracic Surgery Short Reports

Research paper thumbnail of State of the art – Extracorporeal membrane oxygenation as a bridge to thoracic transplantation

Research paper thumbnail of 1-Year Outcomes of Lung Transplantation for Coronavirus Disease 2019–Associated End-Stage Lung Disease in the United States

Clinical Infectious Diseases

Background Lung transplantation can provide quality of life and survival benefits for patients wi... more Background Lung transplantation can provide quality of life and survival benefits for patients with coronavirus disease 2019 (COVID-19)–associated end-stage lung disease. Characteristics and outcomes of these lung transplant recipients are limited to mostly single-center experiences or provide a short-term follow-up. Methods Characteristics of deceased donors and adult lung transplant recipients for COVID-19–associated end-stage lung disease between August-2020 and June-2022 were analyzed using deidentified United Network for Organ Sharing database. Post-transplant patient survival of COVID-19 recipients was analyzed and compared with non–COVID-19 recipients. Secondary outcomes were length of hospitalization, post-transplant complications, and rates of organ rejection. Results During the study period, 400 lung transplants for COVID-associated end-stage lung disease comprised 8.7% of all lung transplants performed in United States. In the COVID-19 group, Hispanic males received lung ...

Research paper thumbnail of Eculizumab as Salvage Therapy for Lung Transplant in a Sensitized Patient with a Positive T and B Cell Cross Match and Severe Allograft Dysfunction

Research paper thumbnail of Disseminated Mycobacterium Avium Complex in a Lung Transplant Patient Without Allograft Involvement

Research paper thumbnail of SARS-CoV-2 Infections among Recent Organ Recipients, March–May 2020, United States

Emerging Infectious Diseases, 2021

Research paper thumbnail of Right Lung Herniation to Left Chest After Heart-Lung Transplant

Chest, 2018

Lung herniation to contralateral pleural space is a rare complication after heart-lung transplant... more Lung herniation to contralateral pleural space is a rare complication after heart-lung transplant (HLT). CASE PRESENTATION: A 51-year-old Hispanic female with a history of congestive heart failure, pulmonary hypertension, Sjogren's syndrome, and pulmonary fibrosis underwent HLT. Post-operative course was initially uneventful and she was extubated on post-operative day (POD) 3. Bilateral chest tubes were removed POD 5. Patient was transferred to the telemetry floor on low dose dobutamine on POD 6. Chest radiography showed right greater than left pleural effusion which progressed over the next few days. On POD 8 she underwent ultrasound-guided right thoracentesis with removal of 800 mL of fluid serosanguinous fluid and bronchoscopy revealed features concerning for right middle lobe torsion and right lower lobe (RLL) atelectasis. This prompted a computed tomography (CT) scan of the chest on POD 9 that showed herniation of the RLL into the left pleural space behind the heart with complete atelectasis of the RLL. On POD 10 she was taken to the operating room for mediastinal exploration and reduction of RLL herniation. RLL appeared viable. The airway and vessels appeared patent. Pneumopexy of right upper, middle, and lower lobes was completed. RLL was also pexied to the chest wall and diaphragm to prevent recurrence. Patient did well. She was extubated, and eventually discharged home without negative sequela related to herniation. DISCUSSION: This patient was doing well clinically despite lung herniation. Chest X ray findings suggestive of lung herniation were obscured by bilateral pleural effusions in our case. Lung herniation behind the heart into the contralateral thoracic cavity can increase infection risk, cause vascular compromise, or infarction. CONCLUSIONS: Lung herniation after HLT is a rare complication. CT scan is the diagnostic imaging of choice. Early diagnosis and surgical correction can prevent lung compromise. If diagnosis is delayed, irreversible damage may occur that may potentially require resection of the nonviable lung lobe.

Research paper thumbnail of Postoperative Horner Syndrome After Lung Transplantation

Journal of Neuro-Ophthalmology, 2019

BACKGROUND Horner syndrome arises from a disruption along the oculosympathetic efferent chain and... more BACKGROUND Horner syndrome arises from a disruption along the oculosympathetic efferent chain and can be caused by a variety of pathological and iatrogenic etiologies. We present 3 cases of postoperative Horner syndrome after bilateral lung transplantation. METHODS The electronic health records of 3 patients with iatrogenic Horner syndrome after lung transplantation were examined, including notes from each patient's medical history, operative and postoperative records, and ophthalmology consultation results. A literature review was performed. RESULTS All 3 of our patients displayed anisocoria and ptosis, symptoms consistent with Horner syndrome, and the patients from Cases 1 and 2 showed reversal of anisocoria after an application of topical apraclonidine. CONCLUSIONS Ophthalmologists should be aware of the risk of Horner syndrome after lung transplantation.

Research paper thumbnail of Demographics, Clinical Features, and Management Strategies Employed in Lung Transplant Patients Admitted With a Diagnosis of Gastroparesis to a Large Metropolitan Hospital

American Journal of Gastroenterology, 2017

From initial 201 citations, 3 trials fulfilled all selection criteria with a total of 396 patient... more From initial 201 citations, 3 trials fulfilled all selection criteria with a total of 396 patients. H. pylori eradication was determined by 13 C or 14 C urea breath test or rapid urease test performed at least 4 weeks after the end of intervention. In an intention-to-treat analysis, addition of polaprezinc to triple therapy led to significantly higher H. pylori eradication rates compared to triple therapy alone (OR: 1.98; CI: 1.09-3.60; p= .03; Figure 1). Similar results were obtained on per-protocol analysis (n= 364; OR: 2.49; CI: 1.10-5.63; p= .03; Figure 2). The number needed to treat was 7.5. There was no significant difference in the adverse events profile (OR: 0.93; CI: 0.36-2.42, p= .88; Figure 3). Overall, only minor treatmentemergent adverse events were reported in both the arms. Conclusion: Addition of polaprezinc to triple therapy significantly improves H. pylori eradication rate without an increase in toxicity.

Research paper thumbnail of Primary lung carcinoma in cystic fibrosis: A case report and literature review

Respiratory Medicine Case Reports, 2020

Patients with cystic fibrosis (CF) have increased life span because of improved care over last 50... more Patients with cystic fibrosis (CF) have increased life span because of improved care over last 50 years. With increasing survival, predisposition of cancer may become evident. We have observed increase risk of gastrointestinal tract cancer, testicular cancer and lymphoid leukemia. Lung cancer in patients with CF is rare. Our patient developed chronic respiratory failure due to CF related bronchiectasis. Patient had progressive disease despite optimum treatment, requiring lung transplantation. Pathology of explant lung showed focus of invasive adenocarcinoma of lung origin. Patient had no evidence of lung carcinoma recurrence in one year. To our knowledge this is the fourth reported lung cancer case in a patient with CF.

Research paper thumbnail of The Houston Methodist Lung Transplant Risk Model: A Validated Tool for Pretransplant Risk Assessment

The Annals of Thoracic Surgery, 2019

Background. Lung transplantation is the gold standard for a carefully selected patient population... more Background. Lung transplantation is the gold standard for a carefully selected patient population with end-stage lung disease. This study sought to create a risk stratification model using only preoperative recipient data to predict 1-year postoperative mortality during the pretransplant assessment. Methods. Data of lung transplant recipients at Houston Methodist Hospital in Houston, Texas from January 2009 to December 2014 were extracted from the United Network for Organ Sharing (UNOS) database. Patients were randomly divided into development and validation cohorts. Cox proportional-hazards models were conducted. Variables associated with 1-year mortality after transplantation were assigned weights on the basis of the beta coefficients, and risk scores were derived. Patients were stratified into low-, medium-and high-risk categories. The model was validated using the validation data set and data from other US transplant centers in the UNOS database. Organ Sharing (UNOS). Additional oversight by the Centers for Medicare & Medicaid Services started in 2007 to ensure that minimum outcome requirements are met. 6 Regulators use data and outcome measures developed by the Scientific Registry of Transplant Recipients (SRTR) risk adjustment model to assess performance of transplant program outcomes in comparison with their expected outcomes. The SRTR model analyzes both recipient and donor factors to assess each patient's risk. Of the 35 variables in this model, 16 are donor dependent and unknowable at the time of recipient evaluation.

Research paper thumbnail of A rare case of pulmonary cement embolism in a lung transplant patient

Respiratory medicine case reports, 2018

Pulmonary cement embolism (PCE) is a complication of percutaneous vertebral augmentation techniqu... more Pulmonary cement embolism (PCE) is a complication of percutaneous vertebral augmentation techniques. PCE in lung transplant patient population has not been reported. We report a case 57-year-old male patient with double lung transplant secondary to idiopathic pulmonary fibrosis presented with shortness of breath after vertebroplasty. CTA chest showed thin dense opacities within the bilateral pulmonary arteries consistent with pulmonary cement embolism. The patient was treated with therapeutic enoxaparin and remained stable at one year follow up.

Research paper thumbnail of Long-Term Survival in Bilateral Lung Transplantation for Scleroderma-Related Lung Disease

The Annals of thoracic surgery, Jan 27, 2018

Lung disease is the leading cause of morbidity and death in scleroderma patients, but scleroderma... more Lung disease is the leading cause of morbidity and death in scleroderma patients, but scleroderma is often considered a contraindication to lung transplantation because of concerns for worse outcomes. We evaluated whether 5-year survival in scleroderma patients after lung transplantation differed from other patients with restrictive lung disease. This was a single-center, retrospective cohort study of all patients undergoing bilateral lung transplantation for scleroderma-related pulmonary disease between January 2006 and December 2014. This cohort was compared with patients undergoing bilateral lung transplantation for nonscleroderma group D restrictive disease. Primary outcomes reported were 1-year and 5-year survival. Diagnoses were identified by United Network of Organ Sharing listing and were confirmed by clinical examination and prelisting workup. We compared 26 patients who underwent BLT for scleroderma and 155 patients who underwent BLT for group D restrictive disease. Overal...

Research paper thumbnail of The Lung Transplant Risk Model - A Nationally Validated Tool for Pre-Transplant Risk Assessment

The Journal of Heart and Lung Transplantation, 2017

The CPE of the CRS was 0.74 in the derivation cohort and 0.72 in the validation cohort. The corre... more The CPE of the CRS was 0.74 in the derivation cohort and 0.72 in the validation cohort. The correlation between observed and expected 1-year waitlist mortality in the validation cohort was 0.86. Conclusion: The candidate risk score provides an accurate objective prediction of waitlist mortality. It is currently being used to develop a modified cardiac allocation system in France.

Research paper thumbnail of Association of Methacholine Challenge Test with Diagnosis of Bronchiolitis Obliterans Syndrome in Lung Transplant Patients

The Journal of Heart and Lung Transplantation, 2017

Research paper thumbnail of Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation

Clinical transplantation, Aug 28, 2017

The natural history of de novo donor-specific antibodies (dnDSA) after lung transplantation is no... more The natural history of de novo donor-specific antibodies (dnDSA) after lung transplantation is not well-described. We sought to determine the incidence and risk factors associated with dnDSA and compare outcomes between recipients with transient (or isolated) vs persistent dnDSA after transplantation. A single-center review of all lung transplants from 1/2009-7/2013. DSAs were tested eight times in the first year and every 4 months thereafter. Outcomes examined included acute rejection and graft failure. Median follow-up was 18 months (range: 1-61 months), and 24.6% of 333 first-time lung-only transplant recipients developed a dnDSA. Ethnicity, HLA-DQ mismatches, post-transplantation platelet transfusion and Lung Allocation Score >60 were associated with dnDSA (P<.05). Overall graft survival was worse for dnDSA-positive vs negative recipients (P=.025). Of 323 recipients with 1-year follow-up, 72 (22.2%) developed dnDSA, and in 25 (34.7%), the dnDSA was transient and cleared. R...

Research paper thumbnail of Early Experience with Carfilzomib as an Adjunct to Current Therapies for Donor Specific Antibodies After Lung Transplantation

The Journal of Heart and Lung Transplantation, 2016

Endpoints were compared between genotype groups with independent t-tests. Results: The study incl... more Endpoints were compared between genotype groups with independent t-tests. Results: The study included 78% men, 65% Caucasian, 17% African American, and mean age at HTx= 49 ± 13 yrs. The mean time to achieve first TAC trough level within the goal range of 10-15 ng/ml was 7 ± 3 days. Mean TAC TDD at HTx discharge was 1.85 times higher in CYP3A5 expressors compared with non-expressors (15.0 ± 6.8 vs 8.1 ± 3.2 mg per day, p= 0.008). Similarly, TAC L/D at HTx discharge was 2-fold lower in CYP3A5 expressors compared with non-expressors (0.9 ± 0.3 vs 1.8 ± 0.9 ng/ml per mg/day, p= 0.004). Mean time to achieve TAC trough level within goal range was longer in CYP3A5 expressors vs non-expressors (8.6 ± 3.5 vs 6.1 ± 2.5 days, p= 0.07). No significant differences in TAC exposure were found between CYP3A4 genotype groups. Conclusion: Our findings in HTx are consistent with general CPIC recommendations for TAC dosing in relation to CYP3A5 genotype, i.e., CYP3A5 expressors require 1.5-2 times higher TAC doses than non-expressors. Prospective studies are needed to determine if CYP3A5 genotype-guided TAC dosing influences clinical outcomes (e.g., cardiac allograft rejection or nephrotoxicity) in HTx recipients.

Research paper thumbnail of Survival of Single Lung Transplant Recipients in 50-64 Year Age Group

The Journal of Heart and Lung Transplantation, 2015

showed superior survival for SLT vs BLT in restrictive lung diseases (p = 0.04), and similar surv... more showed superior survival for SLT vs BLT in restrictive lung diseases (p = 0.04), and similar survival for SLT vs BLT in obstructive lung diseases (p = 0.12). The non-inferiority of SLT vs BLT was maintained in different age subgroups within 50-64 year age group (number of recipients deceased within 3 years in 50-59 year age subgroup: 14 % vs 24 %, p = 0.21; and in 60-64 year age subgroup: 15 % vs 38 %, p = 0.01). Conclusion: Within 50-64 year age group, survival in SLT was superior to BLT in restrictive lung disease recipients, and similar to BLT in obstructive lung disease recipients. Preferentially performing SLT in 50-64 age group may result in improved donor lung utilization and superior survival in restrictive lung disease recipients, and improved donor lung utilization without compromising survival in obstructive lung disease recipients.

Research paper thumbnail of Single center experience in lung transplantation using extended donors versus standard donors

ABSTRACT Background Currently a shortage of donor lungs remains the most important limitation to ... more ABSTRACT Background Currently a shortage of donor lungs remains the most important limitation to lung transplantation. Short-term and long-term effects of lung transplants with extended donors are not well known. This study evaluated the outcome of recipients of lungs from extended donors in our program. Methods We performed a retrospective analysis of 492 consecutive lung transplants at our institution from January 2007 through September 2012. Recipients were divided into two groups, standard donor (SD) or extended donor (ED). ED was defined as having one of the following criteria: donor age&gt; 55 years, pulmonary contusion, pulmonary inflammation, smoking 20 pack/year, duration of ventilation longer than 5 days, purulent secretions or inflammation at bronchoscopy, PO2 &lt; 300 on FiO2 100%, Chest X-ray/ CT indicate infiltration, Localized emphysema. The primary end point was 30-day, 6-month and 12-month mortality. Survival data were calculated by Kaplan-Meier analysis with the Log-Rank test. Results Of 492 double/single lung transplants done, 156(31.7 %) were from ED. The two groups were evenly matched in recipient age, sex and BMI. ED group had 62 elderly donors (mean 59.3 years old, range 55-70); 50 smokers; 51 intubation&gt;5 days; 26 all others. Primary diagnoses and double or single lung transplant were not significantly different between two groups. The 30-day mortality for SD was 18(5.4%) of 336 versus 16(10.3 %) of 156 for ED (P=0.049). The six-month mortality for SD was 37(11%) of 336 versus 32(20.5%) of 156 for ED (P=0.018). The 12-month mortality for SD was 49(14.6%) of 336 versus 37 (23.7 %) of 156 for ED. The 30-day, 6-month and 12-month mortality for SD versus ED if smoker lungs were excluded was not statistically significant (p=0.42, 0.067, 0.11). Conclusions The result of this analysis showed inferior outcomes from ED with heavy smoking history. Donor age &gt; 55 years, intubation time and mild lung contusion had no significant effect on postoperative survival.

Research paper thumbnail of Disseminated Mycobacterium abscessus in a Lung Transplant Patient Manifesting as a Chest Wall Mass and Acute Renal Failure

Research paper thumbnail of Repair of Tracheal Dehiscence after Heart-Lung Transplant complicated by SARS-CoV-2 Infection

Annals of Thoracic Surgery Short Reports

Research paper thumbnail of State of the art – Extracorporeal membrane oxygenation as a bridge to thoracic transplantation

Research paper thumbnail of 1-Year Outcomes of Lung Transplantation for Coronavirus Disease 2019–Associated End-Stage Lung Disease in the United States

Clinical Infectious Diseases

Background Lung transplantation can provide quality of life and survival benefits for patients wi... more Background Lung transplantation can provide quality of life and survival benefits for patients with coronavirus disease 2019 (COVID-19)–associated end-stage lung disease. Characteristics and outcomes of these lung transplant recipients are limited to mostly single-center experiences or provide a short-term follow-up. Methods Characteristics of deceased donors and adult lung transplant recipients for COVID-19–associated end-stage lung disease between August-2020 and June-2022 were analyzed using deidentified United Network for Organ Sharing database. Post-transplant patient survival of COVID-19 recipients was analyzed and compared with non–COVID-19 recipients. Secondary outcomes were length of hospitalization, post-transplant complications, and rates of organ rejection. Results During the study period, 400 lung transplants for COVID-associated end-stage lung disease comprised 8.7% of all lung transplants performed in United States. In the COVID-19 group, Hispanic males received lung ...

Research paper thumbnail of Eculizumab as Salvage Therapy for Lung Transplant in a Sensitized Patient with a Positive T and B Cell Cross Match and Severe Allograft Dysfunction

Research paper thumbnail of Disseminated Mycobacterium Avium Complex in a Lung Transplant Patient Without Allograft Involvement

Research paper thumbnail of SARS-CoV-2 Infections among Recent Organ Recipients, March–May 2020, United States

Emerging Infectious Diseases, 2021

Research paper thumbnail of Right Lung Herniation to Left Chest After Heart-Lung Transplant

Chest, 2018

Lung herniation to contralateral pleural space is a rare complication after heart-lung transplant... more Lung herniation to contralateral pleural space is a rare complication after heart-lung transplant (HLT). CASE PRESENTATION: A 51-year-old Hispanic female with a history of congestive heart failure, pulmonary hypertension, Sjogren's syndrome, and pulmonary fibrosis underwent HLT. Post-operative course was initially uneventful and she was extubated on post-operative day (POD) 3. Bilateral chest tubes were removed POD 5. Patient was transferred to the telemetry floor on low dose dobutamine on POD 6. Chest radiography showed right greater than left pleural effusion which progressed over the next few days. On POD 8 she underwent ultrasound-guided right thoracentesis with removal of 800 mL of fluid serosanguinous fluid and bronchoscopy revealed features concerning for right middle lobe torsion and right lower lobe (RLL) atelectasis. This prompted a computed tomography (CT) scan of the chest on POD 9 that showed herniation of the RLL into the left pleural space behind the heart with complete atelectasis of the RLL. On POD 10 she was taken to the operating room for mediastinal exploration and reduction of RLL herniation. RLL appeared viable. The airway and vessels appeared patent. Pneumopexy of right upper, middle, and lower lobes was completed. RLL was also pexied to the chest wall and diaphragm to prevent recurrence. Patient did well. She was extubated, and eventually discharged home without negative sequela related to herniation. DISCUSSION: This patient was doing well clinically despite lung herniation. Chest X ray findings suggestive of lung herniation were obscured by bilateral pleural effusions in our case. Lung herniation behind the heart into the contralateral thoracic cavity can increase infection risk, cause vascular compromise, or infarction. CONCLUSIONS: Lung herniation after HLT is a rare complication. CT scan is the diagnostic imaging of choice. Early diagnosis and surgical correction can prevent lung compromise. If diagnosis is delayed, irreversible damage may occur that may potentially require resection of the nonviable lung lobe.

Research paper thumbnail of Postoperative Horner Syndrome After Lung Transplantation

Journal of Neuro-Ophthalmology, 2019

BACKGROUND Horner syndrome arises from a disruption along the oculosympathetic efferent chain and... more BACKGROUND Horner syndrome arises from a disruption along the oculosympathetic efferent chain and can be caused by a variety of pathological and iatrogenic etiologies. We present 3 cases of postoperative Horner syndrome after bilateral lung transplantation. METHODS The electronic health records of 3 patients with iatrogenic Horner syndrome after lung transplantation were examined, including notes from each patient's medical history, operative and postoperative records, and ophthalmology consultation results. A literature review was performed. RESULTS All 3 of our patients displayed anisocoria and ptosis, symptoms consistent with Horner syndrome, and the patients from Cases 1 and 2 showed reversal of anisocoria after an application of topical apraclonidine. CONCLUSIONS Ophthalmologists should be aware of the risk of Horner syndrome after lung transplantation.

Research paper thumbnail of Demographics, Clinical Features, and Management Strategies Employed in Lung Transplant Patients Admitted With a Diagnosis of Gastroparesis to a Large Metropolitan Hospital

American Journal of Gastroenterology, 2017

From initial 201 citations, 3 trials fulfilled all selection criteria with a total of 396 patient... more From initial 201 citations, 3 trials fulfilled all selection criteria with a total of 396 patients. H. pylori eradication was determined by 13 C or 14 C urea breath test or rapid urease test performed at least 4 weeks after the end of intervention. In an intention-to-treat analysis, addition of polaprezinc to triple therapy led to significantly higher H. pylori eradication rates compared to triple therapy alone (OR: 1.98; CI: 1.09-3.60; p= .03; Figure 1). Similar results were obtained on per-protocol analysis (n= 364; OR: 2.49; CI: 1.10-5.63; p= .03; Figure 2). The number needed to treat was 7.5. There was no significant difference in the adverse events profile (OR: 0.93; CI: 0.36-2.42, p= .88; Figure 3). Overall, only minor treatmentemergent adverse events were reported in both the arms. Conclusion: Addition of polaprezinc to triple therapy significantly improves H. pylori eradication rate without an increase in toxicity.

Research paper thumbnail of Primary lung carcinoma in cystic fibrosis: A case report and literature review

Respiratory Medicine Case Reports, 2020

Patients with cystic fibrosis (CF) have increased life span because of improved care over last 50... more Patients with cystic fibrosis (CF) have increased life span because of improved care over last 50 years. With increasing survival, predisposition of cancer may become evident. We have observed increase risk of gastrointestinal tract cancer, testicular cancer and lymphoid leukemia. Lung cancer in patients with CF is rare. Our patient developed chronic respiratory failure due to CF related bronchiectasis. Patient had progressive disease despite optimum treatment, requiring lung transplantation. Pathology of explant lung showed focus of invasive adenocarcinoma of lung origin. Patient had no evidence of lung carcinoma recurrence in one year. To our knowledge this is the fourth reported lung cancer case in a patient with CF.

Research paper thumbnail of The Houston Methodist Lung Transplant Risk Model: A Validated Tool for Pretransplant Risk Assessment

The Annals of Thoracic Surgery, 2019

Background. Lung transplantation is the gold standard for a carefully selected patient population... more Background. Lung transplantation is the gold standard for a carefully selected patient population with end-stage lung disease. This study sought to create a risk stratification model using only preoperative recipient data to predict 1-year postoperative mortality during the pretransplant assessment. Methods. Data of lung transplant recipients at Houston Methodist Hospital in Houston, Texas from January 2009 to December 2014 were extracted from the United Network for Organ Sharing (UNOS) database. Patients were randomly divided into development and validation cohorts. Cox proportional-hazards models were conducted. Variables associated with 1-year mortality after transplantation were assigned weights on the basis of the beta coefficients, and risk scores were derived. Patients were stratified into low-, medium-and high-risk categories. The model was validated using the validation data set and data from other US transplant centers in the UNOS database. Organ Sharing (UNOS). Additional oversight by the Centers for Medicare & Medicaid Services started in 2007 to ensure that minimum outcome requirements are met. 6 Regulators use data and outcome measures developed by the Scientific Registry of Transplant Recipients (SRTR) risk adjustment model to assess performance of transplant program outcomes in comparison with their expected outcomes. The SRTR model analyzes both recipient and donor factors to assess each patient's risk. Of the 35 variables in this model, 16 are donor dependent and unknowable at the time of recipient evaluation.

Research paper thumbnail of A rare case of pulmonary cement embolism in a lung transplant patient

Respiratory medicine case reports, 2018

Pulmonary cement embolism (PCE) is a complication of percutaneous vertebral augmentation techniqu... more Pulmonary cement embolism (PCE) is a complication of percutaneous vertebral augmentation techniques. PCE in lung transplant patient population has not been reported. We report a case 57-year-old male patient with double lung transplant secondary to idiopathic pulmonary fibrosis presented with shortness of breath after vertebroplasty. CTA chest showed thin dense opacities within the bilateral pulmonary arteries consistent with pulmonary cement embolism. The patient was treated with therapeutic enoxaparin and remained stable at one year follow up.

Research paper thumbnail of Long-Term Survival in Bilateral Lung Transplantation for Scleroderma-Related Lung Disease

The Annals of thoracic surgery, Jan 27, 2018

Lung disease is the leading cause of morbidity and death in scleroderma patients, but scleroderma... more Lung disease is the leading cause of morbidity and death in scleroderma patients, but scleroderma is often considered a contraindication to lung transplantation because of concerns for worse outcomes. We evaluated whether 5-year survival in scleroderma patients after lung transplantation differed from other patients with restrictive lung disease. This was a single-center, retrospective cohort study of all patients undergoing bilateral lung transplantation for scleroderma-related pulmonary disease between January 2006 and December 2014. This cohort was compared with patients undergoing bilateral lung transplantation for nonscleroderma group D restrictive disease. Primary outcomes reported were 1-year and 5-year survival. Diagnoses were identified by United Network of Organ Sharing listing and were confirmed by clinical examination and prelisting workup. We compared 26 patients who underwent BLT for scleroderma and 155 patients who underwent BLT for group D restrictive disease. Overal...

Research paper thumbnail of The Lung Transplant Risk Model - A Nationally Validated Tool for Pre-Transplant Risk Assessment

The Journal of Heart and Lung Transplantation, 2017

The CPE of the CRS was 0.74 in the derivation cohort and 0.72 in the validation cohort. The corre... more The CPE of the CRS was 0.74 in the derivation cohort and 0.72 in the validation cohort. The correlation between observed and expected 1-year waitlist mortality in the validation cohort was 0.86. Conclusion: The candidate risk score provides an accurate objective prediction of waitlist mortality. It is currently being used to develop a modified cardiac allocation system in France.

Research paper thumbnail of Association of Methacholine Challenge Test with Diagnosis of Bronchiolitis Obliterans Syndrome in Lung Transplant Patients

The Journal of Heart and Lung Transplantation, 2017

Research paper thumbnail of Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation

Clinical transplantation, Aug 28, 2017

The natural history of de novo donor-specific antibodies (dnDSA) after lung transplantation is no... more The natural history of de novo donor-specific antibodies (dnDSA) after lung transplantation is not well-described. We sought to determine the incidence and risk factors associated with dnDSA and compare outcomes between recipients with transient (or isolated) vs persistent dnDSA after transplantation. A single-center review of all lung transplants from 1/2009-7/2013. DSAs were tested eight times in the first year and every 4 months thereafter. Outcomes examined included acute rejection and graft failure. Median follow-up was 18 months (range: 1-61 months), and 24.6% of 333 first-time lung-only transplant recipients developed a dnDSA. Ethnicity, HLA-DQ mismatches, post-transplantation platelet transfusion and Lung Allocation Score >60 were associated with dnDSA (P<.05). Overall graft survival was worse for dnDSA-positive vs negative recipients (P=.025). Of 323 recipients with 1-year follow-up, 72 (22.2%) developed dnDSA, and in 25 (34.7%), the dnDSA was transient and cleared. R...

Research paper thumbnail of Early Experience with Carfilzomib as an Adjunct to Current Therapies for Donor Specific Antibodies After Lung Transplantation

The Journal of Heart and Lung Transplantation, 2016

Endpoints were compared between genotype groups with independent t-tests. Results: The study incl... more Endpoints were compared between genotype groups with independent t-tests. Results: The study included 78% men, 65% Caucasian, 17% African American, and mean age at HTx= 49 ± 13 yrs. The mean time to achieve first TAC trough level within the goal range of 10-15 ng/ml was 7 ± 3 days. Mean TAC TDD at HTx discharge was 1.85 times higher in CYP3A5 expressors compared with non-expressors (15.0 ± 6.8 vs 8.1 ± 3.2 mg per day, p= 0.008). Similarly, TAC L/D at HTx discharge was 2-fold lower in CYP3A5 expressors compared with non-expressors (0.9 ± 0.3 vs 1.8 ± 0.9 ng/ml per mg/day, p= 0.004). Mean time to achieve TAC trough level within goal range was longer in CYP3A5 expressors vs non-expressors (8.6 ± 3.5 vs 6.1 ± 2.5 days, p= 0.07). No significant differences in TAC exposure were found between CYP3A4 genotype groups. Conclusion: Our findings in HTx are consistent with general CPIC recommendations for TAC dosing in relation to CYP3A5 genotype, i.e., CYP3A5 expressors require 1.5-2 times higher TAC doses than non-expressors. Prospective studies are needed to determine if CYP3A5 genotype-guided TAC dosing influences clinical outcomes (e.g., cardiac allograft rejection or nephrotoxicity) in HTx recipients.

Research paper thumbnail of Survival of Single Lung Transplant Recipients in 50-64 Year Age Group

The Journal of Heart and Lung Transplantation, 2015

showed superior survival for SLT vs BLT in restrictive lung diseases (p = 0.04), and similar surv... more showed superior survival for SLT vs BLT in restrictive lung diseases (p = 0.04), and similar survival for SLT vs BLT in obstructive lung diseases (p = 0.12). The non-inferiority of SLT vs BLT was maintained in different age subgroups within 50-64 year age group (number of recipients deceased within 3 years in 50-59 year age subgroup: 14 % vs 24 %, p = 0.21; and in 60-64 year age subgroup: 15 % vs 38 %, p = 0.01). Conclusion: Within 50-64 year age group, survival in SLT was superior to BLT in restrictive lung disease recipients, and similar to BLT in obstructive lung disease recipients. Preferentially performing SLT in 50-64 age group may result in improved donor lung utilization and superior survival in restrictive lung disease recipients, and improved donor lung utilization without compromising survival in obstructive lung disease recipients.

Research paper thumbnail of Single center experience in lung transplantation using extended donors versus standard donors

ABSTRACT Background Currently a shortage of donor lungs remains the most important limitation to ... more ABSTRACT Background Currently a shortage of donor lungs remains the most important limitation to lung transplantation. Short-term and long-term effects of lung transplants with extended donors are not well known. This study evaluated the outcome of recipients of lungs from extended donors in our program. Methods We performed a retrospective analysis of 492 consecutive lung transplants at our institution from January 2007 through September 2012. Recipients were divided into two groups, standard donor (SD) or extended donor (ED). ED was defined as having one of the following criteria: donor age&gt; 55 years, pulmonary contusion, pulmonary inflammation, smoking 20 pack/year, duration of ventilation longer than 5 days, purulent secretions or inflammation at bronchoscopy, PO2 &lt; 300 on FiO2 100%, Chest X-ray/ CT indicate infiltration, Localized emphysema. The primary end point was 30-day, 6-month and 12-month mortality. Survival data were calculated by Kaplan-Meier analysis with the Log-Rank test. Results Of 492 double/single lung transplants done, 156(31.7 %) were from ED. The two groups were evenly matched in recipient age, sex and BMI. ED group had 62 elderly donors (mean 59.3 years old, range 55-70); 50 smokers; 51 intubation&gt;5 days; 26 all others. Primary diagnoses and double or single lung transplant were not significantly different between two groups. The 30-day mortality for SD was 18(5.4%) of 336 versus 16(10.3 %) of 156 for ED (P=0.049). The six-month mortality for SD was 37(11%) of 336 versus 32(20.5%) of 156 for ED (P=0.018). The 12-month mortality for SD was 49(14.6%) of 336 versus 37 (23.7 %) of 156 for ED. The 30-day, 6-month and 12-month mortality for SD versus ED if smoker lungs were excluded was not statistically significant (p=0.42, 0.067, 0.11). Conclusions The result of this analysis showed inferior outcomes from ED with heavy smoking history. Donor age &gt; 55 years, intubation time and mild lung contusion had no significant effect on postoperative survival.

Research paper thumbnail of Disseminated Mycobacterium abscessus in a Lung Transplant Patient Manifesting as a Chest Wall Mass and Acute Renal Failure