Phillip Camp | Michigan State University (original) (raw)

Papers by Phillip Camp

European Respiratory Journal

New England Journal of Medicine

The Annals of thoracic surgery, Jan 6, 2017

Epstein-Barr virus (EBV) donor positive/recipient negative (D+/R-) status is a significant risk f... more Epstein-Barr virus (EBV) donor positive/recipient negative (D+/R-) status is a significant risk factor for posttransplant lymphoproliferative disorder (PTLD) in lung transplant. There are, however, no studies that identify the risk factors for PTLD in the EBV D+/R- lung transplant population to guide the decision to proceed with an EBV-positive donor. This was a retrospective cohort study of adults listed in the Scientific Registry of Transplant Recipients between May 5, 2005, and August 31, 2016. Cox proportional hazards models were used to assess the impact of EBV D+/R- status on the development of PTLD, the impact of PTLD on survival, and survival differences between EBV D+/R- and EBV D-/R- recipients. The incidence of PTLD was 6.2% (79 of 1,281) versus 1.4% (145 of 10,352) in EBV D+/R- versus all other recipients (adjusted odds ratio 4.0; 95% confidence interval: 2.8 to 5.9, p < 0.001). Among EBV D+/R- recipients, age less than 40 years and white race were associated with PTL...

The Journal of Heart and Lung Transplantation, 2017

BACKGROUND: Survival after lung transplantation is limited by chronic lung allograft dysfunction ... more BACKGROUND: Survival after lung transplantation is limited by chronic lung allograft dysfunction (CLAD). Immunomodulatory therapies such as extracorporeal photopheresis (ECP) and alemtuzumab (AL) have been described for refractory CLAD, but comparative outcomes are not well defined. METHODS: We retrospectively reviewed spirometric values and clinical outcomes after therapy with ECP, AL, or no treatment (NT) in patients with CLAD who underwent transplant between January 2005 and December 2014. We used inverse probability-weighted regression adjustment (IPWRA) to adjust for potential confounders affecting treatment choice. RESULTS: Of 267 patients, 31 received immunomodulatory therapies for CLAD, and 78 received NT. The slope of forced expiratory volume in 1 second (FEV 1) decline significantly improved after treatment with AL and with ECP compared with pre-treatment FEV 1 slope; however, there was no significant change in slope of forced vital capacity (FVC). Comparison with NT was limited because of clinical differences in treatment groups. After IPWRA, we found no significant difference in mean difference of FEV 1 slope (ml/month) when comparing treatment with NT, suggesting stabilization of lung function in the treatment group. We found no difference between the 2 immunomodulatory therapies 1, 3, and 6 months post-treatment (À49.9 [95% CI À581.8, þ482.0], p ¼ 0.85; þ27.7 [95% CI À167.6, þ223.0], p ¼ 0.78; À9.6 [95% CI À167.5, þ148.2], p ¼ 0.91). We found no difference in mean FVC slope or differences between ECP and AL in infection rates or survival after treatment.

Clinical transplantation, May 28, 2017

Bronchiolitis obliterans syndrome (BOS) is a clinical manifestation of chronic allograft rejectio... more Bronchiolitis obliterans syndrome (BOS) is a clinical manifestation of chronic allograft rejection following lung transplantation. We examined the quantitative measurements of the proximal airway and vessels and pathologic correlations in subjects with BOS. Patients who received a lung transplant at the Brigham and Women's Hospital between December 1st 2002 and December 31st 2010 were included in this study. We characterized the quantitative CT measures of proximal airways and vessels and pathological changes. 94 (46.1%) of the 204 subjects were included in the study. There was a significant increase in the airway vessel ratio in subjects who developed progressive BOS compared to controls and non-progressors. There was a significant increase in airway lumen area and decrease in vessel cross sectional area in patients with BOS compared to controls. Patients with BOS had a significant increase in proximal airway fibrosis compared to controls. BOS is characterized by central airway...

Transplantation, 2016

Development of Donor-specific Antibodies (DSA) after lung transplantation is associated with anti... more Development of Donor-specific Antibodies (DSA) after lung transplantation is associated with antibody mediated rejection (AMR), acute cellular rejection, and bronchiolitis obliterans syndrome (BOS); however, the significance of circulating antibodies before transplant remains unclear. We performed a retrospective cohort study including recipients of primary lung transplants between 2008 and 2012.We assessed the impact of circulating human leukocyte (HLA) and noncytotoxic Donor Specific antibodies (DSA) detected before transplant on development of Chronic Lung Allograft Dysfunction (CLAD) or CLAD related death. 30% of subjects had circulating class I antibodies alone, 4% Class II, and 14.4% class I and class II at MFI &amp;amp;amp;amp;amp;gt; 1000. 9% of subjects had DSA Class I, 9% Class II and 2.4% both DSA Class 1 and 2. Neither the presence of circulating antibodies (adjusted HR 0.87; 95% CI 0.50 - 1.54 p=0.65) nor the presence of DSA (adjusted HR 1.56; 95% CI 0.77 - 3.18) before transplant at MFI &amp;amp;amp;amp;amp;gt; 1000 was associated with the development of CLAD or CLAD related death. While in previous studies we have shown an increased incidence of AMR in patients with pretransplant DSA, neither the presence of HLA antibodies nor DSA translated to an increased risk of allograft dysfunction or death if prospective crossmatch testing was negative. Prospective studies are needed to define the impact of pretransplant sensitization on lung transplant recipients.

Transplantation, Jul 11, 2012

Lung transplant recipients are at high risk of invasive fungal disease (IFD), particularly invasi... more Lung transplant recipients are at high risk of invasive fungal disease (IFD), particularly invasive aspergillosis and candidiasis. The antifungal strategy that optimally balances effective reduction of IFD with a minimum of toxicity remains undefined; universal triazole prophylaxis is common at lung transplantation (LT) centers, despite the well-known toxicities and costs of this approach. We implemented an antifungal strategy in March 2007 targeted at LT recipients at highest risk for IFD based on our institutional epidemiology. All patients received inhaled amphotericin B during their initial LT hospitalization, bilateral lung transplant recipients received 7 to 10 days of micafungin, and only patients with growth of yeast or mold in their day-of-transplant cultures received further oral antifungal therapy tailored to their fungal isolate. IFD events were assessed in sequential cohorts composed of 82 lung transplant recipients before and 83 patients after the implementation of this targeted antifungal strategy. We observed a sharp decline in IFD; in the second cohort, 87%, 91%, and 96% of patients were free of IFD, invasive candidiasis, and invasive aspergillosis at 1 year. Only 19% of patients in the second cohort received systemic antifungal therapy beyond the initial LT hospitalization, and no patients experienced antifungal drug-related toxicity or IFD-associated mortality. The targeted antifungal strategy studied seems to be a reasonable approach to reducing post-LT IFD events while limiting treatment-related toxicities and costs.

Clinical Transplantation, 2016

Unplanned early rehospitalization (UER), defined as an unscheduled admission within 30 days of a ... more Unplanned early rehospitalization (UER), defined as an unscheduled admission within 30 days of a hospital discharge, is associated with graft loss and recipient mortality in some solid organ transplants but has not been investigated in lung transplant. In this retrospective study, we collected socio-demographic and clinical factors to determine predictors and outcomes of UER in the first year following lung transplantation. There were 193 patients who underwent lung transplantation and survived to discharge during the 7.9 year study period. There were 116 (60.1%) patients with at least one UER. Infections (32.8%) and post-surgical complications (11.8%) were the most common reasons for UER. On multivariate analysis, the strongest predictor of having an UER was discharge to a long term acute care facility (odds ratio: 3.01, 95% confidence interval [CI] 1.46-6.20; p = 0.003). Patients with any UER in the first year following transplantation had worse adjusted survival (hazard ratio: 1.89, 95% CI 1.02-3.50; p = 0.04). It is unclear, however, to what extent UER reflect preventable outcomes. Further large-scale, prospective research is needed to identify the extent to which certain types of UER are modifiable and to define patients at high-risk for preventable UER. This article is protected by copyright. All rights reserved.

General Hospital Psychiatry, 2016

Psychiatric comorbidities such as mood, anxiety and adjustment disorders are common among individ... more Psychiatric comorbidities such as mood, anxiety and adjustment disorders are common among individuals seeking lung transplantation. The objective of this study is to describe the association between these disorders and length of initial hospitalization and number of hospitalizations in the first year following transplantation. This was a retrospective cohort study of all lung transplantation patients between January 1, 2008 and July 1, 2014 at a large academic center. We evaluated whether pretransplantation mood, anxiety or adjustment disorders were associated with length and number of hospitalizations after transplant, adjusting for age, sex, native disease, forced expiratory volume in 1 s prior to transplantation, wait list time and lung allocation score. There were 185 patients who underwent transplantation during the 7.5-year study period of whom 125 (67.6%) had a mood, anxiety or adjustment disorder. Patients with an adjustment disorder had decreased length of initial hospitalization [B coefficient=-5.76; 95% confidence interval (CI)=-11.40 to -0.13; P=.04]. Patients with anxiety disorders had an increased number of hospitalizations in the first year following transplantation (rate ratio=1.41; 95% CI=1.06-1.88; P=.02). There was no association between mood disorders and length or number of hospitalizations. Mood, adjustment and anxiety disorders were not associated with time to initial rehospitalization. Among the three most common pretransplantation psychiatric disorders, only anxiety disorders are associated with increased hospitalization in the first year following lung transplant. Interventions designed to better control pretransplantation and posttransplantation anxiety may be associated with less frequent hospitalization.

American Journal of Roentgenology, Nov 23, 2012

OBJECTIVE: The purpose of this article is to illustrate the spectrum of central airway and vascul... more OBJECTIVE: The purpose of this article is to illustrate the spectrum of central airway and vascular complications in lung transplantation using MDCT, with an emphasis on the usefulness of advanced postprocessing techniques. CONCLUSION: MDCT is an invaluable tool in the diagnosis, evaluation, and posttreatment assessment of central airway and vascular complications in lung transplant recipients. Advanced postprocessing techniques provide complementary information that is visually accessible and anatomically meaningful for the clinician.

Hernia the Journal of Hernias and Abdominal Wall Surgery, Mar 1, 2001

Spigelian hernias are true interparietal hernias that are frequently not associated with a palpab... more Spigelian hernias are true interparietal hernias that are frequently not associated with a palpable mass and, as such, are not frequently diagnosed before surgery. Reported herein, is the serendipitous discovery of an incarcerated Spigelian hernia that was discovered on a CT scan being performed for presumed diverticulitis.

$Research paper thumbnail of Successful Treatment of Refractory Bleeding After Bridging from Acute to Chronic Left Ventricular Assist Device Support with Recombinant Activated Factor VII$

Asaio Journal, 2004

Cardiac surgery often is associated with a significant disruption of the coagulation system, part... more Cardiac surgery often is associated with a significant disruption of the coagulation system, particularly in high risk patients such as those undergoing placement of ventricular assist devices. This type of severe coagulopathy can lead to life threatening bleeding that can require massive transfusions to restore hemostasis. Recently, recombinant activated factor VII (rFVlla) has been +used as an alternative to massive transfusion for the treatment of refractory bleeding in several patient populations, including cardiac surgery patients. In the case reported here, the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s risk was compounded by multiple operations in a short period of time and circulatory collapse that was initially managed with a shortterm left ventricular assist device. After multiple failed attempts at weaning the patient from circulatory assistance, he was taken back to the operating room for conversion to a chronic, implantable device. This procedure was complicated by a severe coagulopathy secondary to a myriad of factors commonly encountered after the use of cardiopulmonary bypass. The administration of rFVlla resulted in a rapid cessation of bleeding without thrombotic complications. This is the first case reported involving an acute to chronic bridge patient. Despite the anecdotal success of rFVlla, further clinical research is needed to establish both the safety and economic feasibility of this agent.

Heart & lung : the journal of critical care, Jan 19, 2016

Extracorporeal membrane oxygenation (ECMO) is associated with a significant risk of bleeding and ... more Extracorporeal membrane oxygenation (ECMO) is associated with a significant risk of bleeding and thrombosis. Despite high rates of bleeding and bleeding-related mortality in patients on ECMO, there is little evidence available to guide clinicians in the management of ECMO-associated bleeding. We report the use of aminocaproic acid in four patients with bleeding on ECMO and a review of the literature. High D-dimer levels and low fibrinogen levels suggested that an antifibrinolytic agent may be effective as an adjunct to control bleeding. After aminocaproic acid administration, bleeding was controlled in each patient as evidenced by clinical and laboratory parameters. One patient suffered a cardiac arrest and care was withdrawn. In patients on ECMO with evidence of fibrinolysis, aminocaproic acid may be an effective option to control bleeding and to stabilize clot formation.

European Journal of Cardio-Thoracic Surgery, 2015

OBJECTIVES: Fat embolism is a known complication of severe trauma and closed chest cardiac resusc... more OBJECTIVES: Fat embolism is a known complication of severe trauma and closed chest cardiac resuscitation both of which are more common in the lung transplant donor population and can lead to donor-acquired fat embolism syndrome (DAFES). The objective was to review the diagnosis and management of DAFES in the lung transplantation literature and at our centre. METHODS: We performed a literature review on DAFES using the Medline database. We then reviewed the transplant record of Brigham and Women's Hospital, a large academic hospital with an active lung transplant programme, for cases of DAFES. RESULTS: We identified 2 cases of DAFES in our centre, one of which required extracorporeal membrane oxygenation (ECMO) for successful management. In contrast to the broader literature on DAFES, which emphasizes unsuccessfully treated cases, both patients survived. CONCLUSION: DAFES is a rare but likely underappreciated early complication of lung transplant as it can mimic primary graft dysfunction. Aggressive interventions, including ECMO, may be necessary to achieve a good clinical outcome following DAFES.

Prompt controlled reperfusion of a pulmonary allograft in a sequential double lung transplant may... more Prompt controlled reperfusion of a pulmonary allograft in a sequential double lung transplant may correct cellular ischemia prior to exposure to full hydrostatic pressures and minimize organ dysfunction. We reviewed the process of a sequential double lung transplant and describe the technique of controlled antegrade graft reperfusion of the initial implant as performed at our institution. 2009 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

Journal of the American College of Cardiology, Jan 17, 2015

Seminars in thoracic and cardiovascular surgery, 2007

Three surgical procedures are pertinent to the treatment of end-stage emphysema: giant bullectomy... more Three surgical procedures are pertinent to the treatment of end-stage emphysema: giant bullectomy, lung volume reduction surgery (LVRS), and lung transplantation. Patients with localized disease manifesting as a giant bulla that compresses adjacent healthy lung tissues can be offered bullectomy. Patients with diffuse disease can be offered LVRS, lung transplantation, or staged LVRS/lung transplant, depending on multiple factors including age, lung function parameters, lobar predominance, and whether the disease is uni- or bilateral. Since end-stage emphysema is refractory to most medical treatment, surgery is often the only remaining option.

Circulation. Arrhythmia and electrophysiology, 2009

Atrial arrhythmias (AAs) including atrial fibrillation (AF) and atrial tachycardia (AT) are often... more Atrial arrhythmias (AAs) including atrial fibrillation (AF) and atrial tachycardia (AT) are often observed after cardiothoracic surgery. Our aim was to evaluate the prevalence and mechanism of AAs after lung transplantation. All patients (n=127) after bilateral sequential lung transplantation followed at our institution over 20 years were included. All patients received postoperative rhythm monitoring and clinic visits with ECG at 1, 3, 6, and 12 months, or as needed. AAs occurred in 40 of 127 (31.5%) patients over 4.2+/-4.1 years. AA prevalence at postoperation and 1, 3, 6, 12, and >12 months was 24%, 11%, 3%, 2%, 4%, and 11%, respectively. Early AAs were predominantly AF, whereas all AAs >12 months were AT. Time to first AF versus AT was 11+/-9 versus 1485+/-2462 days (P=0.09). Male sex, age, and preoperative AA predicted any early (<3 months) AA but did not predict late AA. Early AA did not predict late AT. In 4 patients with drug-resistant AT, electrophysiology studies ...

Interactive cardiovascular and thoracic surgery, 2009