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Hartwig, Matthew

Positions:

Associate Professor of Surgery

Surgery, Cardiovascular and Thoracic Surgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2001

M.D. — Duke University

Intern,

Duke University

Junior Assistant Resident,

Duke University

Research Fellow,

Duke University

Senior Assistant Resident,

Duke University

Chief Resident,

Duke University

Resident,

Duke University

Chief Resident,

Duke University

News:

Grants:

A Phase 2, Multicenter, Open Label Study To Measure Safety Donor Lungs (EVLP)

Administered By
Surgery, Cardiovascular and Thoracic Surgery
AwardedBy
Lung Bioengineering, Inc.
Role
Principal Investigator
Start Date
January 06, 2017
End Date
December 31, 2023

Expand Trial

Administered By
Surgery, Cardiovascular and Thoracic Surgery
AwardedBy
TransMedics
Role
Principal Investigator
Start Date
July 01, 2016
End Date
June 30, 2021

FSF Fellowship

Administered By
Surgery, Cardiovascular and Thoracic Surgery
AwardedBy
Foundation for Surgical Fellowships
Role
Principal Investigator
Start Date
August 01, 2017
End Date
July 31, 2018

FSF Fellowship

Administered By
Surgery, Cardiovascular and Thoracic Surgery
AwardedBy
Foundation for Surgical Fellowships
Role
Principal Investigator
Start Date
July 01, 2016
End Date
June 30, 2017

Clinical Risk Factors for Primary Graft Dysfunction

Administered By
Surgery, Cardiovascular and Thoracic Surgery
AwardedBy
University of Pennsylvania
Role
Principal Investigator
Start Date
July 01, 2016
End Date
June 30, 2017

Obesity, Inflammation, and Lung Injury after Lung Transplantation

Administered By
Medicine, Pulmonary, Allergy, and Critical Care Medicine
AwardedBy
Columbia University
Role
Co Investigator
Start Date
May 23, 2013
End Date
March 31, 2017

Prospective Registry of Outcomes in Patients Electing Lung Transplantation (PROPEL)

Administered By
Surgery, Cardiovascular and Thoracic Surgery
AwardedBy
University of Pennsylvania
Role
Principal Investigator
Start Date
October 01, 2014
End Date
September 30, 2016

More and Better Lungs: Ex-Vivo Perfusion of Non-Heart-Beating Donors?

Administered By
Surgery, Cardiovascular and Thoracic Surgery
AwardedBy
University of North Carolina - Chapel Hill
Role
Principal Investigator
Start Date
July 01, 2014
End Date
September 30, 2016
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Publications:

The wait for the waitlist: The next challenge in the lung allocation system.

Authors
Englum, BR; Hartwig, MG
MLA Citation
Englum, BR, and Hartwig, MG. "The wait for the waitlist: The next challenge in the lung allocation system." The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 36.3 (March 2017): 250-252.
PMID
28110831
Source
epmc
Published In
The Journal of Heart and Lung Transplantation
Volume
36
Issue
3
Publish Date
2017
Start Page
250
End Page
252
DOI
10.1016/j.healun.2016.11.011

Adverse outcomes associated with postoperative atrial arrhythmias after lung transplantation: a meta-analysis and systematic review of the literature.

Postoperative atrial arrhythmias (AAs) are common after lung transplantation but studies are mixed regarding their impact on outcomes. We therefore performed this systematic review and meta-analysis to determine whether AAs after lung transplantation impede postoperative recovery.MEDLINE, EMBASE, CINAHL, and the Cochrane Register were searched to identify studies comparing outcomes in adult patients undergoing lung transplantation who experienced postoperative AAs in the immediate postoperative period versus those without postoperative AAs. Our primary outcome was perioperative mortality, and secondary outcomes were length of stay (LOS), postoperative complications, and mid-term (1-6 year) mortality.Nine studies including 2653 patients were included in this analysis. Of this group, 791 (29.8%) had postoperative AAs. Patients with postoperative AAs had significantly higher perioperative (OR 2.70 [95% CI: 1.73 - 4.19], p<0.0001) mortality, longer hospital LOS (MD 8.29 [95% CI: 4.37 - 12.21] days, p<0.0001), more frequent requirement for tracheostomy (OR 4.67 [95% CI: 2.59 - 8.44], p<0.0001), and higher mid-term mortality (OR 1.71 [95% CI: 1.28 - 2.30], p=0.0003).AAs after lung transplantation are frequent and associated with significantly higher mortality, longer hospital LOS, and requirement for tracheostomy. Given their impact on recovery, prophylactic strategies against atrial arrhythmias need to be developed. This article is protected by copyright. All rights reserved.

Authors
Waldron, NH; Klinger, RY; Hartwig, MG; Snyder, LD; Daubert, JP; Mathew, JP
MLA Citation
Waldron, NH, Klinger, RY, Hartwig, MG, Snyder, LD, Daubert, JP, and Mathew, JP. "Adverse outcomes associated with postoperative atrial arrhythmias after lung transplantation: a meta-analysis and systematic review of the literature." Clinical transplantation (February 9, 2017).
PMID
28181294
Source
epmc
Published In
Clinical Transplantation
Publish Date
2017
DOI
10.1111/ctr.12926

Tough problem, creative solution

Authors
Klapper, JA; Hartwig, MG
MLA Citation
Klapper, JA, and Hartwig, MG. "Tough problem, creative solution." The Journal of Thoracic and Cardiovascular Surgery 153.2 (February 2017): 476-476.
Source
crossref
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
153
Issue
2
Publish Date
2017
Start Page
476
End Page
476
DOI
10.1016/j.jtcvs.2016.10.038

Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation.

Nontuberculous mycobacteria (NTM) commonly colonize municipal water and cause healthcare-associated outbreaks. We investigated a biphasic outbreak of Mycobacterium abscessus at a tertiary care hospital.Case patients had recent hospital exposure and laboratory-confirmed colonization or infection with M. abscessus from January 2013 through December 2015. We conducted a multidisciplinary epidemiologic, field, and laboratory investigation.The incidence rate of M. abscessus increased from 0.7 cases per 10,000 patient-days during the baseline period (1/2013 - 7/2013) to 3.0 cases per 10,000 patient-days during Phase 1 of the outbreak (8/2013 - 5/2014) (incidence rate ratio, 4.6; 95% confidence interval, 2.3-8.8; P<0.001). Thirty-six (51%) of 71 Phase 1 cases were lung transplant patients with positive respiratory cultures. We eliminated tap water exposure to the aero-digestive tract among high risk patients, and the incidence rate decreased to baseline. Twelve (50%) of 24 Phase 2 (12/2014 - 6/2015) cases occurred in cardiac surgery patients with invasive infections. Phase 2 resolved after we implemented an intensified disinfection protocol and used sterile water for heater-cooler units of cardiopulmonary bypass machines. Molecular fingerprinting of clinical isolates identified two clonal strains of M. abscessus; one clone was isolated from water sources at a new hospital addition. We made several water engineering interventions to improve water flow and increase disinfectant levels.We investigated and mitigated a two-phase clonal outbreak of M. abscessus linked to hospital tap water. Healthcare facilities with endemic NTM should consider similar tap water avoidance and engineering strategies to decrease risk of NTM infection.

Authors
Baker, AW; Lewis, SS; Alexander, BD; Chen, LF; Wallace, RJ; Brown-Elliott, BA; Isaacs, PJ; Pickett, LC; Patel, CB; Smith, PK; Reynolds, JM; Engel, J; Wolfe, CR; Milano, CA; Schroder, JN; Davis, RD; Hartwig, MG; Stout, JE; Strittholt, N; Maziarz, EK; Saullo, JH; Hazen, KC; Walczak, RJ; Vasireddy, R; Vasireddy, S; McKnight, CM; Anderson, DJ; Sexton, DJ
MLA Citation
Baker, AW, Lewis, SS, Alexander, BD, Chen, LF, Wallace, RJ, Brown-Elliott, BA, Isaacs, PJ, Pickett, LC, Patel, CB, Smith, PK, Reynolds, JM, Engel, J, Wolfe, CR, Milano, CA, Schroder, JN, Davis, RD, Hartwig, MG, Stout, JE, Strittholt, N, Maziarz, EK, Saullo, JH, Hazen, KC, Walczak, RJ, Vasireddy, R, Vasireddy, S, McKnight, CM, Anderson, DJ, and Sexton, DJ. "Two-Phase Hospital-Associated Outbreak of Mycobacterium abscessus: Investigation and Mitigation." Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (January 11, 2017).
PMID
28077517
Source
epmc
Published In
Clinical Infectious Diseases
Publish Date
2017
DOI
10.1093/cid/ciw877

The Role of Extent of Surgical Resection and Lymph Node Assessment for Clinical Stage I Pulmonary Lepidic Adenocarcinoma: An Analysis of 1991 Patients.

This study examined the association of extent of lung resection, pathologic nodal evaluation, and survival for patients with clinical stage I (cT1-2N0M0) adenocarcinoma with lepidic histologic features in the National Cancer Data Base.The association between extent of surgical resection and long-term survival for patients in the National Cancer Data Base with clinical stage I lepidic adenocarcinoma who underwent lobectomy or sublobar resection was evaluated using Kaplan-Meier and Cox proportional hazards regression analyses.Of the 1991 patients with cT1-2N0M0 lepidic adenocarcinoma who met the study criteria, 1544 underwent lobectomy and 447 underwent sublobar resection. Patients treated with sublobar resection were older, more likely to be female, and had higher Charlson/Deyo comorbidity scores, but they had smaller tumors and lower T status. Of the patients treated with lobectomy, 6% (n = 92) were upstaged because of positive nodal disease, with a median of seven lymph nodes sampled (interquartile range 4-10). In an analysis of the entire cohort, lobectomy was associated with a significant survival advantage over sublobar resection in univariate analysis (median survival 9.2 versus 7.5 years, p = 0.022, 5-year survival 70.5% versus 67.8%) and after multivariable adjustment (hazard ratio = 0.81, 95% confidence interval: 0.68-0.95, p = 0.011). However, lobectomy was no longer independently associated with improved survival when compared with sublobar resection (hazard ratio = 0.99, 95% confidence interval: 0.77-1.27, p = 0.905) in a multivariable analysis of a subset of patients in which only those patients who had undergone a sublobar resection including lymph node sampling were compared with patients treated with lobectomy.Surgeons treating patients with stage I lung adenocarcinoma with lepidic features should cautiously utilize sublobar resection rather than lobectomy, and they must always perform adequate pathologic lymph node evaluation.

Authors
Cox, ML; Yang, C-FJ; Speicher, PJ; Anderson, KL; Fitch, ZW; Gu, L; Davis, RP; Wang, X; D'Amico, TA; Hartwig, MG; Harpole, DH; Berry, MF
MLA Citation
Cox, ML, Yang, C-FJ, Speicher, PJ, Anderson, KL, Fitch, ZW, Gu, L, Davis, RP, Wang, X, D'Amico, TA, Hartwig, MG, Harpole, DH, and Berry, MF. "The Role of Extent of Surgical Resection and Lymph Node Assessment for Clinical Stage I Pulmonary Lepidic Adenocarcinoma: An Analysis of 1991 Patients." Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer (January 7, 2017).
PMID
28082103
Source
epmc
Published In
Journal of Thoracic Oncology
Publish Date
2017
DOI
10.1016/j.jtho.2017.01.003

Transplant Size Mismatch in Restrictive Lung Disease.

To maximize the benefit of lung transplantation, the effect of size mismatch on survival in lung transplant recipients with restrictive lung disease (RLD) was examined.All single and bilateral RLD lung transplants from 1987-2011 in the UNOS Database were identified. Donor pTLC:Recipient pTLC ratio (pTLCr), quantified mismatch. pTLCr was segregated into 5 strata. A Cox proportional hazards model evaluated the association of pTLCr with mortality hazard. To identify a critical pTLCr, a Cox model using a restricted cubic spline for pTLCr was used.6,656 transplants for RLD were identified. Median pTLCr for SOLT and BOLT was 1.0 (0.69-1.47) and 0.98 (0.66-1.45). Examination of pTLCr as a categorical variable revealed that undersizing (pTLCr<0.8) for SOLT and moderate oversizing (pTLCr=1.1-1.2) for SOLT and BOLT had a harmful survival effect (for SOLT pTLC < 0.8: HR 1.711 [95% CI 1.146-2.557], P = 0.01 and for BOLT pTLC 1.1-1.2: HR 1.717 [95% CI 1.112-2.651], P = 0.02). Spline analysis revealed significant changes in SOLT mortality by variation of pTLCr between 0.8-0.9 and 1.1-1.2.RLD patients undergoing SOLT are susceptible to detriments of an undersized lung. RLD patients undergoing BOLT have higher risk of mortality when pTLCr falls between 1.1-1.2. This article is protected by copyright. All rights reserved.

Authors
Ganapathi, AM; Mulvihill, MS; Englum, BR; Speicher, PJ; Gulack, BC; Osho, AA; Yerokun, BA; Snyder, LR; Davis, D; Hartwig, MG
MLA Citation
Ganapathi, AM, Mulvihill, MS, Englum, BR, Speicher, PJ, Gulack, BC, Osho, AA, Yerokun, BA, Snyder, LR, Davis, D, and Hartwig, MG. "Transplant Size Mismatch in Restrictive Lung Disease." Transplant international : official journal of the European Society for Organ Transplantation (January 6, 2017).
PMID
28058795
Source
epmc
Published In
Transplant International
Publish Date
2017
DOI
10.1111/tri.12913

Lung Transplant Center Volume Ameliorates Adverse Influence of Prolonged Ischemic Time on Mortality.

The influence of prolonged ischemic time on outcomes after lung transplant is controversial, but no research has investigated ischemic time in the context of center volume. We used data from the United Network for Organ Sharing to estimate the influence of ischemic time on patient survival conditional on center volume in the post-lung allocation score era (2005-2015). The analytic sample included 14 877 adult lung transplant recipients, of whom 12 447 were included in multivariable survival analysis. Patient survival was improved in high-volume centers compared with low-volume centers (log-rank test p = 0.001), although mean ischemic times were longer at high-volume centers (5.16 ± 1.70 h vs. 4.83 ± 1.63 h, p < 0.001). Multivariable Cox proportional hazards regression stratified by transplant center found an adverse influence of longer ischemic time at low-volume centers but not at high-volume centers. At centers performing 50 transplants in the period 2005-2015, for example, 8 versus 6 h of ischemia were associated with an 18.9% (95% confidence interval 6.5-32.7%; p < 0.001) greater mortality hazard, whereas at centers performing 350 transplants in this period, no differences in survival by ischemic time were predicted. Despite longer mean ischemic time at high-volume transplant centers, these centers had favorable patient outcomes and no adverse survival implications of prolonged ischemia.

Authors
Hayes, D; Hartwig, MG; Tobias, JD; Tumin, D
MLA Citation
Hayes, D, Hartwig, MG, Tobias, JD, and Tumin, D. "Lung Transplant Center Volume Ameliorates Adverse Influence of Prolonged Ischemic Time on Mortality." American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 17.1 (January 2017): 218-226.
PMID
27278264
Source
epmc
Published In
American Journal of Transplantation
Volume
17
Issue
1
Publish Date
2017
Start Page
218
End Page
226
DOI
10.1111/ajt.13916

Medication Nonadherence After Lung Transplantation in Adult Recipients.

Our objective was to identify potential avenues for resource allocation and patient advocacy to improve outcomes by evaluating the association between recipient sociodemographic and patient characteristics and medication nonadherence after lung transplantation.States US adult, lung-only transplantations per the United Network for Organ Sharing database were analyzed from October 1996 through December 2006, based on the period during which nonadherence information was recorded. Generalized linear models were used to determine the association of demographic, disease, and transplantation center characteristics with early nonadherence (defined as within the first year after transplantation) as well as late nonadherence (years 2 to 4 after transplantation). Outcomes comparing adherent and nonadherent patients were also evaluated.Patients (n = 7,284) were included for analysis. Early and late nonadherence rates were 3.1% and 10.6%, respectively. Factors associated with early nonadherence were Medicaid insurance compared with private insurance (adjusted odds ratio [AOR] 2.45, 95% confidence interval [CI]: 1.16 to 5.15), and black race (AOR 2.38, 95% CI: 1.08 to 5.25). Medicaid insurance and black race were also associated with late nonadherence (AOR 2.38, 95% CI: 1.51 to 3.73 and OR 1.73, 95% CI: 1.04 to 2.89, respectively), as were age 18 to 20 years (AOR 3.41, 95% CI: 1.29 to 8.99) and grade school or lower education (AOR 1.88, 95% CI: 1.05 to 3.35). Early and late nonadherence were both associated with significantly shorter unadjusted survival (p < 0.001).Identifying patients at risk of nonadherence may enable resource allocation and patient advocacy to improve outcomes.

Authors
Castleberry, AW; Bishawi, M; Worni, M; Erhunmwunsee, L; Speicher, PJ; Osho, AA; Snyder, LD; Hartwig, MG
MLA Citation
Castleberry, AW, Bishawi, M, Worni, M, Erhunmwunsee, L, Speicher, PJ, Osho, AA, Snyder, LD, and Hartwig, MG. "Medication Nonadherence After Lung Transplantation in Adult Recipients." The Annals of thoracic surgery 103.1 (January 2017): 274-280.
PMID
27624294
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
103
Issue
1
Publish Date
2017
Start Page
274
End Page
280
DOI
10.1016/j.athoracsur.2016.06.067

The utility of 6-minute walk distance in predicting waitlist mortality for lung transplant candidates.

The lung allocation score (LAS) has led to improved organ allocation for transplant candidates. At present, the 6-minute walk distance (6MWD) is treated as a binary categorical variable of whether or not a candidate can walk more than 150 feet in 6 minutes. In this study, we tested the hypothesis that 6MWD is presently under-utilized with respect to discriminatory power, and that, as a continuous variable, could better prognosticate risk of waitlist mortality.A retrospective cohort analysis was performed using the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) transplant database. Candidates listed for isolated lung transplant between May 2005 and December 2011 were included. The population was stratified by 6MWD quartiles and unadjusted survival rates were estimated. Multivariable Cox proportional hazards modeling was used to assess the effect of 6MWD on risk of death. The Scientific Registry of Transplant Recipients (SRTR) Waitlist Risk Model was used to adjust for confounders. The optimal 6MWD for discriminative accuracy in predicting waitlist mortality was assessed by receiver-operating characteristic (ROC) curves.Analysis was performed on 12,298 recipients. Recipients were segregated into quartiles by distance walked. Waitlist mortality decreased as 6MWD increased. In the multivariable model, significant variables included 6MWD, male gender, non-white ethnicity and restrictive lung diseases. ROC curves discriminated 6-month mortality was best at 655 feet.The 6MWD is a significant predictor of waitlist mortality. A cut-off of 150 feet sub-optimally identifies candidates with increased risk of mortality. A cut-off between 550 and 655 feet is more optimal if 6MWD is to be treated as a dichotomous variable. Utilization of the LAS as a continuous variable could further enhance predictive capabilities.

Authors
Castleberry, A; Mulvihill, MS; Yerokun, BA; Gulack, BC; Englum, B; Snyder, L; Worni, M; Osho, A; Palmer, S; Davis, RD; Hartwig, MG
MLA Citation
Castleberry, A, Mulvihill, MS, Yerokun, BA, Gulack, BC, Englum, B, Snyder, L, Worni, M, Osho, A, Palmer, S, Davis, RD, and Hartwig, MG. "The utility of 6-minute walk distance in predicting waitlist mortality for lung transplant candidates." The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (December 30, 2016).
PMID
28131666
Source
epmc
Published In
The Journal of Heart and Lung Transplantation
Publish Date
2016
DOI
10.1016/j.healun.2016.12.015

Spontaneously Breathing Extracorporeal Membrane Oxygenation Support Provides the Optimal Bridge to Lung Transplantation.

Extracorporeal membrane oxygenation (ECMO) is being increasingly used as a bridge to lung transplantation. Small, single-institution series have described increased success using ECMO in spontaneously breathing patients compared with patients on ECMO with mechanical ventilation, but this strategy has not been evaluated on a large scale.Using the United Network for Organ Sharing database, all adult patients undergoing isolated lung transplantation from May 2005 through September 2013 were identified. Patients were categorized by their type of pretransplant support: no support, ECMO only, invasive mechanical ventilation (iMV) only, and ECMO + iMV. Kaplan-Meier survival analysis with log-rank testing was performed to compare survival based on type of preoperative support. A Cox regression model was used to determine whether type of preoperative support was independently associated with survival, using previously established predictors of survival as covariates.Approximately 12,403 primary adult pulmonary transplantations were included in this analysis. Sixty-five patients (0.52%) were on ECMO only, 612 (4.93%) required only iMV, 119 (0.96%) were on ECMO + iMV, and the remaining 11,607 (94.6%) required no invasive support before transplantation. One-year survival was decreased in all patients requiring support, regardless of type. However, mid-term survival was similar between patients on ECMO alone and those not on support but significantly worse with patients requiring iMV only or ECMO + iMV. In multivariable analysis, ECMO + iMV and iMV alone were independently associated with decreased survival compared with nonsupport patients, whereas ECMO alone was not significant.In patients with worsening pulmonary disease awaiting lung transplantation, those supported via ECMO with spontaneous breathing demonstrated improved survival compared with other bridging strategies.

Authors
Schechter, MA; Ganapathi, AM; Englum, BR; Speicher, PJ; Daneshmand, MA; Davis, RD; Hartwig, MG
MLA Citation
Schechter, MA, Ganapathi, AM, Englum, BR, Speicher, PJ, Daneshmand, MA, Davis, RD, and Hartwig, MG. "Spontaneously Breathing Extracorporeal Membrane Oxygenation Support Provides the Optimal Bridge to Lung Transplantation." Transplantation 100.12 (December 2016): 2699-2704.
PMID
26910331
Source
epmc
Published In
Transplantation
Volume
100
Issue
12
Publish Date
2016
Start Page
2699
End Page
2704

A Risk Score to Assist Selecting Lobectomy Versus Sublobar Resection for Early Stage Non-Small Cell Lung Cancer.

The long-term survival benefit of lobectomy over sublobar resection for early-stage non-small cell lung cancer must be weighed against a potentially increased risk of perioperative mortality. The objective of the current study was to create a risk score to identify patients with favorable short-term outcomes following lobectomy.The 2005-2012 American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing a lobectomy or sublobar resection (either segmentectomy or wedge resection) for lung cancer. A multivariable logistic regression model was utilized to determine factors associated with 30-day mortality among the lobectomy group and to develop an associated risk score to predict perioperative mortality.Of the 5,749 patients who met study criteria, 4,424 (77%) underwent lobectomy, 1,098 (19%) underwent wedge resection, and 227 (4%) underwent segmentectomy. Age, chronic obstructive pulmonary disease, previous cerebrovascular event, functional status, recent smoking status, and surgical approach (minimally invasive versus open) were utilized to develop the risk score. Patients with a risk score of 5 or lower had no significant difference in perioperative mortality by surgical procedure. Patients with a risk score greater than 5 had significantly higher perioperative mortality after lobectomy (4.9%) as compared to segmentectomy (3.6%) or wedge resection (0.8%, p < 0.01).In this study, we have developed a risk model that predicts relative operative mortality from a sublobar resection as compared to a lobectomy. Among patients with a risk score of 5 or less, lobectomy confers no additional perioperative risk over sublobar resection.

Authors
Gulack, BC; Jeffrey Yang, C-F; Speicher, PJ; Yerokun, BA; Tong, BC; Onaitis, MW; D'Amico, TA; Harpole, DH; Hartwig, MG; Berry, MF
MLA Citation
Gulack, BC, Jeffrey Yang, C-F, Speicher, PJ, Yerokun, BA, Tong, BC, Onaitis, MW, D'Amico, TA, Harpole, DH, Hartwig, MG, and Berry, MF. "A Risk Score to Assist Selecting Lobectomy Versus Sublobar Resection for Early Stage Non-Small Cell Lung Cancer." The Annals of thoracic surgery 102.6 (December 2016): 1814-1820.
PMID
27592602
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
102
Issue
6
Publish Date
2016
Start Page
1814
End Page
1820
DOI
10.1016/j.athoracsur.2016.06.032

Patient Preferences in Treatment Choices for Early-Stage Lung Cancer.

Decision-making for lung cancer treatment can be complex because it involves both provider recommendations based on the patient's clinical condition and patient preferences. This study describes the relative importance of several considerations in lung cancer treatment from the patient's perspective.A conjoint preference experiment began by asking respondents to imagine that they had just been diagnosed with lung cancer. Respondents then chose among procedures that differed regarding treatment modalities, the potential for treatment-related complications, the likelihood of recurrence, provider case volume, and distance needed to travel for treatment. Conjoint analysis derived relative weights for these attributes.A total of 225 responses were analyzed. Respondents were most willing to accept minimally invasive operations for treatment of their hypothetical lung cancer, followed by stereotactic body radiation therapy (SBRT); they were least willing to accept thoracotomy. Treatment type and risk of recurrence were the most important attributes from the conjoint experiment (each with a relative weight of 0.23), followed by provider volume (relative weight of 0.21), risk of major complications (relative weight of 0.18), and distance needed to travel for treatment (relative weight of 0.15). Procedural and treatment preferences did not vary with demographics, self-reported health status, or familiarity with the procedures.Survey respondents preferred minimally invasive operations over SBRT or thoracotomy for treatment of early-stage non-small cell lung cancer. Treatment modality and risk of cancer recurrence were the most important factors associated with treatment preferences. Provider experience outweighed the potential need to travel for lung cancer treatment.

Authors
Tong, BC; Wallace, S; Hartwig, MG; D'Amico, TA; Huber, JC
MLA Citation
Tong, BC, Wallace, S, Hartwig, MG, D'Amico, TA, and Huber, JC. "Patient Preferences in Treatment Choices for Early-Stage Lung Cancer." The Annals of thoracic surgery 102.6 (December 2016): 1837-1844.
PMID
27623277
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
102
Issue
6
Publish Date
2016
Start Page
1837
End Page
1844
DOI
10.1016/j.athoracsur.2016.06.031

Staging of Bilateral Lung Transplantation for High-Risk Patients With Interstitial Lung Disease: One Lung at a Time.

The choice of a single or bilateral lung transplant for interstitial lung disease (ILD) is controversial, as surgical risk, long-term survival and organ allocation are competing factors. In an effort to balance risk and benefit, our center adopted a staged bilateral lung transplant approach for higher surgical risk ILD patients where the patient has a single lung transplant followed by a second single transplant at a later date. We sought to understand the surgical risk, organ allocation and early outcomes of these staged bilateral recipients as a group and in comparison to matched single and bilateral recipients. Our analysis demonstrates that staged bilateral lung transplant recipients (n = 12) have a higher lung allocation score (LAS), lower pulmonary function tests and a lower glomerular filtration rate prior to the first transplant compared to the second (p < 0.01). There was a shorter length of hospital stay for the second transplant (p = 0.02). The staged bilateral compared to the single and bilateral case-matched controls had comparable short-term survival (p = 0.20) and pulmonary function tests at 1 year. There was a higher incidence of renal injury in the conventional bilateral group compared to the single and staged bilateral groups. The staged bilateral procedure is a viable option in select ILD patients.

Authors
Hartwig, MG; Ganapathi, AM; Osho, AA; Hirji, SA; Englum, BR; Speicher, PJ; Palmer, SM; Davis, RD; Snyder, LD
MLA Citation
Hartwig, MG, Ganapathi, AM, Osho, AA, Hirji, SA, Englum, BR, Speicher, PJ, Palmer, SM, Davis, RD, and Snyder, LD. "Staging of Bilateral Lung Transplantation for High-Risk Patients With Interstitial Lung Disease: One Lung at a Time." American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 16.11 (November 2016): 3270-3277.
PMID
27233085
Source
epmc
Published In
American Journal of Transplantation
Volume
16
Issue
11
Publish Date
2016
Start Page
3270
End Page
3277
DOI
10.1111/ajt.13892

Mitral Regurgitation After Orthotopic Lung Transplantation: Natural History and Impact on Outcomes.

Progression of mitral regurgitation (MR) after orthotopic lung transplantation (OLT) may be an underrecognized phenomenon due to the overlapping symptomatology of pulmonary and valvular disease. Literature evaluating the progression of MR after OLT currently is limited to case reports. Therefore, the hypothesis that MR progresses after OLT was tested and the association of preprocedure MR with postoperative mortality was assessed.A retrospective cohort.A tertiary-care hospital.Patients who underwent OLT between January 1, 2003 and February 4, 2012.After receiving institutional review board approval, a preprocedure transesophageal echocardiogram was compared with a postoperative transthoracic echocardiogram (TTE) to determine the progression of MR. Univariate and multivariate association between preprocedure MR grade and 1- and 5-year mortality was assessed. A p value of<0.05 was considered statistically significant.From 715 patients who underwent OLT, 352 had a postoperative TTE and were included in the evaluation of progression of MR. Five patients had progression of MR postoperatively, and the mean change in MR score of -0.04 was found to be nonsignificant (p = 0.25). Mortality data were available for 634 of the 715 patients. After covariate adjustment, there was no significant association between MR grade and 1-year mortality (p = 0.20) or 5-year mortality (p = 0.46).This study rejected the hypothesis that primary and secondary MR progresses after OLT and found that preprocedure MR was not associated with increased postoperative mortality. Despite the findings that MR does not progress in all patients, there is a subset of patients for whom MR progression is clinically significant. © 2016 Elsevier Inc. All rights reserved.

Authors
McCartney, SL; Cooter, M; Samad, Z; Sivak, J; Castleberry, A; Gregory, S; Haney, J; Hartwig, M; Swaminathan, M
MLA Citation
McCartney, SL, Cooter, M, Samad, Z, Sivak, J, Castleberry, A, Gregory, S, Haney, J, Hartwig, M, and Swaminathan, M. "Mitral Regurgitation After Orthotopic Lung Transplantation: Natural History and Impact on Outcomes." Journal of cardiothoracic and vascular anesthesia (October 21, 2016).
PMID
28082025
Source
epmc
Published In
Journal of Cardiothoracic and Vascular Anesthesia
Publish Date
2016
DOI
10.1053/j.jvca.2016.10.025

Outcomes of Major Lung Resection After Induction Therapy for Non-Small Cell Lung Cancer in Elderly Patients.

This study analyzes the impact of age on perioperative outcomes and long-term survival of patients undergoing surgery after induction chemotherapy for non-small cell lung cancer.Short- and long-term outcomes of patients with non-small cell lung cancer who were at least 70 years and received induction chemotherapy followed by major lung resection (lobectomy or pneumonectomy) from 1996 to 2012 were assessed using multivariable logistic regression, Kaplan-Meier, and Cox proportional hazard analysis. The outcomes of these elderly patients were compared with those of patients younger than 70 years who underwent the same treatment from 1996 to 2012.Of the 317 patients who met the study criteria, 53 patients were at least 70 years. The median age was 74 years (range, 70 to 82 years) in the elderly group, and induction chemoradiation was used in 24 (45%) patients. Thirty-day mortality was similar between the younger (n = 12) and elderly (n = 3) patients (5% versus 6%; p = 0.52). There were no significant differences in the incidence of postoperative complications between younger and elderly patients (49% versus 57%; p = 0.30). Patients younger than 70 years had a median overall survival (30 months; 95% confidence interval [CI], 24 to 43) and a 5-year survival (39%; 95% CI, 33 to 45) that was not significantly different from patients at least 70 years (median overall survival, 30 months; 95% CI, 18 to 68; and 5-year overall survival, 36%; 95% CI, 21 to 51). However, there was a trend toward worse survival in the elderly group after multivariable adjustment (hazard ratio, 1.43; 95% CI, 0.97 to 2.12; p = 0.071).Major lung resection after induction chemotherapy can be performed with acceptable short- and long-term results in appropriately selected patients at least 70 years, with outcomes that are comparable to those of younger patients.

Authors
Yang, C-FJ; Mayne, NR; Wang, H; Meyerhoff, RR; Hirji, S; Tong, BC; Hartwig, M; Harpole, D; D'Amico, TA; Berry, M
MLA Citation
Yang, C-FJ, Mayne, NR, Wang, H, Meyerhoff, RR, Hirji, S, Tong, BC, Hartwig, M, Harpole, D, D'Amico, TA, and Berry, M. "Outcomes of Major Lung Resection After Induction Therapy for Non-Small Cell Lung Cancer in Elderly Patients." The Annals of thoracic surgery 102.3 (September 2016): 962-970.
PMID
27234579
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
102
Issue
3
Publish Date
2016
Start Page
962
End Page
970
DOI
10.1016/j.athoracsur.2016.03.088

Impact of Age on Long-Term Outcomes of Surgery for Malignant Pleural Mesothelioma.

Although malignant pleural mesothelioma (MPM) is generally a disease associated with more advanced age, the association of age, treatment, and outcomes has not been well-characterized. We evaluated the impact of age on outcomes in patients with MPM to provide data for use in the treatment selection process for elderly patients with potentially resectable disease.Overall survival (OS) of patients younger than 70 and 70 years or older with Stage I to III MPM who underwent cancer-directed surgery or nonoperative management in the Surveillance, Epidemiology, and End Results database (2004-2010) was evaluated using multivariable Cox proportional hazard models and propensity score-matched analysis.Cancer-directed surgery was used in 284 of 879 (32%) patients who met inclusion criteria, and was associated with improved OS in multivariable analysis (hazard ratio, 0.71; P = .001). Cancer-directed surgery was used much less commonly in patients 70 years and older compared with patients younger than 70 years (22% [109/497] vs. 46% [175/382]; P < .001), but patients 70 years and older had improved 1-year (59.4% vs. 37.9%) and 3-year (15.4% vs. 8.0%) OS compared with nonoperative management. The benefit of surgery in patients 70 years and older was observed even after propensity score-matched analysis was used to control for selection bias.Surgical treatment is associated with improved survival compared with nonoperative management for both patients younger than 70 years and patients aged 70 years or older.

Authors
Yang, C-FJ; Yan, BW; Meyerhoff, RR; Saud, SM; Gulack, BC; Speicher, PJ; Hartwig, MG; D'Amico, TA; Harpole, DH; Berry, MF
MLA Citation
Yang, C-FJ, Yan, BW, Meyerhoff, RR, Saud, SM, Gulack, BC, Speicher, PJ, Hartwig, MG, D'Amico, TA, Harpole, DH, and Berry, MF. "Impact of Age on Long-Term Outcomes of Surgery for Malignant Pleural Mesothelioma." Clinical lung cancer 17.5 (September 2016): 419-426.
PMID
27236386
Source
epmc
Published In
Clinical lung cancer
Volume
17
Issue
5
Publish Date
2016
Start Page
419
End Page
426
DOI
10.1016/j.cllc.2016.03.002

Safety of hyperbaric oxygen therapy for management of central airway stenosis after lung transplant.

Central airway stenosis (CAS) is common after lung transplantation and causes significant post-transplant morbidity. It is often preceded by extensive airway necrosis, related to airway ischemia. Hyperbaric oxygen therapy (HBOT) is useful for ischemic grafts and may reduce the development of CAS.The purpose of this study was to determine whether HBOT could be safely administered to lung transplant patients with extensive necrotic airway plaques. Secondarily, we assessed any effects of HBOT on the incidence and severity of CAS. Patients with extensive necrotic airway plaques within 1-2 months after lung transplantation were treated with HBOT along with standard care. These patients were compared with a contemporaneous reference group with similar plaques who did not receive HBOT.Ten patients received HBOT for 18.5 (interquartile range, IQR 11-20) sessions, starting at 40.5 (IQR 34-54) days after transplantation. HBOT was well tolerated. Incidence of CAS was similar between HBOT-treated patients and reference patients (70% vs 87%, respectively; P=.34), but fewer stents were required in HBOT patients (10% vs 56%, respectively; P=.03).This pilot study is the first to demonstrate HBOT safety in patients who develop necrotic airway plaques after lung transplantation. HBOT may reduce the need for airway stent placement in patients with CAS.

Authors
Mahmood, K; Kraft, BD; Glisinski, K; Hartwig, MG; Harlan, NP; Piantadosi, CA; Shofer, SL
MLA Citation
Mahmood, K, Kraft, BD, Glisinski, K, Hartwig, MG, Harlan, NP, Piantadosi, CA, and Shofer, SL. "Safety of hyperbaric oxygen therapy for management of central airway stenosis after lung transplant." Clinical transplantation 30.9 (September 2016): 1134-1139.
PMID
27410718
Source
epmc
Published In
Clinical Transplantation
Volume
30
Issue
9
Publish Date
2016
Start Page
1134
End Page
1139
DOI
10.1111/ctr.12798

Induction Chemotherapy is Not Superior to a Surgery-First Strategy for Clinical N1 Non-Small Cell Lung Cancer.

Guidelines recommend primary surgical resection for non-small cell lung cancer (NSCLC) patients with clinical N1 disease and adjuvant chemotherapy if nodal disease is confirmed after resection. We tested the hypothesis that induction chemotherapy for clinical N1 (cN1) disease improves survival.Patients treated with lobectomy or pneumonectomy for cT1-3 N1 M0 NSCLC from 2006 to 2011 in the National Cancer Data Base were stratified by treatment strategy: surgery first vs induction chemotherapy. Propensity scores were developed and matched with a 2:1 nearest neighbor algorithm. Survival analyses using Kaplan-Meier methods were performed on the unadjusted and propensity-matched cohorts.A total of 5,364 cN1 patients were identified for inclusion, of which 565 (10.5%) were treated with induction chemotherapy. Clinical nodal staging was accurate in 68.6% (n = 3,292) of patients treated with surgical resection first, whereas 16.3% (n = 780) were pN0 and 10.7% (n = 514) were pN2-3. Adjuvant chemotherapy was given to 60.9% of the surgery-first patients who were pN1-3 after resection. Before adjustment, patients treated with induction chemotherapy were younger, with lower comorbidity burden, were more likely to be treated at an academic center and to have private insurance (all p < 0.001), but were significantly more likely to have T3 tumors (28.7% vs 9.9%, p < 0.001) and to require pneumonectomy (23.5% vs 18.5%, p = 0.005). The unadjusted and propensity-matched analyses found no differences in short-term outcomes or survival between groups.Induction chemotherapy for cN1 NSCLC is not associated with improved survival. This finding supports the currently recommended treatment paradigm of surgery first for cN1 NSCLC.

Authors
Speicher, PJ; Fitch, ZW; Gulack, BC; Yang, C-FJ; Tong, BC; Harpole, DH; D'Amico, TA; Berry, MF; Hartwig, MG
MLA Citation
Speicher, PJ, Fitch, ZW, Gulack, BC, Yang, C-FJ, Tong, BC, Harpole, DH, D'Amico, TA, Berry, MF, and Hartwig, MG. "Induction Chemotherapy is Not Superior to a Surgery-First Strategy for Clinical N1 Non-Small Cell Lung Cancer." The Annals of thoracic surgery 102.3 (September 2016): 884-894.
PMID
27476819
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
102
Issue
3
Publish Date
2016
Start Page
884
End Page
894
DOI
10.1016/j.athoracsur.2016.05.065

Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer: A Population-Based Analysis.

The objective of this study was to evaluate outcomes of minimally invasive approaches to esophagectomy using population-level data.Multivariable regression modeling was used to determine predictors associated with the use of minimally invasive approaches for patients in the National Cancer Data Base who underwent resection of middle and distal clinical T13N03M0 esophageal cancers from 2010 to 2012. Perioperative outcomes and 3-year survival were compared between propensity-matched groups of patients with esophageal cancer who underwent minimally invasive esophagectomy (MIE) or open esophagectomy (OE). A subgroup analysis was performed to evaluate the impact of using robotic-assisted operations as part of the minimally invasive approach.Among 4,266 patients included, 1,308 (30.6%) underwent MIE. It was more likely to be used in patients treated at academic (adjusted odds ratio [OR], 10.1; 95% confidence interval [CI], 4.2-33.1) or comprehensive cancer facilities (adjusted OR, 6.4; 95% CI, 2.6-21.1). Compared with propensity-matched patients who underwent OE, patients who underwent MIE had significantly more lymph nodes examined (15 versus 13; p = 0.016) and shorter hospital lengths of stay (10 days versus 11 days; p = 0.046) but similar resection margin positivity, readmission, and 30-day mortality (all p > 0.05). Survival was similar between the matched groups at 3 years for both adenocarcinoma and squamous cell carcinoma (p > 0.05). Compared with MIE without robotic assistance, use of a robotic approach was not associated with any significant differences in perioperative outcomes (p > 0.05).The use of minimally invasive techniques to perform esophagectomy for esophageal cancer is associated with modestly improved perioperative outcomes without compromising survival.

Authors
Yerokun, BA; Sun, Z; Jeffrey Yang, C-F; Gulack, BC; Speicher, PJ; Adam, MA; D'Amico, TA; Onaitis, MW; Harpole, DH; Berry, MF; Hartwig, MG
MLA Citation
Yerokun, BA, Sun, Z, Jeffrey Yang, C-F, Gulack, BC, Speicher, PJ, Adam, MA, D'Amico, TA, Onaitis, MW, Harpole, DH, Berry, MF, and Hartwig, MG. "Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer: A Population-Based Analysis." The Annals of thoracic surgery 102.2 (August 2016): 416-423.
PMID
27157326
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
102
Issue
2
Publish Date
2016
Start Page
416
End Page
423
DOI
10.1016/j.athoracsur.2016.02.078

Long-term survival following open versus thoracoscopic lobectomy after preoperative chemotherapy for non-small cell lung cancer.

Video-assisted thoracoscopic (VATS) lobectomy is increasingly accepted for the management of early-stage non-small cell lung cancer (NSCLC), but its role for locally advanced cancers has not been as well characterized. We compared outcomes of patients who received induction therapy followed by lobectomy, via VATS or thoracotomy.Perioperative complications and long-term survival of all patients with NSCLC who received induction chemotherapy (ICT) (with or without induction radiation therapy) followed by lobectomy from 1996-2012 were assessed using Kaplan-Meier and Cox proportional hazard analysis. Propensity score-matched comparisons were used to assess the potential impact of selection bias.From 1996 to 2012, 272 patients met inclusion criteria and underwent lobectomy after ICT: 69 (25%) by VATS and 203 (75%) by thoracotomy. An 'intent-to-treat' analysis was performed. Compared with thoracotomy patients, VATS patients had a higher clinical stage, were older, had greater body mass index, and were more likely to have coronary disease and chronic obstructive pulmonary disease. Induction radiation was used more commonly in thoracotomy patients [VATS 28% (n = 19) vs open 72% (n = 146), P < 0.001]. Thirty-day mortality was similar between the VATS [3% (n = 2)] and open [4% (n = 8)] groups (P = 0.69). Seven (10%) of the VATS cases were converted to thoracotomy due to difficulty in dissection from fibrotic tissue and adhesions (n = 5) or bleeding (n = 2); none of these conversions led to perioperative deaths. In univariate analysis, VATS patients had improved 3-year survival compared with thoracotomy (61% vs 43%, P = 0.010). In multivariable analysis, the VATS approach showed a trend towards improved survival, but this did not reach statistical significance (hazard ratio, 0.56; 95% confidence interval, 0.32-1.01; P = 0.053). Moreover, a propensity score-matched analysis balancing patient characteristics demonstrated that the VATS approach had similar survival to an open approach (P = 0.56).VATS lobectomy in patients treated with induction therapy for locally advanced NSCLC is feasible and effective and does not appear to compromise oncologic outcomes.

Authors
Yang, C-FJ; Meyerhoff, RR; Mayne, NR; Singhapricha, T; Toomey, CB; Speicher, PJ; Hartwig, MG; Tong, BC; Onaitis, MW; Harpole, DH; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, Meyerhoff, RR, Mayne, NR, Singhapricha, T, Toomey, CB, Speicher, PJ, Hartwig, MG, Tong, BC, Onaitis, MW, Harpole, DH, D'Amico, TA, and Berry, MF. "Long-term survival following open versus thoracoscopic lobectomy after preoperative chemotherapy for non-small cell lung cancer." European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 49.6 (June 2016): 1615-1623.
PMID
26719408
Source
epmc
Published In
European Journal of Cardio-Thoracic Surgery
Volume
49
Issue
6
Publish Date
2016
Start Page
1615
End Page
1623
DOI
10.1093/ejcts/ezv428

Impact of patient selection and treatment strategies on outcomes after lobectomy for biopsy-proven stage IIIA pN2 non-small cell lung cancer.

We evaluated the impact of patient selection and treatment strategies on long-term outcomes of patients who had lobectomy after induction therapy for stage IIIA pN2 non-small cell lung cancer (NSCLC).The impact of various patient selection, induction therapy and operative strategies on survival of patients with biopsy-proven stage IIIA pN2 NSCLC who received induction chemotherapy ± radiation followed by lobectomy from 1995 to 2012 was assessed using Cox proportional hazards analysis.From 1995 to 2012, 111 patients had lobectomy for stage IIIA pN2 NSCLC after chemotherapy ± radiation with an overall 5-year survival of 39%. The use of induction chemoradiation decreased over time; from 1996 to 2007, 46/65 (71%) patients underwent induction chemoradiation, whereas from 2007 to 2012, 36/46 (78%) patients underwent induction chemotherapy. The use of video-assisted thoracoscopic surgery (VATS) increased over the time period of the study, from 0/26 (0%) in 1996-2001, to 4/39 (10%) in 2002-07 to 33/46 (72%) in 2008-12. Compared with patients given induction chemotherapy alone, patients given additional induction radiation were more likely to have complete pathologic response (30 vs 11%, P = 0.01) but had worse 5-year survival in univariable analysis (31 vs 48%, log-rank P = 0.021). Patients who underwent pathologic mediastinal restaging following induction therapy but prior to resection had an improved overall survival compared with patients who did not undergo pathologic mediastinal restaging {5-year survival: 45.2 [95% confidence interval (CI): 33.9-55.9] vs 13.9% (95% CI: 2.5-34.7); log-rank, P = 0.004}. In multivariable analysis, the particular induction therapy strategy and the surgical approach used, as well as the extent of mediastinal disease were not important predictors of survival. However, pathologic mediastinal restaging was associated with improved survival (HR 0.39; 95% CI: 0.21-0.72; P = 0.003).For patients with stage IIIA pN2 NSCLC, the VATS approach or the addition of radiation to induction therapy can be selectively employed without compromising survival. The strategy of assessing response to induction therapy with pathologic mediastinal restaging allows one to select appropriate patients for complete resection and is associated with a 5-year overall survival of 39% in this population.

Authors
Yang, C-FJ; Adil, SM; Anderson, KL; Meyerhoff, RR; Turley, RS; Hartwig, MG; Harpole, DH; Tong, BC; Onaitis, MW; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, Adil, SM, Anderson, KL, Meyerhoff, RR, Turley, RS, Hartwig, MG, Harpole, DH, Tong, BC, Onaitis, MW, D'Amico, TA, and Berry, MF. "Impact of patient selection and treatment strategies on outcomes after lobectomy for biopsy-proven stage IIIA pN2 non-small cell lung cancer." European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 49.6 (June 2016): 1607-1613.
PMID
26719403
Source
epmc
Published In
European Journal of Cardio-Thoracic Surgery
Volume
49
Issue
6
Publish Date
2016
Start Page
1607
End Page
1613
DOI
10.1093/ejcts/ezv431

Long-term outcomes after lobectomy for non-small cell lung cancer when unsuspected pN2 disease is found: A National Cancer Data Base analysis.

There are few studies evaluating whether to proceed with planned resection when a patient with non-small cell lung cancer (NSCLC) unexpectedly is found to have N2 disease at the time of thoracoscopy or thoracotomy. To help guide management of this clinical scenario, we evaluated outcomes for patients who were upstaged to pN2 after lobectomy without induction therapy using the National Cancer Data Base (NCDB).Survival of NSCLC patients treated with lobectomy for clinically unsuspected mediastinal nodal disease (cT1-cT3 cN0-cN1, pN2 disease) from 1998-2006 in the NCDB was compared with "suspected" N2 disease patients (cT1-cT3 cN2) who were treated with chemotherapy with or without radiation followed by lobectomy, using matched analysis based on propensity scores.Unsuspected pN2 disease was found in 4.4% of patients (2047 out of 46,691) who underwent lobectomy as primary therapy for cT1-cT3 cN0-cN1 NSCLC. The 5-year survival was 42%, 36%, 21%, and 28% for patients who underwent adjuvant chemotherapy (n = 385), chemoradiation (n = 504), radiation (n = 300), and no adjuvant therapy (n = 858), respectively. Five-year survival of the entire unsuspected pN2 cohort was worse than survival of 2302 patients who were treated with lobectomy after induction therapy for clinical N2 disease (30% vs 40%; P < .001), although no significant difference in 5-year survival was found in a matched-analysis of 655 patients from each group (37% vs 37%; P = .95).This population-based analysis suggests that, in the setting of unsuspected pN2 NSCLC, proceeding with lobectomy does not appear to compromise outcomes if adjuvant chemotherapy with or without radiation therapy can be administered following surgery.

Authors
Yang, C-FJ; Kumar, A; Gulack, BC; Mulvihill, MS; Hartwig, MG; Wang, X; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, Kumar, A, Gulack, BC, Mulvihill, MS, Hartwig, MG, Wang, X, D'Amico, TA, and Berry, MF. "Long-term outcomes after lobectomy for non-small cell lung cancer when unsuspected pN2 disease is found: A National Cancer Data Base analysis." The Journal of thoracic and cardiovascular surgery 151.5 (May 2016): 1380-1388.
PMID
26874598
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
151
Issue
5
Publish Date
2016
Start Page
1380
End Page
1388
DOI
10.1016/j.jtcvs.2015.12.028

Role of Adjuvant Therapy in a Population-Based Cohort of Patients With Early-Stage Small-Cell Lung Cancer.

Data on optimal adjuvant therapy after complete resection of small-cell lung cancer (SCLC) are limited, and in particular, there have been no studies evaluating the role of adjuvant chemotherapy, with or without prophylactic cranial irradiation, relative to no adjuvant therapy for stage T1-2N0M0 SCLC. This National Cancer Data Base analysis was performed to determine the potential benefits of adjuvant chemotherapy with and without prophylactic cranial irradiation in patients who undergo complete resection for early-stage small-cell lung cancer.Overall survival of patients with pathologic T1-2N0M0 SCLC who underwent complete resection in the National Cancer Data Base from 2003 to 2011, stratified by adjuvant therapy regimen, was evaluated using Kaplan-Meier and Cox proportional hazards analysis. Patients treated with induction therapy and those who died within 30 days of surgery were excluded from analysis.Of 1,574 patients who had pT1-2N0M0 SCLC during the study period, 954 patients (61%) underwent complete R0 resection with a 5-year survival of 47%. Adjuvant therapy was administered to 59% of patients (n = 566), including chemotherapy alone (n = 354), chemoradiation (n = 190, including 99 patients who underwent cranial irradiation), and radiation alone (n = 22). Compared with surgery alone, adjuvant chemotherapy with or without radiation was associated with significantly improved survival. In addition, multivariable Cox modeling demonstrated that treatment with adjuvant chemotherapy (hazard ratio [HR], 0.78; 95% CI, 0.63 to 0.95) or chemotherapy with radiation directed at the brain (HR, 0.52; 95% CI, 0.36 to 0.75) was associated with improved survival when compared with no adjuvant therapy.Patients with pT1-2N0M0 SCLC treated with surgical resection alone have worse outcomes than those who undergo resection with adjuvant chemotherapy alone or chemotherapy with cranial irradiation.

Authors
Yang, C-FJ; Chan, DY; Speicher, PJ; Gulack, BC; Wang, X; Hartwig, MG; Onaitis, MW; Tong, BC; D'Amico, TA; Berry, MF; Harpole, DH
MLA Citation
Yang, C-FJ, Chan, DY, Speicher, PJ, Gulack, BC, Wang, X, Hartwig, MG, Onaitis, MW, Tong, BC, D'Amico, TA, Berry, MF, and Harpole, DH. "Role of Adjuvant Therapy in a Population-Based Cohort of Patients With Early-Stage Small-Cell Lung Cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 34.10 (April 2016): 1057-1064.
PMID
26786925
Source
epmc
Published In
Journal of Clinical Oncology
Volume
34
Issue
10
Publish Date
2016
Start Page
1057
End Page
1064
DOI
10.1200/jco.2015.63.8171

Does Single Lung Transplantation Change Perfusion in Relation to Native Lung in Pulmonary Fibrosis? Implications in Choosing Laterality

Authors
Reddy, LS; Daneshmand, M; Haney, JC; Snyder, L; Gray, AL; Reynolds, JM; Hartwig, MG
MLA Citation
Reddy, LS, Daneshmand, M, Haney, JC, Snyder, L, Gray, AL, Reynolds, JM, and Hartwig, MG. "Does Single Lung Transplantation Change Perfusion in Relation to Native Lung in Pulmonary Fibrosis? Implications in Choosing Laterality." April 2016.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
35
Issue
4
Publish Date
2016
Start Page
S68
End Page
S68

Soluble CD14 and LBP as Markers for Primary Graft Dysfunction

Authors
Ramphal, K; Cantu, E; Porteous, M; Oyster, M; Kawut, S; Lederer, DJ; Shah, R; Arcasoy, S; Snyder, L; Hartwig, M; Palmer, S; Wille, KM; Ware, L; Shah, R; Crespo, M; Hage, C; Weinacker, A; Lama, V; Suzuki, Y; Orens, J; Christie, JD; Diamond, J
MLA Citation
Ramphal, K, Cantu, E, Porteous, M, Oyster, M, Kawut, S, Lederer, DJ, Shah, R, Arcasoy, S, Snyder, L, Hartwig, M, Palmer, S, Wille, KM, Ware, L, Shah, R, Crespo, M, Hage, C, Weinacker, A, Lama, V, Suzuki, Y, Orens, J, Christie, JD, and Diamond, J. "Soluble CD14 and LBP as Markers for Primary Graft Dysfunction." April 2016.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
35
Issue
4
Publish Date
2016
Start Page
S314
End Page
S315

Plasma RIP3 Is Decreased in PGD after Lung Transplantation

Authors
D'Errico, C; Hotz, M; Cantu, E; Porteous, M; Oyster, M; Shah, R; Arcasoy, S; Snyder, L; Wille, KM; Hartwig, M; Ware, LB; Shah, P; Crespo, M; Hage, C; Weinacker, A; Lama, V; Suzuki, Y; Orens, J; Kawut, S; Palmer, S; Lederer, DJ; Christie, JD; Mangalmurti, N; Diamond, JM
MLA Citation
D'Errico, C, Hotz, M, Cantu, E, Porteous, M, Oyster, M, Shah, R, Arcasoy, S, Snyder, L, Wille, KM, Hartwig, M, Ware, LB, Shah, P, Crespo, M, Hage, C, Weinacker, A, Lama, V, Suzuki, Y, Orens, J, Kawut, S, Palmer, S, Lederer, DJ, Christie, JD, Mangalmurti, N, and Diamond, JM. "Plasma RIP3 Is Decreased in PGD after Lung Transplantation." April 2016.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
35
Issue
4
Publish Date
2016
Start Page
S87
End Page
S87

Interim Results of a Phase II Clinical Trial Comparing Outcomes of Recipients of Lungs Recovered from Uncontrolled Donation After Circulatory Determination of Death Donors (uDCDDs) Assessed by Ex-Vivo Lung Perfusion (EVLP) and CT Scan to Outcomes of Recipients of Lungs from Brain-Dead Donors (BDDs)

Authors
Egan, TM; Haithcock, B; Long, J; Birchard, K; Lobo, J; Stewart, P; Blackwell, J; Yuan, D; Thys, C; Karb, D; Miller, S; Hartwig, M
MLA Citation
Egan, TM, Haithcock, B, Long, J, Birchard, K, Lobo, J, Stewart, P, Blackwell, J, Yuan, D, Thys, C, Karb, D, Miller, S, and Hartwig, M. "Interim Results of a Phase II Clinical Trial Comparing Outcomes of Recipients of Lungs Recovered from Uncontrolled Donation After Circulatory Determination of Death Donors (uDCDDs) Assessed by Ex-Vivo Lung Perfusion (EVLP) and CT Scan to Outcomes of Recipients of Lungs from Brain-Dead Donors (BDDs)." April 2016.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
35
Issue
4
Publish Date
2016
Start Page
S372
End Page
S372

High Rates of Post-Transplant Depressive Symptoms Identified Using the CES-D

Authors
Holland, T; Byrd, R; Crouch, R; Hartwig, MG; Holleman, K; Pastva, A; Reynolds, J; Smith, P; Snyder, LD
MLA Citation
Holland, T, Byrd, R, Crouch, R, Hartwig, MG, Holleman, K, Pastva, A, Reynolds, J, Smith, P, and Snyder, LD. "High Rates of Post-Transplant Depressive Symptoms Identified Using the CES-D." April 2016.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
35
Issue
4
Publish Date
2016
Start Page
S342
End Page
S342

Redefining Primary Graft Dysfunction after Lung Transplantation

Authors
Cantu, E; Diamond, J; Nellen, J; Beduhn, B; Suzuki, Y; Borders, C; Lasky, J; Schaufler, C; Shah, R; Porteous, M; Lederer, DJ; Kawut, SM; Arcasoy, S; Palmer, SM; Snyder, L; Hartwig, MG; Lama, VN; Crespo, M; Wille, K; Orens, A; Shah, PD; Weinacker, A; Ware, LB; Bellamy, SL; Christie, JD
MLA Citation
Cantu, E, Diamond, J, Nellen, J, Beduhn, B, Suzuki, Y, Borders, C, Lasky, J, Schaufler, C, Shah, R, Porteous, M, Lederer, DJ, Kawut, SM, Arcasoy, S, Palmer, SM, Snyder, L, Hartwig, MG, Lama, VN, Crespo, M, Wille, K, Orens, A, Shah, PD, Weinacker, A, Ware, LB, Bellamy, SL, and Christie, JD. "Redefining Primary Graft Dysfunction after Lung Transplantation." April 2016.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
35
Issue
4
Publish Date
2016
Start Page
S89
End Page
S89

Intravenous Immunoglobulin in Sensitized Lung Transplant Recipients and Early Outcomes

Authors
Benedetti, EC; Chery, G; Hartwig, M; Hulbert, A; Reynolds, J; Snyder, L
MLA Citation
Benedetti, EC, Chery, G, Hartwig, M, Hulbert, A, Reynolds, J, and Snyder, L. "Intravenous Immunoglobulin in Sensitized Lung Transplant Recipients and Early Outcomes." April 2016.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
35
Issue
4
Publish Date
2016
Start Page
S237
End Page
S238

Traveling to a High-volume Center is Associated With Improved Survival for Patients With Esophageal Cancer.

An association between volume and outcomes has been observed for esophagectomy, though little is known about why or how patients choose low- or high-volume centers. The purpose of this study was to evaluate how travel burden and hospital volume influence treatment and outcomes of patients with locally advanced esophageal cancer.Predictors of receiving esophagectomy for patients with T1-3N1M0 mid or distal esophageal cancer in the National Cancer Data Base from 2006 to 2011 were identified using multivariable logistic regression. Survival was compared using propensity score-matched groups: patients in the bottom quartile of travel distance who underwent treatment at low-volume facilities (Local) and patients in the top quartile of travel distance who underwent treatment at high-volume facilities (Travel).Of 4979 patients who met inclusion criteria, we identified 867 Local patients who traveled 2.7 [interquartile range (IQR): 1.6-4 miles] miles to centers that treated 2.6 (IQR: 1.9-3.3) esophageal cancers per year, and 317 Travel patients who traveled 107.1 (IQR: 65-247) miles to centers treating 31.9 (IQR: 30.9-38.5) cases. Travel patients were more likely to undergo esophagectomy (67.8% vs 42.9%, P < 0.001) and had significantly better 5-year survival (39.8% vs 20.6%, P < 0.001) than Local patients.Patients who travel longer distances to high-volume centers have significantly different treatment and better outcomes than patients who stay close to home at low-volume centers. Strategies that support patient travel for treatment at high-volume centers may improve esophageal cancer outcomes.

Authors
Speicher, PJ; Englum, BR; Ganapathi, AM; Wang, X; Hartwig, MG; D'Amico, TA; Berry, MF
MLA Citation
Speicher, PJ, Englum, BR, Ganapathi, AM, Wang, X, Hartwig, MG, D'Amico, TA, and Berry, MF. "Traveling to a High-volume Center is Associated With Improved Survival for Patients With Esophageal Cancer." Annals of surgery (March 15, 2016).
PMID
26982688
Source
epmc
Published In
Annals of Surgery
Publish Date
2016

Large clinical databases for the study of lung cancer: Making up for the failure of randomized trials.

Authors
Yang, C-FJ; Hartwig, MG; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, Hartwig, MG, D'Amico, TA, and Berry, MF. "Large clinical databases for the study of lung cancer: Making up for the failure of randomized trials." The Journal of thoracic and cardiovascular surgery 151.3 (March 2016): 626-628.
PMID
26432720
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
151
Issue
3
Publish Date
2016
Start Page
626
End Page
628
DOI
10.1016/j.jtcvs.2015.08.110

Hypoxic Gene Expression of Donor Bronchi Linked to Airway Complications after Lung Transplantation.

Central airway stenosis (CAS) after lung transplantation has been attributed in part to chronic airway ischemia; however, little is known about the time course or significance of large airway hypoxia early after transplantation.To evaluate large airway oxygenation and hypoxic gene expression during the first month after lung transplantation and their relation to airway complications.Subjects who underwent lung transplantation underwent endobronchial tissue oximetry of native and donor bronchi at 0, 3, and 30 days after transplantation (n = 11) and/or endobronchial biopsies (n = 14) at 30 days for real-time polymerase chain reaction of hypoxia-inducible genes. Patients were monitored for 6 months for the development of transplant-related complications.Compared with native endobronchial tissues, donor tissue oxygen saturations (Sto2) were reduced in the upper lobes (74.1 ± 1.8% vs. 68.8 ± 1.7%; P < 0.05) and lower lobes (75.6 ± 1.6% vs. 71.5 ± 1.8%; P = 0.065) at 30 days post-transplantation. Donor upper lobe and subcarina Sto2 levels were also lower than the main carina (difference of -3.9 ± 1.5 and -4.8 ± 2.1, respectively; P < 0.05) at 30 days. Up-regulation of hypoxia-inducible genes VEGFA, FLT1, VEGFC, HMOX1, and TIE2 was significant in donor airways relative to native airways (all P < 0.05). VEGFA, KDR, and HMOX1 were associated with prolonged respiratory failure, prolonged hospitalization, extensive airway necrosis, and CAS (P < 0.05).These findings implicate donor bronchial hypoxia as a driving factor for post-transplantation airway complications. Strategies to improve airway oxygenation, such as bronchial artery re-anastomosis and hyperbaric oxygen therapy merit clinical investigation.

Authors
Kraft, BD; Suliman, HB; Colman, EC; Mahmood, K; Hartwig, MG; Piantadosi, CA; Shofer, SL
MLA Citation
Kraft, BD, Suliman, HB, Colman, EC, Mahmood, K, Hartwig, MG, Piantadosi, CA, and Shofer, SL. "Hypoxic Gene Expression of Donor Bronchi Linked to Airway Complications after Lung Transplantation." American journal of respiratory and critical care medicine 193.5 (March 2016): 552-560.
PMID
26488115
Source
epmc
Published In
American journal of respiratory and critical care medicine
Volume
193
Issue
5
Publish Date
2016
Start Page
552
End Page
560
DOI
10.1164/rccm.201508-1634oc

Impact of Positive Margins on Survival in Patients Undergoing Esophagogastrectomy for Esophageal Cancer.

Multimodality treatment that includes esophagogastrectomy may represent the best option for curing accurately staged patients with esophageal cancer. We analyzed the impact of incomplete resection on outcomes after esophagogastrectomy for esophageal cancer.The incidence of positive margins for patients who underwent esophagogastrectomy without induction therapy for pathologic T1-3N0-1M0 esophageal cancer of the mid and lower esophagus from 2003 to 2006 in the National Cancer Database was analyzed with multivariate logistic regression. The impact of positive margins on survival was assessed using Kaplan-Meier and Cox proportional hazards analysis.Positive margins occurred in 342 of 3,125 patients (10.9%) who met study criteria. Increasing clinical T status was an independent predictor of positive margins in multivariate analysis, but the chance of positive margins decreased with larger facility case volumes. The presence of clinical nodal disease was not predictive of an incomplete resection. The 5-year survival of patients with positive margins (13.8%, 95% confidence interval [CI]: 10.5% to 18.1%) was significantly worse than that for patients with negative margins (46.3%, 95% CI: 44.4% to 48.3%, p < 0.001). Both microscopic residual disease (hazard ratio 1.37, 95% CI: 1.16 to 1.60, p < 0.001) and gross residual disease (hazard ratio 1.98, 95% CI: 1.62 to 2.42, p < 0.001) predicted worse survival in multivariate analysis of the entire cohort. Receiving adjuvant chemoradiation therapy slightly improved 5-year survival of patients with positive margins (16.9%, 95% CI: 11.3% to 23.6%, versus 13.5%, 95% CI: 9% to 20.3%, p < 0.001).Positive margins are associated with poor survival, and adjuvant therapy only marginally improved prognosis. Future studies are needed to better evaluate whether induction therapy can lower the incidence of positive margins.

Authors
Javidfar, J; Speicher, PJ; Hartwig, MG; D'Amico, TA; Berry, MF
MLA Citation
Javidfar, J, Speicher, PJ, Hartwig, MG, D'Amico, TA, and Berry, MF. "Impact of Positive Margins on Survival in Patients Undergoing Esophagogastrectomy for Esophageal Cancer." The Annals of thoracic surgery 101.3 (March 2016): 1060-1067.
PMID
26576752
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
101
Issue
3
Publish Date
2016
Start Page
1060
End Page
1067
DOI
10.1016/j.athoracsur.2015.09.005

Protein Quantitative Trait Loci Analysis Identifies Genetic Variation in the Innate Immune Regulator TOLLIP in Post-Lung Transplant Primary Graft Dysfunction Risk.

The authors previously identified plasma plasminogen activator inhibitor-1 (PAI-1) level as a quantitative lung injury biomarker in primary graft dysfunction (PGD). They hypothesized that plasma levels of PAI-1 used as a quantitative trait could facilitate discovery of genetic loci important in PGD pathogenesis. A two-stage cohort study was performed. In stage 1, they tested associations of loci with PAI-1 plasma level using linear modeling. Genotyping was performed using the Illumina CVD Bead Chip v2. Loci meeting a p < 5 × 10(-4) cutoff were carried forward and tested in stage 2 for association with PGD. Two hundred ninety-seven enrollees were evaluated in stage 1. Six loci, associated with PAI-1, were carried forward to stage 2 and evaluated in 728 patients. rs3168046 (Toll interacting protein [TOLLIP]) was significantly associated with PGD (p = 0.006). The increased risk of PGD for carrying at least one copy of this variant was 11.7% (95% confidence interval 4.9-18.5%). The false-positive rate for individuals with this genotype who did not have PGD was 6.1%. Variants in the TOLLIP gene are associated with higher circulating PAI-1 plasma levels and validate for association with clinical PGD. A protein quantitative trait analysis for PGD risk prioritizes genetic variations in TOLLIP and supports a role for Toll-like receptors in PGD pathogenesis.

Authors
Cantu, E; Suzuki, Y; Diamond, JM; Ellis, J; Tiwari, J; Beduhn, B; Nellen, JR; Shah, R; Meyer, NJ; Lederer, DJ; Kawut, SM; Palmer, SM; Snyder, LD; Hartwig, MG; Lama, VN; Bhorade, S; Crespo, M; Demissie, E; Wille, K; Orens, J; Shah, PD; Weinacker, A; Weill, D; Wilkes, D; Roe, D; Ware, LB; Wang, F; Feng, R; Christie, JD
MLA Citation
Cantu, E, Suzuki, Y, Diamond, JM, Ellis, J, Tiwari, J, Beduhn, B, Nellen, JR, Shah, R, Meyer, NJ, Lederer, DJ, Kawut, SM, Palmer, SM, Snyder, LD, Hartwig, MG, Lama, VN, Bhorade, S, Crespo, M, Demissie, E, Wille, K, Orens, J, Shah, PD, Weinacker, A, Weill, D, Wilkes, D, Roe, D, Ware, LB, Wang, F, Feng, R, and Christie, JD. "Protein Quantitative Trait Loci Analysis Identifies Genetic Variation in the Innate Immune Regulator TOLLIP in Post-Lung Transplant Primary Graft Dysfunction Risk." American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 16.3 (March 2016): 833-840.
PMID
26663441
Source
epmc
Published In
American Journal of Transplantation
Volume
16
Issue
3
Publish Date
2016
Start Page
833
End Page
840
DOI
10.1111/ajt.13525

Use and Outcomes of Minimally Invasive Lobectomy for Stage I Non-Small Cell Lung Cancer in the National Cancer Data Base.

Previous studies have raised concerns that video-assisted thoracoscopic (VATS) lobectomy may compromise nodal evaluation. The advantages or limitations of robotic lobectomy have not been thoroughly evaluated.Perioperative outcomes and survival of patients who underwent open versus minimally-invasive surgery (MIS [VATS and robotic]) lobectomy and VATS versus robotic lobectomy for clinical T1-2, N0 non-small cell lung cancer from 2010 to 2012 in the National Cancer Data Base were evaluated using propensity score matching.Of 30,040 lobectomies, 7,824 were VATS and 2,025 were robotic. After propensity score matching, when compared with the open approach (n = 9,390), MIS (n = 9,390) was found to have increased 30-day readmission rates (5% versus 4%, p < 0.01), shorter median hospital length of stay (5 versus 6 days, p < 0.01), and improved 2-year survival (87% versus 86%, p = 0.04). There were no significant differences in nodal upstaging and 30-day mortality between the two groups. After propensity score matching, when compared with the robotic group (n = 1,938), VATS (n = 1,938) was not significantly different from robotics with regard to nodal upstaging, 30-day mortality, and 2-year survival.In this population-based analysis, MIS (VATS and robotic) lobectomy was used in the minority of patients for stage I non-small cell lung cancer. MIS lobectomy was associated with shorter length of hospital stay and was not associated with increased perioperative mortality, compromised nodal evaluation, or reduced short-term survival when compared with the open approach. These results suggest the need for broader implementation of MIS techniques.

Authors
Yang, C-FJ; Sun, Z; Speicher, PJ; Saud, SM; Gulack, BC; Hartwig, MG; Harpole, DH; Onaitis, MW; Tong, BC; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, Sun, Z, Speicher, PJ, Saud, SM, Gulack, BC, Hartwig, MG, Harpole, DH, Onaitis, MW, Tong, BC, D'Amico, TA, and Berry, MF. "Use and Outcomes of Minimally Invasive Lobectomy for Stage I Non-Small Cell Lung Cancer in the National Cancer Data Base." The Annals of thoracic surgery 101.3 (March 2016): 1037-1042.
PMID
26822346
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
101
Issue
3
Publish Date
2016
Start Page
1037
End Page
1042
DOI
10.1016/j.athoracsur.2015.11.018

Lung transplantation at Duke.

Lung transplantation represents the gold-standard therapy for patients with end-stage lung disease. Utilization of this therapy continues to rise. The Lung Transplant Program at Duke University Medical Center was established in 1992, and since that time has grown to one of the highest volume centers in the world. The program to date has performed over 1,600 lung transplants. This report represents an up-to-date review of the practice and management strategies employed for safe and effective lung transplantation at our center. Specific attention is paid to the evaluation of candidacy for lung transplantation, donor selection, surgical approach, and postoperative management. These evidence-based strategies form the foundation of the clinical transplantation program at Duke.

Authors
Gray, AL; Mulvihill, MS; Hartwig, MG
MLA Citation
Gray, AL, Mulvihill, MS, and Hartwig, MG. "Lung transplantation at Duke." Journal of thoracic disease 8.3 (March 2016): E185-E196. (Review)
PMID
27076968
Source
epmc
Published In
Journal of Thoracic Disease
Volume
8
Issue
3
Publish Date
2016
Start Page
E185
End Page
E196
DOI
10.21037/jtd.2016.02.08

Impact of donor and recipient hepatitis C status in lung transplantation.

Studies of lung transplantation in the setting of donors or recipients with hepatitis C virus (HCV) have been limited but have raised concerns about outcomes associated with this infection.Lung transplant cases in the United Network for Organ Sharing (UNOS) database from 1994 to 2011 were analyzed for the HCV status of both donor and recipient. First, among HCV-negative recipients, those who received a lung from an HCV-positive donor (HCV(+) D) were compared with those who received an HCV-negative lung (HCV(-) D). Donor, recipient and operative characteristics as well as outcomes were compared between groups, and overall survival was compared after adjustment for confounders. In a second analysis, HCV-positive recipients (HCV(+) R) were compared with HCV-negative recipients (HCV(-) R). The analysis was stratified by era (1994 to 1999 and 2000 to 2011) and long-term survival was compared.Of 16,604 HCV-negative patients in the UNOS database, 28 (0.2%) received a lung from an HCV(+) D, with use of HCV(+) D decreasing significantly over time. Overall survival (OS) was shorter in the HCV(+) D group (median survival: 1.3 vs 5.1 years; p = 0.002). Results were confirmed in adjusted analyses. After inclusion criteria were met, 289 (1.7%) of the lung transplant recipients were HCV(+) R. These patients appeared similar to their HCV(-) R counterparts, except they were older and had more limited functional status. OS was significantly lower in HCV-positive individuals during the early era (median survival: 1.7 vs 4.5 years; p = 0.004), but not the recent era (median survival: 4.4 vs 5.4 years; p = 0.100). Again, results were confirmed by adjusted analysis.HCV-positive status is a rare problem when considering both lung recipients and donors. Current data demonstrate significantly worse outcomes for HCV-negative patients receiving an HCV(+) lung; however, since 2000, HCV(+) recipients undergoing lung transplantation appear to have survival approximating that of HCV(-) recipients, an improvement from previous years. Recent medical advances in treatment for HCV may further improve outcomes in these groups.

Authors
Englum, BR; Ganapathi, AM; Speicher, PJ; Gulack, BC; Snyder, LD; Davis, RD; Hartwig, MG
MLA Citation
Englum, BR, Ganapathi, AM, Speicher, PJ, Gulack, BC, Snyder, LD, Davis, RD, and Hartwig, MG. "Impact of donor and recipient hepatitis C status in lung transplantation." The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 35.2 (February 2016): 228-235.
PMID
26615769
Source
epmc
Published In
The Journal of Heart and Lung Transplantation
Volume
35
Issue
2
Publish Date
2016
Start Page
228
End Page
235
DOI
10.1016/j.healun.2015.10.012

Single-lung transplantation in the United States: What happens to the other lung?

© 2015 International Society for Heart and Lung Transplantation.Background This study assessed treatment patterns and examined organ utilization in the setting of single-lung transplantation (SLT).Methods The United Network for Organ Sharing database was queried for all SLTs performed from 1987 to 2011. Trends in utilization of the second donor lung were assessed, both from recipient and donor perspectives. Donors were stratified into 2 groups: those donating both lungs and those donating only 1 lung. Independent predictors of using only 1 donor lung were identified using multivariable logistic regression.Results We identified 10,361 SLTs originating from 7,232 unique donors. Of these donors, both lungs were used in only 3,129 (43.3%), resulting in more than 200 second donor lungs going unused annually since 2005, with no significant increase in use over time (p = 0.95). After adjustment, donor characteristics predicting the second donor lung going unused included B/AB blood groups (adjusted odds ratio [AOR]: 1.69 and 2.62, respectively; p < 0.001), smaller body surface area (AOR, 1.30; p = 0.02), lower donor partial pressure of arterial oxygen (AOR, 0.90 per 50 mm Hg increase; p < 0.001), pulmonary infection (AOR, 1.15; p = 0.04), extended criteria donor status (AOR, 1.66; p < 0.001), and death caused by head trauma (AOR, 1.57; p < 0.001) or anoxia (AOR, 1.53; p = 0.001).Conclusions Among donors for SLT, less than half of all cases led to use of the second donor lung. Although anatomic, infectious, or other pathophysiologic issues prohibit 100% utilization, more aggressive donor matching efforts may be a simple method of increasing the utilization of this scarce resource, particularly for less common blood types.

Authors
Speicher, PJ; Ganapathi, AM; Englum, BR; Gulack, BC; Osho, AA; Hirji, SA; Castleberry, AW; Snyder, LD; Duane Davis, R; Hartwig, MG
MLA Citation
Speicher, PJ, Ganapathi, AM, Englum, BR, Gulack, BC, Osho, AA, Hirji, SA, Castleberry, AW, Snyder, LD, Duane Davis, R, and Hartwig, MG. "Single-lung transplantation in the United States: What happens to the other lung?." Journal of Heart and Lung Transplantation 34.1 (January 1, 2016): 36-42.
Source
scopus
Published In
The Journal of Heart and Lung Transplantation
Volume
34
Issue
1
Publish Date
2016
Start Page
36
End Page
42
DOI
10.1016/j.healun.2014.08.018

Sublobar Resection for Clinical Stage IA Non-small-cell Lung Cancer in the United States.

This study evaluated the use of lobectomy and sublobar resection for clinical stage IA non-small-cell lung cancer (NSCLC) in the National Cancer Data Base (NCDB).The NCDB from 2003 to 2011 was analyzed to determine factors associated with the use of a sublobar resection versus a lobectomy for the treatment of clinical stage IA NSCLC. Overall survival was assessed using the Kaplan-Meier method and Cox proportional hazard modeling.Among 39,403 patients included for analysis, 29,736 (75.5%) received a lobectomy and 9667 (24.5%) received a sublobar resection: 84.7% wedge resection (n = 8192) and 15.3% segmental resection (n = 1475). Lymph node evaluation was not performed in 2788 (28.8%) of sublobar resection patients, and 7298 (75.5%) of sublobar resections were for tumors ≤ 2 cm. After multivariable logistic regression, older age, higher Charlson-Deyo comorbidity scores, smaller tumor size, and treatment at lower-volume institutions were associated with sublobar resection (all P < .001). Overall, lobectomy was associated with significantly improved 5-year survival compared to sublobar resection (66.2% vs. 51.2%; P < .001, adjusted hazard ratio 0.66; P < .001). However among sublobar resection patients, nodal sampling was associated with significantly better 5-year survival (58.2% vs. 46.4%; P < .001).Despite adjustment for patient and tumor related characteristics, a sublobar resection is associated with significantly reduced long-term survival compared to a formal surgical lobectomy among patients with NSCLC, even for stage 1A tumors. For patients who cannot tolerate lobectomy and who are treated with sublobar resection, lymph node evaluation is essential to help guide further treatment.

Authors
Speicher, PJ; Gu, L; Gulack, BC; Wang, X; D'Amico, TA; Hartwig, MG; Berry, MF
MLA Citation
Speicher, PJ, Gu, L, Gulack, BC, Wang, X, D'Amico, TA, Hartwig, MG, and Berry, MF. "Sublobar Resection for Clinical Stage IA Non-small-cell Lung Cancer in the United States." Clinical lung cancer 17.1 (January 2016): 47-55.
PMID
26602547
Source
epmc
Published In
Clinical lung cancer
Volume
17
Issue
1
Publish Date
2016
Start Page
47
End Page
55
DOI
10.1016/j.cllc.2015.07.005

Adding radiation to induction chemotherapy does not improve survival of patients with operable clinical N2 non-small cell lung cancer.

Radiotherapy is commonly used in induction regimens for patients with non-small cell lung cancer with operable mediastinal nodal disease, although evidence has not shown a benefit over induction chemotherapy alone. We compared outcomes between induction chemotherapy and induction chemoradiation using the National Cancer Data Base.Induction radiation use and survival of patients who underwent lobectomy or pneumonectomy after induction chemotherapy for clinical T1-3N2M0 non-small cell lung cancer in the National Cancer Data Base from 2003 to 2006 were assessed using logistic regression, general linear regression, Kaplan-Meier, and Cox proportional hazard analysis.Of 1362 patients who met study criteria, 834 (61%) underwent induction chemoradiation and 528 (39%) underwent induction chemotherapy. Lobectomy was performed in 82% of patients (n = 1111), and pneumonectomy was performed in 18% of patients (n = 251). Pneumonectomy was performed more often after induction chemoradiation than after induction chemotherapy (20% vs 16%, P = .04). Downstaging from N2 to N0/N1 was more common with induction chemoradiation compared with induction chemotherapy (58% vs 46%, P < .01), but 5-year survival of patients receiving induction chemoradiation and patients receiving induction chemotherapy was similar in unadjusted analysis (41% vs 41%, P = .41). In multivariable analysis, the addition of radiation to induction chemotherapy also was not associated with a survival benefit (hazard ratio, 1.03; 95% confidence interval, 0.89-1.18; P = .73).Induction chemoradiation is used in the majority of patients with non-small cell lung cancer with N2 disease who undergo induction therapy before surgical resection, but it is not associated with improved survival compared with induction chemotherapy.

Authors
Yang, C-FJ; Gulack, BC; Gu, L; Speicher, PJ; Wang, X; Harpole, DH; Onaitis, MW; D'Amico, TA; Berry, MF; Hartwig, MG
MLA Citation
Yang, C-FJ, Gulack, BC, Gu, L, Speicher, PJ, Wang, X, Harpole, DH, Onaitis, MW, D'Amico, TA, Berry, MF, and Hartwig, MG. "Adding radiation to induction chemotherapy does not improve survival of patients with operable clinical N2 non-small cell lung cancer." The Journal of thoracic and cardiovascular surgery 150.6 (December 2015): 1484-1492.
PMID
26259994
Source
epmc
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
150
Issue
6
Publish Date
2015
Start Page
1484
End Page
1492
DOI
10.1016/j.jtcvs.2015.06.062

The impact of tumor size on the association of the extent of lymph node resection and survival in clinical stage I non-small cell lung cancer.

Lymph node evaluation for node-negative non-small cell lung cancer (NSCLC) is associated with long-term survival but it is not clear if smaller tumors require as extensive a pathologic nodal assessment as larger tumors. This study evaluated the relationship of tumor size and optimal extent of lymph node resection using the National Cancer Data Base (NCDB).The incremental survival benefit of each additional lymph node that was evaluated for patients in the NCDB who underwent lobectomy for clinical Stage I NSCLC from 2003 to 2006 was evaluated using Cox multivariable proportional hazards regression modeling. The impact of tumor size was assessed by repeating the Cox analysis with patients stratified by tumor size ≥2 cm vs <2 cm.A median of 7 [interquartile range: 4,11] lymph nodes were examined in 13,827 patients who met study criteria. Following adjustment, the evaluation of each additional lymph node demonstrated a significant survival benefit through 11 lymph nodes. After grouping patients by tumor size, patients with tumors <2 cm demonstrated a significant survival benefit for the incremental resection of each additional lymph node through 4 lymph nodes while patients with tumors ≥2 cm had a significant survival benefit through 14 lymph nodes.Pathologic lymph node evaluation is associated with improved survival for clinically node-negative NSCLC, but the extent of the necessary evaluation varies by tumor size. These results have implications for guidelines for lymph node assessment as well as the choice of surgery vs other ablative techniques for clinical stage I NSCLC.

Authors
Gulack, BC; Yang, C-FJ; Speicher, PJ; Meza, JM; Gu, L; Wang, X; D'Amico, TA; Hartwig, MG; Berry, MF
MLA Citation
Gulack, BC, Yang, C-FJ, Speicher, PJ, Meza, JM, Gu, L, Wang, X, D'Amico, TA, Hartwig, MG, and Berry, MF. "The impact of tumor size on the association of the extent of lymph node resection and survival in clinical stage I non-small cell lung cancer." Lung cancer (Amsterdam, Netherlands) 90.3 (December 2015): 554-560.
PMID
26519122
Source
epmc
Published In
Lung Cancer
Volume
90
Issue
3
Publish Date
2015
Start Page
554
End Page
560
DOI
10.1016/j.lungcan.2015.10.011

Induction chemoradiation therapy prior to esophagectomy is associated with superior long-term survival for esophageal cancer.

The purpose of this study was to examine the role of induction chemoradiation in the treatment of potentially resectable locally advanced (T2-3N0 and T1-3N+) esophageal cancer utilizing a large national database. The National Cancer Data Base (NCDB) was queried for all patients undergoing esophagectomy for clinical T2-3N0 and T1-3N+ esophageal cancer of the mid- or lower esophagus. Patients were stratified by the use of induction chemoradiation therapy versus surgery-first. Trends were assessed with the Cochran-Armitage test. Predictors of receiving induction therapy were evaluated with multivariable logistic regression. A propensity-matched analysis was conducted to compare outcomes between groups, and the Kaplan-Meier method was used to estimate long-term survival. Within the NCDB, 7921 patients were identified, of which 6103 (77.0%) were treated with chemoradiation prior to esophagectomy, while the remaining 1818 (23.0%) were managed with surgery-first. Use of induction therapy increased over time, with an absolute increase of 11.8% from 2003-2011 (P < 0.001). As revealed by the propensity model, induction therapy was associated with higher rates of negative margins and shorter hospital length of stay, but no differences in unplanned readmission and 30-day mortality rates. In unadjusted survival analysis, induction therapy was associated with better long-term survival compared to a strategy of surgery-first, with 5-year survival rates of 37.2% versus 28.6%, P < 0.001. Following propensity score matching analysis, the use of induction therapy maintained a significant survival advantage over surgery-first (5-year survival: 37.9% vs. 28.7%, P < 0.001). Treatment with induction chemoradiation therapy prior to surgical resection is associated with significant improvement in long-term survival, even after adjusting for confounders with a propensity model. Induction therapy should be considered in all medically appropriate patients with resectable cT2-3N0 and cT1-3N+ esophageal cancer, prior to esophagectomy.

Authors
Speicher, PJ; Wang, X; Englum, BR; Ganapathi, AM; Yerokun, B; Hartwig, MG; D'Amico, TA; Berry, MF
MLA Citation
Speicher, PJ, Wang, X, Englum, BR, Ganapathi, AM, Yerokun, B, Hartwig, MG, D'Amico, TA, and Berry, MF. "Induction chemoradiation therapy prior to esophagectomy is associated with superior long-term survival for esophageal cancer." Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus 28.8 (November 2015): 788-796.
PMID
25212528
Source
epmc
Published In
Diseases of the Esophagus
Volume
28
Issue
8
Publish Date
2015
Start Page
788
End Page
796
DOI
10.1111/dote.12285

What Is the Optimal Transplant for Older Patients With Idiopathic Pulmonary Fibrosis?

There is controversy regarding the optimal type of lung transplant--single orthotopic lung transplantation (SOLT) versus bilateral orthotopic lung transplantation (BOLT)--for patients with idiopathic pulmonary fibrosis. We performed this study to determine which type of transplant is more appropriate for older patients with this condition.We conducted a review of the United Network for Organ Sharing database from 2005 to 2013 for patients aged 65 years or more with idiopathic pulmonary fibrosis. A 1:1 nearest-neighbor propensity match was utilized to determine differences in survival by transplant procedure type (SOLT versus BOLT). Logistic regression modeling taking into account interaction terms between prespecified variables and the type of transplant was utilized to determine variables that altered the survival outcomes associated with SOLT versus BOLT.Of 1,564 patients who met study criteria, 521 (33.3%) received BOLT. After propensity matching 498 BOLT recipients to 498 SOLT recipients, BOLT was associated with a significantly improved 5-year survival (48.7% versus 35.2%, p < 0.01). However, the mortality hazard associated with BOLT varied from a nonsignificant reduction in survival within 3 months after transplant (hazard ratio 1.24, 95% confidence interval: 0.80 to 1.93) to a significant survival benefit for patients who survived beyond 1 year (hazard ratio 0.64, 95% confidence interval: 0.47 to 0.86). Functional status was also found to be a significant predictor of the survival benefit associated with BOLT.Bilateral orthotopic lung transplantation is associated with significantly improved survival over SOLT for older patients with idiopathic pulmonary fibrosis, driven by a late survival benefit from bilateral transplantation. However, patients with a reduced preoperative functional status do not appear to derive a similar benefit from bilateral transplantation.

Authors
Gulack, BC; Ganapathi, AM; Speicher, PJ; Meza, JM; Hirji, SA; Snyder, LD; Davis, RD; Hartwig, MG
MLA Citation
Gulack, BC, Ganapathi, AM, Speicher, PJ, Meza, JM, Hirji, SA, Snyder, LD, Davis, RD, and Hartwig, MG. "What Is the Optimal Transplant for Older Patients With Idiopathic Pulmonary Fibrosis?." The Annals of thoracic surgery 100.5 (November 2015): 1826-1833.
PMID
26210946
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
100
Issue
5
Publish Date
2015
Start Page
1826
End Page
1833
DOI
10.1016/j.athoracsur.2015.05.008

The utility of preoperative six-minute-walk distance in lung transplantation.

The use of 6-minute-walk distance (6MWD) as an indicator of exercise capacity to predict postoperative survival in lung transplantation has not previously been well studied.To evaluate the association between 6MWD and postoperative survival following lung transplantation.Adult, first time, lung-only transplantations per the United Network for Organ Sharing database from May 2005 to December 2011 were analyzed. Kaplan-Meier methods and Cox proportional hazards modeling were used to determine the association between preoperative 6MWD and post-transplant survival after adjusting for potential confounders. A receiver operating characteristic curve was used to determine the 6MWD value that provided maximal separation in 1-year mortality. A subanalysis was performed to assess the association between 6MWD and post-transplant survival by disease category.A total of 9,526 patients were included for analysis. The median 6MWD was 787 ft (25th-75th percentiles = 450-1,082 ft). Increasing 6MWD was associated with significantly lower overall hazard of death (P < 0.001). Continuous increase in walk distance through 1,200-1,400 ft conferred an incremental survival advantage. Although 6MWD strongly correlated with survival, the impact of a single dichotomous value to predict outcomes was limited. All disease categories demonstrated significantly longer survival with increasing 6MWD (P ≤ 0.009) except pulmonary vascular disease (P = 0.74); however, the low volume in this category (n = 312; 3.3%) may limit the ability to detect an association.6MWD is significantly associated with post-transplant survival and is best incorporated into transplant evaluations on a continuous basis given limited ability of a single, dichotomous value to predict outcomes.

Authors
Castleberry, AW; Englum, BR; Snyder, LD; Worni, M; Osho, AA; Gulack, BC; Palmer, SM; Davis, RD; Hartwig, MG
MLA Citation
Castleberry, AW, Englum, BR, Snyder, LD, Worni, M, Osho, AA, Gulack, BC, Palmer, SM, Davis, RD, and Hartwig, MG. "The utility of preoperative six-minute-walk distance in lung transplantation." American journal of respiratory and critical care medicine 192.7 (October 2015): 843-852.
PMID
26067395
Source
epmc
Published In
American journal of respiratory and critical care medicine
Volume
192
Issue
7
Publish Date
2015
Start Page
843
End Page
852
DOI
10.1164/rccm.201409-1698oc

Right-Sided vs. Left-Sided Pneumonectomy after Induction Therapy for Non-Small Cell Lung Cancer

Authors
Yang, C-FJ; Chan, DY; Gulack, BC; Ranney, DN; Tong, BC; Onaitis, MW; Harpole, D; D'Amico, TA; Hartwig, MG; Berry, MF
MLA Citation
Yang, C-FJ, Chan, DY, Gulack, BC, Ranney, DN, Tong, BC, Onaitis, MW, Harpole, D, D'Amico, TA, Hartwig, MG, and Berry, MF. "Right-Sided vs. Left-Sided Pneumonectomy after Induction Therapy for Non-Small Cell Lung Cancer." JOURNAL OF THORACIC ONCOLOGY 10.9 (September 2015): S335-S336.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
10
Issue
9
Publish Date
2015
Start Page
S335
End Page
S336

Survival after Surgery for pN1 and pN2 Small Cell Lung Cancer: A Comparison with Surgical Treatment of Non-Small Cell Lung Cancer

Authors
Yang, C-FJ; Chan, DY; Gulack, BC; Speicher, PJ; Hartwig, MG; Berry, MF; Tong, BC; Onaitis, MW; D'Amico, TA; Harpole, D
MLA Citation
Yang, C-FJ, Chan, DY, Gulack, BC, Speicher, PJ, Hartwig, MG, Berry, MF, Tong, BC, Onaitis, MW, D'Amico, TA, and Harpole, D. "Survival after Surgery for pN1 and pN2 Small Cell Lung Cancer: A Comparison with Surgical Treatment of Non-Small Cell Lung Cancer." JOURNAL OF THORACIC ONCOLOGY 10.9 (September 2015): S399-S400.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
10
Issue
9
Publish Date
2015
Start Page
S399
End Page
S400

Long-Term Survival after Surgery for Pathologic N1 and N2 Small Cell Lung Cancer: A Comparison with Nonoperative Management

Authors
Yang, C-FJ; Chan, DY; Speicher, PJ; Gulack, BC; Onaitis, MW; Hartwig, MG; Tong, BC; Berry, MF; D'Amico, TA; Harpole, D
MLA Citation
Yang, C-FJ, Chan, DY, Speicher, PJ, Gulack, BC, Onaitis, MW, Hartwig, MG, Tong, BC, Berry, MF, D'Amico, TA, and Harpole, D. "Long-Term Survival after Surgery for Pathologic N1 and N2 Small Cell Lung Cancer: A Comparison with Nonoperative Management." JOURNAL OF THORACIC ONCOLOGY 10.9 (September 2015): S193-S194.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
10
Issue
9
Publish Date
2015
Start Page
S193
End Page
S194

Wedge Resection vs Segmentectomy for Patients with T1A N0 Non-Small Cell Lung Cancer

Authors
Yang, C-FJ; Chan, DY; Gulack, BC; Speicher, PJ; Onaitis, MW; Tong, BC; D'Amico, TA; Harpole, D; Berry, MF; Hartwig, MG
MLA Citation
Yang, C-FJ, Chan, DY, Gulack, BC, Speicher, PJ, Onaitis, MW, Tong, BC, D'Amico, TA, Harpole, D, Berry, MF, and Hartwig, MG. "Wedge Resection vs Segmentectomy for Patients with T1A N0 Non-Small Cell Lung Cancer." JOURNAL OF THORACIC ONCOLOGY 10.9 (September 2015): S242-S242.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
10
Issue
9
Publish Date
2015
Start Page
S242
End Page
S242

Impact of Radiation on Recurrence Patterns and Survival for Patients Undergoing Lobectomy for Stage IIIA-pN2 Non-Small Cell Lung Cancer

Authors
Yang, C-FJ; Adil, SM; Meyerhoff, RR; Anderson, KL; Hirji, SA; Harpole, D; Tong, BC; Onaitis, MW; Hartwig, MG; D'Amico, TA; Berry, MF
MLA Citation
Yang, C-FJ, Adil, SM, Meyerhoff, RR, Anderson, KL, Hirji, SA, Harpole, D, Tong, BC, Onaitis, MW, Hartwig, MG, D'Amico, TA, and Berry, MF. "Impact of Radiation on Recurrence Patterns and Survival for Patients Undergoing Lobectomy for Stage IIIA-pN2 Non-Small Cell Lung Cancer." JOURNAL OF THORACIC ONCOLOGY 10.9 (September 2015): S573-S573.
Source
wos-lite
Published In
Journal of Thoracic Oncology
Volume
10
Issue
9
Publish Date
2015
Start Page
S573
End Page
S573

Impact of Pulmonary Function Measurements on Long-Term Survival After Lobectomy for Stage I Non-Small Cell Lung Cancer.

Pulmonary function tests predict respiratory complications after lobectomy. We evaluated the impact of pulmonary function measurements on long-term survival after lobectomy for stage I non-small cell lung cancer.The relationship between percent predicted forced expiratory volume in 1 second (FEV1) and percent predicted diffusing capacity of the lung for carbon monoxide (Dlco) and overall survival for patients who underwent lobectomy without induction therapy for stage I (T1-2N0M0) non-small cell lung cancer from 1996 to 2012 was evaluated using the Kaplan-Meier approach and a multivariable Cox proportional hazard model.During the study period, 972 patients (mean Dlco 76 ± 21, mean FEV1 73 ± 21) met inclusion criteria. Perioperative mortality was 2.6% (n = 25). The 5-year survival of the entire cohort was 60.1%, with a median follow-up of 43 months. The 5-year survival for patients with percent predicted FEV1 stratified by more than 80%, 61% to 80%, 41% to 60%, and 40% or less was 70.1%, 59.3%, 52.5%, and 53.4%, respectively. The 5-year survival for patients with percent predicted Dlco stratified by more than 80%, 61% to 80%, 41% to 60%, and 40% or less was 70.2%, 63.4%, 44.2%, and 33.1%, respectively. In multivariable survival analysis, both larger tumor size (hazard ratio 1.15, p = 0.01) and lower Dlco (hazard ratio 0.986, p < 0.0001) were significant predictors of worse survival. The association of FEV1 and survival was not statistically significant (p = 0.18).Survival after lobectomy for patients with stage I non-small cell lung cancer is impacted by lower Dlco, which can be used in the risk and benefit assessment when choosing therapy.

Authors
Berry, MF; Jeffrey Yang, C-F; Hartwig, MG; Tong, BC; Harpole, DH; D'Amico, TA; Onaitis, MW
MLA Citation
Berry, MF, Jeffrey Yang, C-F, Hartwig, MG, Tong, BC, Harpole, DH, D'Amico, TA, and Onaitis, MW. "Impact of Pulmonary Function Measurements on Long-Term Survival After Lobectomy for Stage I Non-Small Cell Lung Cancer." The Annals of thoracic surgery 100.1 (July 2015): 271-276.
PMID
25986099
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
100
Issue
1
Publish Date
2015
Start Page
271
End Page
276
DOI
10.1016/j.athoracsur.2015.02.076

Impact of mesothelioma histologic subtype on outcomes in the Surveillance, Epidemiology, and End Results database.

This study was conducted to determine how malignant pleural mesothelioma (MPM) histology was associated with the use of surgery and survival.Overall survival of patients with stage I-III epithelioid, sarcomatoid, and biphasic MPM in the Surveillance, Epidemiology, and End Results database from 2004-2010 was evaluated using multivariate Cox proportional hazards models.Of 1183 patients who met inclusion criteria, histologic subtype was epithelioid in 811 patients (69%), biphasic in 148 patients (12%), and sarcomatoid in 224 patients (19%). Median survival was 14 mo in the epithelioid group, 10 mo in the biphasic group, and 4 mo in the sarcomatoid group (P < 0.01). Cancer-directed surgery was used more often in patients with epithelioid (37%, 299/811) and biphasic (44%, 65/148) histologies as compared with patients with sarcomatoid histology (26%, 58/224; P < 0.01). Among patients who underwent surgery, median survival was 19 mo in the epithelioid group, 12 mo in the biphasic group, and 4 mo in the sarcomatoid group (P < 0.01). In multivariate analysis, surgery was associated with improved survival in the epithelioid group (hazard ratio [HR] 0.72; P < 0.01) but not in biphasic (HR 0.73; P = 0.19) or sarcomatoid (HR 0.79; P = 0.18) groups.Cancer-directed surgery is associated with significantly improved survival for MPM patients with epithelioid histology, but patients with sarcomatoid and biphasic histologies have poor prognoses that may not be favored by operative treatment. The specific histology should be identified before treatment, so that surgery can be offered to patients with epithelioid histology, as these patients are most likely to benefit.

Authors
Meyerhoff, RR; Yang, C-FJ; Speicher, PJ; Gulack, BC; Hartwig, MG; D'Amico, TA; Harpole, DH; Berry, MF
MLA Citation
Meyerhoff, RR, Yang, C-FJ, Speicher, PJ, Gulack, BC, Hartwig, MG, D'Amico, TA, Harpole, DH, and Berry, MF. "Impact of mesothelioma histologic subtype on outcomes in the Surveillance, Epidemiology, and End Results database." The Journal of surgical research 196.1 (June 2015): 23-32.
PMID
25791825
Source
epmc
Published In
Journal of Surgical Research
Volume
196
Issue
1
Publish Date
2015
Start Page
23
End Page
32
DOI
10.1016/j.jss.2015.01.043

Adjuvant Chemotherapy After Lobectomy for T1-2N0 Non-Small Cell Lung Cancer: Are the Guidelines Supported?

Evidence guiding adjuvant chemotherapy (AC) use after lobectomy for stage I non-small cell lung cancer (NSCLC) is limited. This study evaluated the impact of AC use and tumor size on outcomes using a large, nationwide cancer database.The effect of AC on long-term survival among patients who underwent lobectomy for margin-negative pathologic T1-2N0M0 NSCLC in the National Cancer Data Base from 2003 to 2006 was estimated using the Kaplan-Meier method. The specific tumor size threshold at which AC began providing benefit was estimated with multivariable Cox proportional hazards modeling.Overall 3,496 of 34,360 patients (10.2%) who met inclusion criteria were treated with AC, although AC use increased over time from 2003, when only 2.7% of patients with tumors less than 4 cm and 6.2% of patients with tumors of 4 cm or larger received AC. In unadjusted survival analysis, AC was associated with a significant 5-year survival benefit for patients with tumors less than 4 cm (74.3% vs 66.9%; P<.0001) and 4 cm or greater (64.8% vs 49.8%; P<.0001). In subanalyses of patients grouped by strata of 0.5-cm increments in tumor size, AC was associated with a survival advantage for tumor sizes ranging from 3.0 to 8.5 cm.Use of AC among patients with stage I NSCLC has increased over time but remains uncommon. The results of this study support current treatment guidelines that recommend AC use after lobectomy for stage I NSCLC tumors larger than 4 cm. These results also suggest that AC use is associated with superior survival for patients with tumors ranging from 3.0 to 8.5 cm in diameter.

Authors
Speicher, PJ; Gu, L; Wang, X; Hartwig, MG; D'Amico, TA; Berry, MF
MLA Citation
Speicher, PJ, Gu, L, Wang, X, Hartwig, MG, D'Amico, TA, and Berry, MF. "Adjuvant Chemotherapy After Lobectomy for T1-2N0 Non-Small Cell Lung Cancer: Are the Guidelines Supported?." Journal of the National Comprehensive Cancer Network : JNCCN 13.6 (June 2015): 755-761.
PMID
26085391
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
13
Issue
6
Publish Date
2015
Start Page
755
End Page
761

Lung Transplantation from Donors With Kidney Disease

Authors
Ganapathi, A; Gulack, B; Castleberry, A; Davis, R; Snyder, L; Hartwig, M
MLA Citation
Ganapathi, A, Gulack, B, Castleberry, A, Davis, R, Snyder, L, and Hartwig, M. "Lung Transplantation from Donors With Kidney Disease." May 2015.
Source
wos-lite
Published In
American Journal of Transplantation
Volume
15
Publish Date
2015

Determining eligibility for lung transplantation: A nationwide assessment of the cutoff glomerular filtration rate.

Historical concerns about lung transplantation in patients with a glomerular filtration rate (GFR) ≤ 50 ml/min/1.73 m(2) have not been validated. We hypothesize that a pre-transplant GFR ≤ 50 ml/min/1.73 m(2) represents a high mortality risk, especially in the setting of acute GFR decline. In addition, we explore the potential for improved risk stratification using a statistically derivable alternative cutoff.Adult, primary, lung recipients in the United Network for Organ Sharing database were analyzed (October 1987 to December 2011). Recursive partitioning identified the GFR value that provides maximal separation in 1-year mortality. Survival over/under the cutoffs was compared using stratified log-rank, Cox, and Kaplan-Meier methods, before and after 1:2 propensity score matching.Median GFR at time of transplant for 19,425 study patients was 94.2 ml/min/1.73 m(2) (quartile 1-quartile, 2 76.9-105.9 ml/min/1.73 m(2)). Recursive partitioning identified a GFR of 40.2 ml/min/1.73 m(2) as the ideal inflection point for predicting 1-year survival. Cutoffs demonstrated statistically significant effects on survival after 840 patients with a GFR ≤ 50 ml/min/1.73 m(2) (hazard ratio, 1.28; 95% confidence interval, 1.15-1.43) and 401 patients with a GFR ≤ 40.2 ml/min/1.73 m(2) (hazard ratio, 1.57; 95% confidence interval, 1.36-1.83) were matched with high GFR controls (p < 0.001). In 13,509 patients with available GFR at the time of listing and transplant, a pre-transplant GFR decline of ≥ 50% from baseline was associated with worse survival (p < 0.001).A pre-transplant GFR ≤ 50 ml/min/1.73 m(2) is associated with decreased survival. However, patients with GFR between 40 and 50 ml/min/1.73 m(2) do not suffer excessive post-transplant mortality and should not be automatically excluded from listing. Notably, outcomes are worse in patients with poor renal function and concomitant pre-transplant GFR decline. Strategies should be devised to detect and manage interval renal deterioration before lung transplantation.

Authors
Osho, AA; Castleberry, AW; Snyder, LD; Ganapathi, AM; Speicher, PJ; Hirji, SA; Stafford-Smith, M; Daneshmand, MA; Duane Davis, R; Hartwig, MG
MLA Citation
Osho, AA, Castleberry, AW, Snyder, LD, Ganapathi, AM, Speicher, PJ, Hirji, SA, Stafford-Smith, M, Daneshmand, MA, Duane Davis, R, and Hartwig, MG. "Determining eligibility for lung transplantation: A nationwide assessment of the cutoff glomerular filtration rate." The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 34.4 (April 2015): 571-579.
PMID
25524142
Source
epmc
Published In
The Journal of Heart and Lung Transplantation
Volume
34
Issue
4
Publish Date
2015
Start Page
571
End Page
579
DOI
10.1016/j.healun.2014.09.035

The Association of Donor Age and Survival Is Independent of Ischemic Time Following Cadaveric Lung Transplantation

Authors
Gulack, BC; Ganapathi, AM; Speicher, PJ; Englum, BR; Snyder, LD; Davis, RD; Hartwig, MG
MLA Citation
Gulack, BC, Ganapathi, AM, Speicher, PJ, Englum, BR, Snyder, LD, Davis, RD, and Hartwig, MG. "The Association of Donor Age and Survival Is Independent of Ischemic Time Following Cadaveric Lung Transplantation." April 2015.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
34
Issue
4
Publish Date
2015
Start Page
S46
End Page
S46

Survival After Lung Transplant in Alpha-1-Antitrypsin Deficiency Recipients Compared to Other Forms of Chronic Obstructive Pulmonary Disease

Authors
Gulack, BC; Ganapathi, AM; Speicher, PJ; Chery, G; Snyder, LD; Davis, RD; Hartwig, MG
MLA Citation
Gulack, BC, Ganapathi, AM, Speicher, PJ, Chery, G, Snyder, LD, Davis, RD, and Hartwig, MG. "Survival After Lung Transplant in Alpha-1-Antitrypsin Deficiency Recipients Compared to Other Forms of Chronic Obstructive Pulmonary Disease." April 2015.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
34
Issue
4
Publish Date
2015
Start Page
S243
End Page
S244

Factors Predicting Survival in Early Lung Retransplantation

Authors
Osho, AA; Hirji, SA; Gulack, BC; Ganapathi, AM; Davis, RD; Hartwig, MG
MLA Citation
Osho, AA, Hirji, SA, Gulack, BC, Ganapathi, AM, Davis, RD, and Hartwig, MG. "Factors Predicting Survival in Early Lung Retransplantation." April 2015.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
34
Issue
4
Publish Date
2015
Start Page
S251
End Page
S252

Large Airway Oximetry and Hypoxia Related Gene Expression in Bronchial Epithelium in Early Post-Lung Transplantation

Authors
Shofer, S; Kraft, B; Hartwig, M; Piantadosi, C
MLA Citation
Shofer, S, Kraft, B, Hartwig, M, and Piantadosi, C. "Large Airway Oximetry and Hypoxia Related Gene Expression in Bronchial Epithelium in Early Post-Lung Transplantation." April 2015.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
34
Issue
4
Publish Date
2015
Start Page
S253
End Page
S254

Defining the role of adjuvant chemotherapy after lobectomy for typical bronchopulmonary carcinoid tumors.

BACKGROUND: Treatment guidelines for typical bronchopulmonary carcinoid tumors recommend observation alone after resection of stage I-IIIA disease, but there are limited data related to the use of adjuvant chemotherapy in the setting of nodal metastases found at operation. METHODS: Patients in the National Cancer Data Base (NDCB) who underwent lobectomy for typical carcinoid and had metastatic nodal disease were stratified by the use of adjuvant chemotherapy. Baseline characteristics and outcomes were compared between groups. Next, patients were propensity matched using a 3:1 nearest-neighbor algorithm, and adjusted outcomes were compared. Finally, long-term survival was evaluated using the Kaplan-Meier method with comparisons based on the log-rank test. RESULTS: Overall, 4,612 patients were identified, among whom 629 (13.6%) had positive lymph nodes at the time of operation. Of them, adjuvant chemotherapy was used in 37 patients (5.9%). There were no baseline differences between patients who did and those who did not receive adjuvant chemotherapy. Patients treated with chemotherapy demonstrated a survival disadvantage at 5 years (69.7% versus 81.9%; p = 0.042). After propensity matching, all baseline characteristics between groups were highly similar. There remained a trend toward inferior 5-year survival for patients who received adjuvant chemotherapy, although the difference no longer met statistical significance (69.7% versus 80.9%; p = 0.096). CONCLUSIONS: Adjuvant chemotherapy is not associated with improved survival among patients who undergo lobectomy for typical carcinoids and nodal metastases. These data support current treatment guidelines.

Authors
Nussbaum, DP; Speicher, PJ; Gulack, BC; Hartwig, MG; Onaitis, MW; D'Amico, TA; Berry, MF
MLA Citation
Nussbaum, DP, Speicher, PJ, Gulack, BC, Hartwig, MG, Onaitis, MW, D'Amico, TA, and Berry, MF. "Defining the role of adjuvant chemotherapy after lobectomy for typical bronchopulmonary carcinoid tumors." The Annals of thoracic surgery 99.2 (February 2015): 428-434.
PMID
25499480
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
99
Issue
2
Publish Date
2015
Start Page
428
End Page
434
DOI
10.1016/j.athoracsur.2014.08.030

Single-lung transplantation in the United States: what happens to the other lung?

This study assessed treatment patterns and examined organ utilization in the setting of single-lung transplantation (SLT).The United Network for Organ Sharing database was queried for all SLTs performed from 1987 to 2011. Trends in utilization of the second donor lung were assessed, both from recipient and donor perspectives. Donors were stratified into 2 groups: those donating both lungs and those donating only 1 lung. Independent predictors of using only 1 donor lung were identified using multivariable logistic regression.We identified 10,361 SLTs originating from 7,232 unique donors. Of these donors, both lungs were used in only 3,129 (43.3%), resulting in more than 200 second donor lungs going unused annually since 2005, with no significant increase in use over time (p = 0.95). After adjustment, donor characteristics predicting the second donor lung going unused included B/AB blood groups (adjusted odds ratio [AOR]: 1.69 and 2.62, respectively; p < 0.001), smaller body surface area (AOR, 1.30; p = 0.02), lower donor partial pressure of arterial oxygen (AOR, 0.90 per 50 mm Hg increase; p < 0.001), pulmonary infection (AOR, 1.15; p = 0.04), extended criteria donor status (AOR, 1.66; p < 0.001), and death caused by head trauma (AOR, 1.57; p < 0.001) or anoxia (AOR, 1.53; p = 0.001).Among donors for SLT, less than half of all cases led to use of the second donor lung. Although anatomic, infectious, or other pathophysiologic issues prohibit 100% utilization, more aggressive donor matching efforts may be a simple method of increasing the utilization of this scarce resource, particularly for less common blood types.

Authors
Speicher, PJ; Ganapathi, AM; Englum, BR; Gulack, BC; Osho, AA; Hirji, SA; Castleberry, AW; Snyder, LD; Duane Davis, R; Hartwig, MG
MLA Citation
Speicher, PJ, Ganapathi, AM, Englum, BR, Gulack, BC, Osho, AA, Hirji, SA, Castleberry, AW, Snyder, LD, Duane Davis, R, and Hartwig, MG. "Single-lung transplantation in the United States: what happens to the other lung?." January 2015.
PMID
25305097
Source
epmc
Published In
The Journal of Heart and Lung Transplantation
Volume
34
Issue
1
Publish Date
2015
Start Page
36
End Page
42
DOI
10.1016/j.healun.2014.08.018

Reflux and allograft dysfunction: is there a connection?

Despite improving outcomes following lung transplantation, chronic rejection continues to limit survival. The predominant form of chronic rejection, bronchiolitis obliterans syndrome, has been associated with multiple etiologies including aspiration from gastroduodenal reflux. This article reviews the current literature with regards to the incidence of reflux following lung transplantation, the association of reflux with allograft dysfunction and survival, and the success of prevention and treatment of reflux in this patient population. Although antireflux surgery has been demonstrated to be safe in this population and leads to a stabilization of lung function in patients with reflux, there have not been definitive data that it improves survival.

Authors
Gulack, BC; Meza, JM; Lin, SS; Hartwig, MG; Davis, RD
MLA Citation
Gulack, BC, Meza, JM, Lin, SS, Hartwig, MG, and Davis, RD. "Reflux and allograft dysfunction: is there a connection?." Thoracic surgery clinics 25.1 (January 2015): 97-105.
PMID
25430433
Source
epmc
Published In
Thoracic Surgery Clinics
Volume
25
Issue
1
Publish Date
2015
Start Page
97
End Page
105
DOI
10.1016/j.thorsurg.2014.09.006

Adjuvant chemotherapy is associated with improved survival after esophagectomy without induction therapy for node-positive adenocarcinoma.

This study investigated adjuvant chemotherapy (AC) use after esophagectomy without induction therapy for node-positive (pN+) adenocarcinoma using the National Cancer Database, including the impact of complications related to surgery (CRS) on outcomes.Predictors of AC use in 1694 patients in the National Cancer Data Base who underwent R0 esophagectomy from 2003-2011 without induction therapy for pN+ adenocarcinoma of the middle or lower esophagus and survived more than 30 days were identified with multivariable logistic regression. The impact of AC on survival was estimated using Kaplan-Meier and Cox-proportional hazards methods.AC was given to 874 of 1694 (51.6%) patients; 618 (70.7%) AC patients received radiation. Older age (adjusted odds ratio [AOR] 0.58/decade, p < 0.001), longer travel distance (AOR 0.78 per 100 miles, p = 0.03) and CRS (AOR 0.45, p < 0.001) predicted that AC was not used. Patients given AC had better 5-year survival than patients not given AC (24.2% versus 14.9%, p < 0.001), and AC use predicted improved survival in multivariate analysis (hazard ratio 0.67, p = 0.008). Receiving radiation in addition to AC did not improve survival (p = 0.35). Although CRS was associated with worse survival, patients who had CRS but received AC had superior survival compared to patients who did not have CRS or get AC (p = 0.016).AC after esophagectomy is associated with improved survival but was only used in half of patients with pN+ esophageal adenocarcinoma. We also found that the addition of radiation to AC was not associated with a survival benefit. CRS predict worse long-term survival and lower the chance of getting AC, but even patients with CRS had improved survival when given AC.

Authors
Speicher, PJ; Englum, BR; Ganapathi, AM; Mulvihill, MS; Hartwig, MG; Onaitis, MW; D'Amico, TA; Berry, MF
MLA Citation
Speicher, PJ, Englum, BR, Ganapathi, AM, Mulvihill, MS, Hartwig, MG, Onaitis, MW, D'Amico, TA, and Berry, MF. "Adjuvant chemotherapy is associated with improved survival after esophagectomy without induction therapy for node-positive adenocarcinoma." Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 10.1 (January 2015): 181-188.
PMID
25490005
Source
epmc
Published In
Journal of Thoracic Oncology
Volume
10
Issue
1
Publish Date
2015
Start Page
181
End Page
188
DOI
10.1097/jto.0000000000000384

The Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) equation best characterizes kidney function in patients being considered for lung transplantation.

Methods for direct measurement of glomerular filtration rate (GFR) are expensive and inconsistently applied across transplant centers. The Modified Diet in Renal Disease (MDRD) equation is commonly used for GFR estimation, but is inaccurate for GFRs >60 ml/min per 1.73 m(2). The Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) and Wright equations have shown improved predictive capabilities in some patient populations. We compared these equations to determine which one correlates best with direct GFR measurement in lung transplant candidates.We conducted a retrospective cohort analysis of 274 lung transplant recipients. Pre-operative GFR was measured directly using a radionuclide GFR assay. Results from the MDRD, CKDEPI, Wright, and Cockroft-Gault equations were compared with direct measurement. Findings were validated using logistic regression models and receiver operating characteristic (ROC) analyses in looking at GFR as a predictor of mortality and renal function outcomes post-transplant.Assessed against the radionuclide GFR measurement, CKDEPI provided the most consistent results, with low values for bias (0.78), relative standard error (0.03) and mean absolute percentage error (15.02). Greater deviation from radionuclide GFR was observed for all other equations. Pearson's correlation between radionuclide and calculated GFR was significant for all equations. Regression and ROC analyses revealed equivalent utility of the radionuclide assay and GFR equations for predicting post-transplant acute kidney injury and chronic kidney disease (p < 0.05).In patients being evaluated for lung transplantation, CKDEPI correlates closely with direct radionuclide GFR measurement and equivalently predicts post-operative renal outcomes. Transplant centers could consider replacing or supplementing direct GFR measurement with less expensive, more convenient estimation by using the CKDEPI equation.

Authors
Osho, AA; Castleberry, AW; Snyder, LD; Palmer, SM; Stafford-Smith, M; Lin, SS; Duane Davis, R; Hartwig, MG
MLA Citation
Osho, AA, Castleberry, AW, Snyder, LD, Palmer, SM, Stafford-Smith, M, Lin, SS, Duane Davis, R, and Hartwig, MG. "The Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) equation best characterizes kidney function in patients being considered for lung transplantation." The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 33.12 (December 2014): 1248-1254.
PMID
25107351
Source
epmc
Published In
The Journal of Heart and Lung Transplantation
Volume
33
Issue
12
Publish Date
2014
Start Page
1248
End Page
1254
DOI
10.1016/j.healun.2014.06.011

Differential outcomes with early and late repeat transplantation in the era of the lung allocation score.

Rates of repeat lung transplantation have increased since implementation of the lung allocation score (LAS). The purpose of this study is to compare survival between repeat (ReTx) and primary (LTx) lung transplant recipients in the LAS era.We extracted data from 9,270 LTx and 456 ReTx recipients since LAS implementation, from the United Network for Organ Sharing registry. Propensity scoring was used to match ReTx and LTx recipients. Kaplan-Meier analysis compared survival between LTx and ReTx groups, with and without stratification based on time between first and second transplant. Multivariable Cox models estimated predictors of survival in lung recipients.Comparing all ReTx to LTx demonstrates a survival advantage for LTx that is diminished with propensity score matching (p = 0.174). Considering LTx against ReTx greater than 90 days after the initial procedure, there are similar survival results (p < 0.067). In contrast, ReTx within 90 days was associated with a survival disadvantage that persisted despite matching (p = 0.011). In ReTx populations, factors conferring worse outcomes include intensive care unit admission, unilateral transplantation, poor functional status, and primary graft dysfunction as the indication for retransplantation (p < 0.05).Late lung retransplantation appears to be as beneficial as primary transplantation in propensity-matched patients. However, survival is severely diminished in those retransplanted less than 90 days after primary transplantation. The utility of early retransplantation needs to be carefully weighed in light of risks.

Authors
Osho, AA; Castleberry, AW; Snyder, LD; Palmer, SM; Ganapathi, AM; Hirji, SA; Lin, SS; Davis, RD; Hartwig, MG
MLA Citation
Osho, AA, Castleberry, AW, Snyder, LD, Palmer, SM, Ganapathi, AM, Hirji, SA, Lin, SS, Davis, RD, and Hartwig, MG. "Differential outcomes with early and late repeat transplantation in the era of the lung allocation score." The Annals of thoracic surgery 98.6 (December 2014): 1914-1920.
PMID
25442999
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
98
Issue
6
Publish Date
2014
Start Page
1914
End Page
1920
DOI
10.1016/j.athoracsur.2014.06.036

The effect of prior pneumonectomy or lobectomy on subsequent lung transplantation.

BACKGROUND: Lung transplantation in patients with prior lobectomy or pneumonectomy is not well understood. Using the United Network for Organ Sharing (UNOS) database, we address the impact of prior major lung resection on lung transplantation outcomes. METHODS: Retrospective review of adult lung transplants from October 1999 to December 2011 in the UNOS database identified 15,300 lung transplants; 102 patients had undergone major lung resection, defined as prior pneumonectomy (n = 22) or lobectomy (n = 80). Propensity match with nonparametric 3:1 nearest-neighbor matching algorithm adjusted for treatment-level differences. After matching, the primary outcome (90-day mortality) and secondary outcome (airway dehiscence, need for dialysis, length of stay more than 25 days) were assessed with univariable and multivariable methods. Subanalysis of pneumonectomy and lobectomy individually compared with matched nonresection patients was done in a similar manner. The Kaplan-Meier method estimated long-term survival. RESULTS: After matching, no significant differences were noted between groups for recipient, donor, or operative characteristics. There were 10 double lung and 12 single lung transplants after pneumonectomy and 51 double lung and 29 single lung transplants after lobectomy. Mortality at 90 days was 13.9% (n = 14) for the resection group and 8.6% (n = 1,247) for the nonresection group (p = 0.09). After matching, a significant increase was noted in 90-day mortality (p = 0.017) and perioperative dialysis (p = 0.039) for the resection versus nonresection patients. Dialysis was significantly higher among pneumonectomy patients (p = 0.03). No long-term survival difference was observed (p = 0.514). CONCLUSIONS: After propensity-matching, resection was associated with increased 90-day mortality and dialysis. Careful patient selection is necessary with patients who have undergone prior major lung resection, given their increased risk of perioperative mortality and dialysis.

Authors
Ganapathi, AM; Speicher, PJ; Castleberry, AW; Englum, BR; Osho, AA; Davis, RD; Hartwig, MG
MLA Citation
Ganapathi, AM, Speicher, PJ, Castleberry, AW, Englum, BR, Osho, AA, Davis, RD, and Hartwig, MG. "The effect of prior pneumonectomy or lobectomy on subsequent lung transplantation." The Annals of thoracic surgery 98.6 (December 2014): 1922-1928.
PMID
25443000
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
98
Issue
6
Publish Date
2014
Start Page
1922
End Page
1928
DOI
10.1016/j.athoracsur.2014.06.042

Acute kidney injury after ex vivo lung perfusion (EVLP).

BACKGROUND: Ex vivo lung perfusion (EVLP) identifies viability for marginal organs but complicates and lengthens lung transplantation surgery. Preliminary evidence supports equivalency for EVLP-assisted versus traditional (non-EVLP) procedures regarding graft function, postoperative course, mortality, and survival. However, acute kidney injury (AKI), a common serious complication of lung transplantation, has not been assessed. We tested the hypothesis that EVLP-assisted and non-EVLP lung transplantations are associated with different AKI rates. METHODS: Demographic, procedural, and renal data were gathered for 13 EVLP-viable lung transplantations and a non-EVLP group matched 4:1 for single versus double, pulmonary disease, and age. AKI was defined by AKI Network (AKIN) criteria and peak creatinine rise relative to baseline (Δ%Cr) during the 1st 10 postoperative days. Chi-square was performed for AKIN and 2-tailed t test for %ΔCr. RESULTS: Patient and procedural characteristics were similar between the groups. One non-EVLP patient required postoperative dialysis. AKI rates were also similar, as assessed by both AKIN (EVLP 7/13 (54%) vs non-EVLP 32/52 (62%); P = .61) and %ΔCr (EVLP 91 ± 81% vs non-EVLP 72 ± 62%; P = .63). CONCLUSIONS: We did not observe different AKI rates between EVLP-assisted and traditional lung transplant procedures. Although 1 non-EVLP patient required dialysis, AKI rates were otherwise similar. These findings further support EVLP as a strategy to expand the organ pool and reduce concerns for high-renal risk recipients. The small sample size and retrospective design are limitations. However, our sample size is similar to other reports, and it is the first to analyze AKI after EVLP-assisted lung transplantation. Larger multicenter prospective studies are needed.

Authors
Hauck, J; Osho, A; Castleberry, A; Hartwig, M; Reddy, L; Phillips-Bute, B; Swaminathan, M; Mathew, J; Stafford-Smith, M
MLA Citation
Hauck, J, Osho, A, Castleberry, A, Hartwig, M, Reddy, L, Phillips-Bute, B, Swaminathan, M, Mathew, J, and Stafford-Smith, M. "Acute kidney injury after ex vivo lung perfusion (EVLP)." Transplantation proceedings 46.10 (December 2014): 3598-3602.
PMID
25498096
Source
epmc
Published In
Transplantation Proceedings
Volume
46
Issue
10
Publish Date
2014
Start Page
3598
End Page
3602
DOI
10.1016/j.transproceed.2014.06.068

Outcomes after pneumonectomy for benign disease: the impact of urgent resection.

Pneumonectomy for benign disease is often complicated by inflammatory processes that obscure operative planes. We reviewed our experience to evaluate the impact of requiring urgent or emergent pneumonectomy on outcomes.All pneumonectomies for benign conditions from 1997 to 2012 at a single institution were retrospectively reviewed. Mortality was assessed using multivariable logistic regression that included laterality, age, and surgery status, which was emergent if performed within 24 hours of initial evaluation, urgent if performed after 24 hours but within the same hospital stay, and otherwise elective.Among 42 pneumonectomies, completion pneumonectomy after previous ipsilateral lung resection was performed in 14 patients (33%). Resection was elective in 22 patients (52%), urgent in 12 (28%), and emergent in 8 (19%). The most common indication was for necrotic lung (n = 12; 29%). Muscle flaps were used in 26 patients (62%). Perioperative mortality for the entire cohort was 29% (n = 12) and was significantly higher when surgery was urgent (5 of 12; 42%) or emergent (5 of 8; 62.5%) compared with elective (2 of 22; 9.1%) (p = 0.03). Requiring urgent or emergent surgery remained a significant predictor of mortality in multivariable analysis (odds ratio 10.4, p = 0.01).Pneumonectomy for benign disease has significant risk for mortality, particularly when not performed electively. Although surgery cannot be planned in the setting of trauma or some situations of acute infection, patients known to have conditions that are likely to require pneumonectomy should be considered for surgery earlier in their disease course, before developing an acute problem that requires urgent or emergent resection.

Authors
Klapper, J; Hirji, S; Hartwig, MG; D'Amico, TA; Harpole, DH; Onaitis, MW; Berry, MF
MLA Citation
Klapper, J, Hirji, S, Hartwig, MG, D'Amico, TA, Harpole, DH, Onaitis, MW, and Berry, MF. "Outcomes after pneumonectomy for benign disease: the impact of urgent resection." Journal of the American College of Surgeons 219.3 (September 2014): 518-524.
PMID
24862885
Source
epmc
Published In
Journal of The American College of Surgeons
Volume
219
Issue
3
Publish Date
2014
Start Page
518
End Page
524
DOI
10.1016/j.jamcollsurg.2014.01.062

Induction therapy does not improve survival for clinical stage T2N0 esophageal cancer.

This study compared survival after initial treatment with esophagectomy as primary therapy to induction therapy followed by esophagectomy for patients with clinical T2N0 (cT2N0) esophageal cancer in the National Cancer Database (NCDB).Predictors of therapy selection for patients with cT2N0 esophageal cancer in the NCDB from 1998 to 2011 were identified with multivariable logistic regression. Survival was evaluated using Kaplan-Meier and Cox proportional hazards methods.Surgery was used in 42.9% (2057 of 4799) of cT2N0 patients. Of 1599 esophagectomy patients for whom treatment timing was recorded, induction therapy was used in 44.1% (688). Pretreatment staging was proven accurate in only 26.7% of patients (210 of 786) who underwent initial surgery without induction treatment and had complete pathologic data available: 41.6% (n = 327) were upstaged and 31.7% (n = 249) were downstaged. Adjuvant therapy (chemotherapy or radiation therapy) was given to 50.2% of patients treated initially with surgery who were found after resection to have nodal disease. There was no significant difference in long-term survival between strategies of primary surgery and induction therapy followed by surgery (median 41.1 versus 41.9 months, p = 0.51). In multivariable analysis, induction therapy was not independently associated with risk of death (hazard ratio [HR], 1.16, p = 0.32).Current clinical staging for early-stage esophageal cancer is highly inaccurate, with only a quarter of surgically resected cT2N0 patients found to have had accurate pretreatment staging. Induction therapy for patients with cT2N0 esophageal cancer in the NCDB is not associated with improved survival.

Authors
Speicher, PJ; Ganapathi, AM; Englum, BR; Hartwig, MG; Onaitis, MW; D'Amico, TA; Berry, MF
MLA Citation
Speicher, PJ, Ganapathi, AM, Englum, BR, Hartwig, MG, Onaitis, MW, D'Amico, TA, and Berry, MF. "Induction therapy does not improve survival for clinical stage T2N0 esophageal cancer." Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 9.8 (August 2014): 1195-1201.
PMID
25157773
Source
epmc
Published In
Journal of Thoracic Oncology
Volume
9
Issue
8
Publish Date
2014
Start Page
1195
End Page
1201
DOI
10.1097/jto.0000000000000228

Incidence of Delayed Gastric Emptying Following Lung Transplantation

Authors
Hirji, S; Gulack, B; Englum, B; Paul, S; Asvin, G; Osho, A; Shimpi, R; Perez, A; Hartwig, M
MLA Citation
Hirji, S, Gulack, B, Englum, B, Paul, S, Asvin, G, Osho, A, Shimpi, R, Perez, A, and Hartwig, M. "Incidence of Delayed Gastric Emptying Following Lung Transplantation." July 15, 2014.
Source
wos-lite
Published In
Transplantation
Volume
98
Publish Date
2014
Start Page
801
End Page
802

Graft and Patient Survival Following Kidney Transplantation in Previous Lung Transplant Recipients.

Authors
Osho, A; Anthony, C; Snyder, L; Ganapathi, A; Brian, G; Hirji, S; Daneshmand, M; Duane, D; Hartwig, M
MLA Citation
Osho, A, Anthony, C, Snyder, L, Ganapathi, A, Brian, G, Hirji, S, Daneshmand, M, Duane, D, and Hartwig, M. "Graft and Patient Survival Following Kidney Transplantation in Previous Lung Transplant Recipients." July 15, 2014.
Source
wos-lite
Published In
Transplantation
Volume
98
Publish Date
2014
Start Page
192
End Page
193

Transplant Size Mismatch in Restrictive Lung Disease

Authors
Ganapathi, A; Englum, B; Speicher, P; Hirji, S; Gulack, B; Osho, A; Snyder, L; Davis, R; Hartwig, M
MLA Citation
Ganapathi, A, Englum, B, Speicher, P, Hirji, S, Gulack, B, Osho, A, Snyder, L, Davis, R, and Hartwig, M. "Transplant Size Mismatch in Restrictive Lung Disease." July 15, 2014.
Source
wos-lite
Published In
Transplantation
Volume
98
Publish Date
2014
Start Page
801
End Page
801

Alterations in Esophageal Function Following Lung Transplantation.

Authors
Gulack, B; Hirji, S; Englum, B; Speicher, P; Ganapathi, A; Osho, A; Wood, R; Perez, A; Hartwig, M
MLA Citation
Gulack, B, Hirji, S, Englum, B, Speicher, P, Ganapathi, A, Osho, A, Wood, R, Perez, A, and Hartwig, M. "Alterations in Esophageal Function Following Lung Transplantation." July 15, 2014.
Source
wos-lite
Published In
Transplantation
Volume
98
Publish Date
2014
Start Page
195
End Page
195

Assessment of different threshold preoperative glomerular filtration rates as markers of outcomes in lung transplantation.

The evidence behind the widely used pre-lung transplant glomerular filtration rate (GFR) cutoff of 50 mL/min per 1.73 m2 is limited. This study reviews data from a large cohort to assess outcomes associated with this historical cutoff and to estimate other possible cutoffs that might be appropriate in lung transplantation.We conducted a retrospective cohort analysis of lung recipients at a single center. Recursive partitioning and receiver operating characteristics analysis were used to estimate other potential GFR cutoffs with 1-year mortality as the outcome. Postoperative outcomes around the various cutoffs, including survival, acute kidney injury, and dialysis, were assessed using χ2, Kaplan-Meier, and Cox regression methods.A total of 794 lung recipients met study inclusion criteria. Compared with 778 patients with GFR 50 mL/min per 1.73 m2 or greater at time of transplant, 16 patients with GFR below this cutoff were older and more likely to have restrictive disease. One-year mortality below the cutoff was 31.3% compared with 15.1% above the cutoff (p=0.021). Recursive partitioning estimated potential GFR cutoff values between 46 and 61 mL/min per 1.73 m2. Patients with GFR below these cutoffs were at significantly higher risk for adverse outcomes (p<0.05). Receiver operating characteristics analysis was less successful at identifying meaningful cutoff values with areas under the curve approximately 0.5.Study results support the practice of requiring candidate GFR 50 mL/min per 1.73 m2 or greater for lung transplantation. Future work should focus on reproducing the analysis in a larger cohort of patients including more individuals with low GFR.

Authors
Osho, AA; Castleberry, AW; Snyder, LD; Ganapathi, AM; Hirji, SA; Stafford-Smith, M; Lin, SS; Davis, RD; Hartwig, MG
MLA Citation
Osho, AA, Castleberry, AW, Snyder, LD, Ganapathi, AM, Hirji, SA, Stafford-Smith, M, Lin, SS, Davis, RD, and Hartwig, MG. "Assessment of different threshold preoperative glomerular filtration rates as markers of outcomes in lung transplantation." The Annals of thoracic surgery 98.1 (July 2014): 283-289.
PMID
24793682
Source
epmc
Published In
The Annals of Thoracic Surgery
Volume
98
Issue
1
Publish Date
2014
Start Page
283
End Page
289
DOI
10.1016/j.athoracsur.2014.03.010

Cromolyn ameliorates acute and chronic injury in a rat lung transplant model.

Mast cells have been associated with obliterative bronchiolitis (OB) in human pulmonary allografts, although their role in the development of OB remains unknown.In this study, we evaluated the role of mast cells in pulmonary allograft rejection using an orthotopic rat pulmonary allograft model that utilizes chronic aspiration of gastric fluid to reliably obtain OB. Pulmonary allograft recipients (n = 35) received chronic aspiration of gastric fluid with (n = 10) and without (n = 16) treatment with a mast cell membrane stabilizer, cromolyn sodium, or chronic aspiration with normal saline (n = 9) as a control.The acute graft injury associated with long ischemic time in the model (6 hours total ischemic time; typical acute graft injury rate ~30%) was apparently blocked by cromolyn, because peri-operative mortality associated with the acute graft injury was not observed in any of the animals receiving cromolyn (p = 0.045). Further, the rats receiving cromolyn developed significantly fewer OB lesions than those treated with gastric fluid alone (p < 0.001), with a mean reduction of 46% of the airways affected.These findings provide impetus for further studies aimed at elucidating the effects of cromolyn and the role of mast cells in pulmonary allotransplantation.

Authors
Chang, J-C; Leung, J; Tang, T; Holzknecht, ZE; Hartwig, MG; Duane Davis, R; Parker, W; Abraham, SN; Lin, SS
MLA Citation
Chang, J-C, Leung, J, Tang, T, Holzknecht, ZE, Hartwig, MG, Duane Davis, R, Parker, W, Abraham, SN, and Lin, SS. "Cromolyn ameliorates acute and chronic injury in a rat lung transplant model." The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 33.7 (July 2014): 749-757.
PMID
24768366
Source
epmc
Published In
The Journal of Heart and Lung Transplantation
Volume
33
Issue
7
Publish Date
2014
Start Page
749
End Page
757
DOI
10.1016/j.healun.2014.03.004

Alterations in Esophageal Function Following Lung Transplantation.

Authors
Gulack, B; Hirji, S; Englum, B; Speicher, P; Ganapathi, A; Osho, A; Wood, R; Perez, A; Hartwig, M
MLA Citation
Gulack, B, Hirji, S, Englum, B, Speicher, P, Ganapathi, A, Osho, A, Wood, R, Perez, A, and Hartwig, M. "Alterations in Esophageal Function Following Lung Transplantation." June 2014.
Source
wos-lite
Published In
American Journal of Transplantation
Volume
14
Publish Date
2014
Start Page
195
End Page
195

Graft and Patient Survival Following Kidney Transplantation in Previous Lung Transplant Recipients

Authors
Osho, A; Anthony, C; Snyder, L; Ganapathi, A; Brian, G; Hirji, S; Daneshmand, M; Duane, D; Hartwig, M
MLA Citation
Osho, A, Anthony, C, Snyder, L, Ganapathi, A, Brian, G, Hirji, S, Daneshmand, M, Duane, D, and Hartwig, M. "Graft and Patient Survival Following Kidney Transplantation in Previous Lung Transplant Recipients." June 2014.
Source
wos-lite
Published In
American Journal of Transplantation
Volume
14
Publish Date
2014
Start Page
192
End Page
193

Incidence of Delayed Gastric Emptying Following Lung Transplantation.

Authors
Hirji, S; Gulack, B; Englum, B; Paul, S; Asvin, G; Osho, A; Shimpi, R; Perez, A; Hartwig, M
MLA Citation
Hirji, S, Gulack, B, Englum, B, Paul, S, Asvin, G, Osho, A, Shimpi, R, Perez, A, and Hartwig, M. "Incidence of Delayed Gastric Emptying Following Lung Transplantation." June 2014.
Source
wos-lite
Published In
American Journal of Transplantation
Volume
14
Publish Date
2014
Start Page
801
End Page
802

Antibody desensitization therapy in highly sensitized lung transplant candidates.

As HLAs antibody detection technology has evolved, there is now detailed HLA antibody information available on prospective transplant recipients. Determining single antigen antibody specificity allows for a calculated panel reactive antibodies (cPRA) value, providing an estimate of the effective donor pool. For broadly sensitized lung transplant candidates (cPRA ≥ 80%), our center adopted a pretransplant multi-modal desensitization protocol in an effort to decrease the cPRA and expand the donor pool. This desensitization protocol included plasmapheresis, solumedrol, bortezomib and rituximab given in combination over 19 days followed by intravenous immunoglobulin. Eight of 18 candidates completed therapy with the primary reasons for early discontinuation being transplant (by avoiding unacceptable antigens) or thrombocytopenia. In a mixed-model analysis, there were no significant changes in PRA or cPRA changes over time with the protocol. A sub-analysis of the median fluorescence intensity (MFI) change indicated a small decline that was significant in antibodies with MFI 5000-10,000. Nine of 18 candidates subsequently had a transplant. Posttransplant survival in these nine recipients was comparable to other pretransplant-sensitized recipients who did not receive therapy. In summary, an aggressive multi-modal desensitization protocol does not significantly reduce pretransplant HLA antibodies in a broadly sensitized lung transplant candidate cohort.

Authors
Snyder, LD; Gray, AL; Reynolds, JM; Arepally, GM; Bedoya, A; Hartwig, MG; Davis, RD; Lopes, KE; Wegner, WE; Chen, DF; Palmer, SM
MLA Citation
Snyder, LD, Gray, AL, Reynolds, JM, Arepally, GM, Bedoya, A, Hartwig, MG, Davis, RD, Lopes, KE, Wegner, WE, Chen, DF, and Palmer, SM. "Antibody desensitization therapy in highly sensitized lung transplant candidates." American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 14.4 (April 2014): 849-856.
PMID
24666831
Source
epmc
Published In
American Journal of Transplantation
Volume
14
Issue
4
Publish Date
2014
Start Page
849
End Page
856
DOI
10.1111/ajt.12636

Donor and Recipient Hepatitis C Status in Lung Transplant

Authors
Englum, BR; Ganapathi, AM; Speicher, PJ; Gulack, BC; Lin, SS; Palmer, SM; Snyder, LD; Daneshmand, M; Davis, RD; Hartwig, MG
MLA Citation
Englum, BR, Ganapathi, AM, Speicher, PJ, Gulack, BC, Lin, SS, Palmer, SM, Snyder, LD, Daneshmand, M, Davis, RD, and Hartwig, MG. "Donor and Recipient Hepatitis C Status in Lung Transplant." April 2014.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
33
Issue
4
Publish Date
2014
Start Page
S182
End Page
S183

Donor Diabetes and Lung Transplant: Does It Matter?

Authors
Haney, JC; Ganapathi, AM; Englum, BR; Speicher, PJ; Gulack, BC; Osho, AA; Castleberry, AW; Davis, RD; Hartwig, MG
MLA Citation
Haney, JC, Ganapathi, AM, Englum, BR, Speicher, PJ, Gulack, BC, Osho, AA, Castleberry, AW, Davis, RD, and Hartwig, MG. "Donor Diabetes and Lung Transplant: Does It Matter?." April 2014.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
33
Issue
4
Publish Date
2014
Start Page
S50
End Page
S50

Cryoanalgesia Complements Thoracic Epidural Use Following Lung Transplantation

Authors
Hartwig, MG; Osho, AA; Hirji, S; Castleberry, AW; Ganapathi, A; Lin, SS; Davis, DR
MLA Citation
Hartwig, MG, Osho, AA, Hirji, S, Castleberry, AW, Ganapathi, A, Lin, SS, and Davis, DR. "Cryoanalgesia Complements Thoracic Epidural Use Following Lung Transplantation." April 2014.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
33
Issue
4
Publish Date
2014
Start Page
S290
End Page
S291

Is a Priori Staging of Bilateral Lung Transplant the Optimal Surgical Approach for High-risk Patients With Interstitial Lung Disease?

Authors
Hartwig, MG
MLA Citation
Hartwig, MG. "Is a Priori Staging of Bilateral Lung Transplant the Optimal Surgical Approach for High-risk Patients With Interstitial Lung Disease?." April 2014.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
33
Issue
4
Publish Date
2014
Start Page
S30
End Page
S30

Perioperative Venous Thromboembolism Prophylaxis in Lung Transplant Patients

Authors
McGugan, PL; Albon, D; Hartwig, MG
MLA Citation
McGugan, PL, Albon, D, and Hartwig, MG. "Perioperative Venous Thromboembolism Prophylaxis in Lung Transplant Patients." April 2014.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
33
Issue
4
Publish Date
2014
Start Page
S293
End Page
S293

Bridge to lung transplantation and rescue post-transplant: The expanding role of extracorporeal membrane oxygenation

© Pioneer Bioscience Publishing Company.Over the last several decades, the growth of lung transplantation has been hindered by a much higher demand for donor lungs than can be supplied, leading to considerable waiting time and mortality among patients waiting for transplant. This has led to the search for an alternative bridging strategy in patients with end-stage lung disease. The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation as well as a rescue strategy post-transplant for primary graft dysfunction (PGD) has been studied previously, however due to initially poor outcomes, its use was not heavily instituted. In recent years, with significant improvement in technologies, several single and multi-center studies have shown promising outcomes related to the use of ECMO as a bridging strategy as well as a therapy for patients suffering from PGD post-transplant. These results have challenged our current notion on ECMO use and hence forced us to reexamine the utility, efficacy and safety of ECMO in conjunction with lung transplantation. Through this review, we will address the various aspects related to ECMO use as a bridge to lung transplantation as well as a rescue post-transplant in the treatment of PGD. We will emphasize newer technologies related to ECMO use, examine recent observational studies and randomized trials of ECMO use before and after lung transplantation, and reflect upon our own institutional experience with the use of ECMO in these difficult clinical situations.

Authors
Gulack, BC; Hirji, SA; Hartwig, MG
MLA Citation
Gulack, BC, Hirji, SA, and Hartwig, MG. "Bridge to lung transplantation and rescue post-transplant: The expanding role of extracorporeal membrane oxygenation." Journal of Thoracic Disease 6.8 (January 1, 2014): 1070-1079. (Review)
Source
scopus
Published In
Journal of Thoracic Disease
Volume
6
Issue
8
Publish Date
2014
Start Page
1070
End Page
1079
DOI
10.3978/j.issn.2072-1439.2014.06.04

Preoperative mild-to-moderate coronary artery disease does not affect long-term outcomes of lung transplantation

Background: Coronary artery disease has a high prevalence among lung transplant recipients and has historically been a contraindication to transplant at many institutions. In patients with mild-to-moderate coronary artery disease (Mod-CAD) undergoing lung transplant, outcomes are not well defined. Methods: All patients who underwent pulmonary transplantation from January 1996 through November 2010 with pretransplant coronary angiogram were included in our study. Recipients of multivisceral, redo, and lobar lung transplants and those who underwent pretransplant coronary revascularization were excluded. Patients were grouped into Mod-CAD or no-coronary artery disease group (No-CAD). Primary end point was overall survival. Secondary end points were 30-day events and the need for posttransplant coronary revascularization. Results: Approximately 539 patients were included in the study: 362 in the No-CAD, 177 in the Mod-CAD group. Patients with Mod-CAD were predominantly male, older, and had a higher body mass index. No difference in either perioperative morbidity and mortality (Mod-CAD, 4.2% vs. No-CAD 3.3%, P=0.705) or late overall mortality was shown between groups. Mod-CAD patients had a shorter hospitalization (median: 12 days vs. 14 days, P=0.009) and required a higher rate of late coronary revascularization procedures (PCI: Mod-CAD vs. No-CAD, 0.3% vs. 4.0%, P=0.0035; CABG: Mod-CAD vs. No-CAD, 0.3% vs. 2.3%, P=0.0411). Conclusions: Mod-CAD does not appear to be associated with increased perioperative morbidity or decreased survival after transplant. Coronary artery disease may worsen and require coronary revascularization in patients with risk factors for disease progression. In these patients, close follow-up and screening for progression of coronary artery disease may help prevent late cardiac morbidity. Copyright © 2014 by Lippincott Williams & Wilkins.

Authors
Zanotti, G; Hartwig, MG; Castleberry, AW; Martin, JT; Shaw, LK; Williams, JB; Lin, SS; Davis, RD
MLA Citation
Zanotti, G, Hartwig, MG, Castleberry, AW, Martin, JT, Shaw, LK, Williams, JB, Lin, SS, and Davis, RD. "Preoperative mild-to-moderate coronary artery disease does not affect long-term outcomes of lung transplantation." Transplantation 97.10 (2014): 1079-1085.
Source
scival
Published In
Transplantation
Volume
97
Issue
10
Publish Date
2014
Start Page
1079
End Page
1085
DOI
10.1097/01.TP.0000438619.96933.02

Coronary revascularization in lung transplant recipients with concomitant coronary artery disease

Coronary artery disease (CAD) is not uncommon among lung transplant candidates. Several small, single-center series have suggested that short-term outcomes are acceptable in selected patients who undergo coronary revascularization prior to, or concomitant with, lung transplantation. Our objective was to evaluate perioperative and intermediate-term outcomes in this patient population at our institution. We performed a retrospective, observational cohort analysis of 898 lung transplant recipients between 1997 and 2010. Pediatric, multivisceral, lobar or repeat transplantations were excluded, resulting in 791 patients for comparative analysis, of which 49 (median age 62, 79.6% bilateral transplant) underwent concurrent coronary artery bypass and 38 (median age 64, 63.2% bilateral transplant) received preoperative percutaneous coronary intervention (PCI). Perioperative mortality, overall unadjusted survival and adjusted hazard ratio for cumulative risk of death were similar among both revascularization groups as well as controls. The rate of postoperative major adverse cardiac events was also similar among groups; however, concurrent coronary artery bypass was associated with longer postoperative length of stay, more time in the intensive care unit and more postoperative days requiring ventilator support. These results suggest that patients with CAD need not be excluded from lung transplantation. Preferential consideration should be given to preoperative PCI when feasible. © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.

Authors
Castleberry, AW; Martin, JT; Osho, AA; Hartwig, MG; Hashmi, ZA; Zanotti, G; Shaw, LK; Williams, JB; Lin, SS; Davis, RD
MLA Citation
Castleberry, AW, Martin, JT, Osho, AA, Hartwig, MG, Hashmi, ZA, Zanotti, G, Shaw, LK, Williams, JB, Lin, SS, and Davis, RD. "Coronary revascularization in lung transplant recipients with concomitant coronary artery disease." American Journal of Transplantation 13.11 (November 1, 2013): 2978-2988.
Source
scopus
Published In
American Journal of Transplantation
Volume
13
Issue
11
Publish Date
2013
Start Page
2978
End Page
2988
DOI
10.1111/ajt.12435

A comparative analysis of bronchial stricture after lung transplantation in recipients with and without early acute rejection.

BACKGROUND: Risk factors and outcomes of bronchial stricture after lung transplantation are not well defined. An association between acute rejection and development of stricture has been suggested in small case series. We evaluated this relationship using a large national registry. METHODS: All lung transplantations between April 1994 and December 2008 per the United Network for Organ Sharing (UNOS) database were analyzed. Generalized linear models were used to determine the association between early rejection and development of stricture after adjusting for potential confounders. The association of stricture with postoperative lung function and overall survival was also evaluated. RESULTS: Nine thousand three hundred thirty-five patients were included for analysis. The incidence of stricture was 11.5% (1,077/9,335), with no significant change in incidence during the study period (P=0.13). Early rejection was associated with a significantly greater incidence of stricture (adjusted odds ratio [AOR], 1.40; 95% confidence interval [CI], 1.22-1.61; p<0.0001). Male sex, restrictive lung disease, and pretransplantation requirement for hospitalization were also associated with stricture. Those who experienced stricture had a lower postoperative peak percent predicted forced expiratory volume at 1 second (FEV1) (median 74% versus 86% for bilateral transplants only; p<0.0001), shorter unadjusted survival (median 6.09 versus 6.82 years; p<0.001) and increased risk of death after adjusting for potential confounders (adjusted hazard ratio 1.13; 95% CI, 1.03-1.23; p=0.007). CONCLUSIONS: Early rejection is associated with an increased incidence of stricture. Recipients with stricture demonstrate worse postoperative lung function and survival. Prospective studies may be warranted to further assess causality and the potential for coordinated rejection and stricture surveillance strategies to improve postoperative outcomes.

Authors
Castleberry, AW; Worni, M; Kuchibhatla, M; Lin, SS; Snyder, LD; Shofer, SL; Palmer, SM; Pietrobon, R; Davis, RD; Hartwig, MG
MLA Citation
Castleberry, AW, Worni, M, Kuchibhatla, M, Lin, SS, Snyder, LD, Shofer, SL, Palmer, SM, Pietrobon, R, Davis, RD, and Hartwig, MG. "A comparative analysis of bronchial stricture after lung transplantation in recipients with and without early acute rejection." Ann Thorac Surg 96.3 (September 2013): 1008-1017.
PMID
23870829
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
96
Issue
3
Publish Date
2013
Start Page
1008
End Page
1017
DOI
10.1016/j.athoracsur.2013.01.104

Use of lung allografts from brain-dead donors after cardiopulmonary arrest and resuscitation.

RATIONALE: Patients who progress to brain death after resuscitation from cardiac arrest have been hypothesized to represent an underused source of potential organ donors; however, there is a paucity of data regarding the viability of lung allografts after a period of cardiac arrest in the donor. OBJECTIVES: To analyze postoperative complications and survival after lung transplant from brain-dead donors resuscitated after cardiac arrest. METHODS: The United Network for Organ Sharing database records donors with cardiac arrest occurring after brain death. Adult recipients of lung allografts from these arrest/resuscitation donors between 2005 and 2011 were compared with nonarrest donors. Propensity score matching was used to reduce the effect of confounding. Postoperative complications and overall survival were assessed using McNemar's test for correlated binary proportions and Kaplan-Meier methods. MEASUREMENTS AND MAIN RESULTS: A total of 479 lung transplant recipients from arrest/resuscitation donors were 1:1 propensity matched from a cohort of 9,076 control subjects. Baseline characteristics in the 1:1-matched cohort were balanced. There was no significant difference in perioperative mortality, airway dehiscence, dialysis requirement, postoperative length of stay (P ≥ 0.38 for all), or overall survival (P = 0.52). A subanalysis of the donor arrest group demonstrated similar survival when stratified by resuscitation time quartile (P = 0.38). CONCLUSIONS: There is no evidence of inferior outcomes after lung transplant from brain-dead donors who have had a period of cardiac arrest provided that good lung function is preserved and the donor is otherwise deemed acceptable for transplantation. Potential expansion of the donor pool to include cardiac arrest as the cause of brain death requires further study.

Authors
Castleberry, AW; Worni, M; Osho, AA; Snyder, LD; Palmer, SM; Pietrobon, R; Davis, RD; Hartwig, MG
MLA Citation
Castleberry, AW, Worni, M, Osho, AA, Snyder, LD, Palmer, SM, Pietrobon, R, Davis, RD, and Hartwig, MG. "Use of lung allografts from brain-dead donors after cardiopulmonary arrest and resuscitation." Am J Respir Crit Care Med 188.4 (August 15, 2013): 466-473.
PMID
23777361
Source
pubmed
Published In
American journal of respiratory and critical care medicine
Volume
188
Issue
4
Publish Date
2013
Start Page
466
End Page
473
DOI
10.1164/rccm.201303-0588OC

Active rehabilitation during extracorporeal membrane oxygenation as a bridge to lung transplantation.

BACKGROUND: Patients with end-stage lung disease often progress to critical illness, which dramatically reduces their chance of survival following lung transplantation. Pre-transplant deconditioning has a significant impact on outcomes for all lung transplant patients, and is likely a major contributor to increased mortality in critically ill lung transplant recipients. The aim of this report is to describe a series of patients bridged to lung transplant with extracorporeal membrane oxygenation (ECMO) and to examine the potential impact of active rehabilitation and ambulation during pre-transplant ECMO. METHODS: This retrospective case series reviews all patients bridged to lung transplantation with ECMO at a single tertiary care lung transplant center. Pre-transplant ECMO patients receiving active rehabilitation and ambulation were compared to those patients who were bridged with ECMO but did not receive pre-transplant rehabilitation. RESULTS: Nine consecutive subjects between April 2007 and May 2012 were identified for inclusion. One-year survival for all subjects was 100%, with one subject alive at 4 months post-transplant. The 5 subjects participating in pre-transplant rehabilitation had shorter mean post-transplant mechanical ventilation (4 d vs 34 d, P = .01), ICU stay (11 d vs 45 d, P = .01), and hospital stay (26 d vs 80 d, P = .01). No subject who participated in active rehabilitation had post-transplant myopathy, compared to 3 of 4 subjects who did not participate in pre-transplant rehabilitation on ECMO. CONCLUSIONS: Bridging selected critically ill patients to transplant with ECMO is a viable treatment option, and active participation in physical therapy, including ambulation, may provide a more rapid post-transplantation recovery. This innovative strategy requires further study to fully evaluate potential benefits and risks.

Authors
Rehder, KJ; Turner, DA; Hartwig, MG; Williford, WL; Bonadonna, D; Walczak, RJ; Davis, RD; Zaas, D; Cheifetz, IM
MLA Citation
Rehder, KJ, Turner, DA, Hartwig, MG, Williford, WL, Bonadonna, D, Walczak, RJ, Davis, RD, Zaas, D, and Cheifetz, IM. "Active rehabilitation during extracorporeal membrane oxygenation as a bridge to lung transplantation." Respir Care 58.8 (August 2013): 1291-1298.
PMID
23232742
Source
pubmed
Published In
Respiratory Care: a monthly science journal
Volume
58
Issue
8
Publish Date
2013
Start Page
1291
End Page
1298
DOI
10.4187/respcare.02155

Socioeconomic Disparities Associated with Medication Non-Adherence Following Lung Transplantation in Adult Recipients

Authors
Castleberry, AW; Speicher, PJ; Worni, M; Osho, AA; Snyder, LD; Gandy, KL; Pietrobon, RS; Davis, RD; Hartwig, MG
MLA Citation
Castleberry, AW, Speicher, PJ, Worni, M, Osho, AA, Snyder, LD, Gandy, KL, Pietrobon, RS, Davis, RD, and Hartwig, MG. "Socioeconomic Disparities Associated with Medication Non-Adherence Following Lung Transplantation in Adult Recipients." April 2013.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
32
Issue
4
Publish Date
2013
Start Page
S44
End Page
S45

Utility of Six-Minute Walk Distance in Predicting Outcomes after Lung Transplant: A Nationwide Survival Analysis

Authors
Castleberry, AW; Englum, BR; Snyder, LD; Worni, M; Osho, AA; Pietrobon, RS; Palmer, SM; Davis, RD; Hartwig, MG
MLA Citation
Castleberry, AW, Englum, BR, Snyder, LD, Worni, M, Osho, AA, Pietrobon, RS, Palmer, SM, Davis, RD, and Hartwig, MG. "Utility of Six-Minute Walk Distance in Predicting Outcomes after Lung Transplant: A Nationwide Survival Analysis." April 2013.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
32
Issue
4
Publish Date
2013
Start Page
S147
End Page
S147

Optimizing the Estimation of Renal Function in Lung Transplant Candidates

Authors
Osho, AA; Castleberry, AW; Snyder, LD; Palmer, SM; Lin, SS; Davis, RD; Hartwig, MQ
MLA Citation
Osho, AA, Castleberry, AW, Snyder, LD, Palmer, SM, Lin, SS, Davis, RD, and Hartwig, MQ. "Optimizing the Estimation of Renal Function in Lung Transplant Candidates." April 2013.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
32
Issue
4
Publish Date
2013
Start Page
S217
End Page
S217

Clinical Predictors and Outcome Implications of 30-Day Hospital Readmission in Lung Transplant Recipients

Authors
Osho, AA; Castleberry, AW; Snyder, LD; Palmer, SM; Lin, SS; Davis, RD; Hartwig, MG
MLA Citation
Osho, AA, Castleberry, AW, Snyder, LD, Palmer, SM, Lin, SS, Davis, RD, and Hartwig, MG. "Clinical Predictors and Outcome Implications of 30-Day Hospital Readmission in Lung Transplant Recipients." JOURNAL OF HEART AND LUNG TRANSPLANTATION 32.4 (April 2013): S265-S266.
PMID
27932071
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
32
Issue
4
Publish Date
2013
Start Page
S265
End Page
S266

Utilization of the Chronic Kidney Disease-EPI Equation To Predict Outcomes in Lung Transplant Recipients.

Authors
Osho, A; Castleberry, A; Snyder, L; Palmer, S; Lin, S; Davis, R; Hartwig, M
MLA Citation
Osho, A, Castleberry, A, Snyder, L, Palmer, S, Lin, S, Davis, R, and Hartwig, M. "Utilization of the Chronic Kidney Disease-EPI Equation To Predict Outcomes in Lung Transplant Recipients." April 2013.
Source
wos-lite
Published In
American Journal of Transplantation
Volume
13
Publish Date
2013
Start Page
300
End Page
300

Lung Transplant with Allografts from Donors with a History of Smoking: A Nationwide Analysis of Usage and Outcomes

Authors
Castleberry, A; Speicher, P; Worni, M; Snyder, L; Osho, A; Pietrobon, R; Palmer, S; Davis, R; Hartwig, M
MLA Citation
Castleberry, A, Speicher, P, Worni, M, Snyder, L, Osho, A, Pietrobon, R, Palmer, S, Davis, R, and Hartwig, M. "Lung Transplant with Allografts from Donors with a History of Smoking: A Nationwide Analysis of Usage and Outcomes." April 2013.
Source
wos-lite
Published In
American Journal of Transplantation
Volume
13
Publish Date
2013
Start Page
105
End Page
105

Outcomes in Lung Transplantation: The RIFLE Classification Optimizes the Predictive Utility of Post-Transplant Acute Kidney Injury as a Determinant of Early and Late Outcomes

Authors
Osho, A; Castleberry, A; Snyder, L; Palmer, S; Lin, S; Davis, R; Hartwig, M
MLA Citation
Osho, A, Castleberry, A, Snyder, L, Palmer, S, Lin, S, Davis, R, and Hartwig, M. "Outcomes in Lung Transplantation: The RIFLE Classification Optimizes the Predictive Utility of Post-Transplant Acute Kidney Injury as a Determinant of Early and Late Outcomes." April 2013.
Source
wos-lite
Published In
American Journal of Transplantation
Volume
13
Publish Date
2013
Start Page
106
End Page
106

Significance of and risk factors for the development of central airway stenosis after lung transplantation.

Central airways stenosis (CAS) after lung transplant is a poorly understood complication. Objectives of this study were to determine if CAS was associated with chronic rejection or worse survival after transplant as well as to identify factors associated with CAS in a large cohort of lung transplant recipients. Lung transplant recipients transplanted at a single center were retrospectively reviewed for the development of CAS requiring airway dilation. A total of 467 subjects met inclusion criteria with 60 (13%) of these developing CAS requiring intervention. Of these 60 recipients, 22 (37%) had resolution of CAS with bronchoplasty alone, while 32 (53%) ultimately required stent placement. CAS that required intervention was not a risk factor for the development of bronchiolitis obliterans syndrome or worse overall survival. Significant risk factors for the subsequent development of CAS in a time-dependant multivariable model were pulmonary fungal infections and the need for postoperative tracheostomy. While CAS was not associated with BOS or worse survival, it remains an important complication after lung transplant with potentially preventable risk factors.

Authors
Shofer, SL; Wahidi, MM; Davis, WA; Palmer, SM; Hartwig, MG; Lu, Y; Snyder, LD
MLA Citation
Shofer, SL, Wahidi, MM, Davis, WA, Palmer, SM, Hartwig, MG, Lu, Y, and Snyder, LD. "Significance of and risk factors for the development of central airway stenosis after lung transplantation." Am J Transplant 13.2 (February 2013): 383-389.
PMID
23279590
Source
pubmed
Published In
American Journal of Transplantation
Volume
13
Issue
2
Publish Date
2013
Start Page
383
End Page
389
DOI
10.1111/ajt.12017

Extracorporeal membrane oxygenation post lung transplantation

Purpose of review: Extracorporeal membrane oxygenation (ECMO) has been employed as a management strategy to support the failing pulmonary allograft following lung transplantation. We review the indications, technical considerations, management strategies, and outcomes of using ECMO after lung transplantation. Recent findings: ECMO is typically indicated for early pulmonary allograft failure despite optimized conventional support measures. Initiation of ECMO has been advocated early in the postoperative course (<48 h) when ventilatory requirements reach a peak inspiratory pressure of 35cmH 2O or FiO2 surpasses 60% in order to reduce oxidative stress and barotrauma from aggressive mechanical ventilation. Both veno-venous approach and dual-stage cannulation have the potential to reduce thromboembolic complications and enable patient mobilization. Key management strategies while on ECMO include minimizing sedation, pressure-controlled ventilator support minimizing FiO2, and maintaining a hypovolemic state as tolerated. Bivalruden has been proposed as an anticoagulation alternative to heparin, which may ameliorate the effects of heparin resistance or heparin-induced thrombocytopenia syndrome. Single-center series have documented successful ECMO wean in as high as 96% of patients with 30-day survival of 82% and a 1-year survival of 64%. Summary: Advances in technology and management strategies continue to increase the effectiveness of ECMO in supporting the failing pulmonary allograft. Copyright © 2013, Lippincott Williams & Wilkins.

Authors
Castleberry, AW; Hartwig, MG; Whitson, BA
MLA Citation
Castleberry, AW, Hartwig, MG, and Whitson, BA. "Extracorporeal membrane oxygenation post lung transplantation." Current Opinion in Organ Transplantation 18.5 (January 1, 2013): 524-530. (Review)
PMID
23995371
Source
scopus
Published In
Current Opinion in Organ Transplantation
Volume
18
Issue
5
Publish Date
2013
Start Page
524
End Page
530
DOI
10.1097/MOT.0b013e328365197e

A simplified technique for pulmonary artery aneurysm repair in a lung transplant recipient with right ventricular outflow tract obstruction.

Authors
Zanotti, G; Hartwig, MG; Davis, RD
MLA Citation
Zanotti, G, Hartwig, MG, and Davis, RD. "A simplified technique for pulmonary artery aneurysm repair in a lung transplant recipient with right ventricular outflow tract obstruction." J Thorac Cardiovasc Surg 145.1 (January 2013): 295-296.
PMID
22944090
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
145
Issue
1
Publish Date
2013
Start Page
295
End Page
296
DOI
10.1016/j.jtcvs.2012.08.027

Extracorporeal membrane oxygenation post lung transplantation

Purpose of review: Extracorporeal membrane oxygenation (ECMO) has been employed as a management strategy to support the failing pulmonary allograft following lung transplantation. We review the indications, technical considerations, management strategies, and outcomes of using ECMO after lung transplantation. Recent findings: ECMO is typically indicated for early pulmonary allograft failure despite optimized conventional support measures. Initiation of ECMO has been advocated early in the postoperative course (<48 h) when ventilatory requirements reach a peak inspiratory pressure of 35cmH 2O or FiO2 surpasses 60% in order to reduce oxidative stress and barotrauma from aggressive mechanical ventilation. Both veno-venous approach and dual-stage cannulation have the potential to reduce thromboembolic complications and enable patient mobilization. Key management strategies while on ECMO include minimizing sedation, pressure-controlled ventilator support minimizing FiO2, and maintaining a hypovolemic state as tolerated. Bivalruden has been proposed as an anticoagulation alternative to heparin, which may ameliorate the effects of heparin resistance or heparin-induced thrombocytopenia syndrome. Single-center series have documented successful ECMO wean in as high as 96% of patients with 30-day survival of 82% and a 1-year survival of 64%. Summary: Advances in technology and management strategies continue to increase the effectiveness of ECMO in supporting the failing pulmonary allograft. Copyright © 2013, Lippincott Williams & Wilkins.

Authors
Castleberry, AW; Hartwig, MG; Whitson, BA
MLA Citation
Castleberry, AW, Hartwig, MG, and Whitson, BA. "Extracorporeal membrane oxygenation post lung transplantation." Current Opinion in Organ Transplantation 18.5 (2013): 524-530.
Source
scival
Published In
Current Opinion in Organ Transplantation
Volume
18
Issue
5
Publish Date
2013
Start Page
524
End Page
530
DOI
10.1097/MOT.0b013e328365197e

In the face of chronic aspiration, prolonged ischemic time exacerbates obliterative bronchiolitis in rat pulmonary allografts.

Aspiration of gastric fluid into the lung mediates the development of obliterative bronchiolitis (OB) in orthotopic WKY-to-F344 rat pulmonary transplants that have been subjected to immunosuppression with cyclosporine. However, the contribution of ischemic time to this process remains unknown. In this study, the effect of long (n = 16) and short (n = 12) ischemic times (average of 6 h and of 73 min, respectively) on rat lung transplants receiving aspiration of gastric fluid was assessed. Long ischemic times (LIT) led to significantly (p < 0.05) greater development of OB (ratio of OB lesions/total airways = 0.45 ± 0.07, mean ± standard error) compared to short ischemic times (ratio = 0.19 ± 0.05). However, the development of OB was dependent on aspiration, as controls receiving aspiration with normal saline showed little development of OB, regardless of ischemic time (p < 0.05). These data suggest that LIT, while insufficient by itself to lead to OB, works synergistically with aspiration of gastric fluid to exacerbate the development of OB.

Authors
Chang, J-C; Leung, JH; Tang, T; Hartwig, MG; Holzknecht, ZE; Parker, W; Davis, RD; Lin, SS
MLA Citation
Chang, J-C, Leung, JH, Tang, T, Hartwig, MG, Holzknecht, ZE, Parker, W, Davis, RD, and Lin, SS. "In the face of chronic aspiration, prolonged ischemic time exacerbates obliterative bronchiolitis in rat pulmonary allografts." Am J Transplant 12.11 (November 2012): 2930-2937.
PMID
22882880
Source
pubmed
Published In
American Journal of Transplantation
Volume
12
Issue
11
Publish Date
2012
Start Page
2930
End Page
2937
DOI
10.1111/j.1600-6143.2012.04215.x

Gastroesophageal reflux disease-induced aspiration injury following lung transplantation.

PURPOSE OF REVIEW: Chronic allograft failure remains the leading cause of late mortality following lung transplantation. Considerable evidence demonstrates a relationship between gastroesophageal reflux disease (GERD) induced allograft injury and bronchiolitis obliterans syndrome; however, the mechanism of injury, identification of at-risk patients, and treatment options remain to be elucidated. RECENT FINDINGS: The recent findings in this area help delineate the inflammatory pathways associated with GERD-induced lung injury. They also demonstrate that clinically useful markers of aspiration-induced injury may be available via studying bronchoalveolar fluid or even induced sputum. Simple acid neutralization is not adequate to protect these patients from aspiration injury. In fact, there are no convincing data to indicate that medical therapies provide adequate treatment. In contradistinction, surgical fundoplication is associated with decreased levels of inflammatory cytokines and markers of aspiration in bronchoalveolar fluid, as well as improvements in pulmonary function in these patients. SUMMARY: Recent findings support ubiquitous testing for GERD or aspiration in patients with end-stage lung disease both pretransplant and posttransplant and demonstrate that fundoplication can safely and effectively protect these patients from the on-going injury of GERD-induced pulmonary injury.

Authors
Hartwig, MG; Davis, RD
MLA Citation
Hartwig, MG, and Davis, RD. "Gastroesophageal reflux disease-induced aspiration injury following lung transplantation." Curr Opin Organ Transplant 17.5 (October 2012): 474-478. (Review)
PMID
22941322
Source
pubmed
Published In
Current Opinion in Organ Transplantation
Volume
17
Issue
5
Publish Date
2012
Start Page
474
End Page
478
DOI
10.1097/MOT.0b013e328357f84f

Coronary Revascularization in Lung Transplant Recipients with Concomitant Coronary Artery Disease

Authors
Martin, JT; Hartwig, MG; Hashmi, ZA; Castleberry, AW; Zanotti, G; Shaw, LK; Williams, JB; Lin, SS; Reddy, SL; Davis, RD
MLA Citation
Martin, JT, Hartwig, MG, Hashmi, ZA, Castleberry, AW, Zanotti, G, Shaw, LK, Williams, JB, Lin, SS, Reddy, SL, and Davis, RD. "Coronary Revascularization in Lung Transplant Recipients with Concomitant Coronary Artery Disease." April 2012.
PMID
24102830
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
31
Issue
4
Publish Date
2012
Start Page
S38
End Page
S38

Preoperative Mild or Moderate Coronary Artery Disease (CAD) Does Not Affect Long-Term Outcomes of Lung Transplantation

Authors
Zanotti, G; Hartwig, MG; Castleberry, A; Martin, JT; Hashmi, ZA; Horvath, M; Lin, SS; Davis, RD
MLA Citation
Zanotti, G, Hartwig, MG, Castleberry, A, Martin, JT, Hashmi, ZA, Horvath, M, Lin, SS, and Davis, RD. "Preoperative Mild or Moderate Coronary Artery Disease (CAD) Does Not Affect Long-Term Outcomes of Lung Transplantation." April 2012.
PMID
24646771
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
31
Issue
4
Publish Date
2012
Start Page
S38
End Page
S38

Prolonged Ischemic Time Exacerbates the Development of Chronic Gastric Fluid Aspiration-Associated Bronchiolitis Obliterans in Rat Pulmonary Allografts

Authors
Chang, J-C; Tang, T; Leung, J; Hartwig, MG; Parker, W; Davis, RD; Lin, SS
MLA Citation
Chang, J-C, Tang, T, Leung, J, Hartwig, MG, Parker, W, Davis, RD, and Lin, SS. "Prolonged Ischemic Time Exacerbates the Development of Chronic Gastric Fluid Aspiration-Associated Bronchiolitis Obliterans in Rat Pulmonary Allografts." April 2012.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
31
Issue
4
Publish Date
2012
Start Page
S15
End Page
S16

Ambulatory ECMO Provides a Superior Bridge to Lung Transplantation Compared to Conventional ECMO

Authors
Hartwig, MG; Zanotti, G; Rehder, K; Turner, DA; Lin, SS; Davis, RD
MLA Citation
Hartwig, MG, Zanotti, G, Rehder, K, Turner, DA, Lin, SS, and Davis, RD. "Ambulatory ECMO Provides a Superior Bridge to Lung Transplantation Compared to Conventional ECMO." April 2012.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
31
Issue
4
Publish Date
2012
Start Page
S59
End Page
S59

Does Pulmonary Hypertension Preclude or Impact Outcomes in Single Lung Transplantations for Pulmonary Fibrosis in the Older Recipients

Authors
Reddy, SLC; Hartwig, M; Hashmi, Z; Lin, S; Davis, DR
MLA Citation
Reddy, SLC, Hartwig, M, Hashmi, Z, Lin, S, and Davis, DR. "Does Pulmonary Hypertension Preclude or Impact Outcomes in Single Lung Transplantations for Pulmonary Fibrosis in the Older Recipients." April 2012.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
31
Issue
4
Publish Date
2012
Start Page
S181
End Page
S181

Lung Transplantation Is an Effective Treatment Option for Patients over the Age of 70

Authors
Hartwig, MG; Hashmi, ZA; Albon, D; Martin, JT; Castleberry, AW; Snyder, LD; Palmer, SM; Lin, SS; Davis, RD
MLA Citation
Hartwig, MG, Hashmi, ZA, Albon, D, Martin, JT, Castleberry, AW, Snyder, LD, Palmer, SM, Lin, SS, and Davis, RD. "Lung Transplantation Is an Effective Treatment Option for Patients over the Age of 70." April 2012.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
31
Issue
4
Publish Date
2012
Start Page
S37
End Page
S38

Improved survival but marginal allograft function in patients treated with extracorporeal membrane oxygenation after lung transplantation.

BACKGROUND: Previous reports demonstrate that 1-year survival is severely compromised in patients with severe primary graft dysfunction (PGD) after lung transplantation. We examined if advances in extracorporeal membrane oxygenation (ECMO) support, including polymethylpentene oxygenators and reliance on venovenous (VV) ECMO have improved outcomes in patients with severe PGD after lung transplantation. METHODS: The analysis included data prospectively collected on all single-lung or double-lung transplants between November 2001 and December 2009. Heart-lung transplants were excluded. Comparisons were made between recipients who did and did not require ECMO for PGD after transplant. RESULTS: Since November 2001, when VV ECMO became the routine treatment for severe PGD after transplant at our center, 28 of 498 patients (6%) have required VV ECMO support. Successful weaning occurred in 27 of 28 (96%). Support was withdrawn for 1 patient with irreversible neurologic injury. Survival was substantially better than in previous reports: 30 days, 82%; 1 year, 64%; and 5 years, 49%. Freedom from bronchiolitis obliterans syndrome was 88% in the ECMO survivors at 3 years, but maximum allograft function was considerably worse than in transplant recipients not requiring ECMO (peak forced expiratory volume in 1 second: 58% in ECMO vs 83% in non-ECMO, p=0.001). CONCLUSIONS: Advances in ECMO technology, particularly VV ECMO, have greatly improved the ability to support patients with severe PGD after lung transplantation. VV ECMO is an important tool in the armamentarium of any lung transplant program to optimize patient outcomes; however, strategies to improve lung allograft function in patients experiencing severe PGD are still needed.

Authors
Hartwig, MG; Walczak, R; Lin, SS; Davis, RD
MLA Citation
Hartwig, MG, Walczak, R, Lin, SS, and Davis, RD. "Improved survival but marginal allograft function in patients treated with extracorporeal membrane oxygenation after lung transplantation." Ann Thorac Surg 93.2 (February 2012): 366-371.
PMID
21962264
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
93
Issue
2
Publish Date
2012
Start Page
366
End Page
371
DOI
10.1016/j.athoracsur.2011.05.017

Reply

Authors
Hartwig, MG; Davis, RD
MLA Citation
Hartwig, MG, and Davis, RD. "Reply." Annals of Thoracic Surgery 94.2 (2012): 687--.
Source
scival
Published In
The Annals of Thoracic Surgery
Volume
94
Issue
2
Publish Date
2012
Start Page
687-
DOI
10.1016/j.athoracsur.2012.06.015

The Trade-Off of Using Positive-Smoking Donor Lungs

The existing donor supply is unable to meet the demand of patients waiting for lung transplantation. A recent article explores the consequences of donor smoking on post-transplant survival as well as the potential effect of excluding such donors from contributing to the organ pool for lung transplantation. We review the intricacies of this study and potential implications for transplant centers and patients with end-stage lung disease. © 2012 Elsevier Inc.

Authors
Castleberry, AW; Hartwig, MG
MLA Citation
Castleberry, AW, and Hartwig, MG. "The Trade-Off of Using Positive-Smoking Donor Lungs." Seminars in Thoracic and Cardiovascular Surgery 24.3 (2012): 151-152.
PMID
23200068
Source
scival
Published In
Seminars in Thoracic and Cardiovascular Surgery
Volume
24
Issue
3
Publish Date
2012
Start Page
151
End Page
152
DOI
10.1053/j.semtcvs.2012.10.001

Fundoplication after lung transplantation prevents the allograft dysfunction associated with reflux.

BACKGROUND: Gastroesophageal reflux disease (GERD) in lung recipients is associated with decreased survival and attenuated allograft function. This study evaluates fundoplication in preventing GERD-related allograft dysfunction. METHODS: Prospectively collected data on patients who underwent transplantation between January 2001 and August 2009 were included. Lung transplant candidates underwent esophageal pH probe testing before transplantation and surveillance spirometry evaluation after transplantation. Bilateral lung transplant recipients who had pretransplant pH probe testing and posttransplant 1-year forced expiratory volume in the first second of expiration (FEV1) data were included for analysis. RESULTS: Of 297 patients who met study criteria, 222 (75%) had an abnormal pH probe study before or early after transplantation and 157 (53%) had a fundoplication performed within the first year after transplantation. Patients with total proximal acid contact times greater than 1.2% or total distal acid contact times greater than 7.0% demonstrated an absolute decrease of 9.4% (±4.6) or 12.0% (±5.4) in their respective mean 1-year FEV1 values. Patients with abnormal acid contact times who did not undergo fundoplication had considerably worse predicted peak and 1-year FEV1 results compared with recipients receiving fundoplication (peak percent predicted=75% vs. 84%; p=0.004 and 1-year percent predicted=68% vs. 77%; p=0.003, respectively). CONCLUSIONS: Lung transplant recipients with abnormal esophageal pH studies attain a lower peak allograft function as well as a diminished 1-year FEV1 after transplantation. However a strategy of early fundoplication in these recipients appears to preserve lung allograft function.

Authors
Hartwig, MG; Anderson, DJ; Onaitis, MW; Reddy, S; Snyder, LD; Lin, SS; Davis, RD
MLA Citation
Hartwig, MG, Anderson, DJ, Onaitis, MW, Reddy, S, Snyder, LD, Lin, SS, and Davis, RD. "Fundoplication after lung transplantation prevents the allograft dysfunction associated with reflux." Ann Thorac Surg 92.2 (August 2011): 462-468.
PMID
21801907
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
92
Issue
2
Publish Date
2011
Start Page
462
End Page
468
DOI
10.1016/j.athoracsur.2011.04.035

Surgical site infections following bariatric surgery in community hospitals: a weighty concern?

BACKGROUND: Although obesity is a well-known risk factor for surgical site infection (SSI), specific risk factors for SSI among obese patients undergoing bariatric surgery (BS) have not been well-defined. METHODS: We performed a prospective cohort study on patients who underwent BS at nine community hospitals in the USA between 7/1/2007 and 12/31/2008. Each patient had the following data recorded: National Nosocomial Infection Surveillance (NNIS) risk index; the choice, timing, and dose of antibiotic prophylaxis; age; body mass index; and duration of surgery. NNIS criteria were used to define SSI. Cases were detected during the post-operative hospital stay, on readmission to hospital within 30 days of the procedure and by post-discharge surveillance. RESULTS: A total of 2,012 patients were included in the study. The majority of procedures were laparoscopic (82%). The overall rate of SSI was 1.4% (28/2012). Patients who received vancomycin surgical prophylaxis were more likely to develop SSI than patients who received other antibiotics (relative risk [RR] = 9.4; 95% confidence interval [CI] = 3.1-26.1; p = 0.005). More specifically, patients who received vancomycin prophylaxis as a single agent at a dose less than 2 g were more likely to develop SSI than patients who received other antibiotic regimens (RR = 7.1; 95% CI = 1.9-23.8; p = 0.035). CONCLUSIONS: Inadequate dosing of vancomycin prophylaxis prior to BS is associated with increased risk of SSI. If vancomycin is used for prophylaxis, the appropriate dose should be calculated using actual bodyweight rather than lean bodyweight in accordance with Infectious Disease Society of America recommendations.

Authors
Freeman, JT; Anderson, DJ; Hartwig, MG; Sexton, DJ
MLA Citation
Freeman, JT, Anderson, DJ, Hartwig, MG, and Sexton, DJ. "Surgical site infections following bariatric surgery in community hospitals: a weighty concern?." Obes Surg 21.7 (July 2011): 836-840.
PMID
20198452
Source
pubmed
Published In
Obesity Surgery
Volume
21
Issue
7
Publish Date
2011
Start Page
836
End Page
840
DOI
10.1007/s11695-010-0105-3

Thoracoscopic lobectomy: the gold standard for early-stage lung cancer?

Primary lung cancers remain the most lethal of all the malignancies, predicted to account for nearly 160,000 deaths and 220,000 new diagnoses in 2009. The cornerstone of therapy for early-stage lung cancer is surgical resection by lobectomy with concomitant removal of the draining nodal basin. Minimally invasive lobectomy with the use of a thoracoscope has been established as an alternative to standard thoracotomy approaches. Thoracoscopic lobectomy provides advantages over a traditional thoracotomy, including less pain, shorter hospitalization, decreased overall costs, superior chemotherapy compliance, and fewer overall complications. In light of these advantages and with evidence of oncologic equivalence, thoracoscopic lobectomy should be considered the gold standard for the treatment of early-stage lung cancer. This article details the technical strategies for performing thoracoscopic lobectomy and highlights the published evidence demonstrating its advantages over a traditional thoracotomy approach.

Authors
Hartwig, MG; D'Amico, TA
MLA Citation
Hartwig, MG, and D'Amico, TA. "Thoracoscopic lobectomy: the gold standard for early-stage lung cancer?." Ann Thorac Surg 89.6 (June 2010): S2098-S2101.
PMID
20493989
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
89
Issue
6
Publish Date
2010
Start Page
S2098
End Page
S2101
DOI
10.1016/j.athoracsur.2010.02.102

Multiseptate gallbladder.

INTRODUCTION: Multiseptate gallbladder is a rare congenital condition that may be asymptomatic or may lead to symptoms consistent with biliary colic, even in the absence of cholelithiasis. DISCUSSION: We present the case of a 19-year-old female who underwent an extensive gastrointestinal workup before she was referred for cholecystectomy, which led to resolution of her symptoms. The distinct imaging features of this entity are presented.

Authors
Rivera-Troche, EY; Hartwig, MG; Vaslef, SN
MLA Citation
Rivera-Troche, EY, Hartwig, MG, and Vaslef, SN. "Multiseptate gallbladder." J Gastrointest Surg 13.9 (September 2009): 1741-1743.
PMID
19352782
Source
pubmed
Published In
Journal of Gastrointestinal Surgery
Volume
13
Issue
9
Publish Date
2009
Start Page
1741
End Page
1743
DOI
10.1007/s11605-009-0880-0

Aprotinin's effect on blood product transfusion in off-pump bilateral lung transplantation.

In lung transplants necessitating cardiopulmonary bypass (CPB), aprotinin has been shown to decrease transfusion requirements. More recently, off-pump transplantation has become the standard of care. The efficacy of aprotinin use in this population has yet to be definitively examined. We completed a retrospective review of all adult OP-BOLTs performed between January 2000 and January 2006 at a single university center (n=215). Aprotinin use was determined by the attending anesthesiologist or surgeon. It was administered at the time of induction. The primary outcome was total blood products utilized in terms of units transfused during postoperative days 0, 1 and 2. One-hundred and one patients received aprotinin and 114 did not. An overall analysis of all of the patients in this study demonstrated a trend towards statistical significance for reduced total blood product transfusion for the aprotinin group compared to the non-aprotinin group (P=0.13). A subgroup analysis was performed in relation to each diagnosis. The use of aprotinin was associated with a significant reduction in peri-operative total blood products transfused in COPD patients (P=0.03) undergoing OP-BOLT. Subgroup analysis demonstrated that the use of aprotinin in the COPD population did result in a statistically significant decrease in total blood products transfused, specifically the total number of units of packed red blood cells given. These findings suggest that aprotinin administration should be considered for all patients undergoing OP-BOLT to reduce exposure to blood products and potential immune sensitization and infectious complications.

Authors
Balsara, KR; Morozowich, ST; Lin, SS; Davis, RD; Phillips-Bute, BG; Hartwig, M; Appel, JZ; Welsby, IJ
MLA Citation
Balsara, KR, Morozowich, ST, Lin, SS, Davis, RD, Phillips-Bute, BG, Hartwig, M, Appel, JZ, and Welsby, IJ. "Aprotinin's effect on blood product transfusion in off-pump bilateral lung transplantation." Interact Cardiovasc Thorac Surg 8.1 (January 2009): 45-48.
PMID
18669527
Source
pubmed
Published In
Interactive Cardiovascular and Thoracic Surgery
Volume
8
Issue
1
Publish Date
2009
Start Page
45
End Page
48
DOI
10.1510/icvts.2008.178749

Lung transplantation at Duke University.

Clinical lung transplantation continues to grow worldwide. Advances in donor selection and management have been critical to support the expanded growth of lung transplant as a therapeutic option for patients with advanced lung disease. In recent years, allocation in the US has changed to a disease severity based system that has led to a dramatic reduction of deaths on the waiting list with concomitant increases in transplantation of recipients who are now sicker, older, and more likely to have interstitial lung disease. Increased experience with the LAS will help to further refine optimal recipient selection and balance urgency with utility. Our center's experience demonstrates survival is comparable post-LAS as compared to pre-LAS despite transplantation of increasingly ill recipients. After transplantation, the incidence of severe PGD has decreased in recent years with advances in donor lung management and perseveration. In cases of severe PGD, VV ECMO has provided our center with a successful method of supporting patients and reducing mortality immediately following transplantation. Long-term outcomes after lung transplantation continue to be limited by BOS, a condition of progressive allograft dysfunction. Our center has led research that identified gastric reflux as a potential contributing factor to posttransplant allograft dysfunction and suggested that Nissen fundoplication surgery might help prevent the development of BOS. Continued refinements in donor management and selection, prevention and treatment of PGD, and enhanced understanding of the mechanisms of BOS will support further growth of lung transplantation and further improvements in overall posttransplant outcomes.

Authors
Hartwig, MG; Snyder, LD; Finlen-Copeland, A; Lin, SS; Zaas, DW; Davis, RD; Palmer, SM
MLA Citation
Hartwig, MG, Snyder, LD, Finlen-Copeland, A, Lin, SS, Zaas, DW, Davis, RD, and Palmer, SM. "Lung transplantation at Duke University." Clin Transpl (2009): 197-210.
PMID
20524285
Source
pubmed
Published In
Clinical transplants
Publish Date
2009
Start Page
197
End Page
210

Chronic aspiration of gastric fluid induces the development of obliterative bronchiolitis in rat lung transplants.

Long-term survival of a pulmonary allograft is currently hampered by obliterative bronchiolitis (OB), a form of chronic rejection that is unique to lung transplantation. While tracheobronchial aspiration from gastroesophageal reflux disease (GERD) has clinically been associated with OB, no experimental model exists to investigate this problem. Using a WKY-to-F344 rat orthotopic left lung transplant model, the effects of chronic aspiration on pulmonary allograft were evaluated. Recipients received cyclosporine with or without 8 weekly aspirations of gastric fluid into the allograft. Six (66.7%) of 9 allografts with aspiration demonstrated bronchioles with surrounding monocytic infiltrates, fibrosis and loss of normal lumen anatomy, consistent with the development of OB. In contrast, none of the allografts without aspiration (n = 10) demonstrated these findings (p = 0.002). Of the grafts examined grossly, 83% of the allografts with chronic aspiration but only 20% without aspiration appeared consolidated (p = 0.013). Aspiration was associated with increased levels of IL-1 alpha, IL-1 beta, IL-6, IL-10, TNF-alpha and TGF-beta in BAL and of IL-1 alpha, IL-4 and GM-CSF in serum. This study provides experimental evidence linking chronic aspiration to the development of OB and suggests that strategies aimed at preventing aspiration-related injuries might improve outcomes in clinical lung transplantation.

Authors
Li, B; Hartwig, MG; Appel, JZ; Bush, EL; Balsara, KR; Holzknecht, ZE; Collins, BH; Howell, DN; Parker, W; Lin, SS; Davis, RD
MLA Citation
Li, B, Hartwig, MG, Appel, JZ, Bush, EL, Balsara, KR, Holzknecht, ZE, Collins, BH, Howell, DN, Parker, W, Lin, SS, and Davis, RD. "Chronic aspiration of gastric fluid induces the development of obliterative bronchiolitis in rat lung transplants." Am J Transplant 8.8 (August 2008): 1614-1621.
PMID
18557728
Source
pubmed
Published In
American Journal of Transplantation
Volume
8
Issue
8
Publish Date
2008
Start Page
1614
End Page
1621
DOI
10.1111/j.1600-6143.2008.02298.x

Rabbit anti-thymocyte globulin induction therapy does not prolong survival after lung transplantation.

BACKGROUND: Lung transplant survival is limited by the development of bronchiolitis obliterans syndrome (BOS). The strongest risk factor for BOS is acute rejection (AR). We have previously shown that rabbit anti-thymocyte globulin (RATG) induction therapy is associated with a decrease in early AR. Thus, we hypothesized that RATG induction would translate to reduced BOS and improved long-term graft survival. METHODS: Forty-four lung recipients were prospectively randomized to receive conventional immunosuppression with RATG induction (RATG group) or conventional immunosuppression alone (control group). End-points included graft survival, early and total acute rejection, BOS and treatment complications. RESULTS: There was no difference in graft survival between the groups at 8 years (RATG: 36%; control: 23%; p = 0.48). The RATG group had fewer early rejections compared with the control group (5% vs 41%; p = 0.01). However, the overall rejection incidence did not differ (RATG: 62%; control: 68%; p = 0.52). There was a trend toward a delay in BOS onset among RATG subjects compared with control subjects (2,376 days vs 1,108 days; log rank, p = 0.15). There was no difference in the incidence of infections, but the RATG group had a higher rate of malignancies. CONCLUSIONS: Our results suggest that alternative approaches to anti-thymocyte induction should be pursued to reduce BOS and prolong allograft survival.

Authors
Hartwig, MG; Snyder, LD; Appel, JZ; Cantu, E; Lin, SS; Palmer, SM; Davis, RD
MLA Citation
Hartwig, MG, Snyder, LD, Appel, JZ, Cantu, E, Lin, SS, Palmer, SM, and Davis, RD. "Rabbit anti-thymocyte globulin induction therapy does not prolong survival after lung transplantation." J Heart Lung Transplant 27.5 (May 2008): 547-553.
PMID
18442722
Source
pubmed
Published In
Journal of Heart and Lung Transplantation
Volume
27
Issue
5
Publish Date
2008
Start Page
547
End Page
553
DOI
10.1016/j.healun.2008.01.022

Surgical volume and the risk of surgical site infection in community hospitals: size matters.

OBJECTIVE: To determine if surgical volume affects the risk of surgical site infections (SSI) in community hospitals. BACKGROUND: The utility of public reporting and the optimal methods to employ when reporting SSI rates remain controversial and contentious issues. Studies examining the association between surgical volume and SSI risk have included few community hospitals and have reported conflicting results. METHODS: A prospective study of surgical procedures performed at 18 community hospitals from January 1, 2004 to December 31, 2005, was performed. Hospitals were separated based on average surgical volume per year: small (<1500 procedures), medium (1500 < or = procedures < 4000), and large (> or =4000 procedures). The risk of SSI for each category was determined using multivariable Poisson regression. RESULTS: Prospective surveillance identified 1434 SSIs after 132,111 surgical procedures (prevalence rate = 1.09/100 procedures). In unadjusted analysis, the risk of SSI was almost twice as high at small hospitals [prevalence rate ratio (PRR) = 1.9 (95% CI 1.78-2.05)] and large hospitals [PRR = 1.79 (95% CI 1.70-1.90)] compared with medium hospitals. After adjusting for differences between hospital category and important confounders, the risk of SSI at small hospitals was still 1.5 times higher than medium hospitals [adjusted PRR = 1.49 (95% CI 1.39-1.60)], whereas the risk at large hospitals was substantially decreased compared with medium hospitals [adjusted PRR = 1.29 (95% CI 1.22-1.36)]. OUTCOMES: The relationship between hospital surgical volume and rates of SSI in community hospitals is important and complex. As public reporting of SSI rates expands, improved methods for risk-adjusting infection rates are needed.

Authors
Anderson, DJ; Hartwig, MG; Pappas, T; Sexton, DJ; Kanafani, ZA; Auten, G; Kaye, KS
MLA Citation
Anderson, DJ, Hartwig, MG, Pappas, T, Sexton, DJ, Kanafani, ZA, Auten, G, and Kaye, KS. "Surgical volume and the risk of surgical site infection in community hospitals: size matters." Ann Surg 247.2 (February 2008): 343-349.
PMID
18216543
Source
pubmed
Published In
Annals of Surgery
Volume
247
Issue
2
Publish Date
2008
Start Page
343
End Page
349
DOI
10.1097/SLA.0b013e31815aab38

Early fundoplication reduces the incidence of chronic allograft drysfunction in patients with gastroesophageal reflux disease

Authors
Balsara, KR; Cantu, E; Bush, EL; Appel, JZ; Hartwig, MG; Lin, SS; Davis, RD
MLA Citation
Balsara, KR, Cantu, E, Bush, EL, Appel, JZ, Hartwig, MG, Lin, SS, and Davis, RD. "Early fundoplication reduces the incidence of chronic allograft drysfunction in patients with gastroesophageal reflux disease." February 2008.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
27
Issue
2
Publish Date
2008
Start Page
S125
End Page
S125
DOI
10.1016/j.healun.2007.11.187

Surgical site infections after laparoscopic and open cholecystectomies in community hospitals .

Authors
Chen, LF; Anderson, DJ; Hartwig, MG; Kaye, KS; Sexton, DJ
MLA Citation
Chen, LF, Anderson, DJ, Hartwig, MG, Kaye, KS, and Sexton, DJ. "Surgical site infections after laparoscopic and open cholecystectomies in community hospitals ." Infect Control Hosp Epidemiol 29.1 (January 2008): 92-94. (Letter)
PMID
18171198
Source
pubmed
Published In
Infection Control and Hospital Epidemiology
Volume
29
Issue
1
Publish Date
2008
Start Page
92
End Page
94
DOI
10.1086/524335

Characterization of the innate immune response to chronic aspiration in a novel rodent model.

BACKGROUND: Although chronic aspiration has been associated with several pulmonary diseases, the inflammatory response has not been characterized. A novel rodent model of chronic aspiration was therefore developed in order to investigate the resulting innate immune response in the lung. METHODS: Gastric fluid or normal saline was instilled into the left lung of rats (n = 48) weekly for 4, 8, 12, or 16 weeks (n = 6 each group). Thereafter, bronchoalveolar lavage specimens were collected and cellular phenotypes and cytokine concentrations of IL-1alpha, IL-1beta, IL-2, IL-4, IL-6, IL-10, GM-CSF, IFN-gamma, TNF-alpha, and TGF-beta were determined. RESULTS: Following the administration of gastric fluid but not normal saline, histologic specimens exhibited prominent evidence of giant cells, fibrosis, lymphocytic bronchiolitis, and obliterative bronchiolitis. Bronchoalveolar lavage specimens from the left (treated) lungs exhibited consistently higher macrophages and T cells with an increased CD4:CD8 T cell ratio after treatment with gastric fluid compared to normal saline. The concentrations of IL-1alpha, IL-1beta, IL-2, TNF-alpha and TGF-beta were increased in bronchoalveolar lavage specimens following gastric fluid aspiration compared to normal saline. CONCLUSION: This represents the first description of the pulmonary inflammatory response that results from chronic aspiration. Repetitive aspiration events can initiate an inflammatory response consisting of macrophages and T cells that is associated with increased TGF-beta, TNF-alpha, IL-1alpha, IL-1beta, IL-2 and fibrosis in the lung. Combined with the observation of gastric fluid-induced lymphocyitic bronchiolitis and obliterative bronchiolitis, these findings further support an association between chronic aspiration and pulmonary diseases, such as obliterative bronchiolitis, pulmonary fibrosis, and asthma.

Authors
Appel, JZ; Lee, SM; Hartwig, MG; Li, B; Hsieh, C-C; Cantu, E; Yoon, Y; Lin, SS; Parker, W; Davis, RD
MLA Citation
Appel, JZ, Lee, SM, Hartwig, MG, Li, B, Hsieh, C-C, Cantu, E, Yoon, Y, Lin, SS, Parker, W, and Davis, RD. "Characterization of the innate immune response to chronic aspiration in a novel rodent model. (Published online)" Respir Res 8 (November 27, 2007): 87-.
PMID
18042282
Source
pubmed
Published In
Respiratory Research
Volume
8
Publish Date
2007
Start Page
87
DOI
10.1186/1465-9921-8-87

Chronic aspiration in lung allotransplantation induces a donor-specific hyperimmune state

Authors
Bush, EL; Appel, JZ; Li, B; Balsara, KR; Hartwig, M; III, CE; Parker, W; Davis, RD; Lin, SS
MLA Citation
Bush, EL, Appel, JZ, Li, B, Balsara, KR, Hartwig, M, III, CE, Parker, W, Davis, RD, and Lin, SS. "Chronic aspiration in lung allotransplantation induces a donor-specific hyperimmune state." February 2007.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
26
Issue
2
Publish Date
2007
Start Page
S196
End Page
S196
DOI
10.1016/j.healun.2006.11.401

Perioperative predictors of renal failure following off-pump primary double lung transplantation

Authors
Bush, EL; Balsara, KR; Hartwig, M; Pbillips-Bute, BG; Shaw, A; III, CE; Appel, JZ; Davis, RD; Welsby, IJ; Lin, SS
MLA Citation
Bush, EL, Balsara, KR, Hartwig, M, Pbillips-Bute, BG, Shaw, A, III, CE, Appel, JZ, Davis, RD, Welsby, IJ, and Lin, SS. "Perioperative predictors of renal failure following off-pump primary double lung transplantation." February 2007.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
26
Issue
2
Publish Date
2007
Start Page
S116
End Page
S116
DOI
10.1016/j.healun.2006.11.174

Lung transplantation at Duke University Medical Center.

Lung transplantation has undergone remarkable changes in clinical practice to address the higher rate of rejection and mortality. Our protocols include increased immunosuppression and strategies to address non-alloimmune injury, including GER. New and innovative approaches to lung transplantation are still needed to improve short- and long-term outcomes. The LAS implementation has had a strong influence on the type of native disease transplanted at our center as well as our waiting list time. However, the LAS was not predictive of survival posttransplant at one year. Further refinements of the LAS and protocols may improve survival posttransplant.

Authors
Snyder, LD; Finlen-Copeland, A; Hartwig, MG; Lin, SS; Davis, RD; Palmer, SM
MLA Citation
Snyder, LD, Finlen-Copeland, A, Hartwig, MG, Lin, SS, Davis, RD, and Palmer, SM. "Lung transplantation at Duke University Medical Center." Clin Transpl (2007): 99-111.
PMID
18637462
Source
pubmed
Published In
Clinical transplants
Publish Date
2007
Start Page
99
End Page
111

Cytokine gene polymorphisms are not associated with bronchiolitis obliterans syndrome or survival after lung transplant.

BACKGROUND: Cytokine polymorphisms are inconsistently associated with transplant rejection and other adverse outcomes. To address this controversy, we evaluated cytokine single nucleotide polymorphisms (SNPs) in a lung transplant cohort. METHODS: All patients who underwent lung transplantation from 1993 to 1998 and had post-transplant survival of at least 6 months were included in the initial analysis. Subjects were genotyped for: TNF-alpha -308 G/A; IFN-gamma +874 A/T; TGF-beta1 +869 T/C and +915 G/C; IL-10 -1082 A/G, -819 C/T and -592 C/A; and IL-6 -174 G/C. End-points were onset of broncholitis obliterans syndrome (BOS) and survival. RESULTS: In the cohort, 78 subjects, with an overall mean +/- SE survival 2,339 +/- 117 days, had no correlation between onset of BOS1, BOS2 or survival with TNF-alpha, IFN-gamma, TGF-beta1 or IL-10 gene polymorphisms. However, IL-6 polymorphisms GG or GC were associated with an earlier onset of BOS1 (p = 0.039), BOS2 (p = 0.021), and decreased overall post-transplant survival (p = 0.038). A second cohort of more recent lung transplant recipients did not validate an association between IL-6 polymorphisms and earlier onset of BOS1 (p = 0.70), BOS2 (p = 0.54) or overall post-transplant survival (p = 0.25). CONCLUSIONS: Polymorphisms of TNF-alpha, IFN-gamma, TGF-beta1, IL-10 and IL-6 do not appear to influence the onset of BOS or graft survival in recipients.

Authors
Snyder, LD; Hartwig, MG; Ganous, T; Davis, RD; Herczyk, WF; Reinsmoen, NL; Schwartz, DA; Palmer, SM
MLA Citation
Snyder, LD, Hartwig, MG, Ganous, T, Davis, RD, Herczyk, WF, Reinsmoen, NL, Schwartz, DA, and Palmer, SM. "Cytokine gene polymorphisms are not associated with bronchiolitis obliterans syndrome or survival after lung transplant." J Heart Lung Transplant 25.11 (November 2006): 1330-1335.
PMID
17097497
Source
pubmed
Published In
Journal of Heart and Lung Transplantation
Volume
25
Issue
11
Publish Date
2006
Start Page
1330
End Page
1335
DOI
10.1016/j.healun.2006.07.001

Role of flow cytometry to define unacceptable HLA antigens in lung transplant recipients with HLA-specific antibodies.

BACKGROUND: Antidonor HLA-specific antibodies have been associated with hyperacute rejection and primary graft failure in lung transplant recipients. Thus, transplant candidates with HLA-specific antibodies generally undergo prospective crossmatching to exclude donors with unacceptable HLA antigens. However, the need to perform a prospective crossmatch limits the donor pool and is associated with increased waiting list times and mortality. A virtual crossmatch strategy using flow cytometry, which enables precise determination of HLA-specific antibody specificity, was compared to prospective crossmatching in sensitized lung transplant candidates. METHODS: In all, 341 lung transplant recipients were analyzed retrospectively (April 1992 to July 2003). Sixteen patients with HLA-specific antibodies underwent transplantation based on flow cytometric determination of antibody specificity and 10 underwent prospective crossmatching. RESULTS: Freedom from bronchiolitis obliterans syndrome (BOS) at three years was similar in those undergoing a virtual crossmatch, those undergoing prospective crossmatching, and those without HLA-specific antibodies (80.4% +/- 13.4, 85.7% +/- 13.2, and 73.8% +/- 2.8, respectively, P = 0.88). Three-year survival was also comparable (87.5% +/- 8.3, 70.0% +/- 14.5, and 78.5% +/- 2.4, respectively, P = 0.31). Elimination of prospective crossmatching for sensitized patients was associated with a significant decrease in time on the waiting list (P < 0.01) and in waiting list mortality (P < 0.05). All 16 patients undergoing a virtual crossmatch had negative retrospective crossmatches. CONCLUSIONS: By carefully determining the specificity of HLA-specific antibodies, flow cytometry methodologies enable the prediction of negative crossmatch results with up to 100% accuracy, enabling the determination of appropriateness of donors. Using this virtual crossmatch strategy, crossmatching can be safely omitted prior to lung transplantation, thereby decreasing waiting list time and mortality rates for candidates with HLA-specific antibodies.

Authors
Appel, JZ; Hartwig, MG; Cantu, E; Palmer, SM; Reinsmoen, NL; Davis, RD
MLA Citation
Appel, JZ, Hartwig, MG, Cantu, E, Palmer, SM, Reinsmoen, NL, and Davis, RD. "Role of flow cytometry to define unacceptable HLA antigens in lung transplant recipients with HLA-specific antibodies." Transplantation 81.7 (April 15, 2006): 1049-1057.
PMID
16612283
Source
pubmed
Published In
Transplantation
Volume
81
Issue
7
Publish Date
2006
Start Page
1049
End Page
1057
DOI
10.1097/01.tp.0000204046.89396.c5

Successful bilateral lung transplant outcomes in recipients 61 years of age and older.

BACKGROUND: Controversy exists regarding the optimal use of bilateral lung transplant (BLT) in older recipients in diseases where either single or bilateral transplant is appropriate. International Society for Heart and Lung Transplant (ISHLT) guidelines suggest an upper age limit of 60 for BLT, despite limited data regarding outcomes with BLT in patients over 60. We hypothesize that BLT offers comparable, if not superior, clinical outcomes to SLT in all patients independent of recipient age. METHODS: In order to test our hypothesis, we conducted a case-control study to compare the effect of transplant operation on survival and the onset of bronchiolitis obliterans syndrome (BOS) in consecutive lung transplant recipients 61 years of age or older using Kaplan- Meier analysis and Cox proportional hazard models. RESULTS: We identified 107 consecutive lung transplant recipients 61 or older at the time of transplant. Patients received SLT (n=46) or BLT (n=61) based on donor organ availability. Comparable survival was achieved with BLT in older patients vs. SLT P=0.19). One-, two-, and five-year survival estimates in BLT were 82%, 75% and 68%, respectively, vs. in SLT 78%, 70% and 44%, respectively. A comparable onset of BOS was also observed in the patients who received BLT vs. SLT (P=0.23). CONCLUSION: Successful short- and medium-term outcomes are achieved with BLT in older recipients and are comparable to those achieved with SLT. Our results suggest that age over 60 should not exclude patients from consideration of BLT.

Authors
Palmer, SM; Davis, RD; Simsir, SA; Lin, SS; Hartwig, M; Reidy, MF; Steele, MP; Eu, PC; Blumenthal, JA; Babyak, MA
MLA Citation
Palmer, SM, Davis, RD, Simsir, SA, Lin, SS, Hartwig, M, Reidy, MF, Steele, MP, Eu, PC, Blumenthal, JA, and Babyak, MA. "Successful bilateral lung transplant outcomes in recipients 61 years of age and older." Transplantation 81.6 (March 27, 2006): 862-865.
PMID
16570009
Source
pubmed
Published In
Transplantation
Volume
81
Issue
6
Publish Date
2006
Start Page
862
End Page
865
DOI
10.1097/01.tp.0000203298.00475.0d

Chronic gastric fluid aspiration causes bronchiolitis obliterans in rat pulmonary allografts

Authors
Lin, SS; Li, B; Hartwig, MG; Appel, JZ; Bush, EL; Hsieh, C-C; Parker, W; Davis, RD
MLA Citation
Lin, SS, Li, B, Hartwig, MG, Appel, JZ, Bush, EL, Hsieh, C-C, Parker, W, and Davis, RD. "Chronic gastric fluid aspiration causes bronchiolitis obliterans in rat pulmonary allografts." February 2006.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
25
Issue
2
Publish Date
2006
Start Page
S129
End Page
S130
DOI
10.1016/j.healun.2005.11.257

Chronic aspiration of gastric fluid accelerates pulmonary allograft dysfunction in a rat model of lung transplantation.

OBJECTIVE: Emerging clinical evidence suggests that gastroesophageal reflux disease is associated with pulmonary allograft dysfunction. In this study, we used a model of rat lung transplantation to test the hypothesis that chronic aspiration of gastric contents accelerates pulmonary allograft dysfunction. METHODS: We evaluated the effects of chronic aspiration on pulmonary isografts (strain F344) and pulmonary allografts (strain WKY to strain F344). Chronic aspiration consisted of 0.5 mL/kg of filtered gastric contents injected weekly into the left lung for 4 to 8 weeks beginning 1 week after transplantation. Seven days after the last aspiration, animals were killed, and grafts were evaluated grossly and by histologic and immunochemical analyses, including Masson trichrome staining for collagen and immunostaining for CD68+ and CD8+ cells. Serum cytokine concentrations were determined by bead-based immunoassays or enzyme-linked immunosorbent assay. RESULTS: Allografts without aspiration (n = 12) demonstrated a relatively normal architecture with diffuse International Society for Heart and Lung Transplantation grade 3 acute rejection; occasional grade 4 rejection was noted. In contrast, allografts with chronic aspiration (n = 7) demonstrated severe grade 4 acute rejection with significant monocyte infiltration, fibrosis, and loss of normal alveolar anatomy. Grossly, 8 (67%) of 12 allografts without aspiration seemed to inflate and perfuse normally, whereas all allografts exposed to chronic aspiration were firm and shrunken, without the ability to ventilate (P = .013; Fisher exact test). Aspiration was associated with increases in graft-infiltrating macrophages and CD8+ T cells and higher levels of serum transforming growth factor beta. CONCLUSIONS: Chronic aspiration of gastric contents promotes accelerated allograft failure and may promote a profibrotic environment.

Authors
Hartwig, MG; Appel, JZ; Li, B; Hsieh, C-C; Yoon, YH; Lin, SS; Irish, W; Parker, W; Davis, RD
MLA Citation
Hartwig, MG, Appel, JZ, Li, B, Hsieh, C-C, Yoon, YH, Lin, SS, Irish, W, Parker, W, and Davis, RD. "Chronic aspiration of gastric fluid accelerates pulmonary allograft dysfunction in a rat model of lung transplantation." J Thorac Cardiovasc Surg 131.1 (January 2006): 209-217.
PMID
16399314
Source
pubmed
Published In
Journal of Thoracic and Cardiovascular Surgery
Volume
131
Issue
1
Publish Date
2006
Start Page
209
End Page
217
DOI
10.1016/j.jtcvs.2005.06.054

CABG for chronic disease during repair of traumatic ascending aortic rupture.

Authors
Hartwig, MG; Biswas, SS; Glower, DD; Vaslef, SN
MLA Citation
Hartwig, MG, Biswas, SS, Glower, DD, and Vaslef, SN. "CABG for chronic disease during repair of traumatic ascending aortic rupture." J Trauma 59.6 (December 2005): 1492-1494.
PMID
16394929
Source
pubmed
Published In
Journal of Trauma - Injury, Infection and Critical Care
Volume
59
Issue
6
Publish Date
2005
Start Page
1492
End Page
1494

Improved results treating lung allograft failure with venovenous extracorporeal membrane oxygenation.

BACKGROUND: Primary graft failure remains a significant source of mortality after lung transplantation. Extracorporeal membrane oxygenation (ECMO) provides treatment for affected recipients. We hypothesized that venovenous membrane oxygenation provides a safer alternative than venoarterial support for lung recipients suffering from primary graft failure. METHODS: We conducted an analysis of 522 patients who underwent lung transplantation from April 1992 to July 2004. Twenty-three (4.5%) patients required membrane oxygenation secondary to primary graft failure unresponsive to conventional treatment. Of these recipients, 15 (65%) were treated with venoarterial, while 8 (35%) underwent venovenous membrane oxygenation. RESULTS: Median days to initiation and duration of membrane oxygenation did not differ between groups. Eight of 15 patients (53%) from the venoarterial group were successfully weaned from life support, with one surviving greater than 45 days. This lone long-term survivor required retransplantation 4 days after initial transplant. In contrast, all venovenous patients were weaned from support, with 7 of 8 surviving greater than 30 days. The 30-day survival for venovenous recipients (88%) approximates that of all lung recipients at our center (94%, p = 0.42). Noted complications for ECMO patients included renal failure (n = 16), neurologic catastrophes (n = 8), sepsis (n = 5), and hemorrhage (n = 10). The venoarterial recipients suffered 30 of 39 total complications. Most of the complications for venovenous recipients involved renal failure, but by hospital discharge these patients demonstrated a mean creatinine of 0.9 mg/dL. CONCLUSIONS: For lung recipients with primary graft failure, venovenous membrane oxygenation provides better outcomes, with fewer complications, than venoarterial membrane oxygenation.

Authors
Hartwig, MG; Appel, JZ; Cantu, E; Simsir, S; Lin, SS; Hsieh, C-C; Walczak, R; Palmer, SM; Davis, RD
MLA Citation
Hartwig, MG, Appel, JZ, Cantu, E, Simsir, S, Lin, SS, Hsieh, C-C, Walczak, R, Palmer, SM, and Davis, RD. "Improved results treating lung allograft failure with venovenous extracorporeal membrane oxygenation." Ann Thorac Surg 80.5 (November 2005): 1872-1879.
PMID
16242472
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
80
Issue
5
Publish Date
2005
Start Page
1872
End Page
1879
DOI
10.1016/j.athoracsur.2005.04.063

Hepatitis B core antibody positive donors as a safe and effective therapeutic option to increase available organs for lung transplantation.

BACKGROUND: The use of hepatitis B core antibody (HBcAb+) and hepatitis C antibody (HCV Ab+) positive donors represents one strategy to increase available donor organs, but this remains controversial because of concern for viral transmission to recipients. We hypothesized that isolated HBcAb+ donors represent minimal risk of viral transmission in vaccinated lung transplant (LTx) recipients. METHODS: A retrospective study was performed of LTx recipients who received HBcAb+ or HCV Ab+ pulmonary allografts. We analyzed liver function studies, viral hepatitis screening tests, quantitative polymerase chain reaction for hepatitis B viral DNA (HBV DNA) and hepatitis C viral RNA (HCV RNA), freedom from bronchiolitis obliterans syndrome, acute rejection, and survival. RESULTS: Between April 1992 and August 2003, 456 LTx operations were performed. Twenty-nine patients (HB group) received HBcAb+ allograft transplants with a median posttransplant follow-up of 24.5 months. Three critically ill patients (HC group) received HCV Ab+ allografts with a median follow-up of 21.5 months. One-year survival for the HB group is 83% versus 82% for all patients who received non-HB organs (P=0.36). No patient in the HB group developed clinical liver disease because of viral hepatitis, and all patients alive (n=21) at follow-up are, to date, HBV DNA and/or HBcAb negative. All patients in the HC group tested HCV RNA positive; one patient died of liver failure at 22 months. CONCLUSIONS: Risk of viral transmission with HCV Ab+ allografts seems high after LTx. However, the use of HBcAb+ pulmonary allografts in recipients with prior hepatitis B vaccination seems to be a safe and effective strategy to increase organ availability.

Authors
Hartwig, MG; Patel, V; Palmer, SM; Cantu, E; Appel, JZ; Messier, RH; Davis, RD
MLA Citation
Hartwig, MG, Patel, V, Palmer, SM, Cantu, E, Appel, JZ, Messier, RH, and Davis, RD. "Hepatitis B core antibody positive donors as a safe and effective therapeutic option to increase available organs for lung transplantation." Transplantation 80.3 (August 15, 2005): 320-325.
PMID
16082326
Source
pubmed
Published In
Transplantation
Volume
80
Issue
3
Publish Date
2005
Start Page
320
End Page
325

Antireflux surgery in the setting of lung transplantation: strategies for treating gastroesophageal reflux disease in a high-risk population.

In lung transplant recipients, GERD is associated with increased incidence of acute rejection, earlier onset of chronic rejection, and higher mortality. Surgical treatment of GERD in lung recipients seems to prevent early allograft dysfunction and improve overall survival. A total (360 degrees) fundoplication is shown to be a safe and effective method for treating GERD in lung transplant recipients and is the authors' procedure of choice, in most cases, for this high-risk patient population. The principal goal should be to minimize reflux of enteric contents that may lead to micro- or macroaspiration events in this complicated group of patients. Perioperative care should involve a multidisciplinary approach, including physicians and other health care providers familiar with the complexities of lung transplant recipients.

Authors
Hartwig, MG; Appel, JZ; Davis, RD
MLA Citation
Hartwig, MG, Appel, JZ, and Davis, RD. "Antireflux surgery in the setting of lung transplantation: strategies for treating gastroesophageal reflux disease in a high-risk population." Thoracic surgery clinics 15.3 (August 2005): 417-427.
PMID
16104132
Source
epmc
Published In
Thoracic Surgery Clinics
Volume
15
Issue
3
Publish Date
2005
Start Page
417
End Page
427
DOI
10.1016/j.thorsurg.2005.03.001

Utility of peritransplant and rescue intravenous immunoglobulin and extracorporeal immunoadsorption in lung transplant recipients sensitized to HLA antigens.

The role of anti-human leukocyte antigen (HLA) antibodies in lung transplantation is not fully clear. The presence of pretransplant third-party anti-HLA antibodies or the development of de novo anti-HLA antibodies has been associated with acute posttransplant complications, bronchiolitis obliterans syndrome (BOS), and early mortality in some studies. However, little has been reported regarding the utility of desensitization therapy in sensitized lung transplant recipients. For approximately 3 years, desensitization therapy consisting of intravenous immunoglobulin (IVIG) and, in most instances, extracorporeal immunoadsorption (ECI) has been administered peritransplant to lung transplant recipients at our institution with third-party anti-HLA antibodies or as rescue therapy to those who develop de novo anti-HLA antibodies. Notably, the administration of peritransplant desensitization therapy to these patients has been associated with improvement in several clinical parameters, including acute rejection and BOS. Furthermore, administration of rescue IVIG with or without ECI has been associated with an overall improvement in the rate of pulmonary function decline. Our experience suggests that desensitization therapy may be beneficial for lung transplant recipients with pretransplant or de novo anti-HLA antibodies. We discuss the appropriateness and clinical impact of IVIG and ECI in sensitized lung transplant recipients as well as cellular mechanisms that may contribute.

Authors
Appel, JZ; Hartwig, MG; Davis, RD; Reinsmoen, NL
MLA Citation
Appel, JZ, Hartwig, MG, Davis, RD, and Reinsmoen, NL. "Utility of peritransplant and rescue intravenous immunoglobulin and extracorporeal immunoadsorption in lung transplant recipients sensitized to HLA antigens." Hum Immunol 66.4 (April 2005): 378-386. (Review)
PMID
15866701
Source
pubmed
Published In
Human Immunology
Volume
66
Issue
4
Publish Date
2005
Start Page
378
End Page
386
DOI
10.1016/j.humimm.2005.01.025

Differences in survival and de novo anti-donor antibody development among lung transplant recipients presensitized to third party class I and class IIHLA antigens

Authors
Appel, JZ; Hartwig, MG; Cantu, E; Palmer, SM; Reinsmoen, NL; Davis, RD
MLA Citation
Appel, JZ, Hartwig, MG, Cantu, E, Palmer, SM, Reinsmoen, NL, and Davis, RD. "Differences in survival and de novo anti-donor antibody development among lung transplant recipients presensitized to third party class I and class IIHLA antigens." February 2005.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
24
Issue
2
Publish Date
2005
Start Page
S93
End Page
S93
DOI
10.1016/j.healun.2004.11.178

Rabbit antithymocyte globulin induction therapy for lung transplantation does not affect long-term allograft function or survival

Authors
Hartwig, MG; Snyder, LD; Appel, JZ; Simsir, S; Lin, SS; Palmer, SM; Davis, RD
MLA Citation
Hartwig, MG, Snyder, LD, Appel, JZ, Simsir, S, Lin, SS, Palmer, SM, and Davis, RD. "Rabbit antithymocyte globulin induction therapy for lung transplantation does not affect long-term allograft function or survival." February 2005.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
24
Issue
2
Publish Date
2005
Start Page
S81
End Page
S82
DOI
10.1016/j.healun.2004.11.143

Improved results treating primary lung allograft failure using veno-venous extracorporeal membrane oxygenation (ECMO)

Authors
Hartwig, MG; Appel, JZ; Lin, SS; Simsir, S; Messier, R; Davis, R
MLA Citation
Hartwig, MG, Appel, JZ, Lin, SS, Simsir, S, Messier, R, and Davis, R. "Improved results treating primary lung allograft failure using veno-venous extracorporeal membrane oxygenation (ECMO)." February 2005.
Source
wos-lite
Published In
The Journal of Heart and Lung Transplantation
Volume
24
Issue
2
Publish Date
2005
Start Page
S148
End Page
S148
DOI
10.1016/j.healun.2004.12.037

Nonalloimmune mechanisms contributing to lung allograft dysfunction: A potential role for gastroesophageal reflux disease

Purpose of review: Lung allograft dysfunction and bronchiolitis obliterans syndrome remain the primary impediment to long-term survival after lung transplantation. Chronic aspiration resulting from gastroesophageal reflux disease is particularly common in lung transplant recipients and represents an important form of nonalloimmune injury that may initiate or exacerbate lung allograft dysfunction. Recent findings: New evidence from large retrospective studies not only corroborates that nonalloimmune injury in the form of gastroesophageal reflux disease is associated with acute rejection, bronchiolitis obliterans syndrome, and mortality, but also suggests that these sequelae can be prevented or reversed with fundoplication. More important, however, is that it is becoming clear that fundoplication is less advantageous when delayed (i.e. more than 90 days after transplant), suggesting a dose-dependent relation. Preliminary data from in-vitro studies suggest that nonalloimmune injury in lung transplant recipients with chronic aspiration involves the interaction of innate and acquired immune pathways. The details of these pathways and the extent of interaction between them have yet to be elucidated. Summary: Increasing evidence supports an important association between chronic aspiration in the context of gastroesophageal reflux disease and lung allograft dysfunction. In the future, more extensive studies in animal models and the development of prospective clinical trials will be necessary to fully elucidate this relation. © 2005 Lippincott Williams & Wilkins.

Authors
III, JZA; Hartwig, MG; Davis, RD
MLA Citation
III, JZA, Hartwig, MG, and Davis, RD. "Nonalloimmune mechanisms contributing to lung allograft dysfunction: A potential role for gastroesophageal reflux disease." Current Opinion in Organ Transplantation 10.3 (2005): 205-210.
Source
scival
Published In
Current Opinion in Organ Transplantation
Volume
10
Issue
3
Publish Date
2005
Start Page
205
End Page
210
DOI
10.1097/01.mot.0000169366.00143.73

Antireflux surgery in the setting of lung transplantation: Strategies for treating gastroesophageal reflux disease in a high-risk population

In lung transplant recipients, GERD is associated with increased incidence of acute rejection, earlier onset of chronic rejection, and higher mortality. Surgical treatment of GERD in lung recipients seems to prevent early allograft dysfunction and improve overall survival. A total (360°) fundoplication is shown to be a safe and effective method for treating GERD in lung transplant recipients and is the authors' procedure of choice, in most cases, for this high-risk patient population. The principal goal should be to minimize reflux of enteric contents that may lead to micro- or macroaspiration events in this complicated group of patients. Perioperative care should involve a multidisciplinary approach, including physicians and other health care providers familiar with the complexities of lung transplant recipients. © 2005 Elsevier Inc. All rights reserved.

Authors
Hartwig, MG; Appel, JZ; Davis, RD
MLA Citation
Hartwig, MG, Appel, JZ, and Davis, RD. "Antireflux surgery in the setting of lung transplantation: Strategies for treating gastroesophageal reflux disease in a high-risk population." Thoracic Surgery Clinics 15.3 SPEC. ISS. (2005): 417-427.
Source
scival
Published In
Thoracic Surgery Clinics
Volume
15
Issue
3 SPEC. ISS.
Publish Date
2005
Start Page
417
End Page
427
DOI
10.1016/j.thorsurg.2005.03.001

Surgical considerations in lung transplantation: transplant operation and early postoperative management.

During the last 20 years improvements in perioperative care have led to improved outcomes for lung transplant recipients. Although uncommon, technical complications can be the source of significant morbidity and mortality. Infections and ischemia-reperfusion injury continue to have the greatest impact on short-term outcomes of lung transplant recipients, and research into the prevention and treatment of these two entities will be necessary to improve these patients' outcomes significantly.

Authors
Hartwig, MG; Davis, RD
MLA Citation
Hartwig, MG, and Davis, RD. "Surgical considerations in lung transplantation: transplant operation and early postoperative management." Respir Care Clin N Am 10.4 (December 2004): 473-504. (Review)
PMID
15585179
Source
pubmed
Published In
Respiratory care clinics of North America
Volume
10
Issue
4
Publish Date
2004
Start Page
473
End Page
504
DOI
10.1016/j.rcc.2004.06.007

J. Maxwell Chamberlain Memorial Paper. Early fundoplication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease.

BACKGROUND: Chronic allograft dysfunction limits the long-term success of lung transplantation. Increasing evidence suggests nonimmune mediated injury such as due to reflux contributes to the development of bronchiolitis obliterans syndrome. We have previously demonstrated that fundoplication can reverse bronchiolitis obliterans syndrome in some lung transplant recipients with reflux. We hypothesized that treatment of reflux with early fundoplication would prevent bronchiolitis obliterans syndrome and improve survival. METHODS: A retrospective analysis of 457 patients who underwent lung transplantation from April 1992 through July 2003 was conducted. Patients were stratified into four groups: no history of reflux, history of reflux, history of reflux and early (< 90 days) fundoplication and history of reflux and late fundoplication. RESULTS: Incidence of postoperative reflux was 76% (127 of 167 patients) in pH confirmed subgroups. In 14 patients with early fundoplication, actuarial survival was 100% at 1 and 3 years when compared with those with reflux and no intervention (92% +/- 3.3, 76% +/- 5.8; p < 0.02). Further, those who underwent early fundoplication had improved freedom from bronchiolitis obliterans syndrome at 1 and 3 years (100%, 100%) when compared with no fundoplication in patients with reflux (96% +/- 2.5, 60% +/- 7.5; p < 0.01). CONCLUSIONS: Reflux is a frequent medical complication after lung transplantation. Although the number of patients undergoing early fundoplication is small, our results suggest early aggressive surgical treatment of reflux results in improved rates of bronchiolitis obliterans syndrome and survival. Further research into the mechanisms and treatment of nonalloimmune mediated lung allograft injury is needed to reduce rates of chronic lung failure.

Authors
Cantu, E; Appel, JZ; Hartwig, MG; Woreta, H; Green, C; Messier, R; Palmer, SM; Davis, RD
MLA Citation
Cantu, E, Appel, JZ, Hartwig, MG, Woreta, H, Green, C, Messier, R, Palmer, SM, and Davis, RD. "J. Maxwell Chamberlain Memorial Paper. Early fundoplication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease." Ann Thorac Surg 78.4 (October 2004): 1142-1151.
PMID
15464462
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
78
Issue
4
Publish Date
2004
Start Page
1142
End Page
1151
DOI
10.1016/j.athoracsur.2004.04.044

Role of cellular immunity in GERD-associated bronchiolitis obliterans syndrome

Authors
Appel, JZ; Burnette, A; Mohler, K; Li, B; Hartwig, M; Cantu, E; Palmer, S; Parker, W; Reinsmoen, N; Davis, D
MLA Citation
Appel, JZ, Burnette, A, Mohler, K, Li, B, Hartwig, M, Cantu, E, Palmer, S, Parker, W, Reinsmoen, N, and Davis, D. "Role of cellular immunity in GERD-associated bronchiolitis obliterans syndrome." September 2004.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
199
Issue
3
Publish Date
2004
Start Page
S94
End Page
S95

Neoadjuvant chemoradiation for rectal cancer: analysis of clinical outcomes from a 13-year institutional experience.

OBJECTIVE: To examine clinical outcomes in patients receiving neoadjuvant chemoradiation for locally advanced rectal adenocarcinoma. SUMMARY BACKGROUND DATA: Preoperative radiation therapy, either alone or in combination with 5-fluorouracil-based chemotherapy, has proven both safe and effective in the treatment of rectal cancer. However, data are lacking regarding which subgroups of patients benefit from the therapy in terms of decreased local recurrence and increased survival rates. METHODS: A retrospective chart review was performed on 141 consecutive patients who received neoadjuvant chemoradiation (5-fluorouracil +/- cisplatin and 4,500-5,040 cGy) for biopsy-proven locally advanced adenocarcinoma of the rectum. Surgery was performed 4 to 8 weeks after completion of chemoradiation. Standard statistical methods were used to analyze recurrence and survival. RESULTS: Median follow-up was 27 months, and mean age was 59 years (range 28-81). Mean tumor distance from the anal verge was 6 cm (range 1-15). Of those staged before surgery with endorectal ultrasound or magnetic resonance imaging, 57% of stage II patients and 82% of stage III patients were downstaged. The chemotherapeutic regimens were well tolerated, and resections were performed on 140 patients. The percentage of sphincter-sparing procedures increased from 20% before 1996 to 76% after 1996. On pathologic analysis, 24% of specimens were T0. However, postoperative pathologic T stage had no effect on either recurrence or survival. Positive lymph node status predicted increased local recurrence and decreased survival. CONCLUSIONS: Neoadjuvant chemoradiation is safe, effective, and well tolerated. Postoperative lymph node status is the only independent predictor of recurrence and survival.

Authors
Onaitis, MW; Noone, RB; Hartwig, M; Hurwitz, H; Morse, M; Jowell, P; McGrath, K; Lee, C; Anscher, MS; Clary, B; Mantyh, C; Pappas, TN; Ludwig, K; Seigler, HF; Tyler, DS
MLA Citation
Onaitis, MW, Noone, RB, Hartwig, M, Hurwitz, H, Morse, M, Jowell, P, McGrath, K, Lee, C, Anscher, MS, Clary, B, Mantyh, C, Pappas, TN, Ludwig, K, Seigler, HF, and Tyler, DS. "Neoadjuvant chemoradiation for rectal cancer: analysis of clinical outcomes from a 13-year institutional experience." Ann Surg 233.6 (June 2001): 778-785.
PMID
11371736
Source
pubmed
Published In
Annals of Surgery
Volume
233
Issue
6
Publish Date
2001
Start Page
778
End Page
785

Bilateral Sequential Lung Transplantation

Authors
Ali Daneshmand, M; Lin, SS; Haney, JC; Hartwig, MG; Davis, RD
MLA Citation
Ali Daneshmand, M, Lin, SS, Haney, JC, Hartwig, MG, and Davis, RD. "Bilateral Sequential Lung Transplantation (Accepted)." 138-151.
Source
crossref
Volume
19
Start Page
138
End Page
151
DOI
10.1053/j.optechstcvs.2014.09.001
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