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Ghandi V, Li D, Weinkauf J, Lien D, Hirji A, Varughese R, Weatherald J, Sligl W, Kabbani D, Schwartz I, Doucette K, Cervera C, Halloran K. Systemic corticosteroids for outpatient respiratory viral infections in lung transplant recipients. Transpl Infect Dis 2023; 25:e14181. [PMID: 37922374 DOI: 10.1111/tid.14181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/22/2023] [Accepted: 10/15/2023] [Indexed: 11/05/2023]
Abstract
INTRODUCTION Respiratory viral infections (RVI) in lung transplant recipients (LTR) have variably been associated with rejection and chronic lung allograft dysfunction. Our center has used systemic corticosteroids to treat outpatient RVI in some cases, but evidence is limited. We reviewed all adult LTR diagnosed with outpatient RVI January 2017 to December 2019. The primary outcome was recovery of lung function (forced expiratory volume in 1 s [FEV1]) at next stable visit between 1 and 12 months postinfection, expressed as a ratio over stable preinfection FEV1 (FEV1 recovery ratio). METHODS We identified 100 adult LTR with outpatient RVI diagnoses eligible for study, 36% of whom received corticosteroids. We modelled the adjusted association between corticosteroid use and FEV1 recovery ratio using linear regression. RESULTS Steroid-treated patients had a lower FEV1 presentation ratio (0.92 vs. 1.04, p = .0070) and were more likely to have chronic lung allograft dysfunction at time of infection (25% vs. 5%, p = .0077). Mean FEV1 recovery ratio was 1.02 (SD 0.19) with no association with corticosteroid therapy via multivariable linear regression (p = .5888). CONCLUSIONS Steroid treatment was not associated with FEV1 recovery. This suggests corticosteroids may not have a role in the management of RVI in this population.
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Affiliation(s)
- Vardhil Ghandi
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - David Li
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Justin Weinkauf
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Dale Lien
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Alim Hirji
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Rhea Varughese
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Wendy Sligl
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Dima Kabbani
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ilan Schwartz
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Karen Doucette
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Carlos Cervera
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Kieran Halloran
- Department of Medicine, University of Alberta, Edmonton, Canada
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Ostad S, Sugarman J, Alkhodair A, Liang J, Mielniczuk LM, Hambly N, Helmersen D, Hirani N, Thakrar M, Varughese R, Norena M, Kularatne M, Swiston JR, Kapasi A, Weatherald J, Brunner NW. Association Between the Pulmonary Artery Pulsatility Index and Prognosis in Pulmonary Arterial Hypertension: A Multicentre Study. CJC Open 2023; 5:545-553. [PMID: 37496788 PMCID: PMC10366663 DOI: 10.1016/j.cjco.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/19/2023] [Indexed: 07/28/2023] Open
Abstract
Background Risk stratification is fundamental in the management of pulmonary arterial hypertension (PAH). Pulmonary artery pulsatility index (PAPi), defined as pulmonary arterial pulse pressure divided by right atrial pressure (RAP), is a hemodynamic index shown to predict acute right ventricular (RV) dysfunction in several settings. Our objective was to test the prognostic utility of PAPi in a diverse multicentre cohort of patients with PAH. Methods A multicentre retrospective cohort study of consecutive adult patients with a new diagnosis of PAH on right heart catheterization between January 2016 and December 2020 was undertaken across 4 major centres in Canada. Hemodynamic data, clinical data, and outcomes were collected. The association of PAPi and other hemodynamic variables with mortality was assessed by receiver-operating characteristic curves and Cox proportional hazards modeling. Results We identified 590 patients with a mean age of 61.4 ± 15.5 years, with 66.3% being female. A low PAPi (defined as < 5.3) was associated with higher mortality at 1 year: 10.2% vs 5.2% (P = 0.02). In a multivariable model including age, sex, body mass index, and functional class, a low PAPi was associated with mortality at 1 year (area under the curveof 0.64 (95% confidence interval 0.55-0.74). However, high RAP (> 8 mm Hg) was similarly predictive of mortality, with an area under the curve of 0.65. Conclusion PAPi was associated with mortality in a large incident PAH cohort. However, the discriminative value of PAPi was not higher than that of RAP alone.
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Affiliation(s)
- Sam Ostad
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jordan Sugarman
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Division of Respirology, University of Toronto, Toronto, Ontario, Canada
| | - Abdullah Alkhodair
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jiaming Liang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa M. Mielniczuk
- Department of Medicine, Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Nathan Hambly
- Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Doug Helmersen
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Naushad Hirani
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mitesh Thakrar
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rhea Varughese
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Monica Norena
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Mithum Kularatne
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John R. Swiston
- Department of Medicine, Division of Respirology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ali Kapasi
- Department of Medicine, Division of Respirology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Weatherald
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nathan W. Brunner
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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Sekowski V, Jackson K, Halloran K, Varughese R, Nagendran J, Weinkauf J, Lien D, Hirji A. Corrigendum to "Pre-transplant malignancy is associated with increased risk of de novo malignancy post-lung transplantation" [Respir. Med. 197 (2022) 106855]. Respir Med 2022; 200:106914. [PMID: 35700601 DOI: 10.1016/j.rmed.2022.106914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Viktor Sekowski
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Kathy Jackson
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Kieran Halloran
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Rhea Varughese
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Jayan Nagendran
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Justin Weinkauf
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Dale Lien
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Alim Hirji
- Department of Medicine, University of Alberta, Edmonton, Canada.
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Li D, Weinkauf J, Varughese R, Lien D, Nagendran J, Hirji A, Halloran K. Prognostic Value of First Post-Transplant Lung Function. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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5
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Li D, Hirji A, Weinkauf J, Varughese R, Lien D, Nagendran J, Halloran K. Lung Transplantation from Donors with a History of Substance Use. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Stanton A, Varughese R, Hirji A, Weinkauf J, Nagendran J, Lien D, Li D, Halloran K. Pretransplant Medications and Primary Graft Dysfunction Risk in Lung Transplant Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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7
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Li D, Abele J, Sunner P, Varughese R, Hirji A, Weinkauf J, Nagendran J, Lien D, Halloran K. Mismatched Perfusion Defects on Routine Ventilation-Perfusion Scans after Lung Transplantation. Clin Transplant 2022; 36:e14650. [PMID: 35291045 DOI: 10.1111/ctr.14650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Incidental pulmonary embolism (PE) is a challenging entity with unclear treatment implications. Our program performs routine ventilation-perfusion (VQ) scans at 3-months post-transplant to establish airway and vascular function. We sought to determine the prevalence and prognostic implications of mismatched perfusion defects (MMPD) found on these studies, hypothesizing they would be associated with a benign prognosis. METHODS We studied VQ scans obtained routinely at 3-months post-transplant from double lung transplant recipients 2005-2016 for studies with MMPD interpreted as high or intermediate probability for PE. We tested the relationship between MMPD and 1-year survival via chi square testing, overall survival via Kaplan Meier analysis with log rank testing and peak forced expiratory volume in 1 second (FEV1) percent predicted via t-testing. RESULTS 373 patients met inclusion criteria, of whom 35 (9%) had VQ scans with MMPDs interpreted by radiologists as high or intermediate probability for PE. Baseline recipient and donor characteristics were similar between groups. 7 patients (20%) in the MMPD group were treated with therapeutic anticoagulation. Patients with MMPD had similar 1-year survival (100% vs. 98%, p = 1.00), overall survival (log rank p = 0.90) and peak FEV1% predicted (94% [SD 20%] vs. 92% [SD 21%]; p = 0.58). Anticoagulation did not affect these relationships. CONCLUSION Mismatched perfusion defects on routine post-transplant VQ scan were not associated with a difference in survival or lung function. A conservative approach to these changes may be a viable option in the absence of other anticoagulation indications. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- David Li
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Jonathan Abele
- Department of Diagnostic Imaging and Radiology, University of Alberta, Edmonton, Canada
| | - Parveen Sunner
- Department of Diagnostic Imaging and Radiology, University of Alberta, Edmonton, Canada
| | - Rhea Varughese
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Alim Hirji
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Justin Weinkauf
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Jayan Nagendran
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Dale Lien
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Kieran Halloran
- Department of Medicine, University of Alberta, Edmonton, Canada
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Moolji J, Gill I, Varughese R, Adam B, Halloran K, Weinkauf J, Lien D, Mullen J, Hirji A. Successful long-term outcome after transplantation of lungs affected by smoke inhalation injury. Ann Thorac Surg 2021; 114:e25-e28. [PMID: 34699753 DOI: 10.1016/j.athoracsur.2021.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/13/2021] [Accepted: 09/19/2021] [Indexed: 11/01/2022]
Abstract
We report a case of a 43-year-old woman who underwent double lung transplantation from a donor with severe airway burns following a house fire. The recipient's lung function and quality of life remain excellent 24 months following transplantation. This case is the first to report successful long-term outcomes in transplantation of lungs affected by smoke inhalation.
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Affiliation(s)
| | - Ishrat Gill
- Department of Medicine, University of Alberta
| | | | - Benjamin Adam
- Department of Laboratory Medicine and Pathology, University of Alberta
| | | | | | - Dale Lien
- Department of Medicine, University of Alberta
| | - John Mullen
- Department of Surgery, University of Alberta
| | - Alim Hirji
- Department of Medicine, University of Alberta.
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9
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Zelt JGE, Sugarman J, Weatherald J, Partridge ACR, Liang JC, Swiston J, Brunner N, Chandy G, Stewart DJ, Contreras-Dominguez V, Thakrar M, Helmersen D, Varughese R, Hirani N, Umar F, Dunne R, Doyle-Cox C, Foxall J, Mielniczuk L. Mortality trends in pulmonary arterial hypertension in canada: a temporal analysis of survival per ESC/ERS Guideline Era. Eur Respir J 2021; 59:13993003.01552-2021. [PMID: 34675044 PMCID: PMC9160389 DOI: 10.1183/13993003.01552-2021] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/06/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The evolution in pulmonary arterial hypertension (PAH) management has been summarized in three iterations of the European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines. No study has assessed whether changes in management, as reflected in the changing guidelines, has translated to improved long-term survival in PAH. METHODS Mixed retrospective/prospective analysis of treatment naïve, incident PAH patients (n=392) diagnosed at three major centers in Canada from 2009-2021. Patients were divided into two groups based on their diagnosis date and in accordance with three ESC/ERS guideline iterations: 2009 and 2015. Overall survival was assessed based on date of diagnosis and initial treatment strategy (i.e. mono versus combination). RESULTS In Canada, there was a shift towards more aggressive upfront management with combination therapy after the publication of the 2015 guidelines (10.4% and 30.8% in 2009-2015 patients, and 36.0% and 57.4% in 2016-2021 patients, for baseline and 2-year follow-up respectively). A key factor associated with combination therapy after 2015 was higher pulmonary vascular resistance (p=0.009). The 1, 3 and 5 year survival rates in Canada were 89.2%, 75.6%. and 56.0%, respectively. Despite changes in management, there was no improvement in long-term survival before and after publication of the 2015 ESC/ERS guideline (p=0.53). CONCLUSIONS There was an increase in the use of initial and sequential combination therapy in Canada after publication of the 2015 ESC/ERS guidelines, which was not associated with improved long-term survival. These data highlight the continued difficulties of managing this aggressive pulmonary disease in an era without a cure.
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Affiliation(s)
- Jason G E Zelt
- Department of Cellular and Molecular Medicine and Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada .,Division of Cardiology, University of Ottawa Heart Institute and University of Ottawa
| | - Jordan Sugarman
- Internal Medicine Residency Program, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jason Weatherald
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Arun C R Partridge
- Internal Medicine Residency Program, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jiaming Calvin Liang
- Department of Cellular and Molecular Medicine and Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - John Swiston
- Division of Respirology, University of British Columbia, Vancouver, Canada
| | - Nathan Brunner
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - George Chandy
- Division of Cardiology, University of Ottawa Heart Institute and University of Ottawa.,Division of Respirology and Internal Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Duncan J Stewart
- Department of Cellular and Molecular Medicine and Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Division of Cardiology, University of Ottawa Heart Institute and University of Ottawa.,Sinclair Centre for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Mitesh Thakrar
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Doug Helmersen
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rhea Varughese
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Naushad Hirani
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fraz Umar
- Division of Cardiology, University of Ottawa Heart Institute and University of Ottawa
| | - Rosemary Dunne
- Division of Cardiology, University of Ottawa Heart Institute and University of Ottawa
| | - Caroyln Doyle-Cox
- Division of Cardiology, University of Ottawa Heart Institute and University of Ottawa
| | - Julia Foxall
- Division of Cardiology, University of Ottawa Heart Institute and University of Ottawa
| | - Lisa Mielniczuk
- Department of Cellular and Molecular Medicine and Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Division of Cardiology, University of Ottawa Heart Institute and University of Ottawa
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Li D, Weinkauf J, Kapasi A, Hirji A, Varughese R, Lien D, Nagendran J, Halloran K. Baseline lung allograft dysfunction in primary graft dysfunction survivors after lung transplantation. Respir Med 2021; 188:106617. [PMID: 34571454 DOI: 10.1016/j.rmed.2021.106617] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Primary graft dysfunction (PGD) after lung transplantation has previously been associated with increased risk of death and chronic lung allograft dysfunction (CLAD), but the relationship to baseline lung allograft dysfunction (BLAD), where graft function fails to normalize, is not known. METHODS We reviewed all double lung transplant recipients transplanted in our program 2004-2016. We defined PGD and CLAD as per recent consensus definitions and BLAD as failure to achieve both FEV1 and FVC ≥80% predicted on 2 consecutive tests ≥3 weeks apart. We used logistic and proportional hazards regression to test the association between severe high-grade PGD (PGD3) with BLAD and CLAD respectively, adjusting for known and identified confounders. RESULTS 446 patients met inclusion criteria and 76 (17%) developed PGD3 at 48- or 72-h post-transplant. PGD3 occurred more frequently in patients with interstitial lung disease or pulmonary vascular disease, those with higher BMIs and recipients of older donors. PGD3 was associated with more frequent (58% vs. 36%; p = 0.0008) and more severe BLAD (p < 0.0001) and increased BLAD risk in an adjusted model (OR 2.00 [95% CI 1.13-3.60]; p = 0.0182). PGD3 was not associated with CLAD frequency, severity or time to CLAD onset in an adjusted model (HR 1.10 (95% CI 0.64-1.78), p = 0.7226). CONCLUSION Severe PGD was associated with increased risk and severity of BLAD but not CLAD. The mechanisms via which PGD may mediate baseline function warrant further investigation.
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Affiliation(s)
- David Li
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, T6G 2G3, Canada
| | - Justin Weinkauf
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, T6G 2G3, Canada
| | - Ali Kapasi
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, T6G 2G3, Canada
| | - Alim Hirji
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, T6G 2G3, Canada
| | - Rhea Varughese
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, T6G 2G3, Canada
| | - Dale Lien
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, T6G 2G3, Canada
| | - Jayan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, T6G 2BY, Canada
| | - Kieran Halloran
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, T6G 2G3, Canada.
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Li D, Abele J, Weinkauf J, Kapasi A, Hirji A, Varughese R, Nagendran J, Lien D, Doucette K, Halloran K. Atelectasis in primary graft dysfunction survivors after lung transplantation. Clin Transplant 2021; 35:e14315. [PMID: 33848359 DOI: 10.1111/ctr.14315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/09/2021] [Accepted: 04/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Primary graft dysfunction (PGD) is an important contributor to early mortality in lung transplant recipients and is associated with impaired lung function. The radiographic sequelae of PGD on computed tomography (CT) have not been characterized. METHODS We studied adult double lung transplant recipients from 2010 to 2016 for whom protocol 3-month post-transplant CT scans were available. We assessed CTs for changes including pleural effusions, ground glass opacification, atelectasis, centrilobular nodularity, consolidation, interlobular septal thickening, air trapping and fibrosis, and their relationship to prior post-transplant PGD, future lung function, post-transplant baseline lung allograft dysfunction (BLAD), and chronic lung allograft dysfunction (CLAD). RESULTS Of 237 patients studied, 50 (21%) developed grade 3 PGD (PGD3) at 48 or 72 h. PGD3 was associated with increased interlobular septal thickening (p = .0389) and atelectasis (p = .0001) at 3 months, but only atelectasis remained associated after correction for multiple testing. Atelectasis severity was associated with lower peak forced expiratory volume in 1 s (FEV1) and increased risk of BLAD (p = .0014) but not with future CLAD onset (p = .7789). CONCLUSIONS Severe PGD was associated with atelectasis on 3-month post-transplant CT in our cohort. Atelectasis on routine CT may be an intermediary identifiable stage between PGD and future poor lung function.
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Affiliation(s)
- David Li
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jonathan Abele
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Justin Weinkauf
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ali Kapasi
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Alim Hirji
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Rhea Varughese
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jayan Nagendran
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Dale Lien
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karen Doucette
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kieran Halloran
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Gandhi V, Kapasi A, Weinkauf J, Lien D, Varughese R, Hirji A, Cervera C, Halloran K. Systemic Corticosteroids and Lung Function Recovery after Respiratory Viral Infection in Lung Transplant Recipients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Li D, Abele J, Sunner P, Kapasi A, Hirji A, Weinkauf J, Lien D, Varughese R, Nagendran J, Halloran K. Prognostic Implications of Abnormal Left-Right Lung Perfusion Differential on Routine Post-Transplant Ventilation-Perfusion Scans. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Hirji A, Mabilangan C, Halloran K, Duan Q, Lien D, Varughese R, Kapasi A, Weinkauf J, Pang X, Preiksaitis J. Torque Teno Virus Does Not Predict Cytomegalovirus Infection Post-Lung Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Li D, Abele J, Sunner P, Kapasi A, Varughese R, Hirji A, Weinkauf J, Nagendran J, Lien D, Halloran K. Prognostic Significance of Asymptomatic Pulmonary Embolism on Routine Ventilation-Perfusion Scans after Lung Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Grocholski S, Soong L, Verma L, Robbins M, Kabbani D, Varughese R, Hirji A, Halloran K, Kapasi A, Lien D, Weinkauf J. Rare Case of Neutrophilic Dermatosis in Lung Transplant Recipient. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.2059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sugarman J, Weatherald J, Thakrar M, Helmersen D, Hirani N, Varughese R, Liu J. PULMONARY ARTERIAL PULSATILITY INDEX AS A PREDICTOR OF MORTALITY IN PULMONARY ARTERIAL HYPERTENSION. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Li D, Duan Q, Weinkauf J, Kapasi A, Varughese R, Hirji A, Lien D, Meyer S, Laing B, Nagendran J, Halloran K. Azithromycin prophylaxis after lung transplantation is associated with improved overall survival. J Heart Lung Transplant 2020; 39:1426-1434. [PMID: 33041181 DOI: 10.1016/j.healun.2020.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/25/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Azithromycin prophylaxis (AP) in lung transplant recipients has been shown to reduce the composite end-point of death or chronic lung allograft dysfunction (CLAD) onset but without a clear effect on overall survival. Our program began using AP in 2010. We sought to evaluate the association between AP and survival and the risk of CLAD and baseline lung allograft dysfunction (BLAD). METHODS We studied double lung recipients transplanted between 2004 and 2016. We defined AP as chronic use of azithromycin initiated before CLAD onset. We analyzed the association between AP and death or retransplant using Cox regression with adjustment for potential confounders. We further used Cox and logistic models to assess the relationship between AP and post-transplant CLAD onset and BLAD, respectively. RESULTS A total of 445 patients were included, and 344 (77%) received AP (median time from transplant: 51 days). Patients receiving AP were more likely to receive induction with interleukin-2 receptor antagonists (57% vs 35%; p < 0.001). AP was associated with improved survival (hazard ratio [HR]: 0.59; 95% confidence interval [CI]: 0.42-0.82; p = 0.0020) in our fully adjusted model, with a reduced adjusted risk of BLAD (odds ratio: 0.53; 95% CI: 0.33-0.85; p = 0.0460) but no clear reduction in the adjusted risk of CLAD (HR: 0.69; 95% CI: 0.47-1.03; p = 0.0697). CONCLUSIONS AP is associated with improved survival after lung transplantation, potentially through improved baseline function. These findings build on prior trial results and suggest that AP is beneficial for lung transplant recipients.
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Affiliation(s)
- David Li
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Qiuli Duan
- Health Services Statistical & Analytical Methods, Alberta Health Services, Edmonton, Alberta, Canada
| | - Justin Weinkauf
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ali Kapasi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Rhea Varughese
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Alim Hirji
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Dale Lien
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Steven Meyer
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Bryce Laing
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jayan Nagendran
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Kieran Halloran
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Chohan K, Park J, Dales S, Varughese R, Wickerson L, Singer LG, Stewart B, Rozenberg D. Evaluation of Malnutrition Risk in Lung Transplant Candidates Using the Nutritional Risk Index. Transplant Direct 2020; 6:e574. [PMID: 32766429 PMCID: PMC7339342 DOI: 10.1097/txd.0000000000001028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Malnutrition in lung transplant (LTx) candidates is an important risk factor for adverse outcomes. We sought to evaluate the Nutritional Risk Index (NRI) in LTx candidates, a validated measure of malnutrition risk in chronic disease. We aimed to characterize malnutrition risk using NRI, evaluate change in body weight between nutritional risk groups, and assess association of malnutrition risk with pretransplant and posttransplant outcomes. METHODS Retrospective, single-center cohort study of LTx candidates (2014-2015) evaluated by a dietitian before listing. Nutritional parameters, weight change pretransplant and posttransplant, and clinical outcomes were abstracted up to 1-year posttransplant. NRI was calculated as follows: (1.519 × albumin) + (41.7 × current weight/ideal weight) with high malnutrition risk defined as the lowest quartile of NRI for cystic fibrosis (CF) and non-CF patients. RESULTS The cohort comprises 247 LTx candidates (57% male; median age 59 y; non-CF 88%). Non-CF candidates had a greater mean NRI compared with CF patients (109 ± 11 versus 95 ± 12; P < 0.0001). 86% with high malnutrition risk maintained/gained weight (≥5%) pretransplant. In 196 LTx recipients, malnutrition risk was not associated with hospital stay, discharge disposition, or 1-year mortality. The median percent weight gain for LTx recipients in the first year was 10.5% (4.0-20.1), with high malnutrition risk recipients having comparable or greater weight gain to the low-risk group (mean difference for non CF: 6.8%; P = 0.02 and CF: -3.8%; P = 0.65). CONCLUSIONS Malnutrition risk assessed with NRI was not prognostic of posttransplant outcomes in this retrospective cohort. LTx candidates with high malnutrition risk were able to maintain their weight pretransplant and demonstrated considerable weight gain in the first-year posttransplant.
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Affiliation(s)
- Karan Chohan
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jeff Park
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Dales
- Soham and Shaila Ajmera Family Transplant Centre, Nutrition, University Health Network, Toronto, ON, Canada
| | - Rhea Varughese
- Division of Pulmonary Medicine, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lisa Wickerson
- Toronto Lung Transplant Program, Soham and Shaila Ajmera Family Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Lianne G. Singer
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Lung Transplant Program, Soham and Shaila Ajmera Family Transplant Centre, University Health Network, Toronto, ON, Canada
- Department of Medicine, Division of Respirology, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada
| | - Brooke Stewart
- Soham and Shaila Ajmera Family Transplant Centre, Nutrition, University Health Network, Toronto, ON, Canada
| | - Dmitry Rozenberg
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Lung Transplant Program, Soham and Shaila Ajmera Family Transplant Centre, University Health Network, Toronto, ON, Canada
- Department of Medicine, Division of Respirology, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada
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Kularatne M, Weatherald J, Varughese R, Helmersen D, Hirani N, Chou J, Janovcik J, Livingston N, Petkau J, Lee M, Thakrar M. Validation of a Nurse Led Triage Algorithm for New Referrals in a Specialized Pulmonary Hypertension Clinic. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Vis D, Solverson K, Helmersen D, Weatherald J, Thakrar M, Varughese R, Shaw J, Braganza M, Hirani N, Rannelli L. Diagnostic Utility of the Physical Examination for Moderate and Severe Pulmonary Hypertension. Chest 2016. [DOI: 10.1016/j.chest.2016.08.1282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Varughese R, Bandaranayake G, Mathew A. Cut by a double edged sword: a self limiting companion to focal seizures. Assoc Med J 2015. [DOI: 10.1136/bmj.h1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Varughese R, Nayak JL, LoMonaco M, O'Reilly MA, Ryan RM, D'Angio CT. Effects of hyperoxia on tumor necrosis factor alpha and Grobeta expression in newborn rabbit lungs. Lung 2004; 181:335-46. [PMID: 14749938 DOI: 10.1007/s00408-003-1036-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2003] [Indexed: 11/28/2022]
Abstract
Chemokines have been implicated in the pathogenesis of many inflammatory processes, including bronchopulmonary dysplasia in mechanically ventilated premature infants. We hypothesized that early expression of the proinflammatory cytokine, tumor necrosis factor alpha (TNFalpha), would be followed by later expression of the downstream chemokine, Grobeta, in the oxygen-injured newborn lung. Reverse transcriptase-polymerase chain reaction (RT-PCR) and ribonuclease protection assay (RPA) were used to assess TNFalpha and Grobeta mRNA expression in lung RNA samples from newborn rabbits exposed to > 95% O2 for 8-9 days, followed by 60% O2 for a further 2-4 weeks or from control rabbits exposed to air. Four lung samples per condition were collected every 2 days from day 0 to day 14, and at days 22 and 36. Rabbit alveolar macrophages (AM) stimulated in vitro with bacterial lipopolysaccharide served as positive controls ( n = 8). Grobeta mRNA expression in rabbit lung samples increased with oxygen exposure until day 8, then returned toward baseline levels. This corresponded to previously described elevations in neutrophil number in the lungs. TNFalpha mRNA expression in lung samples was below the limit of detection by RPA and showed no upregulation in hyperoxic lung samples by RT-PCR. TNFalpha activity was assessed in lung lavage ( n = 2 samples per condition per time) using an L929 cell line bioassay and was not increased in hyperoxic animals. The expression of Grobeta mRNA without antecedent or concurrent TNFalpha mRNA expression or activity makes it unlikely that Grobeta in the hyperoxic newborn rabbit lung is elaborated in response to a stimulus by TNFalpha.
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Affiliation(s)
- R Varughese
- Department of Pediatrics, Strong Children's Research Center, University of Rochester, NY 14623, USA
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