Browsing by Author "Dhillon, Gundeep S."

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    Contemporary trends in PGD incidence, outcomes, and therapies
    (Elsevier, 2022) Cantu, Edward; Diamond, Joshua M.; Cevasco, Marisa; Suzuki, Yoshi; Crespo, Maria; Clausen, Emily; Dallara, Laura; Ramon, Christian V.; Harmon, Michael T.; Bermudez, Christian; Benvenuto, Luke; Anderson, Michaela; Wille, Keith M.; Weinacker, Ann; Dhillon, Gundeep S.; Orens, Jonathan; Shah, Pali; Merlo, Christian; Lama, Vibha; McDyer, John; Snyder, Laurie; Palmer, Scott; Hartwig, Matt; Hage, Chadi A.; Singer, Jonathan; Calfee, Carolyn; Kukreja, Jasleen; Greenland, John R.; Ware, Lorraine B.; Localio, Russel; Hsu, Jesse; Gallop, Robert; Christie, Jason D.; Medicine, School of Medicine
    Background: We sought to describe trends in extracorporeal membrane oxygenation (ECMO) use, and define the impact on PGD incidence and early mortality in lung transplantation. Methods: Patients were enrolled from August 2011 to June 2018 at 10 transplant centers in the multi-center Lung Transplant Outcomes Group prospective cohort study. PGD was defined as Grade 3 at 48 or 72 hours, based on the 2016 PGD ISHLT guidelines. Logistic regression and survival models were used to contrast between group effects for event (i.e., PGD and Death) and time-to-event (i.e., death, extubation, discharge) outcomes respectively. Both modeling frameworks accommodate the inclusion of potential confounders. Results: A total of 1,528 subjects were enrolled with a 25.7% incidence of PGD. Annual PGD incidence (14.3%-38.2%, p = .0002), median LAS (38.0-47.7 p = .009) and the use of ECMO salvage for PGD (5.7%-20.9%, p = .007) increased over the course of the study. PGD was associated with increased 1 year mortality (OR 1.7 [95% C.I. 1.2, 2.3], p = .0001). Bridging strategies were not associated with increased mortality compared to non-bridged patients (p = .66); however, salvage ECMO for PGD was significantly associated with increased mortality (OR 1.9 [1.3, 2.7], p = .0007). Restricted mean survival time comparison at 1-year demonstrated 84.1 days lost in venoarterial salvaged recipients with PGD when compared to those without PGD (ratio 1.3 [1.1, 1.5]) and 27.2 days for venovenous with PGD (ratio 1.1 [1.0, 1.4]). Conclusions: PGD incidence continues to rise in modern transplant practice paralleled by significant increases in recipient severity of illness. Bridging strategies have increased but did not affect PGD incidence or mortality. PGD remains highly associated with mortality and is increasingly treated with salvage ECMO.
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    The Impact of Donor Smoking on Primary Graft Dysfunction and Mortality after Lung Transplantation
    (American Thoracic Society, 2024) Diamond, Joshua M.; Cantu, Edward; Calfee, Carolyn S.; Anderson, Michaela R.; Clausen, Emily S.; Shashaty, Michael G. S.; Courtwright, Andrew M.; Kalman, Laurel; Oyster, Michelle; Crespo, Maria M.; Bermudez, Christian A.; Benvenuto, Luke; Palmer, Scott M.; Snyder, Laurie D.; Hartwig, Matthew G.; Todd, Jamie L.; Wille, Keith; Hage, Chadi; McDyer, John F.; Merlo, Christian A.; Shah, Pali D.; Orens, Jonathan B.; Dhillon, Gundeep S.; Weinacker, Ann B.; Lama, Vibha N.; Patel, Mrunal G.; Singer, Jonathan P.; Hsu, Jesse; Localio, A. Russell; Christie, Jason D.; Medicine, School of Medicine
    Rationale: Primary graft dysfunction (PGD) is the leading cause of early morbidity and mortality after lung transplantation. Prior studies implicated proxy-defined donor smoking as a risk factor for PGD and mortality. Objectives: We aimed to more accurately assess the impact of donor smoke exposure on PGD and mortality using quantitative smoke exposure biomarkers. Methods: We performed a multicenter prospective cohort study of lung transplant recipients enrolled in the Lung Transplant Outcomes Group cohort between 2012 and 2018. PGD was defined as grade 3 at 48 or 72 hours after lung reperfusion. Donor smoking was defined using accepted thresholds of urinary biomarkers of nicotine exposure (cotinine) and tobacco-specific nitrosamine (4-[methylnitrosamino]-1-[3-pyridyl]-1-butanol [NNAL]) in addition to clinical history. The donor smoking–PGD association was assessed using logistic regression, and survival analysis was performed using inverse probability of exposure weighting according to smoking category. Measurements and Main Results: Active donor smoking prevalence varied by definition, with 34–43% based on urinary cotinine, 28% by urinary NNAL, and 37% by clinical documentation. The standardized risk of PGD associated with active donor smoking was higher across all definitions, with an absolute risk increase of 11.5% (95% confidence interval [CI], 3.8% to 19.2%) by urinary cotinine, 5.7% (95% CI, −3.4% to 14.9%) by urinary NNAL, and 6.5% (95% CI, −2.8% to 15.8%) defined clinically. Donor smoking was not associated with differential post–lung transplant survival using any definition. Conclusions: Donor smoking associates with a modest increase in PGD risk but not with increased recipient mortality. Use of lungs from smokers is likely safe and may increase lung donor availability.