Browsing by Author "Wille, Keith M."

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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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    Risk of Primary Graft Dysfunction Following Lung Transplantation in Selected Adults with Connective Tissue Disease-associated Interstitial Lung Disease
    (Elsevier, 2021) Natalini, Jake G.; Diamond, Joshua M.; Porteous, Mary K.; Lederer, David J.; Wille, Keith M.; Weinacker, Ann B.; Orens, Jonathan B.; Shah, Pali D.; Lama, Vibha N.; McDyer, John F.; Snyder, Laurie D.; Hage, Chadi A.; Singer, Jonathan P.; Ware, Lorraine B.; Cantu, Edward; Oyster, Michelle; Kalman, Laurel; Christie, Jason D.; Kawut, Steven M.; Bernstein, Elana J.; Medicine, School of Medicine
    Background: Previous studies have reported similarities in long-term outcomes following lung transplantation for connective tissue disease-associated interstitial lung disease (CTD-ILD) and idiopathic pulmonary fibrosis (IPF). However, it is unknown whether CTD-ILD patients are at increased risk of primary graft dysfunction (PGD), delays in extubation, or longer index hospitalizations following transplant compared to IPF patients. Methods: We performed a multicenter retrospective cohort study of CTD-ILD and IPF patients enrolled in the Lung Transplant Outcomes Group registry who underwent lung transplantation between 2012 and 2018. We utilized mixed effects logistic regression and stratified Cox proportional hazards regression to determine whether CTD-ILD was independently associated with increased risk for grade 3 PGD or delays in post-transplant extubation and hospital discharge compared to IPF. Results: A total of 32.7% (33/101) of patients with CTD-ILD and 28.9% (145/501) of patients with IPF developed grade 3 PGD 48-72 hours after transplant. There were no significant differences in odds of grade 3 PGD among patients with CTD-ILD compared to those with IPF (adjusted OR 1.12, 95% CI 0.64-1.97, p = 0.69), nor was CTD-ILD independently associated with a longer post-transplant time to extubation (adjusted HR for first extubation 0.87, 95% CI 0.66-1.13, p = 0.30). However, CTD-ILD was independently associated with a longer post-transplant hospital length of stay (median 23 days [IQR 14-35 days] vs17 days [IQR 12-28 days], adjusted HR for hospital discharge 0.68, 95% CI 0.51-0.90, p = 0.008). Conclusion: Patients with CTD-ILD experienced significantly longer postoperative hospitalizations compared to IPF patients without an increased risk of grade 3 PGD.