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Article ; Online: High-dose Mycophenolate Use at Vaccination Is Independently Associated With Breakthrough COVID-19 Among Lung Transplant Patients.

Joerns, John / Bollineni, Srinivas / Mahan, Luke D / Mohanka, Manish R / Lawrence, Adrian / Timofte, Irina / Torres, Fernando / La Hoz, Ricardo M / Zhang, Song / Kershaw, Corey D / Kaza, Vaidehi / Terada, Lance S / Banga, Amit

Transplantation

2022 Volume 106, Issue 5, Page(s) e271–e274

MeSH term(s)	COVID-19/prevention & control ; Humans ; Immunosuppressive Agents/adverse effects ; Lung Transplantation/adverse effects ; SARS-CoV-2 ; Vaccination
Chemical Substances	Immunosuppressive Agents
Language	English
Publishing date	2022-03-01
Publishing country	United States
Document type	Letter
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000004089
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Zs.A 488: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: A Case Report of Breakthrough Infections With 2 SARS-CoV-2 Variants in a Lung Transplant Patient.

Mahan, Luke D / Mohanka, Manish R / Joerns, John / Lawrence, Adrian / Bollineni, Srinivas / Kaza, Vaidehi / Timofte, Irina / La Hoz, Ricardo M / Sorelle, Jeffrey / Terada, Lance S / Kershaw, Corey D / Torres, Fernando / Banga, Amit

Transplantation proceedings

2022

Abstract: A lung transplant (LT) patient developed 2 distinct episodes of COVID-19, confirmed by whole-genome sequencing, which was caused by the Delta, and then followed 6 weeks later, by the Omicron variant. The clinical course with Omicron was more severe, ... ...

Abstract	A lung transplant (LT) patient developed 2 distinct episodes of COVID-19, confirmed by whole-genome sequencing, which was caused by the Delta, and then followed 6 weeks later, by the Omicron variant. The clinical course with Omicron was more severe, leading us to speculate that Omicron may not be any milder among LT patients. We discuss the potential mechanisms behind the Omicron not being any milder among LT patients and emphasize the need for outcomes data among these patients. Until such data become available, it may be prudent to maintain clinical equipoise as regards the relative virulence of the newer variants among LT patients.
Language	English
Publishing date	2022-07-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2022.07.003
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Article ; Online: Diaphragmatic plication among lung transplant patients: A single-center experience.

Lawrence, Adrian / Lovin, Dylan / Mohanka, Manish R / Joerns, John / Bollineni, Srinivas / Kaza, Vaidehi / Torres, Fernando / Murala, John / Peltz, Matthias / Wait, Michael A / Banga, Amit

Clinical transplantation

2022 Volume 36, Issue 7, Page(s) e14683

Abstract: Background: There is lack of data reporting outcomes among patients needing diaphragmatic plication (DP) during or after lung transplantation (LT). We sought to assess the association of DP with post-transplant spirometry among other outcomes.: ... ...

Abstract	Background: There is lack of data reporting outcomes among patients needing diaphragmatic plication (DP) during or after lung transplantation (LT). We sought to assess the association of DP with post-transplant spirometry among other outcomes. Methods: We included all patients who underwent LT between 2012 and 2016 (n = 324, mean age 56.3±13.4 years; M:F 198:126). We compared early and late outcomes based on the need for DP. Results: The frequency of diaphragmatic dysfunction (DD) on pre-transplant fluoroscopy was 52.2%. A total of 38 DP procedures were performed among 37 patients (11.4% of LT patients). DP was done for anatomic (sizing or spacing issues) or functional indications (symptomatic DD). While patients with DP had significantly lower spirometry throughout the 3-year follow-up period, their slope of decline, functional assessments at the first annual visit, the risk of CLAD, and mortality were similar to patients without DP. A sub-group analysis limited to patients with restrictive lung diseases as the transplant indication had similar findings. Conclusions: Pre-transplant DD is common among LT candidates although it did not predict the need for DP. DP may be performed for functional or anatomic indications especially for addressing the donor-recipient size mismatch. Despite the lack of favorable effect on post-transplant spirometry, patients undergoing DP have acceptable and comparable early and late outcomes.
MeSH term(s)	Adult ; Aged ; Diaphragm ; Humans ; Lung Transplantation ; Middle Aged ; Respiratory Paralysis ; Retrospective Studies
Language	English
Publishing date	2022-05-03
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.14683
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Zs.A 2204: Show issues

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Article ; Online: Characteristics and outcomes among vaccinated lung transplant patients with breakthrough COVID-19.

Bollineni, Srinivas / Mahan, Luke D / Duncan, Patrick / Mohanka, Manish R / Lawrence, Adrian / Joerns, John / Timofte, Irina / Torres, Fernando / La Hoz, Ricardo M / Kershaw, Corey D / Terada, Lance S / Kaza, Vaidehi / Banga, Amit

Transplant infectious disease : an official journal of the Transplantation Society

2022 Volume 24, Issue 2, Page(s) e13784

Abstract: Background: Despite multiple studies evaluating the immunological responsiveness to vaccines, the clinical effectiveness of the two-dose mRNA vaccine schedule among lung transplant (LT) patients has not been evaluated.: Methods: We included LT ... ...

Abstract	Background: Despite multiple studies evaluating the immunological responsiveness to vaccines, the clinical effectiveness of the two-dose mRNA vaccine schedule among lung transplant (LT) patients has not been evaluated. Methods: We included LT patients who tested positive for SARS-CoV-2 on a nasopharyngeal swab between March 1, 2020, and August 25, 2021 (n = 70). The study group was divided based on their vaccination status. Results: During the study period, 14 fully vaccinated LT patients with one of the mRNA vaccines tested positive for COVID-19 (median age 54, range 30-62 years, M:F 9:5). The vaccinated cohort was younger with bilateral LT, have suppurative conditions as the transplant indication, and present with milder symptoms. However, pulmonary parenchymal involvement was seen among all 12 patients where computed tomography (CT) of chest was available. The laboratory profile indicated a more subdued inflammatory response among the vaccinated group. A lower proportion of vaccinated patients developed respiratory failure, needed ICU admission or ventilator support, although none of the differences achieved statistical significance. None of the vaccinated patients succumbed to COVID-19 during the study period, while the 4-week mortality among unvaccinated patients was nearly 15% (8/56). Conclusions: In this cohort of vaccinated LT patients who developed breakthrough COVID-19, the clinical course, risk of complications, and outcomes trended better than unvaccinated patients. However, universal involvement of the allograft demonstrates the continued vulnerability of these patients to significant sequelae from COVID-19. Future studies may evaluate the incremental protection of vaccination after the completion of the third dose of mRNA vaccines among LT patients.
MeSH term(s)	Adult ; COVID-19/prevention & control ; Humans ; Lung Transplantation/adverse effects ; Middle Aged ; SARS-CoV-2 ; Vaccination ; Vaccines, Synthetic ; mRNA Vaccines
Chemical Substances	Vaccines, Synthetic ; mRNA Vaccines
Language	English
Publishing date	2022-01-19
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	1476094-0
ISSN	1399-3062 ; 1398-2273
ISSN (online)	1399-3062
ISSN	1398-2273
DOI	10.1111/tid.13784
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Article ; Online: ECMO Long Haulers: A Distinct Phenotype of COVID-19-Associated ARDS With Implications for Lung Transplant Candidacy.

Mohanka, Manish R / Joerns, John / Lawrence, Adrian / Bollineni, Srinivas / Kaza, Vaidehi / Cheruku, Sreekanth / Leveno, Matthew / Chen, Catherine / Terada, Lance S / Kershaw, Corey D / Torres, Fernando / Peltz, Matthias / Wait, Michael A / Hackmann, Amy E / Banga, Amit

Transplantation

2022 Volume 106, Issue 4, Page(s) e202–e211

Abstract: ... between March 1, 2020, and September 15, 2021 (n = 20; median age, 44 y; range, 22-62 y; male:female, 15:5 ...

Abstract	Background: Studies indicate that the recovery from coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome may be slower than other viral pneumonia. There are limited data to guide decisions among patients who need extracorporeal membrane oxygenation (ECMO) support, especially the expected time of recovery and considering lung transplantation (LT). Methods: This was a retrospective chart review of patients with COVID-19-associated acute respiratory distress syndrome placed on ECMO between March 1, 2020, and September 15, 2021 (n = 20; median age, 44 y; range, 22-62 y; male:female, 15:5). We contrasted the baseline variables and clinical course of patients with and without the need for ECMO support >30 d (ECMO long haulers, n = 10). Results: Ten patients met the criteria for ECMO long haulers (median duration of ECMO, 86 d; range, 42-201 d). The long haulers were healthier at baseline with fewer comorbidities but had worse pulmonary compliance and higher partial pressure of CO2. They had a significantly higher number of membrane oxygenator failures, changes to their cannulation sites, and suffer more complications on ECMO. One of the long hauler was bridged to LT while another 6 patients recovered and were discharged. Overall survival was better among the ECMO long haulers (70% versus 20%; 9.3, 1.2-73; P = 0.03). Conclusions: Despite worse pulmonary physiology, frequent complications, and a tortuous hospital course that may appear to portend a poor prognosis, ECMO long haulers have the potential to recover and be weaned off ECMO without the need for LT. A customized approach comprising a more conservative timeline for the consideration of LT may be prudent among these patients.
MeSH term(s)	Adult ; COVID-19/complications ; Extracorporeal Membrane Oxygenation/adverse effects ; Female ; Humans ; Lung Transplantation ; Male ; Middle Aged ; Phenotype ; Respiratory Distress Syndrome/etiology ; Respiratory Distress Syndrome/therapy ; Retrospective Studies ; Young Adult
Language	English
Publishing date	2022-01-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000004052
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Zs.A 488: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: COVID-19 Vaccination is Associated With Favorable Outcomes Among Lung Transplant Patients With Breakthrough Infections.

Bollineni, Srinivas / Mahan, Luke D / Lawrence, Adrian / Joerns, John / Timofte, Irina / Torres, Fernando / Kaza, Vaidehi / La Hoz, Ricardo M / SoRelle, Jeffrey A / Kershaw, Corey D / Terada, Lance S / Zhang, Song / Mohanka, Manish R / Banga, Amit

Transplantation proceedings

2022 Volume 54, Issue 6, Page(s) 1517–1523

Abstract: ... 2020, and December 10, 2021 (n = 84; median age 55, range, 20-73 years; males 65.5%). The study group ...

Abstract	Background: There are limited data regarding the clinical efficacy of COVID-19 vaccines among lung transplant (LT) patients. Methods: We included all LT patients diagnosed with COVID-19 between March 1, 2020, and December 10, 2021 (n = 84; median age 55, range, 20-73 years; males 65.5%). The study group was divided into 3 groups based on the vaccination status (patients who did not complete the primary series for any of the vaccines: n = 58; those with 2 doses of messenger RNA (mRNA) or 1 dose of the adenoviral vector vaccine, vaccinated group: n = 16; those with at least 1 additional dose beyond the primary series, boosted group: n = 10). Results: Pulmonary parenchymal involvement on chest computed tomography scan was less common among the boosted group (P = .009). The proportion of patients with new or worsening respiratory failure was significantly lower among the vaccinated and boosted groups and these patients were significantly more likely to achieve the composite endpoint of oxygen-dependence free survival (P = .02). On multivariate logistic regression analysis, higher body mass index, restrictive lung disease as the transplant indication, and preinfection chronic lung allograft dysfunction were independently associated with acute or acute on chronic respiratory failure while being on therapeutic dose anticoagulation and having received the booster dose had a protective effect. Conclusion: COVID-19 vaccines appear to have several favorable effects among LT patients with breakthrough infections including lower likelihood of allograft involvement on imaging (among boosted patients), need of hospitalization, and complications such as new or worsening respiratory failure.
MeSH term(s)	Anticoagulants ; COVID-19/prevention & control ; COVID-19 Vaccines/adverse effects ; Humans ; Lung Transplantation ; Male ; Middle Aged ; Oxygen ; RNA, Messenger ; Respiratory Insufficiency ; Vaccination
Chemical Substances	Anticoagulants ; COVID-19 Vaccines ; RNA, Messenger ; Oxygen (S88TT14065)
Language	English
Publishing date	2022-06-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2022.05.030
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Article ; Online: Predictors and outcomes of respiratory failure among lung transplant patients with COVID-19.

Lawrence, Adrian / Mahan, Luke D / Mohanka, Manish R / Bollineni, Srinivas / Kaza, Vaidehi / La Hoz, Ricardo M / Zhang, Song / Kershaw, Corey D / Terada, Lance S / Torres, Fernando / Banga, Amit

Clinical transplantation

2021 Volume 36, Issue 3, Page(s) e14540

Abstract: Background: There is limited data on the predictors and outcomes of new or worsening respiratory failure among lung transplant (LT) patients with Coronavirus disease 2019 (COVID-19).: Methods: We included all the LT patients diagnosed with COVID-19 ... ...

Abstract	Background: There is limited data on the predictors and outcomes of new or worsening respiratory failure among lung transplant (LT) patients with Coronavirus disease 2019 (COVID-19). Methods: We included all the LT patients diagnosed with COVID-19 during a 1-year period (March 2020 to February 2021; n = 54; median age: 60, 20-73 years; M:F 37:17). Development of new or worsening respiratory failure (ARF) was the primary outcome variable. Results: The overall incidence of ARF was 48.1% (n = 26). More than 20% of patients (n = 11) needed intubation and mechanical ventilation. Body mass index > 25 Kg/m Conclusions: COVID-19 is associated with significant morbidity and mortality among LT patients. Patients on chronic anticoagulation seem to enjoy favorable outcomes, while higher BMI and peak D-dimer levels are associated with development of ARF. Pre-infection CLAD is associated with an increased risk of death from COVID-19.
MeSH term(s)	COVID-19/epidemiology ; Humans ; Lung Transplantation/adverse effects ; Respiration, Artificial ; Respiratory Insufficiency/etiology ; SARS-CoV-2
Language	English
Publishing date	2021-12-05
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.14540
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Article ; Online: Characteristics and outcomes among lung transplant patients with respiratory syncytial virus infection.

Mahan, Luke D / Points, April / Mohanka, Manish R / Bollineni, Srinivas / Joerns, John / Kaza, Vaidehi / La Hoz, Ricardo M / Gao, Ang / Zhang, Song / Torres, Fernando / Banga, Amit

Transplant infectious disease : an official journal of the Transplantation Society

2021 Volume 23, Issue 4, Page(s) e13661

Abstract: Background: To describe characteristics and outcomes among lung transplantation (LT) patients with respiratory syncytial virus (RSV) infection and elucidate the predictors of 1-year survival after RSV infection.: Methods: This was a retrospective ... ...

Abstract	Background: To describe characteristics and outcomes among lung transplantation (LT) patients with respiratory syncytial virus (RSV) infection and elucidate the predictors of 1-year survival after RSV infection. Methods: This was a retrospective chart review study among LT patients with RSV infection between 2013 and 2018 (90 episodes among 87 patients; mean age 56.3 ± 13.1 years, M:F 52:35). A contemporaneous control group consisting of LT patients without RSV infection (n = 183) was included. One-year survival after the RSV infection was the primary endpoint. Results: Median time from LT to RSV infection was 30 (1-155) months. Before RSV infection, the median decline in forced vital capacity (FVC) was 9.7 cc (-17.8 to 83 cc) or 0.29% (-1.4% to 4.6%) per month, while the forced expiratory volume (FEV Conclusions: A majority of LT patients in the current cohort did not experience an alteration in the trajectory of FVC or FEV
MeSH term(s)	Adult ; Aged ; Cohort Studies ; Humans ; Lung ; Lung Transplantation/adverse effects ; Middle Aged ; Respiratory Syncytial Virus Infections ; Retrospective Studies
Language	English
Publishing date	2021-06-22
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	1476094-0
ISSN	1399-3062 ; 1398-2273
ISSN (online)	1399-3062
ISSN	1398-2273
DOI	10.1111/tid.13661
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Article ; Online: Clinical characteristics, management practices, and outcomes among lung transplant patients with COVID-19.

Mohanka, Manish R / Mahan, Luke D / Joerns, John / Lawrence, Adrian / Bollineni, Srinivas / Kaza, Vaidehi / La Hoz, Ricardo M / Kershaw, Corey D / Terada, Lance S / Torres, Fernando / Banga, Amit

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

2021 Volume 40, Issue 9, Page(s) 936–947

Abstract: Background: There are limited data on management strategies and outcomes among lung transplant (LT) patients with Coronavirus disease 2019 (COVID-19). We implemented management protocols based on the best available evidence and consensus among ... ...

Abstract	Background: There are limited data on management strategies and outcomes among lung transplant (LT) patients with Coronavirus disease 2019 (COVID-19). We implemented management protocols based on the best available evidence and consensus among multidisciplinary teams. The current study reports our experience and outcomes using this protocol-based management strategy. Methods: We included single or bilateral LT patients who tested positive for SARS-CoV-2 on nasopharyngeal swab between March 1, 2020, to December 15, 2020 (n = 25; median age: 60, range 20-73 years; M: F 17:8). A group of patients with Respiratory Syncytial Virus (RSV) infection during 2016-18 were included to serve as a comparator group (n = 36). Results: As compared to RSV, patients with COVID-19 were more likely to present with constitutional symptoms, spirometric decline, pulmonary opacities, new or worsening respiratory failure, and need for ventilator support. Patients with SARS-CoV-2 infection were less likely to receive a multimodality treatment strategy, and they experienced worse post-infection lung function loss, functional decline, and three-month survival. A significant proportion of patients with COVID-19 needed readmission for worsening allograft function (36.4%), and chronic kidney disease at initial presentation was associated with this complication. Lower pre-morbid FEV Conclusions: Despite similar demographic characteristics and predispositions, LT patients with COVID-19 are sicker and experience worse outcomes as compared to RSV. Despite the availability of newer therapeutic agents, COVID-19 continues to be associated with significant morbidity and mortality.
MeSH term(s)	Adult ; Aged ; COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19/therapy ; Case-Control Studies ; Clinical Protocols ; Female ; Hospitalization ; Humans ; Lung Diseases/mortality ; Lung Diseases/surgery ; Lung Diseases/virology ; Lung Transplantation ; Male ; Middle Aged ; Recovery of Function ; Respiration, Artificial ; Respiratory Insufficiency/mortality ; Respiratory Insufficiency/therapy ; Respiratory Insufficiency/virology ; Spirometry ; Survival Rate ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2021-05-18
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1062522-7
ISSN	1557-3117 ; 1053-2498
ISSN (online)	1557-3117
ISSN	1053-2498
DOI	10.1016/j.healun.2021.05.003
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Article ; Online: Post-infection pulmonary sequelae after COVID-19 among patients with lung transplantation.

Mahan, Luke D / Lill, Isaac / Halverson, Quinn / Mohanka, Manish R / Lawrence, Adrian / Joerns, John / Bollineni, Srinivas / Kaza, Vaidehi / La Hoz, Ricardo M / Zhang, Song / Kershaw, Corey D / Terada, Lance S / Torres, Fernando / Banga, Amit

Transplant infectious disease : an official journal of the Transplantation Society

2021 Volume 23, Issue 6, Page(s) e13739

Abstract: Background: There is limited data on outcomes among lung transplant (LT) patients who survive Coronavirus disease 2019 (COVID-19).: Methods: Any single or bilateral LT patients who tested positive for SARS-CoV-2 between March 1, 2020, to February 15, ...

Abstract	Background: There is limited data on outcomes among lung transplant (LT) patients who survive Coronavirus disease 2019 (COVID-19). Methods: Any single or bilateral LT patients who tested positive for SARS-CoV-2 between March 1, 2020, to February 15, 2021 (n = 54) and survived the acute illness were included (final n = 44). Each patient completed at least 3 months of follow-up (median: 4.5; range 3-12 months) after their index hospitalization for COVID-19. The primary endpoint was a significant loss of lung functions (defined as > 10% decline in forced vital capacity (FVC) or forced expiratory volume in 1 s (FEV Results: A majority of the COVID-19 survivors had persistent parenchymal opacities (n = 29, 65.9%) on post-infection CT chest. Patients had significantly impaired functional status, with the majority reporting residual disabilities (Karnofsky performance scale score of 70% or worse; n = 32, 72.7%). A significant loss of lung function was observed among 18 patients (40.9%). Three patients met the criteria for new chronic lung allograft dysfunction (CLAD) following COVID-19 (5.6%), with all three demonstrating restrictive allograft syndrome phenotype. An absolute lymphocyte count < 0.6 × 10 Conclusions: A significant proportion of COVID-19 survivors suffer persistent allograft injury. Low absolute lymphocyte counts (ALC) and elevated ferritin levels at the conclusion of the hospital course may provide useful prognostic information and form the basis of a customized strategy for ongoing monitoring and management of allograft dysfunction. Tweet: Twitter handle: @AmitBangaMD Lung transplant patients who survive COVID-19 suffer significant morbidity with persistent pulmonary opacities, loss of lung functions, and functional deficits. Residual elevation of the inflammatory markers is predictive.
MeSH term(s)	COVID-19 ; Follow-Up Studies ; Humans ; Lung/diagnostic imaging ; Lung Transplantation/adverse effects ; Retrospective Studies ; SARS-CoV-2
Language	English
Publishing date	2021-10-17
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	1476094-0
ISSN	1399-3062 ; 1398-2273
ISSN (online)	1399-3062
ISSN	1398-2273
DOI	10.1111/tid.13739
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