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Article ; Online: Lung transplantation for COVID-19 associated ARDS: patience is a virtue.

Banga, Amit

2022 Volume 16, Issue 5, Page(s) 495–498

MeSH term(s)	COVID-19 ; Humans ; Lung Transplantation ; Respiratory Distress Syndrome/therapy ; SARS-CoV-2 ; Virtues
Language	English
Publishing date	2022-06-06
Publishing country	England
Document type	Editorial
ZDB-ID	2479146-5
ISSN	1747-6356 ; 1747-6348
ISSN (online)	1747-6356
ISSN	1747-6348
DOI	10.1080/17476348.2022.2084383
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Article ; Online: Alterations in Pulmonary Physiology with Lung Transplantation.

Mohanka, Manish / Banga, Amit

Comprehensive Physiology

2023 Volume 13, Issue 1, Page(s) 4269–4293

Abstract: Lung transplant is a treatment option for patients with end-stage lung diseases; however, survival outcomes continue to be inferior when compared to other solid organs. We review the several anatomic and physiologic changes that result from lung ... ...

Abstract	Lung transplant is a treatment option for patients with end-stage lung diseases; however, survival outcomes continue to be inferior when compared to other solid organs. We review the several anatomic and physiologic changes that result from lung transplantation surgery, and their role in the pathophysiology of common complications encountered by lung recipients. The loss of bronchial circulation into the allograft after transplant surgery results in ischemia-related changes in the bronchial artery territory of the allograft. We discuss the role of bronchopulmonary anastomosis in blood circulation in the allograft posttransplant. We review commonly encountered complications related to loss of bronchial circulation such as allograft airway ischemia, necrosis, anastomotic dehiscence, mucociliary dysfunction, and bronchial stenosis. Loss of dual circulation to the lung also increases the risk of pulmonary infarction with acute pulmonary embolism. The loss of lymphatic drainage during transplant surgery also impairs the management of allograft interstitial fluid, resulting in pulmonary edema and early pleural effusion. We discuss the role of lymphatic drainage in primary graft dysfunction. Besides, we review the association of late posttransplant pleural effusion with complications such as acute rejection. We then review the impact of loss of afferent and efferent innervation from the allograft on control of breathing, as well as lung protective reflexes. We conclude with discussion about pulmonary function testing, allograft monitoring with spirometry, and classification of chronic lung allograft dysfunction phenotypes based on total lung capacity measurements. We also review factors limiting physical exercise capacity after lung transplantation, especially impairment of muscle metabolism. © 2023 American Physiological Society. Compr Physiol 13:4269-4293, 2023.
MeSH term(s)	Humans ; Lung/metabolism ; Lung Transplantation/adverse effects ; Lung Transplantation/methods ; Bronchial Arteries ; Ischemia ; Pleural Effusion/etiology ; Pleural Effusion/metabolism
Language	English
Publishing date	2023-01-30
Publishing country	United States
Document type	Review ; Journal Article
ISSN	2040-4603
ISSN (online)	2040-4603
DOI	10.1002/cphy.c220008
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Article ; Online: Delayed-Onset Psychosis Secondary to Tacrolimus Neurotoxicity After Lung Transplant: A Case Report and Systematic Review.

Gunther, Matthew / Jiang, Shixie / Banga, Amit / Sher, Yelizaveta

Journal of the Academy of Consultation-Liaison Psychiatry

2023 Volume 64, Issue 6, Page(s) 550–561

Abstract: Background: Tacrolimus is the most common immunosuppressant used after transplant, yet it can result in moderate-to-severe neurotoxicity in up to 32% of patients. Signs of neurotoxicity can vary from mild (tremor or headache) to severe (posterior ... ...

Abstract	Background: Tacrolimus is the most common immunosuppressant used after transplant, yet it can result in moderate-to-severe neurotoxicity in up to 32% of patients. Signs of neurotoxicity can vary from mild (tremor or headache) to severe (posterior reversible encephalopathy syndrome or psychosis. Prompt recognition and management is needed to lead to symptom resolution. Objective: The objective of this study is to describe the clinical presentation of tacrolimus-induced psychosis, a type of tacrolimus-inducted neurotoxicity, and distinguish it from other central nervous system disturbances, including delirium. Methods and results: We present a case of delayed onset tacrolimus-induced psychosis with focus on unique clinical features and management strategies. We conducted a systematic review of cases of tacrolimus-induced psychosis using the PubMed database and included 15 manuscripts in our review. Conclusions: Tacrolimus-induced psychosis is a unique presentation of tacrolimus-related neurotoxicity and can present without the cardinal symptoms of delirium. The data on isolated psychotic symptoms are limited with current literature focusing on more common presentations of tacrolimus-induced neurotoxicity, such as delirium and tremor. Development of psychosis can occur later in the treatment course and at normal tacrolimus serum levels. It can improve with antipsychotic therapies, but primary management should include cross-titration to an alternate immunosuppressant regimen.
MeSH term(s)	Humans ; Tacrolimus/adverse effects ; Tremor/chemically induced ; Tremor/drug therapy ; Posterior Leukoencephalopathy Syndrome/chemically induced ; Posterior Leukoencephalopathy Syndrome/drug therapy ; Immunosuppressive Agents/adverse effects ; Psychotic Disorders/drug therapy ; Psychotic Disorders/etiology ; Neurotoxicity Syndromes/diagnosis ; Neurotoxicity Syndromes/etiology ; Neurotoxicity Syndromes/therapy ; Lung Transplantation ; Delirium/chemically induced ; Delirium/diagnosis ; Delirium/therapy
Chemical Substances	Tacrolimus (WM0HAQ4WNM) ; Immunosuppressive Agents
Language	English
Publishing date	2023-09-29
Publishing country	Netherlands
Document type	Case Reports ; Systematic Review ; Journal Article ; Review
ISSN	2667-2960
ISSN (online)	2667-2960
DOI	10.1016/j.jaclp.2023.09.002
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Article: Non-pulmonary complications after lung transplantation: part II.

Kanade, Rohan / Kler, Aditya / Banga, Amit

Indian journal of thoracic and cardiovascular surgery

2021 Volume 38, Issue Suppl 2, Page(s) 290–299

Abstract: Lung transplantation (LT) is a viable therapeutic option in the treatment of advanced lung disease. With improvements in post-transplant survival, complications involving different organ systems after LT are increasingly seen. While non-infectious, ... ...

Abstract	Lung transplantation (LT) is a viable therapeutic option in the treatment of advanced lung disease. With improvements in post-transplant survival, complications involving different organ systems after LT are increasingly seen. While non-infectious, extrapulmonary complications after LT are not frequently responsible for early post-transplant mortality, they significantly impact the quality of life and long-term survival. These complications are, therefore, becoming increasingly relevant as patients with LT are living longer. These complications encompass almost all organ systems and are driven by a combination of the pre-existing comorbidities, events, and complications around the operative procedure and recovery, and perhaps most importantly, medication side effects of the post-LT regimen. In the first of the two-part review, we covered the general approach to management of extrapulmonary complications and covered specific complications pertaining to cardiovascular, renal, neuropsychiatric, and ophthalmologic organ systems. In the current article, we discuss most relevant complications pertaining to the hematologic, endocrine, and gastrointestinal organ systems. In addition, we discuss two of the most common and consequential complications under the miscellaneous category, namely malignancy and venous thrombo-embolism after LT. These two complications have gained increasing significance in the lung allocation score era where progressively sicker and older patients are being transplanted.
Language	English
Publishing date	2021-10-12
Publishing country	India
Document type	Journal Article ; Review
ZDB-ID	2164386-6
ISSN	0973-7723 ; 0970-9134
ISSN (online)	0973-7723
ISSN	0970-9134
DOI	10.1007/s12055-021-01231-z
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Article: Non-pulmonary complications after lung transplantation: Part I.

Kanade, Rohan / Kler, Aditya / Banga, Amit

Indian journal of thoracic and cardiovascular surgery

2021 Volume 38, Issue Suppl 2, Page(s) 280–289

Abstract	Lung transplantation (LT) is a viable therapeutic option in the treatment of advanced lung disease. With improvements in post-transplant survival, complications involving different organ systems after LT are increasingly seen. While non-infectious, extrapulmonary complications after LT are not frequently responsible for early post-transplant mortality, they significantly impact the quality of life and long-term survival. These complications are, therefore, becoming increasingly relevant as patients with LT are living longer. These complications encompass almost all organ systems and are driven by a combination of the preexisting comorbidities, events, and complications around the operative procedure and recovery, and perhaps most importantly, medication side effects of the post-LT regimen. We will discuss the wide array of non-infectious extrapulmonary complications after LT in a two-part series of review articles. While we intend to discuss the relevant literature around these complications, there is little in terms of consensus documents to guide the management approach of these complications. We will, therefore, share our experience and learnings that have shaped the management protocols we have in place in an effort to prevent and treat such complications. The goal of the first part of this two-part review is to provide an overview of the most pertinent non-infectious extrapulmonary complications pertaining to cardiovascular, renal, neuropsychiatric and ophthalmologic organ systems.
Language	English
Publishing date	2021-10-08
Publishing country	India
Document type	Journal Article ; Review
ZDB-ID	2164386-6
ISSN	0973-7723 ; 0970-9134
ISSN (online)	0973-7723
ISSN	0970-9134
DOI	10.1007/s12055-021-01223-z
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Article: Insult to Injury: Development of Alveolar Hemorrhage after Initiation of Extracorporeal Membrane Oxygenation.

Williams, Sarah / Batra, Kiran / Mohanka, Manish / Bollineni, Srinivas / Kaza, Vaidehi / Torres, Fernando / Banga, Amit

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2021 Volume 24, Issue 12, Page(s) 1201–1205

Abstract: Background: Extracorporeal membrane oxygenation (ECMO) is associated with complications that are separate from the underlying diagnoses that require its use. One of the foremost complications of ECMO is a high incidence of bleeding, including alveolar ... ...

Abstract	Background: Extracorporeal membrane oxygenation (ECMO) is associated with complications that are separate from the underlying diagnoses that require its use. One of the foremost complications of ECMO is a high incidence of bleeding, including alveolar hemorrhage (AH), which is believed to be due to both prophylactic anticoagulation and critical illness-induced systemic coagulopathy. However, akin to systemic inflammatory response syndrome after cardiopulmonary bypass, ECMO causes widespread systemic inflammation and acute lung injury, which likely further predisposes patients to AH. The burden of clinically significant AH among patients on ECMO for advanced lung disease remains unknown. Patients and methods: Charts of patients with advanced lung disease who required ECMO at a single institution were reviewed. The clinical course and variables of patients who developed AH and those who did not were compared. Results: This report describes five patients who developed AH after initiation of venovenous ECMO for refractory hypoxemia. Clinical and laboratory variables did not predict the development or the prognosis of AH. Two of these patients with refractory hypoxemia and AH were treated with pulse-dose corticosteroids, with a dramatic response in one case. Conclusion: The acute decompensation of the patients and response to corticosteroids suggest AH was mediated by a systemic inflammatory process, as opposed to coagulopathy alone. Judicious use of steroids may be considered among select patients who develop AH without symptoms of systemic coagulopathy after initiation of ECMO. How to cite this article: Williams S, Batra K, Mohanka M, Bollineni S, Kaza V, Torres F,
Language	English
Publishing date	2021-01-14
Publishing country	India
Document type	Journal Article
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.5005/jp-journals-10071-23677
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Article ; Online: A Randomized, Multicenter, Blinded Pilot Study Assessing the Effects of Gaseous Nitric Oxide in an Ex Vivo System of Human Lungs.

Hartwig, Matthew G / Klapper, Jacob A / Poola, Nagaraju / Banga, Amit / Sanchez, Pablo G / Murala, John S / Potenziano, Jim L

Pulmonary therapy

2022 Volume 9, Issue 1, Page(s) 151–163

Abstract: Introduction: Normothermic ex vivo lung perfusion (EVLP) is used to evaluate and condition donor lungs for transplantation. The objective of this study was to determine whether administration of exogenous nitric oxide during EVLP contributes to ... ...

Abstract	Introduction: Normothermic ex vivo lung perfusion (EVLP) is used to evaluate and condition donor lungs for transplantation. The objective of this study was to determine whether administration of exogenous nitric oxide during EVLP contributes to improvement of lung health. Methods: A multicenter, blinded, two-arm, randomized pilot study evaluated the effect of gaseous nitric oxide (gNO) administered during EVLP on donor lungs rejected for transplantation. gNO introduced into the perfusate at 80 parts per million (ppm) was compared with perfusate alone (P). An open-label substudy assessed inhaled nitric oxide gas (iNO) delivered into the lungs at 20 ppm via a ventilator. Primary endpoints were an aggregate score of lung physiology indicators and total duration of stable EVLP time. Secondary endpoints included assessments of lung weight and left atrium partial pressure of oxygen (LAPO Results: Twenty bilateral donor lungs (blinded study, n = 16; open-label substudy, n = 4) from three centers were enrolled. Median (min, max) total EVLP times for the gNO, P, and iNO groups were 12.4 (8.6, 12.6), 10.6 (6.0, 12.4), and 12.4 (8.7, 13.0) hours, respectively. In the blinded study, median aggregate scores were higher in the gNO group compared to the P group at most time points, suggesting better lung health with gNO (median score range [min, max], 0-3.5 [0, 7]) vs. P (0-2.0 [0, 5] at end of study). In the substudy, median aggregate scores did not improve for lungs in the iNO group. However, both the gNO and iNO groups showed improvements in lung weight and LAPO Conclusions: The data suggest that inclusion of gNO during EVLP may potentially prolong duration of organ stability and improve donor lung health, which warrants further investigation.
Language	English
Publishing date	2022-12-13
Publishing country	United States
Document type	Journal Article
ISSN	2364-1746
ISSN (online)	2364-1746
DOI	10.1007/s41030-022-00209-5
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Article ; Online: Crossroads between Autoimmunity and COVID-19 in Lung Transplant Recipients.

Narasimhan, Madhusudhanan / Muthukumar, Alagarraju / Sataranatarajan, Kavithalakshmi / Mahimainathan, Lenin / Mahan, Luke / Timofte, Irina / Bollineni, Srinivas / Joerns, John / Zhang, Song / Gorman, April / Banga, Amit / Mohanka, Manish / Torres, Fernando / Lawrence, Adrian / Thalachallour, Mohanakumar / Kaza, Vaidehi

Viruses

2023 Volume 15, Issue 10

Abstract: The presence of a certain group of auto-antibodies (AAbs) is known to correlate with the severity of COVID-19. It is, however, unknown if such AAbs are prevalent and impact COVID-19-related outcomes in lung transplant recipients (LTRs) who are ... ...

Abstract	The presence of a certain group of auto-antibodies (AAbs) is known to correlate with the severity of COVID-19. It is, however, unknown if such AAbs are prevalent and impact COVID-19-related outcomes in lung transplant recipients (LTRs) who are immunosuppressed. We performed a retrospective study of LTRs with COVID-19 and analyzed samples before and after COVID-19 for IgG AAbs. AAbs analysis was carried out using autoimmune and coronavirus microarray and the resulting cross-sectional differences in Ab-scores and clinical variables were analyzed using Fischer's Exact test for categorical variables and a paired
MeSH term(s)	Humans ; COVID-19 ; Autoimmunity ; Retrospective Studies ; Transplant Recipients ; Cross-Sectional Studies ; Immunoglobulin G ; Lung
Chemical Substances	Immunoglobulin G
Language	English
Publishing date	2023-10-03
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2516098-9
ISSN	1999-4915 ; 1999-4915
ISSN (online)	1999-4915
ISSN	1999-4915
DOI	10.3390/v15102045
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Article ; Online: Ventilation perfusion pulmonary scintigraphy in the evaluation of pre-and post-lung transplant patients.

Pinho, Daniella F / Banga, Amit / Torres, Fernando / Mathews, Dana

Transplantation reviews (Orlando, Fla.)

2018 Volume 33, Issue 2, Page(s) 107–114

Abstract: Lung transplantation is an established treatment for patients with a variety of advanced lung diseases. Imaging studies play a valuable role not only in evaluation of patients prior to lung transplantation, but also in the follow up of patients after ... ...

Abstract	Lung transplantation is an established treatment for patients with a variety of advanced lung diseases. Imaging studies play a valuable role not only in evaluation of patients prior to lung transplantation, but also in the follow up of patients after transplantation for detection of complications. After lung transplantation, complications can occur as a result of surgical procedure, pulmonary embolism and ultimately chronic lung allograft dysfunction. Lung scintigraphy, which includes physiologic assessment of lung ventilation and perfusion by imaging, has become an important procedure in the evaluation of these patients, assuming a complementary role to high resolution anatomic imaging (computed tomography [CT]), as well as spirometry. The purpose of this atlas article is to demonstrate the uses of ventilation perfusion scintigraphy in the pre-transplantation setting for surgical planning and in the evaluation of complications post-lung transplantation based upon experience at our institution.
MeSH term(s)	Female ; Humans ; Lung Diseases/diagnostic imaging ; Lung Diseases/pathology ; Lung Diseases/surgery ; Lung Transplantation/adverse effects ; Lung Transplantation/methods ; Male ; Patient Safety ; Postoperative Care/methods ; Postoperative Complications/diagnostic imaging ; Postoperative Complications/physiopathology ; Preoperative Care/methods ; Pulmonary Embolism/diagnostic imaging ; Pulmonary Embolism/etiology ; Severity of Illness Index ; Spirometry/methods ; Tomography, X-Ray Computed/methods ; Treatment Outcome ; Ventilation-Perfusion Scan/methods
Language	English
Publishing date	2018-10-23
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Review
ZDB-ID	639400-0
ISSN	1557-9816 ; 0955-470X
ISSN (online)	1557-9816
ISSN	0955-470X
DOI	10.1016/j.trre.2018.10.003
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Article: Effects of Extracorporeal Membrane Oxygenation Initiation on Oxygenation and Pulmonary Opacities.

Batra, Kiran / Mohanka, Manish / Bollineni, Srinivas / Kaza, Vaidehi / Rajiah, Prabhakar / Xi, Yin / Hackmann, Amy / Wait, Michael / Torres, Fernando / Banga, Amit

Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures)

2021 Volume 7, Issue 1, Page(s) 6–13

Abstract: Introduction: There is limited data on the impact of extracorporeal membrane oxygenation (ECMO) on pulmonary physiology and imaging in adult patients. The current study sought to evaluate the serial changes in oxygenation and pulmonary opacities after ... ...

Abstract	Introduction: There is limited data on the impact of extracorporeal membrane oxygenation (ECMO) on pulmonary physiology and imaging in adult patients. The current study sought to evaluate the serial changes in oxygenation and pulmonary opacities after ECMO initiation. Methods: Records of patients started on veno-venous, or veno-arterial ECMO were reviewed (n=33; mean (SD): age 50(16) years; Male: Female 20:13). Clinical and laboratory variables before and after ECMO, including daily PaO Results: ECMO was associated with impaired oxygenation as reflected by the drop in median PFR from 101 (interquartile range, IQR: 63-151) at the initiation of ECMO to a post-ECMO trough of 74 (IQR: 56-98) on post-ECMO day 5. However, the difference was not statistically significant. The appraisal of daily CXR revealed progressively worsening opacities, as reflected by a significant increase in the opacity score (Wilk's Lambda statistic 7.59, p=0.001). During the post-ECMO period, a >10% increase in the opacity score was recorded in 93.9% of patients. There was a negative association between PFR and opacity scores, with an average one-unit decrease in the PFR corresponding to a +0.010 increase in the opacity score (95% confidence interval: 0.002 to 0.019, p-value=0.0162). The median opacity score on each day after ECMO initiation remained significantly higher than the pre-ECMO score. The most significant increase in the opacity score (9, IQR: -8 to 16) was noted on radiographs between pre-ECMO and forty-eight hours post-ECMO. The severity of deteriorating oxygenation or pulmonary opacities was not associated with hospital survival. Conclusions: The use of ECMO is associated with an increase in bilateral opacities and a deterioration in oxygenation that starts early and peaks around 48 hours after ECMO initiation.
Language	English
Publishing date	2021-01-29
Publishing country	Poland
Document type	Journal Article
ISSN	2393-1809
ISSN	2393-1809
DOI	10.2478/jccm-2020-0040
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