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Article: Chronic lung allograft dysfunction.

Kumar, Anupam / Garcha, Puneet Singh

Indian journal of thoracic and cardiovascular surgery

2021 Volume 38, Issue Suppl 2, Page(s) 318–325

Abstract: Lung transplantation remains the only cure for selected patients with advanced irreversible lung diseases. More than 4000 lung transplants are performed worldwide annually. In the last two decades, significant advances have been made in this arena, the ... ...

Abstract	Lung transplantation remains the only cure for selected patients with advanced irreversible lung diseases. More than 4000 lung transplants are performed worldwide annually. In the last two decades, significant advances have been made in this arena, the most impactful being a modest but improved survival of the recipients. Unfortunately majority of recipients still succumb to chronic lung allograft dysfunction (CLAD), and it remains the most common cause of death after the first year of transplantation. Below is a concise review of the current definition of CLAD, including the various phenotypes, and a brief discussion of the tools available for its diagnosis and management.
Language	English
Publishing date	2021-11-16
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/s12055-021-01228-8
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Article ; Online: A 76-Year-Old Man with Exertional Hypoxemia after Left Single Lung Transplantation.

Richards, Katherine / Li, Gloria / Segraves, Justin / Loor, Gabriel / Garcha, Puneet / Kumar, Anupam

Annals of the American Thoracic Society

2022 Volume 19, Issue 9, Page(s) 1591–1595

MeSH term(s)	Aged ; Humans ; Hypoxia/diagnosis ; Hypoxia/etiology ; Lung Transplantation/adverse effects ; Male
Language	English
Publishing date	2022-08-31
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2717461-X
ISSN	2325-6621 ; 1943-5665 ; 2325-6621
ISSN (online)	2325-6621 ; 1943-5665
ISSN	2325-6621
DOI	10.1513/AnnalsATS.202202-172CC
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Zs.A 5828: Show issues

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Article: A narrative review of interstitial lung disease in anti-synthetase syndrome: a clinical approach.

Sawal, Naina / Mukhopadhyay, Sanjay / Rayancha, Sheetal / Moore, Alastair / Garcha, Puneet / Kumar, Anupam / Kaul, Viren

Journal of thoracic disease

2021 Volume 13, Issue 9, Page(s) 5556–5571

Abstract: Anti-synthetase syndrome (AS) is a rare autoimmune disorder characterized by the presence of aminoacyl-transfer RNA synthetase antibodies in conjunction with clinical features such as interstitial lung disease (ILD), Raynaud's phenomenon, nonerosive ... ...

Abstract	Anti-synthetase syndrome (AS) is a rare autoimmune disorder characterized by the presence of aminoacyl-transfer RNA synthetase antibodies in conjunction with clinical features such as interstitial lung disease (ILD), Raynaud's phenomenon, nonerosive arthritis, and myopathy. AS distinguishes itself from other inflammatory myopathies by its significant lung involvement and rapidly progressive interstitial lung disease (AS-ILD), therefore the management of AS-ILD requires careful clinical, serologic and radiologic assessment. Glucocorticoids are considered the mainstay of therapy; however, additional immunosuppressive agents are often required to achieve disease control. Patient prognosis is highly dependent on early diagnosis and symptom recognition as the antibody profile is thought to influence therapy response. Since progressive ILD is the leading cause of morbidity and mortality, this review will discuss the clinical approach to patient with suspected AS, with particular emphasis on diagnosis and management of AS-ILD.
Language	English
Publishing date	2021-10-13
Publishing country	China
Document type	Journal Article ; Review
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd-20-3328
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Article: Power washing pulmonary alveolar proteinosis.

Endicott-Yazdani, Tiana R / Schwartz, Gary S / Zhang, Haiying / Rosenblatt, Randall L / Garcha, Puneet S

Proceedings (Baylor University. Medical Center)

2021 Volume 34, Issue 6, Page(s) 731–733

Abstract: Pulmonary alveolar proteinosis is an uncommon cause of insidious onset shortness of breath and hypoxemia. It is caused by an accumulation of surfactant within the alveoli. Left untreated, it can be fatal. Standard-of-care treatment is whole-lung lavage; ... ...

Abstract	Pulmonary alveolar proteinosis is an uncommon cause of insidious onset shortness of breath and hypoxemia. It is caused by an accumulation of surfactant within the alveoli. Left untreated, it can be fatal. Standard-of-care treatment is whole-lung lavage; however, in severe cases, the associated hypoxemia can be profound and single-lung ventilation would not be tolerated, potentially preventing a lifesaving treatment. Single cases using veno-venous extracorporeal membrane oxygenation to perform whole-lung lavage have been reported. Here we describe three patients with severe pulmonary alveolar proteinosis who were successfully treated with whole-lung lavage using veno-venous extracorporeal membrane oxygenation for oxygenation support.
Language	English
Publishing date	2021-08-18
Publishing country	United States
Document type	Case Reports
ZDB-ID	2703932-8
ISSN	1525-3252 ; 0899-8280
ISSN (online)	1525-3252
ISSN	0899-8280
DOI	10.1080/08998280.2021.1953884
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Zs.A 6987: Show issues

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Article ; Online: Allograft discard risk index for lung transplantation.

Reul, Ross Michael / Loor, Gabriel / Garcha, Puneet S / Goss, John A / Rana, Abbas A

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

2021 Volume 40, Issue 12, Page(s) 1658–1667

Abstract: Background: The demand for donor lungs continues to outpace the supply, yet nearly 75% of donor lungs intended for lung transplantation are discarded.: Methods: We reviewed all donation after brain death organ donors listed within the UNOS Deceased ... ...

Abstract	Background: The demand for donor lungs continues to outpace the supply, yet nearly 75% of donor lungs intended for lung transplantation are discarded. Methods: We reviewed all donation after brain death organ donors listed within the UNOS Deceased Donor Database between 2005 and 2020. Univariable and multivariable analyses were run on the training set (n = 69,355) with the primary outcome defined as lung discard, and the results were used to create a discard risk index (DSRI). Discard data were assessed at DSRI value deciles using the validation set (n = 34,670), and differences in 1-year mortality were assessed using stratum-specific likelihood ratio (SSLR) analysis. Results: Donor factors most associated with higher DSRI values included age > 65, PaO Conclusions: The factors leading to lung allograft discard are not the same as those leading to worse recipient outcomes. This suggests that with proper allocation, many of the grafts that are now commonly discarded could be used in the future donor pool with limited impact on mortality.
MeSH term(s)	Adult ; Databases, Factual ; Female ; Graft Survival ; Humans ; Lung Transplantation ; Male ; Middle Aged ; Odds Ratio ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Sensitivity and Specificity ; Tissue and Organ Procurement/organization & administration ; Young Adult
Language	English
Publishing date	2021-09-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	1062522-7
ISSN	1557-3117 ; 1053-2498
ISSN (online)	1557-3117
ISSN	1053-2498
DOI	10.1016/j.healun.2021.08.017
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Zs.A 2056: Show issues

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ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Pediatric lung transplantation for COVID-19: Unique clinical and psychosocial barriers.

Kumar, Anupam / Li, Gloria W / Segraves, Justin M / Mattar, Aladdein / Ramineni, Maheshwari / Loor, Gabriel / Garcha, Puneet S

Pediatric transplantation

2022 Volume 26, Issue 8, Page(s) e14351

Abstract: Background: SARS-CoV-2 infection in the age group of 0-17 years contributes to approximately 22% of all laboratory-confirmed SARS-CoV-2 infections. Fortunately, this age group has a lower death rate (0.5 per 100 000) that accounts for only 4% of the ... ...

Abstract	Background: SARS-CoV-2 infection in the age group of 0-17 years contributes to approximately 22% of all laboratory-confirmed SARS-CoV-2 infections. Fortunately, this age group has a lower death rate (0.5 per 100 000) that accounts for only 4% of the total deaths due to COVID-19. Despite the low mortality rate in the pediatric population, children of minority groups represented 78% of the deaths highlighting the existing disparities in access to health care. Methods: With the emergence of the more contagious COVID-19 variants and the relatively slow pace of vaccination among the pediatric population, it is possible to see more cases of significant lung injury and potential for transplantation for the younger age group. Results: To our knowledge, our patient is the youngest to have undergone lung transplantation for SARS-CoV-2. Conclusion: The case presented unique challenges, particularly in relation to timing for listing and psychosocial support for parents who were his decision makers.
MeSH term(s)	Humans ; Child ; Infant, Newborn ; Infant ; Child, Preschool ; Adolescent ; COVID-19 ; SARS-CoV-2 ; Lung Transplantation
Language	English
Publishing date	2022-07-07
Publishing country	Denmark
Document type	Case Reports
ZDB-ID	1390284-2
ISSN	1399-3046 ; 1397-3142
ISSN (online)	1399-3046
ISSN	1397-3142
DOI	10.1111/petr.14351
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Zs.A 4947: Show issues

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Article ; Online: Trends in marginal lung allograft survival: Advanced-age donors improve.

Miggins, John James / Reul, Ross Michael / Loor, Gabriel / Ferreira, Liam D / Garcha, Puneet S / Goss, John A / Rana, Abbas A

Clinical transplantation

2022 Volume 36, Issue 9, Page(s) e14777

Abstract: Introduction: Although lung demand continues to outpace supply, 75% of potential donor lungs are discarded without being transplanted in the United States. To identify the discarded cohorts best suited to alleviate the lung shortage and reduce waitlist ... ...

Abstract	Introduction: Although lung demand continues to outpace supply, 75% of potential donor lungs are discarded without being transplanted in the United States. To identify the discarded cohorts best suited to alleviate the lung shortage and reduce waitlist mortality, we explored changes in survival over time for five marginal donor definitions: age >60 years, smoking history >20 pack-years, PaO Methods: Our retrospective cohort study separated 27 803 lung recipients in the UNOS Database into three 5-year eras by transplant date: 2005-2009, 2010-2014, and 2015-2019. Multivariable Cox proportional hazards regression and Kaplan-Meier analysis with log-rank test were used to compare survival across the eras. Results: Three definitions-low PaO Conclusions: Advanced donor age, previously the most significant risk factor, has improved to near-benchmark levels, demonstrating the possibility for matching older donors to healthier non-elderly recipients in selected circumstances. Low PaO
MeSH term(s)	Age Factors ; Allografts ; Humans ; Lung ; Lung Transplantation ; Middle Aged ; Retrospective Studies ; Tissue Donors ; Tissue and Organ Procurement ; Treatment Outcome ; United States/epidemiology
Language	English
Publishing date	2022-07-21
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.14777
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Zs.A 2204: Show issues

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Article: Twenty-year survival following lung transplantation.

Miggins, John James / Reul, Ross M / Barrett, Spencer / Rana, Abbas / Alnajar, Ahmed / Dunson, Jordan / Shafii, Alexis / Garcha, Puneet / Goss, John / Loor, Gabriel

Journal of thoracic disease

2023 Volume 15, Issue 6, Page(s) 2997–3012

Abstract: Background: Lung transplantation median survival has seen improvements due to recognition of short-term survival factors but continues to trail behind other solid organs due to limited understanding of long-term survivorship. Given the creation of the ... ...

Abstract	Background: Lung transplantation median survival has seen improvements due to recognition of short-term survival factors but continues to trail behind other solid organs due to limited understanding of long-term survivorship. Given the creation of the United Network for Organ Sharing (UNOS) database in 1986, it was difficult to accrue data on long-term survivors until recently. This study characterizes factors impacting lung transplant survival beyond 20 years, conditional to 1-year survival. Methods: Lung transplant recipients listed in UNOS from 1987 to 2002 who survived to 1 post-transplant year were reviewed. Kaplan-Meier and adjusted Cox regression analyses were performed at 20 and 10 years to identify risk factors associated with long-term outcomes independent of their short-term effects. Results: A total of 6,172 recipients were analyzed, including 472 (7.6%) recipients who lived 20+ years. Factors associated with increased likelihood of 20-year survival were female-to-female gender match, recipient age 25-44, waitlist time >1 year, human leukocyte antigen (HLA) mismatch level 3, and donor cause of death: head trauma. Factors associated with decreased 20-year survival included recipient age ≥55, chronic obstructive pulmonary disease/emphysema (COPD/E) diagnosis, donor smoking history >20 pack-years, unilateral transplant, blood groups O&AB, recipient glomerular filtration rate (GFR) <10 mL/min, and donor GFR 20-29 mL/min. Conclusions: This is the first study identifying factors associated with multiple-decade survival following lung transplant in the United States. Despite its challenges, long-term survival is possible and more likely in younger females in good waitlist condition without COPD/E who receive a bilateral allograft from a non-smoking, gender-matched donor of minimal HLA mismatch. Further analysis of the molecular and immunologic implications of these conditions are warranted.
Language	English
Publishing date	2023-05-24
Publishing country	China
Document type	Journal Article
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd-22-1414
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Article ; Online: Understanding the "Social" in "Social Media". An Analysis of Twitter Engagement of Pulmonary and Critical Care Fellowship Programs.

Gandotra, Sheetal / Stewart, Nancy H / Khateeb, Dina / Garcha, Puneet / Carlos, W Graham / Carroll, Christopher L / Kaul, Viren

ATS scholar

2021 Volume 2, Issue 2, Page(s) 202–211

Abstract: Background:: Objective:: Methods:: Results:: Conclusion: ...

Abstract	Background: Objective: Methods: Results: Conclusion:
Language	English
Publishing date	2021-04-23
Publishing country	United States
Document type	Journal Article
ISSN	2690-7097
ISSN (online)	2690-7097
DOI	10.34197/ats-scholar.2020-0100OC
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Article ; Online: The Effect of Obstructive Sleep Apnea on 3-Year Outcomes in Patients Who Underwent Orthotopic Heart Transplantation.

Afzal, Aasim / Tecson, Kristen M / Jamil, Aayla K / Felius, Joost / Garcha, Puneet S / Hall, Shelley A / Carey, Sandra A

The American journal of cardiology

2019 Volume 124, Issue 1, Page(s) 51–54

Abstract: Despite the well-known association between obstructive sleep apnea (OSA) and cardiovascular disease, there is a paucity of data regarding OSA in orthotopic heart transplant (OHT) recipients and its effect on clinical outcomes. Hence, we sought to ... ...

Abstract	Despite the well-known association between obstructive sleep apnea (OSA) and cardiovascular disease, there is a paucity of data regarding OSA in orthotopic heart transplant (OHT) recipients and its effect on clinical outcomes. Hence, we sought to determine the association between OSA, as detected by polysomnography, and late graft dysfunction (LGD) after OHT. In this retrospective review of consecutive OHT recipients from 2012 to 2014 at our center, we examined LGD, i.e., graft failure >1 year after OHT, through competing risks analysis. Due to small sample size and event counts, as well as preliminary testing which revealed statistically similar demographics and outcomes, we pooled patients who had treated OSA with those who had no OSA. Of 146 patients, 29 (20%) had untreated OSA, i.e., OSA without use of continuous positive airway pressure therapy, at the time of transplantation. Patients with untreated OSA were significantly older, heavier, and more likely to have baseline hypertension than those with treated/no OSA. Although there were no differences between groups in regard to short-term complications of acute kidney injury, cardiac allograft vasculopathy, or primary graft dysfunction, there were significant differences in the occurrence of LGD. Those with untreated OSA were at 3 times the risk of developing LGD than those with treated/no OSA (hazard ratio 3.2; 95% confidence interval 1.3 to 7.9; p = 0.01). Because OSA is a common co-morbidity of OHT patients and because patients with untreated OSA have an elevated risk of LGD, screening for and treating OSA should occur during the OHT selection period.
MeSH term(s)	Aged ; Continuous Positive Airway Pressure ; Female ; Graft Rejection ; Graft Survival ; Heart Failure/complications ; Heart Failure/mortality ; Heart Failure/surgery ; Heart Transplantation/adverse effects ; Humans ; Male ; Middle Aged ; Polysomnography ; Postoperative Complications/epidemiology ; Retrospective Studies ; Risk Factors ; Sleep Apnea, Obstructive/complications ; Sleep Apnea, Obstructive/diagnosis ; Sleep Apnea, Obstructive/therapy ; Survival Rate ; Treatment Outcome
Language	English
Publishing date	2019-04-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2019.04.005
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