Neurological Sequelae and Clinical Outcomes After Lung Transplantation.

Abstract

Neurological complications are common after lung transplantation. However, no large cohort studies have examined the incidence, predictors, and clinical significance of neurological events sustained by lung transplant recipients.We conducted a retrospective cohort analysis of a consecutive series of lung transplant recipients, transplanted at Duke University Medical Center between May 2014 and February 2017 (n = 276). Early neurological complications (ie, occurring during the first week after transplant) were documented by transplant mental health specialists and included delirium, ischemic injury, and posterior reversible encephalopathy syndrome. Analyses accounted for age, native disease, sex, type of transplant, lung allocation score, and primary graft dysfunction. The objectives of the study were to characterize the prevalence and predictors of early neurological sequelae (NSE), occurring during the first week posttransplant, and the association between NSE and subsequent clinical outcomes, including length of stay and mortality.Neurological sequelae were common, occurring in 123 (45%) patients. Fifty-seven patients died over a follow-up interval of 2.1 years. The most common NSE were postoperative delirium (n = 110 [40%]) and posterior reversible encephalopathy syndrome (n = 12 [4%]), followed by stroke/transient ischemic attack and neurotoxicity. Higher lung allocation score was the strongest predictor of delirium. The presence of a NSE was associated with longer length of hospital stay (32 days vs 17 days, P < 0.001) and greater mortality (hazard ratio, 1.90; 95% confidence interval, 1.09-3.32], P = 0.024), with the greatest mortality risk occurring approximately 2 years after transplantation.Neurological events are relatively common after lung transplantation and associated with adverse clinical outcomes.

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Citation

Published Version (Please cite this version)

10.1097/TXD.0000000000000766

Publication Info

Smith, Patrick J, Gregory L Stonerock, Krista K Ingle, Caroline K Saulino, Benson Hoffman, Brian Wasserman, James A Blumenthal, Scott M Palmer, et al. (2018). Neurological Sequelae and Clinical Outcomes After Lung Transplantation. Transplantation direct, 4(4). p. e353. 10.1097/TXD.0000000000000766 Retrieved from https://hdl.handle.net/10161/17621.

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Scholars@Duke

Stonerock

Gregory Lee Stonerock

Assistant Professor in Psychiatry and Behavioral Sciences

Dr. Stonerock is interested in coping strategies and psychosocial interventions among individuals with chronic illnesses, especially solid organ transplant recipients and candidates. His previous work includes research on coping strategies for chronic and acute pain, sickle cell disease, and the interrelation between sleep and pain processing. Current research interests include identifying psychosocial predictors of good medical outcomes and quality of life for patients after transplantation.

Hoffman

Benson Mark Hoffman

Associate Professor in Psychiatry and Behavioral Sciences

I have a longstanding interest in the effects of cardiopulmonary disease on health-related quality of life, including depression, cognition, and sexual function. I also study the effects of coping, aerobic exercise, and lung transplantation on quality of life.

Blumenthal

James Alan Blumenthal

J. P. Gibbons Distinguished Professor Emeritus of Psychiatry

Psychosocial factors and coronary heart disease, including such factors as social support, Type A behavior and hostility, and depression, exercise training and depression in the elderly; behavioral approaches to the treatment of hypertension (e.g., weight loss and exercise); cardiac rehabilitation; neuropsychological outcomes following cardiac surgery; psychosocial aspects of heart and lung transplantation; exercise training and osteoarthritis and fibromyalgia; compliance.

Palmer

Scott Michael Palmer

Donald F. Fortin, M.D. Distinguished Professor of Medicine

Dr. Palmer leads a successful program of clinical, basic and translational research in lung transplantation, idiopathic pulmonary fibrosis (IPF), bronchiolitis obliterans (BO) and other lung diseases. He directs the Medicine Plus Therapeutic Area at the Duke Clinical Research Institute (DCRI) and serves as Vice Chair for Research in the Department of Medicine. He is also the Director of Clinical Research, Duke Transplant Center.

Dr. Palmer has over 250 peer reviewed publications, received numerous awards, including election into the American Society for Clinical Investigation (ASCI) in 2012, chaired many sessions at national and international meetings, serves regularly on NIH study sections, and is on the editorial board of many prominent journals. He is a dedicated mentor to trainees and junior faculty, having personally mentored over 40 pre-and post-doctoral trainees, many of whom are now engaged in their own successful research careers. He is multiple PI on two Duke R38 awards supporting dedicated resident research, and multiple PI for a Duke Pulmonary T32 training program, all reflecting his deep commitment to support and train the next generation of physician investigators. He has received continuous NIH funding since 2002.

His scientific accomplishments include high impact studies that have demonstrated the importance of innate immunity in transplant rejection, a clinical trial that improved cytomegalovirus (CMV) prevention after lung transplantation, and work that identified rare protein coding exome variants that contribute to the development of IPF.  In addition to these studies he has led numerous multicenter studies, registries and clinical trials.  His program of translational research focuses on the use of human tissue and samples in studying pulmonary transplant rejection, and the use of human airway cells epithelial cells in the study of bronchiolitis obliterans including in the transplant and occupational setting. Recent work has employed single cell RNAseq to discover novel cell types and mechanisms involved in lung disease and transplant rejection.  

Klapper

Jacob A Klapper

Associate Professor of Surgery
Hartwig

Matthew Hartwig

Professor of Surgery

Dr. Hartwig is a thoracic surgeon with a clinical focus in lung transplantation and robotic assisted minimally invasive thoracic surgery for the treatment of diseases of the chest.  He serves as the Surgical Director of the Duke Lung Transplant Program and the Esophageal Center at Duke.  Additionally, he directs the Surgical Office of Clinical Research, which manages the clinical research portfolio for the Department of Surgery.  He also leads a successful program of clinical, basic and translational research in thoracic surgery and lung transplantation. He currently directs the Duke Ex Vivo Organ Laboratory (DEVOL), is the Chief of Lung Transplant Research, and is a faculty member at the Duke Clinical Research Institute (DCRI).

Dr. Hartwig has over 150 peer reviewed publications, received numerous awards, chaired many sessions at national and international meetings, serves regularly on NIH study sections, and is on the editorial board of many prominent journals. He has also personally mentored over pre-and post-doctoral trainees, many of whom are now engaged in their own successful research careers.

Snyder

Laurie D. Snyder

Professor of Medicine

Advanced lung disease, lung transplantation, interstitial lung disease, immune monitoring


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