Immunity to varicella, measles, and mumps in patients evaluated for lung transplantation.
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2021-04-11
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Vaccine-preventable viral infections are associated with increased risk of morbidity and mortality in post-transplant patients on immunosuppression regimens. Therefore, we studied rates of immunity against vaccine-preventable viruses in lung transplantation (LTx) candidates and their associations with underlying lung disease and clinical characteristics. We retrospectively studied 1025 consecutive adult patients who underwent first-time evaluation for LTx at a single center between January 2016 and October 2018. Viruses studied included varicella zoster (VZV), measles, and mumps. Young age (17-48 years old) was negatively associated with immunity for VZV (OR 4.54, p < .001), measles (OR 15.45, p < .001) and mumps (OR 3.1, p < .001), as compared to those 65+. Many LTx candidates with cystic fibrosis (CF) had undetectable virus-specific antibody titers including: 13.5% for VZV, 19.1% for measles, and 15.7% for mumps with significant odds of undetectable titers for VZV (OR 4.54, p < .001) and measles (OR 2.32, p = .010) as compared to those without CF. Therefore, a substantial number of patients undergoing LTx evaluation had undetectable virus-specific antibody titers. Our results emphasize the importance of screening for immunity to vaccine-preventable infections in this population and the need for revaccination in selected patients to boost their humoral immunity prior to transplantation.
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Scholars@Duke
Megan Lee Neely
Survival Analysis; Longitudinal Analysis; Joint Modeling; Prediction Modeling and Metrics; Biomarkers; Applications in Pulmonology and Lung Transplant; Statistical Education
Jamie Lynn Todd
I am a physician-scientist with clinical and research expertise in lung transplantation and advanced lung disease, in particular idiopathic pulmonary fibrosis (IPF). My research aims to advance scientific knowledge related to the clinical and genetic risk factors underlying the development of lung fibrosis including that occurring in chronic lung transplant rejection and diseases leading to transplant, such as IPF. I also have an interest in understanding how the airway epithelial response to injury impacts lung repair, fibrosis, and tissue immunity.
Scott Michael Palmer
Dr. Palmer is physician investigator, clinician, and academic leader. He is a Donald F. Fortin, MD Distinguished Professor of Medicine at Duke University, Vice Chair for Research in the Department of Medicine, Director of Medicine Plus Therapeutic Area at the Duke Clinical Research Institute, and Director of Clinical Research in the Duke Transplant Center. He is an expert in the care of patients with advanced lung diseases and lung transplantation.
Dr. Palmer’s successful research career includes over 20 years of continuous NIH funding and over 300 publications. He has held key leadership roles in national and international pulmonary and transplant societies, has chaired many sessions at national and international meetings, served on the editorial board for prominent journals, and serves regularly on NIH study sections. He has received numerous honors including election into Alpha Omega Alpha (AOA) and the American Society for Clinical Investigation (ASCI). During his career, he has led numerous multicenter clinical trials, data coordinating centers, and observational networks in lung transplant, pulmonary fibrosis, and other lung diseases.
His research has transformed current clinical practices in lung transplant, including prevention of infections such as cytomegalovirus (CMV) and management of chronic lung allograft dysfunction (CLAD). His work in idiopathic pulmonary fibrosis (IPF) has advanced novel clinical treatments, discovered prognostic biomarkers, and identified disease genetic risks. Dr. Palmer’s clinical research also includes studies of patient centered outcomes and analysis of real-world data across different lung diseases. Dr. Palmer’s translational research includes studies of lung innate immunity, airway cell biology and human immunology. His recent translational studies use single cell and spatial transcriptomic approaches to discover novel lung disease mechanisms.
Dr. Palmer 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 also co-leads multiple institutional training programs including two R38 awards supporting dedicated resident research and a T32 training program in pulmonary medicine, reflecting his deep commitment to training the next generation of academic investigators.
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