David P. Mason M.D.

Diwan, T. S., T. C. Lee, S. Nagai, E. Benedetti, A. Posselt, G. Bumgardner, S. Noria, B. A. Whitson, L. Ratner, D. Mason, J. Friedman, K. J. Woodside and J. Heimbach (2020). “Obesity, Transplantation, and Bariatric Surgery: An Evolving Solution for a Growing Epidemic.” Am J Transplant Jan 21. [Epub ahead of print].

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The increasing obesity epidemic has major implications in the realm of transplantation. Patients with obesity face barriers in access to transplantation as well as unique challenges in perioperative and postoperative outcomes. Due to comorbidities associated with obesity along with the underlying end-stage organ disease leading to transplantation candidacy, these patients may not even be referred for transplant evaluation, much less be waitlisted or actually undergo transplantation. However, the utilization of bariatric surgery in this population can help optimize the transplant candidacy of patients with obesity and end-stage organ disease as well as improve perioperative and postoperative outcomes. In this paper, we will review the impact of obesity on kidney, liver, and cardiothoracic transplant candidates and recipients, as well as explore potential interventions to address obesity in these populations.

Van Raemdonck, D., S. Keshavjee, B. Levvey, W. S. Cherikh, G. Snell, M. Erasmus, A. Simon, A. R. Glanville, S. Clark, F. D’Ovidio, P. Catarino, K. McCurry, M. I. Hertz, R. Venkateswaran, P. Hopkins, I. Inci, R. Walia, D. Kreisel, J. Mascaro, D. F. Dilling, P. Camp, D. Mason, M. Musk, M. Burch, A. Fisher, R. D. Yusen, J. Stehlik and M. Cypel (2019). “Donation after circulatory death in lung transplantation-five-year follow-up from ISHLT Registry.” J Heart Lung Transplant 38(12): 1235-1245.

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BACKGROUND: This study aimed to examine intermediate-term outcomes of lung transplantation (LTx) recipients from donors after circulatory death (DCD). METHODS: We examined the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Transplant Registry data for patients transplanted between January 2003 and June 2017 at 22 centers in North America, Europe, and Australia participating in the DCD Registry. The distribution of continuous variables was summarized as median and interquartile range (IQR) values. Wilcoxon rank sum test was used to compare distribution of continuous variables and chi-square or Fisher’s exact test for categorical variables. Kaplan-Meier survival rates after LTx from January 2003 to June 2016 were compared between DCD-III (Maastricht category III withdrawal of life-sustaining therapy [WLST]) only and donors after brain death (DBD) using the log-rank test. Risk factors for 5-year mortality were investigated using Cox multivariate proportional-hazards model. RESULTS: The study cohort included 11,516 lung transplants, of which 1,090 (9.5%) were DCD lung transplants with complete data. DCD-III comprised 94.1% of the DCD cohort. Among the participating centers, the proportion of DCD-LTx performed each year increased from 0.6% in 2003 to 13.5% in 2016. DCD donor management included extubation in 91%, intravenous heparin in 53% and pre-transplant normothermic ex vivo donor lung perfusion in 15%. The median time interval from WLST to cardiac arrest was 15 minutes (IQR: 11-22 minutes) and to cold flush 32 minutes (IQR: 26-41minutes). Compared with DBD, donor age was higher in DCD-III donors (46 years [IQR: 34-55] vs 40 years [IQR: 24-52]), bilateral LTx was performed more often (88.3% vs 76.6%), and more recipients had chronic obstructive pulmonary disease and emphysema as their transplant indication. Five-year survival rates were comparable (63% vs 61%, p=0.72). In multivariable analysis, recipient and donor ages, indication diagnosis, procedure type (single vs bilateral and double LTx), and transplant era (2003-2009 vs 2010-2016) were independently associated with survival (p < 0.001), but donor type was not (DCD-III vs DBD; hazard ratio, 1.04 [0.90-1.19], p=0.61). CONCLUSION: This ISHLT DCD Registry report with 5-year follow-up demonstrated similar favorable long-term survival in DCD-III and DBD lung donor recipients at 22 experienced centers globally. These data indicate that more extensive use of DCD-LTx would increase donor organ availability and may reduce waiting list mortality.

Black, M., D. Arnold, D. Mason, J. Eidt and S. Hohmann (2019). “Diaphragmatic fenestrations seen after peritoneal dialysis catheter placement: A rare cause of hydrothorax.” J Vasc Access Oct 17. [Epub ahead of print].

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This case report summarizes the clinical course of a patient who developed diaphragmatic fenestrations leading to hydrothorax after the initiation of peritoneal dialysis. We will discuss the interesting disease process in the setting of patient presentation, diagnosis, treatment, and outcome. Learning points: 1) Hydrothorax is an uncommon but serious complication that can occur spontaneously after PD catheter placement. 2) Assessment of respiratory symptoms should always be included in post-operative screening for PD catheter patients, and appropriate imaging should be obtained if screening is positive. 3) This case reaffirms the viability of diaphragm plication and imbrication with 2-0 prolene followed by mechanical and chemical pleurodesis via video thoracoscopy.

Steimer, D. A., O. Hernandez, D. P. Mason and G. S. Schwartz (2019). “Timing of ECMO Initiation Impacts Survival in Influenza-Associated ARDS.” Thorac Cardiovasc Surg 67(3): 212-215.

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In the past decade, extracorporeal membrane oxygenation (ECMO) has emerged as an innovative therapy for influenza-associated acute respiratory distress syndrome (ARDS). Despite its promising results, the ideal timing of ECMO initiation for these patients remains unclear. Retrospective analysis of a single institution experience with venovenous ECMO for influenza-induced ARDS was performed. Twenty-one patients were identified and categorized into early (0-2 days), standard (3-6 days), or late (more than 7 days) cannulation cohorts. Patients cannulated within 48 hours of admission had 80% survival rate at 90 days. Comparatively, the standard and late cannulation cohorts had an observed 90-day survival rate of 60 and 16.7%, respectively.

Steimer, D. A., O. Hernandez, D. P. Mason and G. S. Schwartz (2018). “Timing of ECMO Initiation Impacts Survival in Influenza-Associated ARDS.” Thorac Cardiovasc Surg. May 1. [Epub ahead of print].

Full text of this article.

In the past decade, extracorporeal membrane oxygenation (ECMO) has emerged as an innovative therapy for influenza-associated acute respiratory distress syndrome (ARDS). Despite its promising results, the ideal timing of ECMO initiation for these patients remains unclear. Retrospective analysis of a single institution experience with venovenous ECMO for influenza-induced ARDS was performed. Twenty-one patients were identified and categorized into early (0-2 days), standard (3-6 days), or late (more than 7 days) cannulation cohorts. Patients cannulated within 48 hours of admission had 80% survival rate at 90 days. Comparatively, the standard and late cannulation cohorts had an observed 90-day survival rate of 60 and 16.7%, respectively.