Pulmonology 2022

Roles of social determinants of health in post-transplant outcomes of lung recipients

Faculty Mentor’s Name: Dr. Cory Brunson
Email: jason.brunson@medicine.ufl.edu
Phone Number: (352) 273-5902
Project Category: Basic
International Component or Travel: No

Research Project Description:

Roles of social determinants of health in post-transplant outcomes of lung recipients

Impact of g E in parenchymal lung disease

Faculty Mentor’s Name: Dr. Diana Gomez
Email: diana.gomezmanjarres@medicine.ufl.edu
Phone Number: (352) 273-5902
Project Category: Clinical
International Component or Travel: No

Research Project Description:

Allergic bronchopulmonary aspergillosis (ABPA) is an allergic reaction of the airways that occurs when the bronchi become colonized by aspergillus species. The prevalence of this disease in patients with asthma and cystic fibrosis is well known, but in other parenchymal lung diseases such as COPD and interstitial lung disease it is not well established, in part, due to the lack of an individual test to establish the diagnosis.

The diagnosis is usually confirmed by use of a combination of clinical, radiographic, and immunologic criteria. Establishing Ig E sensitization to Aspergillus requires elevation of specific IgE and/or a positive skin prick test in asthma patients. Systemic steroids are therefore used as the mainstay therapy, along with antifungal medications. The significance of Ig E elevation in other parenchymal diseases is not well elucidated and the best therapeutic approach to these patients is a matter of interest.

We will conduct a retrospective chart review of patients age 18 and older with elevated Ig E and parenchymal lung disease at the University of Florida Health, and collect demographic information, pulmonary function tests and CT findings. We will determine if patients meet criteria of ABPA irrespective of pulmonary manifestations. To ensure accuracy, the diagnoses of all patients included in the study will be reviewed and confirmed using the Rosenberg and Patterson diagnostic criteria. Our aim is to describe natural history and respond to different therapies.

Characteristics and outcomes of thoracic transplant recipients residing in US Insular territories

Faculty Mentor’s Name: Dr. Cory Brunson
Email: jason.brunson@medicine.ufl.edu
Phone Number: (352) 273-5902
Project Category: Basic
International Component or Travel: No

Research Project Description:

Background:
In addition to 50 Congressionally admitted states and the District of Columbia, domestic residences in the U.S. include five permanently inhabited and unincorporated “Insular” (island) territories: Guam, Puerto Rico, American Samoa, the U.S. Virgin Islands, and the Northern Marianas.
Retrospective studies of solid organ transplantation in the U.S. using nationwide patient registry data routinely exclude the hundreds of recipients who reside or resided in these territories or absorb them into larger populations by omitting this discriminating characteristic. Yet, due to the combination of racial-ethnic and socioeconomic disparities experienced by all U.S. residents and the peculiar geographic and administrative challenges facing island residents, it is plausible that Insular residents have worse health outcomes both on organ waitlists and following transplant.

Hypotheses:
A descriptive summary of waitlist and post-transplant outcomes for Insular residents is warranted.
Moreover, appropriate statistical comparisons to carefully selected and/or matched non-Insular populations will reveal distinctive baseline characteristics and outcome rates.

Methods:
We will conduct a systematic literature search of organ transplantation case reports, clinical trials, and outcome studies that focus on or distinguish Insular residents. Review of identified publications will inform our statistical analysis.
We have acquired de-identified patient-level data for all thoracic transplants conducted in the U.S. from 1987 October 1 to 2020 August 31 from the United Network for Organ Sharing, which include states or territories of residence and region of transplantation as well as numerous recipient, donor, and perioperative variables and detailed follow-up with complete mortality information through linkage to Social Security data.
The analysis will take three phases: (1) statistical overview of the Insular recipient population, including age, sex, primary pulmonary diagnosis, clinical characteristics, waitlist outcome, and post-transplant outcomes; (2) matched-pairs analysis against comparison groups using propensity scoring; (3) Cox proportional hazard survival analysis pooled with comparison groups.
Phases 2 and 3 will require the identification of suitable comparison groups, which may be selected based on race-ethnicity, island residence (i.e. Hawaii), and distance traveled for transplantation, among other factors.

Student role:
The medical student(s) will participate in and contribute to all aspects of the study, additionally including study designs, data pre-processing, and interpretation and communication of results. This will include at least one manuscript or abstract to be submitted to a peer-reviewed journal or conference. The student will need to join the mentor’s IRB protocol.