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4. Incidence of Acute Cellular Rejection After Granulocyte Colony-Stimulating Factor in Lung Transplant Recipients.

Author

Fredrick, Stacy R., Iasella, Carlo J., Sacha, Lauren M., Rivosecchi, Ryan M., Morrell, Matthew R., Sanchez, Pablo G., Pilewski, Joseph M., Snyder, Mark E., McDyer, John F., and Moore, Cody A.

Subjects
PNEUMONIA, LUNG transplantation, PATIENTS, TRANSPLANTATION of organs, tissues, etc., SEX distribution, LOGISTIC regression analysis, RETROSPECTIVE studies, HOMOGRAFTS, DESCRIPTIVE statistics, MULTIVARIATE analysis, GRAFT rejection, LONGITUDINAL method, CHRONIC diseases, ODDS ratio, MEDICAL records, ACQUISITION of data, GRANULOCYTE-colony stimulating factor, CONFIDENCE intervals, NEUTROPENIA, TIME, IMMUNOSUPPRESSION
Abstract

Background: Neutropenia is a common complication in lung transplant recipients (LTRs). Filgrastim may be used to treat neutropenia in LTRs, but its consequences on acute cellular rejection (ACR) remain controversial. Objective: The purpose was to examine the association between filgrastim and incidence of ACR 6 months after filgrastim administration in LTRs. Secondary outcomes included burden of ACR, infections, chronic lung allograft dysfunction (CLAD), and survival. Methods: This was a matched cohort study of patients transplanted between January 2010 and October 2019. LTRs who received filgrastim for neutropenia were compared to a cohort who did not. LTRs were matched on transplant indication, sex, age, and time post-transplant and multivariable logistic regression models were used to evaluate the likelihood of ACR. Results: 212 patients were included in the analysis (106 in each group). 50 patients (47.2%) in the filgrastim group experienced ACR compared to 37 patients (34.9%) in the no filgrastim group (P =.070). In multivariable analysis, filgrastim use was not associated with ACR at 6 months (OR 1.409, 95% CI 0.772-2.571). Time to first ACR was shorter (P =.049) and 6-month ACR score was higher in the filgrastim group (.49 vs.33, P =.047). LTRs in the filgrastim group had higher incidence of bacterial pneumonia and 1-year mortality. Conclusions: Although not associated with increased likelihood of ACR at 6 months, our study found that filgrastim is associated with increased ACR burden and decreased time to ACR. This study can help inform clinicians of ACR risk after filgrastim use in LTRs. [ABSTRACT FROM AUTHOR]

Published
2024
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5. Cardiogenic shock etiology and exit strategy impact survival in patients with Impella 5.5

Author

Sicke, McKenzie, primary, Modi, Shan, additional, Hong, Yeahwa, additional, Bashline, Michael, additional, Klass, Wyatt, additional, Horn, Ed, additional, Hansra, Barinder S, additional, Ramanan, Raj, additional, Fowler, Jeffrey, additional, Sumzin, Nikita, additional, Rivosecchi, Ryan M, additional, Chaudhary, Rahul, additional, Ziegler, Luke A, additional, Hess, Nicholas R, additional, Agrawal, Nishant, additional, Kaczorowski, David J, additional, and Hickey, Gavin W, additional

Published
2023
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9. Major Publications in the Critical Care Pharmacotherapy Literature: 2022

Author

Gurnani, Payal K., primary, Barlow, Brooke, additional, Boling, Bryan, additional, Busse, Laurence W., additional, Diaz-Gomez, Jose L., additional, Ford, Jenna, additional, Gibson, Gabrielle A., additional, Khanna, Ashish K., additional, Lee, Jennifer S., additional, Rivosecchi, Ryan M., additional, Spezzano, Katherine M., additional, Thornton, Nathan, additional, Vallabhajosyula, Saraschandra, additional, Witenko, Corey J., additional, and Wieruszewski, Patrick M., additional

Published
2023
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17. Amiodarone induced movement disorder after cardiac arrest – A case report

Author

Ratay, Cecelia R., primary, Doshi, Ankur A., additional, Steinberg, Alexis, additional, Kaczorowski, David, additional, Phillips, Dennis P., additional, Rhinehart, Zachary J., additional, Fozard, Jessica, additional, Rivosecchi, Ryan M., additional, Schatz, Kimberly W., additional, Bahl, Katherine D., additional, Schwarm, Paul, additional, and Coppler, Patrick J., additional

Published
2022
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20. Bivalirudin Versus Unfractionated Heparin in Patients With Cardiogenic Shock Requiring Venoarterial Extracorporeal Membrane Oxygenation

Author

Uricchio, Marissa N., primary, Ramanan, Raj, additional, Esper, Stephen A., additional, Murray, Holt, additional, Kaczorowski, David J., additional, D’Aloiso, Brandon, additional, Gomez, Hernando, additional, Sciortino, Christopher, additional, Sanchez, Pablo G., additional, Sappington, Penny L., additional, and Rivosecchi, Ryan M., additional

Published
2022
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21. Outcomes of systemic bivalirudin and sodium bicarbonate purge solution for Impella 5.5.

Author

Bashline, Michael, DiBridge, Julie, Klass, Wyatt J., Morelli, Brian, Kaczorowski, David, Schmidhofer, Mark, Horn, Edward T., Gomez, Hernando, Ramanan, Raj, Hickey, Gavin W., and Rivosecchi, Ryan M.

Subjects
HEPARIN, BIVALIRUDIN, TISSUE plasminogen activator, SODIUM bicarbonate, ISCHEMIC stroke, STROKE
Abstract

Background: Impella 5.5 (Abiomed; Danvers, MA) (IMP5) is a commonly used, surgically implanted, tMCS device that requires systemic anticoagulation and purge solution to avoid pump failure. To avoid heparin‐induced thrombocytopenia (HIT) from unfractionated heparin (UFH) use, our program has explored the utility of bivalirudin (BIV) for systemic anticoagulation and sodium bicarbonate‐dextrose purge solution (SBPS) in IMP5.5. Methods: This single center, retrospective study included 34 patients supported on IMP5.5 with BIV based AC and SBPS between December 1st 2020 to December 1st 2021.The efficacy and safety end points were incidence of development of HIT, Tissue Plasminogen Activator (tPA) use for suspected pump thrombosis, stroke, and device failure as well as clinically significant bleeding. Results: The median duration of IMP5.5 support was 9.8 days (IQR: 6–15). Most patients were bridged to HTX (58%) followed by recovery (27%) and LVAD implantation (15%). Patients were therapeutic on bivalirudin for 64% of their IMP5.5 support. One patient (2.9%) suffered from ischemic stroke and 26.5% (9) patients developed clinically significant bleeding. tPA was administered to 7(21%) patients. One patient in the entire cohort developed HIT. Conclusions: Our experience supports the use of systemic BIV and SBPS as a method to avoid heparin exposure in a patient population predisposed to the development of HIT. [ABSTRACT FROM AUTHOR]

Published
2023
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28. Bivalirudin VersusUnfractionated Heparin in Patients With Cardiogenic Shock Requiring Venoarterial Extracorporeal Membrane Oxygenation

Author

Uricchio, Marissa N., Ramanan, Raj, Esper, Stephen A., Murray, Holt, Kaczorowski, David J., D’Aloiso, Brandon, Gomez, Hernando, Sciortino, Christopher, Sanchez, Pablo G., Sappington, Penny L., and Rivosecchi, Ryan M.

Abstract

This study evaluated differences in efficacy and safety outcomes with bivalirudin compared with unfractionated heparin (UFH) in patients with cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation (VA ECMO). We performed a retrospective study at an academic medical center that included patients greater than 18 years of age supported with VA ECMO due to cardiogenic shock from January 2009 to February 2021. The primary endpoint was ECMO-associated thrombotic events normalized to duration of ECMO support. Secondary safety endpoints included major bleeding (per ELSO criteria) and blood product administration. Overall, 143 patients were included in our analysis with 54 having received bivalirudin and 89 having received UFH. Median duration of ECMO support was 92 (interquartile range, 56–172) hours. ECMO-associated thrombotic events per ECMO day were significantly less among those that received bivalirudin (P< 0.001). In adjusted regression, bivalirudin was independently associated with an increased time to thrombosis when compared with UFH (Exp[B] –3.8; 95% confidence interval, 1.7–8.8; P= 0.002). Patients receiving bivalirudin experienced less major bleeding events (P= 0.02) with less total red blood cell and fresh frozen plasma administration (P= 0.04 and P= 0.03, respectively). Bivalirudin is a safe and efficacious alternative to UFH in patients requiring VA ECMO for cardiogenic shock.

Published
2023
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30. Comparison of Anticoagulation Strategies in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation

Author

Rivosecchi, Ryan M., primary, Arakelians, Aris R., additional, Ryan, John, additional, Murray, Holt, additional, Padmanabhan, Rajagopala, additional, Gomez, Hernando, additional, Phillips, Dennis, additional, Sciortino, Christopher, additional, Arlia, Peter, additional, Freeman, Danielle, additional, Sappington, Penny L., additional, and Sanchez, Pablo G., additional

Published
2021
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33. Achievement of clinical isavuconazole blood concentrations in transplant recipients with isavuconazonium sulphate capsules administered via enteral feeding tube

Author

McCreary, Erin K, primary, Nguyen, M Hong, additional, Davis, Matthew R, additional, Borlagdan, Jared, additional, Shields, Ryan K, additional, Anderson, Anthony D, additional, Rivosecchi, Ryan M, additional, Marini, Rachel V, additional, Sacha, Lauren M, additional, Silveira, Fernanda P, additional, Andes, David R, additional, and Lepak, Alexander J, additional

Published
2020
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34. Isavuconazole Is as Effective as and Better Tolerated Than Voriconazole for Antifungal Prophylaxis in Lung Transplant Recipients

Author

Samanta, Palash, primary, Clancy, Cornelius J, additional, Marini, Rachel V, additional, Rivosecchi, Ryan M, additional, McCreary, Erin K, additional, Shields, Ryan K, additional, Falcione, Bonnie A, additional, Viehman, Alex, additional, Sacha, Lauren, additional, Kwak, Eun Jeong, additional, Silveira, Fernanda P, additional, Sanchez, Pablo G, additional, Morrell, Matthew, additional, Clarke, Lloyd, additional, and Nguyen, M Hong, additional

Published
2020
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37. Isavuconazole Is as Effective as and Better Tolerated Than Voriconazole for Antifungal Prophylaxis in Lung Transplant Recipients.

Author

Samanta, Palash, Clancy, Cornelius J, Marini, Rachel V, Rivosecchi, Ryan M, McCreary, Erin K, Shields, Ryan K, Falcione, Bonnie A, Viehman, Alex, Sacha, Lauren, Kwak, Eun Jeong, Silveira, Fernanda P, Sanchez, Pablo G, Morrell, Matthew, Clarke, Lloyd, and Nguyen, M Hong

Subjects
PREVENTION of surgical complications, ANTIFUNGAL agents, DRUG efficacy, VORICONAZOLE, DRUG tolerance, AMPHOTERICIN B, LUNG transplantation, RETROSPECTIVE studies, MONOCLONAL antibodies, TREATMENT effectiveness, HEPATOTOXICOLOGY, MYCOSES, DESCRIPTIVE statistics, PREVENTIVE medicine, RED blood cell transfusion, NECROSIS, DISEASE risk factors, EVALUATION, DISEASE complications
Abstract

Background Invasive fungal infections (IFIs) are common following lung transplantation. Isavuconazole is unstudied as prophylaxis in organ transplant recipients. We compared effectiveness and tolerability of isavuconazole and voriconazole prophylaxis in lung transplant recipients. Methods A single-center, retrospective study of patients who received isavuconazole (September 2015–February 2018) or voriconazole (September 2013–September 2015) for antifungal prophylaxis. IFIs were defined by EORTC/MSG criteria. Results Patients received isavuconazole (n = 144) or voriconazole (n = 156) for median 3.4 and 3.1 months, respectively. Adjunctive inhaled amphotericin B (iAmB) was administered to 100% and 41% of patients in the respective groups. At 1 year, 8% of patients receiving isavuconazole or voriconazole developed IFIs. For both groups, 70% and 30% of IFIs were caused by molds and yeasts, respectively, and breakthrough IFI (bIFI) rate was 3%. Outcomes did not significantly differ for patients receiving or not receiving iAmB. Independent risk factors for bIFI and breakthrough invasive mold infection (bIMI) were mold-positive respiratory culture and red blood cell transfusion >7 units at transplant. Bronchial necrosis >2 cm from anastomosis and basiliximab induction were also independent risk factors for bIMI. Isavuconazole and voriconazole were discontinued prematurely due to adverse events in 11% and 36% of patients, respectively (P  = .0001). Most common causes of voriconazole and isavuconazole discontinuation were hepatotoxicity and lack of oral intake, respectively. Patients receiving ≥90 days prophylaxis had fewer IFIs at 1 year (3% vs 9%, P  = .02). IFIs were associated with increased mortality (P  = .0001) and longer hospitalizations (P  = .0005). Conclusions Isavuconazole was effective and well tolerated as antifungal prophylaxis following lung transplantation. [ABSTRACT FROM AUTHOR]

Published
2021
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38. Contributors

Author

Akkawi, Abdul Rahman, Almela, M., Amabile, Andrea, Ambrosioni, J., Arnaoutakis, George J., Aziz, Hamza, Bowles, Cayley, Brocklebank, Paul, Bruun, N.E., Chen, Edwin, Chiappelli, Abby L., Cho, Sung-Min, Choi, Chun Woo, Dahl, A., de Kerchove, Laurent, El-Dalati, Sami, Erol, Cetin, Estes, N. A. Mark, III, Etchill, Eric W., Falces, C., Felmly, Lloyd M., Fernandes, Carolyn R., Fukuhara, Shinichi, Fuster, D., García-Pares, D., García de la Maria, C., Geirsson, Arnar, Giuliano, Katherine A., Goerlich, Corbin E., Gopalan, Priya, Gossios, Thomas, Hernandez-Meneses, M., Hiesinger, William, Horn, Edward T., Hovis, Elizabeth, Huckaby, Lauren V., Israel, Alex, Kaya, Cansin Tulunay, Kilcoyne, Maxwell, Kilic, Arman, Kilic, Ahmet, Li, Sui Kwong, Marschalk, Nicholas, McEnteggart, Shayna, McKibben, Lauren B., Miro, J.M., Moreno, A., Mori, Makoto, Nanjappa, Sowmya, Onyeukwu, Chukudi, Perez, Christian O., Pericàs, J.M., Perissinotti, A., Prendergast, Bernard, Quintana, E., Rajani, Ronak, Regunath, Hariharan, Rivosecchi, Ryan M., Sade, Robert M., Sandoval, E., Shah, Neel, Shalaby, Alaa, Shenai, Neeta, Smith, Brandon J., Snawerdt, Jessica, Solari, Silvia, Suffoletto, Matthew, Tchouta, Lise, Tolosana, J.M., Trienski, Tamara L., Uchino, Ken, Vidal, B., Viehman, J. Alexander, Wallen, Tyler J., Weininger, Gabe, Whitman, Glenn J.R., Whitt, Stevan P., and Zhang, Lucy Q.

Published
2022
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41. Dabigatran reversal with idarucizumab prior to lung transplantation.

Author

Harano, Takashi, Rivosecchi, Ryan M., Morrell, Matthew R., and Sanchez, Pablo G.

Subjects
*LUNG transplantation, *ERYTHROCYTES, *DABIGATRAN, *OPERATIVE blood salvage, *HOSPITAL mortality, *BK virus
Abstract

Background: When the transplant candidates are receiving oral anticoagulation therapy before transplantation, it is crucial to have an urgent reversal strategy to prevent hemorrhagic complications perioperatively. The aim of this study was to present the experience with idarucizumab to reverse the anticoagulant activity of dabigatran prior to lung transplantation. Methods: A single‐center retrospective study was performed to analyze the clinical outcomes of idarucizumab use before lung transplantation. Results: Between July 2016 and June 2019, six patients were on dabigatran at the time of transplantation. Out of the six patients, four patients received idarucizumab. These four recipients received a median of 3 units (range 0‐4 units) of packed red blood cells (pRBCs) and 450 ml (range 250‐1500 ml) of intraoperative salvage of shed blood (cell saver blood) during the lung transplant. The two patients who were not administered idarucizumab received 5 units and 13 units of pRBCs and 900 ml and 3600 ml of cell saver blood, respectively. There was no grade 3 primary graft dysfunction (PGD) at 72 hours after transplantation or in‐hospital mortality in idarucizumab group. In the group without idarucizumab, there was one case of grade 3 PGD without any in‐hospital mortality. Conclusion: Dabigatran reversal with idarucizumab provides reasonable hemostasis during lung transplantation. [ABSTRACT FROM AUTHOR]

Published
2021
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42. Clinical Outcomes Associated With Diltiazem Use in Heart Failure With Reduced Ejection Fraction After Implementation of a Clinical Support System

Author

Foster, Elizabeth M., Coons, James C., Puccio, Elena A., Sullinger, Danine, Ibrahim, Rachel, Ibrahim, Joseph, Hickey, Gavin W., Horn, Edward, Mosesso, Vincent, and Rivosecchi, Ryan M.

Abstract

Background: Despite atrial fibrillation guideline recommendations, many patients with heart failure with reduced ejection fraction (EF) continue to receive IV diltiazem for acute rate control.Objective: Our institution recently implemented a clinical decision support system (CDSS)-based tool that recommends against the use of diltiazem in patients with an EF ≤ 40%. The objective of this study was to evaluate outcomes of adherence to the aforementioned CDSS-based tool.Methods: This multi-hospital, retrospective study assessed patients who triggered the CDSS alert and compared those who did and did not discontinue diltiazem. The primary outcome was the occurrence of clinical deterioration. The primary endpoint was compared utilizing a Fisher’s Exact Test, and a multivariate logistic regression model was developed to confirm the results of the primary analysis.Results: A total of 246 patients were included in this study with 146 patients in the nonadherent group (received diltiazem) and 100 patients in the adherent group (did not receive diltiazem). There was a higher proportion of patients experiencing clinical deterioration in the alert nonadherence group (33% vs 21%, P= 0.044), including increased utilization of inotropes and vasopressors, and higher rate of transfer to ICU.Conclusion and Relevance: In patients with heart failure with reduced EF, diltiazem use after nonadherence to a CDSS alert resulted in an increased risk of clinical deterioration. This study highlights the need for improved provider adherence to diltiazem clinical decision support systems.

Published
2024
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48. Drug Class Combination–Associated Acute Kidney Injury

Author

Rivosecchi, Ryan M., primary, Kellum, John A., additional, Dasta, Joseph F., additional, Armahizer, Michael J., additional, Bolesta, Scott, additional, Buckley, Mitchell S., additional, Dzierba, Amy L., additional, Frazee, Erin N., additional, Johnson, Heather J., additional, Kim, Catherine, additional, Murugan, Raghavan, additional, Smithburger, Pamela L., additional, Wong, Adrian, additional, and Kane Gill, Sandra L., additional

Published
2016
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50. Pharmacokinetics of Azole Antifungals in Cystic Fibrosis.

Author

Rivosecchi, Ryan M., Samanta, Palash, Demehin, Moses, and Nguyen, M. Hong

Abstract

Defects in mucociliary clearance predispose cystic fibrosis (CF) patients to airway colonization and infection by various fungi, especially Aspergillus fumigatus. Although the clinical significance of airway fungal colonization is not clear, several studies have suggested its association with worsening lung function and increased risk of CF exacerbations. Antifungal triazole agents have been used in CF patients with airway fungal colonization or infections with varying results. Limited pharmacokinetic studies to date have demonstrated high inter-subject variability of triazole levels among CF patients. This review discusses the basic principles of pharmacokinetics, the pharmacokinetic changes associated with CF and the effect of CF on the pharmacokinetic principles of azole antifungals. The inconsistent azole serum levels in CF patients may be associated with sub-therapeutic (thus risk of therapeutic failure and/or emergence of azole-resistant fungi) or supratherapeutic exposures (thus potential risk of azole toxicity), suggesting that therapeutic dose monitoring is necessary in CF patients. [ABSTRACT FROM AUTHOR]

Published
2018
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