Joshua R Sonett

Columbia University, New York, New York, United States

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Publications (153)756.27 Total impact

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    ABSTRACT: Frailty is associated with morbidity and mortality in abdominal organ transplantation but has not been examined in lung transplantation. To examine the construct and predictive validity of frailty phenotypes in lung transplant candidates. In a multicenter prospective cohort we measured frailty with the Fried Frailty Phenotype (FFP) and Short Physical Performance Battery (SPPB). We evaluated construct validity through comparisons to conceptually related factors. In a nested case-control study of frail and non-frail subjects, we measured serum IL-6, tumor necrosis factor-receptor 1 (TNFR1), insulin-like growth factor I (IGF-1), and leptin. We estimated the association between frailty and disability and risk of delisting/death before transplant using multivariate logistic and cox models, respectively. In 395 subjects, 28% were frail by FFP (95%CI 24-33%) and 10% by SPPB (95%CI 7-14%). By either measure, frailty correlated more strongly with exercise capacity and grip strength than with lung function. Frail subjects tended to have higher plasma IL-6 and TNFR1 and lower IGF-1 and leptin. Frailty by either measure was associated with greater disability. After adjusting for age, gender, diagnosis and transplant center, both FFP and SPPB were associated with increased risk of delisting/death before lung transplantation (FFP, HR 1.30, 95%CI 1.01-1.67; SPPB, HR 1.53, 95%CI 1.19-1.59 per one point worsening in score). Frailty is prevalent among lung transplant candidates and is independently associated with greater disability and an increased risk of delisting or death.
    American Journal of Respiratory and Critical Care Medicine 08/2015; DOI:10.1164/rccm.201506-1150OC · 13.00 Impact Factor
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    ABSTRACT: Extracorporeal life support technology has gained acceptance as a salvage mode for patients in respiratory or cardiac failure. Patients who are sick enough to require extracorporeal membrane oxygenation (ECMO) support are often too unstable for transfer to a hospital with ECMO capabilities. We highlight the progressive development of an ECMO transport team and the manner in which it provides reliable transport with excellent outcomes. All data were collected retrospectively from our hospital's electronic medical record. Patient outcomes are reported through April 2, 2014. Our institution began an ECMO transport program in 2008, with the initial phase involving transport of highly selected patients for short distances. With experience we refined our intake and evaluation process. We also consolidated care for ECMO patients into two intensive care units and developed a dedicated ECMO intensivist position. As the program has matured, patient selection has become more inclusive and we have extended our capabilities to include interstate and international transport. All 100 patients were successfully placed on ECMO and transported to our center. Seventy-nine patients were placed on venovenous ECMO, 19 on venoarterial ECMO, and 2 on venovenous arterial ECMO. The median transport distance was 16 miles and ranged from 2.5 to 7,084 miles. Extracorporeal membrane oxygenation transport can be performed safely and reliably with excellent outcomes with a dedicated team that maintains stringent adherence to well-designed management protocols. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    The Annals of thoracic surgery 04/2015; 100(1). DOI:10.1016/j.athoracsur.2015.02.037 · 3.85 Impact Factor
  • The Journal of Heart and Lung Transplantation 04/2015; 34(4):S14. DOI:10.1016/j.healun.2015.01.025 · 6.65 Impact Factor
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    The Journal of Heart and Lung Transplantation 04/2015; 34(4):S15. DOI:10.1016/j.healun.2015.01.028 · 6.65 Impact Factor
  • The Journal of Heart and Lung Transplantation 04/2015; 34(4):S255-S256. DOI:10.1016/j.healun.2015.01.709 · 6.65 Impact Factor
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    Mauer Biscotti · Joshua Sonett · Matthew Bacchetta
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    ABSTRACT: Since the advent of lung transplantation more than 5 decades ago, preoperative, surgical, and anesthetic management have improved. The growing experience with extracorporeal membrane oxygenation (ECMO) has enabled clinicians to expand its effective use to care for patients while bridging them to transplant (BTT). We highlight the approach in which ECMO is used to successfully bridge critically ill patients to lung transplantation when stringent daily clinical assessment is applied. In patients who continued to meet transplant criteria and were successfully transplanted, postoperative survival rates are acceptable. Larger studies are needed to inform decision algorithms for BTT patients and optimize outcomes.
    Thoracic Surgery Clinics 02/2015; 25(1):17-25. DOI:10.1016/j.thorsurg.2014.09.010 · 0.77 Impact Factor
  • 15th Annual State of the Art Winter Symposium of the; 01/2015
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    ABSTRACT: This study compared differences in patient outcomes and operative parameters for extracorporeal membrane oxygenation (ECMO) versus cardiopulmonary bypass (CPB) in patients undergoing lung transplants. Between January 1, 2008, and July 13, 2013, 316 patients underwent lung transplants at our institution, 102 requiring intraoperative mechanical cardiopulmonary support (CPB, n = 55; ECMO, n = 47). We evaluated survival, blood product transfusions, bleeding complications, graft dysfunction, and rejection. Intraoperatively, the CPB group required more cell saver volume (1123 ± 701 vs 814 ± 826 mL; P = .043), fresh-frozen plasma (3.64 ± 5.0 vs 1.51 ± 3.2 units; P = .014), platelets (1.38 ± 1.6 vs 0.43 ± 1.25 units; P = .001), and cryoprecipitate (4.89 ± 6.3 vs 0.85 ± 2.8 units; P < .001) than the ECMO group. Postoperatively, the CPB group received more platelets (1.09 ± 2.6 vs 0.13 ± 0.39 units; P = .013) and was more likely to have bleeding (15 [27.3%] vs 3 [6.4%]; P = .006) and reoperation (21 [38.2%] vs 7 [14.9%]; P = .009]. The CPB group had higher rates of primary graft dysfunction at 24 and 72 hours (41 [74.5%] vs 23 [48.9%]; P = .008; and 42 [76.4%] vs 26 [56.5%]; P = .034; respectively). There were no differences in 30-day and 1-year survivals. Relative to CPB, the ECMO group required fewer transfusions and had less bleeding, fewer reoperations, and less primary graft dysfunction. There were no statistically significant survival differences at 30 days or 1 year. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
    Journal of Thoracic and Cardiovascular Surgery 11/2014; 148(5):2410-6. DOI:10.1016/j.jtcvs.2014.07.061 · 4.17 Impact Factor
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    ABSTRACT: Rationale: Obesity and underweight are contraindications to lung transplantation based on their associations with mortality in studies performed before implementation of the lung allocation score (LAS)-based organ allocation system in the United States Objectives: To determine the associations of body mass index (BMI) and plasma leptin levels with survival after lung transplantation. Methods: We used multivariable-adjusted regression models to examine associations between BMI and 1-year mortality in 9,073 adults who underwent lung transplantation in the United States between May 2005 and June 2011, and plasma leptin and mortality in 599 Lung Transplant Outcomes Group study participants. We measured body fat and skeletal muscle mass using whole-body dual X-ray absorptiometry in 142 adult lung transplant candidates. Measurements and main results: Adjusted mortality rates were similar among normal weight (BMI 18.5-24.9 kg/m(2)), overweight (BMI 25.0-29.9), and class I obese (BMI 30-34.9) transplant recipients. Underweight (BMI < 18.5) was associated with a 35% increased rate of death (95% confidence interval, 10-66%). Class II-III obesity (BMI ≥ 35 kg/m(2)) was associated with a nearly twofold increase in mortality (hazard ratio, 1.9; 95% confidence interval, 1.3-2.8). Higher leptin levels were associated with increased mortality after transplant surgery performed without cardiopulmonary bypass (P for interaction = 0.03). A BMI greater than or equal to 30 kg/m(2) was 26% sensitive and 97% specific for total body fat-defined obesity. Conclusions: A BMI of 30.0-34.9 kg/m(2) is not associated with 1-year mortality after lung transplantation in the LAS era, perhaps because of its low sensitivity for obesity. The association between leptin and mortality suggests the need to validate alternative methods to measure obesity in candidates for lung transplantation. A BMI greater than or equal to 30 kg/m(2) may no longer contraindicate lung transplantation.
    American Journal of Respiratory and Critical Care Medicine 09/2014; 190(9). DOI:10.1164/rccm.201405-0973OC · 13.00 Impact Factor
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    ABSTRACT: Background Although preoperative chemotherapy (cisplatin-etoposide) and radiotherapy, followed by surgical resection, is considered a standard of care for superior sulcus cancers, treatment is rigorous and relapse limits long-term survival. The Southwest Oncology Group-Intergroup Trial S0220 was designed to incorporate an active systemic agent, docetaxel, as consolidation therapy. Methods Patients with histologically proven and radiologically defined T3 to 4, N0 to 1, M0 superior sulcus non-small cell lung cancer underwent induction therapy with cisplatin-etoposide, concurrently with thoracic radiotherapy at 45 Gy. Nonprogressing patients underwent surgical resection within 7 weeks. Consolidation consisted of docetaxel every 3 weeks for 3 doses. The accrual goal was 45 eligible patients. The primary objective was feasibility. Results Of 46 patients registered, 44 were eligible and assessable; 38 (86%) completed induction, 29 (66%) underwent surgical resection, and 20 (45% of eligible, 69% surgical, and 91% of those initiating consolidation therapy) completed consolidation docetaxel; 28 of 29 (97%) underwent a complete (R0) resection; 2 (7%) died of adult respiratory distress syndrome. In resected patients, 21 of 29 (72%) had a pathologic complete or nearly complete response. The known site of first recurrence was local in 2, local-systemic in 1, and systemic in 10, with 7 in the brain only. The 3-year progression-free survival was 56%, and 3-year overall survival was 61%. Conclusions Although trimodality therapy provides excellent R0 and local control, only 66% of patients underwent surgical resection and only 45% completed the treatment regimen. Even in this subset, distant recurrence continues to be a major problem, particularly brain-only relapse. Future strategies to improve treatment outcomes in this patient population must increase the effectiveness of systemic therapy and reduce the incidence of brain-only metastases.
    The Annals of Thoracic Surgery 08/2014; 98(2). DOI:10.1016/j.athoracsur.2014.04.129 · 3.85 Impact Factor
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    ABSTRACT: Background: Lung cancer is a leading cause of mortality, and patients often present at a late stage. More recently, advances in screening, diagnosing, and treating lung cancer have been made. For instance, greater numbers of minimally invasive procedures are being performed, and identification of lung adenocarcinoma driver mutations has led to the implementation of targeted therapies. Advances in molecular techniques enable use of scant tissue, including cytology specimens. In addition, per recently published consensus guidelines, cytology-derived cell blocks (CBs) are preferred over direct smears. Yet, limited comparison of molecular testing of fine-needle aspiration (FNA) CBs and corresponding histology specimens has been performed. This study aimed to establish concordance of epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma (KRAS) virus homolog testing between FNA CBs and histology samples from the same patients. Materials and Methods: Patients for whom molecular testing for EGFR or KRAS was performed on both FNA CBs and histology samples containing lung adenocarcinoma were identified retrospectively. Following microdissection, when necessary, concordance of EGFR and KRAS molecular testing results between FNA CBs and histology samples was evaluated. Results: EGFR and/or KRAS testing was performed on samples obtained from 26 patients. Concordant results were obtained for all EGFR (22/22) and KRAS (17/17) mutation analyses performed. Conclusions: Identification of mutations in lung adenocarcinomas affects clinical decision-making, and it is important that results from small samples be accurate. This study demonstrates that molecular testing on cytology CBs is as sensitive and specific as that on histology.
    CytoJournal 05/2014; 11(1):12. DOI:10.4103/1742-6413.132989
  • The Journal of Heart and Lung Transplantation 04/2014; 33(4):S139. DOI:10.1016/j.healun.2014.01.375 · 6.65 Impact Factor
  • The Journal of Heart and Lung Transplantation 04/2014; 33(4):S188. DOI:10.1016/j.healun.2014.01.880 · 6.65 Impact Factor
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    ABSTRACT: Traumatic injury to the aortic valve is an uncommon clinical entity. Rarer still is transport of such a patient using Extracorporeal Membrane Oxygenation (ECMO) to a specialized ECMO center for definitive repair. We present a case of traumatic rupture of the aortic valve complicated by severe ARDS with inter-hospital transport using ECMO and subsequent aortic valve replacement (AVR).
    ASAIO journal (American Society for Artificial Internal Organs: 1992) 03/2014; 60(3). DOI:10.1097/MAT.0000000000000068 · 1.52 Impact Factor
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    ABSTRACT: Inherent recipient factors, including pretransplant diagnosis, obesity and elevated pulmonary pressures, are established primary graft dysfunction (PGD) risks. We evaluated the relationship between preoperative lung injury biomarkers and PGD to gain further mechanistic insight in recipients. We performed a prospective cohort study of recipients in the Lung Transplant Outcomes Group enrolled between 2002 and 2010. Our primary outcome was Grade 3 PGD on Day 2 or 3. We measured preoperative plasma levels of five biomarkers (CC-16, sRAGE, ICAM-1, IL-8 and Protein C) that were previously associated with PGD when measured at the postoperative time point. We used multivariable logistic regression to adjust for potential confounders. Of 714 subjects, 130 (18%) developed PGD. Median CC-16 levels were elevated in subjects with PGD (10.1 vs. 6.0, p < 0.001). CC-16 was associated with PGD in nonidiopathic pulmonary fibrosis (non-IPF) subjects (OR for highest quartile of CC-16: 2.87, 95% CI: 1.37, 6.00, p = 0.005) but not in subjects with IPF (OR 1.38, 95% CI: 0.43, 4.45, p = 0.59). After adjustment, preoperative CC-16 levels remained associated with PGD (OR: 3.03, 95% CI: 1.26, 7.30, p = 0.013) in non-IPF subjects. Our study suggests the importance of preexisting airway epithelial injury in PGD. Markers of airway epithelial injury may be helpful in pretransplant risk stratification in specific recipients.
    American Journal of Transplantation 02/2014; 14(2). DOI:10.1111/ajt.12541 · 5.68 Impact Factor
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    ABSTRACT: Thoracic procurements have traditionally been performed by surgical fellows or attending cardiothoracic surgeons. Donor lung procurement protocols are well established and fairly standardized; however, specific procurement training and judgment are essential to optimizing donor utilization. Although the predicted future deficits of cardiothoracic surgeons are based on a variety of analytic models and scenarios, it appears evident that there will not be a sufficient number of trained cardiothoracic surgeons over the next 2 decades. Over the past 5 years in our institution, lung procurements have been performed by a specifically trained physician assistant; as the lead donor surgeon. This model may serve as a cost effective, reproducible, and safe alternative to using surgical fellows and attending surgeons, assuring continuity, ongoing technical expertise, and teaching while addressing future workforce issues as related to transplant. This is a single institution review of 287 consecutive lung procurements performed by either a physician assistant or fellow over 5 years. This study was approved by the Institutional Review Board of Columbia University, which waived the need for informed consent (IRB#AAAL7107). From 2008 to 2012, fellows served as senior surgeon in 90 cases (31.4%) versus 197 cases (68.6%) by the physician assistant, including 12 Donations after Cardiac Death and 6 reoperative donors. Injury rate was significantly lower for the physician assistant compared with the resident cohort (1 of 197 [0.5%] vs 22 of 90 [24%], respectively). Rates for pulmonary graft dysfunction grade 2 and 3 were found to be significantly lower in cases where the physician assistant served as senior surgeon (combined rates of 32.2% [29 of 90] vs 9.6% [19 of 197] in the physician assistant group) (p < 0.01). Use of experienced physician assistants in donor lung procurements is a safe and viable alternative offering continuity of technical expertise and evaluation of lung allografts.
    The Annals of thoracic surgery 10/2013; 96(6). DOI:10.1016/j.athoracsur.2013.07.094 · 3.85 Impact Factor
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    ABSTRACT: Lungs from older adult organ donors are often unused because of concerns for increased mortality. We examined associations between donor age and transplant outcomes among 8860 adult lung transplant recipients using Organ Procurement and Transplantation Network and Lung Transplant Outcomes Group data. We used stratified Cox proportional hazard models and generalized linear mixed models to examine associations between donor age and both 1-year graft failure and primary graft dysfunction (PGD). The rate of 1-year graft failure was similar among recipients of lungs from donors age 18-64 years, but severely ill recipients (Lung Allocation Score [LAS] >47.7 or use of mechanical ventilation) of lungs from donors age 56-64 years had increased rates of 1-year graft failure (p-values for interaction = 0.04 and 0.02, respectively). Recipients of lungs from donors <18 and ≥65 years had increased rates of 1-year graft failure (adjusted hazard ratio [HR] 1.23, 95% CI 1.01-1.50 and adjusted HR 2.15, 95% CI 1.47-3.15, respectively). Donor age was not associated with the risk of PGD. In summary, the use of lungs from donors age 56 to 64 years may be safe for adult candidates without a high LAS and the use of lungs from pediatric donors is associated with a small increase in early graft failure.
    American Journal of Transplantation 08/2013; 13(10). DOI:10.1111/ajt.12428 · 5.68 Impact Factor

Publication Stats

2k Citations
756.27 Total Impact Points


  • 2004–2015
    • Columbia University
      • • Department of Surgery
      • • College of Physicians and Surgeons
      • • Department of Medicine
      • • Department of Epidemiology
      New York, New York, United States
  • 2002–2014
    • New York Presbyterian Hospital
      • • Department of Cardiothoracic Surgery
      • • Department of Pain Medicine
      New York City, New York, United States
  • 2003–2012
    • CUNY Graduate Center
      New York City, New York, United States
  • 2011
    • Mid-Columbia Medical Center
      DLS, Oregon, United States
    • College of Physicians and Surgeons of British Columbia
      ノースヨーク, Ontario, Canada
  • 2007
    • Yale University
      • Department of Pediatrics
      New Haven, Connecticut, United States
  • 1998–2002
    • University of Maryland, Baltimore
      • Department of Surgery
      Baltimore, Maryland, United States
  • 1999
    • University of Maryland Medical Center
      • Greenebaum Cancer Center
      Baltimore, Maryland, United States
    • Loyola University Maryland
      Baltimore, Maryland, United States