Martin Carby

Martin Carby
Royal Brompton and Harefield NHS Foundation Trust · Transplantation

FRCP

About

138
Publications
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Publications

Publications (138)
Article
Purpose Cystic fibrosis (CF) is a life-limiting genetic condition with which often leads to life-threatening respiratory failure requiring lung transplantation. People with CF (PwCF) account for 16% of adult bilateral lung transplants internationally according to a 2016 report of the ISHLT Registry by Yusen et al. With the advent of effective CFTR...
Article
Full-text available
Purpose Lung transplant patients are at increased susceptibility to fungal infections. Isavuconazole, a triazole anti-fungal with broad-spectrum activity against medically important fungal pathogens, received a marketing authorisation in the U.K. in 2015. The use of isavuconazole has advantages over voriconazole and posaconazole as it presents a mo...
Article
Full-text available
Purpose Lung transplant (LTx) patients have increased susceptibility to fungal infections. Isavuconazole received a marketing authorisation in the UK in 2015. The use of isavuconazole has advantages over voriconazole/posaconazole as it presents a more favourable pharmacokinetic and toxicity profile. This retrospective analysis reviews the experienc...
Article
Purpose Lung transplant (LTx) recipients require regular monitoring to ensure graft function, medicines optimisation and minimisation of side effects. Traditionally, clinics are time-limited and focus on medical aspects. The aim was to evaluate physical and psychological wellbeing of LTx recipients, identify unmet needs and develop personalised car...
Article
Purpose Right ventricular (RV) function strongly influences prognosis, but key metrics are not clear, particularly in WHO classified Group 3 pulmonary hypertension (PH) associated with lung disease. We assessed a cardiac magnetic resonance (CMR) index of global longitudinal strain as well as right ventricular (RV) trabecular complexity by its fract...
Conference Paper
Introduction and objectives Patients with advanced ILD (Interstitial Lung Disease) have a narrow window when they can be successfully transplanted. The use of ECMO (Extracorporeal membrane Oxygenation) pretransplant has traditionally been associated with poor posttransplant outcomes. Advances in extracorporeal technology, patients election, and man...
Article
Introduction Right ventricular (RV) dysfunction complicating lung disease is prognostic in patients undergoing lung transplantation. However key metrics are not clear. Purpose We assessed RV-pulmonary arterial (PA) coupling and RV trabecular complexity through cardiac magnetic resonance (CMR) imaging in patients undergoing lung transplant assessme...
Article
Purpose ECMO as a bridge to LTx became over the last decade a standard approach in rapidly deteriorating patients in selected centres. Recent analysis revealed that pre-transplant iMV rather than ECMO by itself is an independent risk factor. In this study we compare our cohort of mechanically and self- ventilated patients bridged to LTx with ECMO....
Article
Purpose Right ventricular (RV) function influences prognosis in pulmonary hypertension (PH), but key metrics are not clear. We assessed a cardiac magnetic resonance (CMR) index of RV-pulmonary arterial (PA) coupling as well as right ventricular (RV) trabecular complexity by its fractal dimension (FD), correlating to imaging indices and outcome. Me...
Article
Purpose The use of awake extracorporeal circulatory support (AECLS) systems, as a means of bridging to lung transplantation, was initiated in the UK at Harefield Hospital in 2011. This centre remains the only UK centre using this approach. Being awake whilst being bridged enables patients to optimize their physical health status pre transplant surg...
Article
Background: Idiopathic pulmonary artery hypertension (iPAH) is a relatively minor indication for lung transplantation (LTx) with comparatively poorer outcomes. Extracorporeal life support (ECLS) in various forms is increasingly being used in the management of this entity. However, the data and experience with this therapy remains limited. We evalu...
Conference Paper
Introduction Right ventricular (RV) function strongly influences prognosis in pulmonary hypertension (PH), but it remains unclear what key metrics are most clinically relevant. The purpose of this study was to assess the clinical relevance of both RV trabecular complexity and adequacy of RV functional adaptation to increased afterload as assessed b...
Conference Paper
Chronic lung allograft dysfunction (CLAD) is the main complication following lung transplantation and remains the most common limitation of long-term survival. CLAD is a descriptive term and is defined by a persistent reduction (>10%) in FEV1 and/or FVC from the best post-transplant baseline. The aim of this study was to assess the predictive abili...
Conference Paper
Rationale Timely, accurate diagnosis of invasive aspergillosis (IA) is key to enable initiation of antifungal therapy in lung transplantation. Despite promising novel fungal biomarkers, the lack of a diagnostic gold-standard creates difficulty in determining utility. Objectives This study aimed to use latent class modelling of fungal diagnostics t...
Article
Closure of the chest after lung transplant in cases of oversized grafts is often difficult. Lung volume reduction and delayed closure of the chest with Bogota bag are the only options available in such situations. Here, we propose to keep the sternum and intercostal spaces open and approximate skin over it. Once lung function improves and reperfusi...
Article
OBJECTIVES Cannabis is the most commonly abused illicit drug and the smokers are at the risk of lung infections, bullous emphysema and lung cancer. However, no evidence about the outcomes of lung transplantation (LTx) utilizing the lungs from such donors is available in the literature. METHODS We retrospectively analysed lung ‘organ offers’ and LT...
Article
Introduction. Donation after cardiac death (DCD) is emerging as a suitable solution to the shortage of grafts for lung transplantation (LTx). The inflammatory response between LTx utilising DCD and brain death donor (DBD) lungs has not been fully elucidated. Here we focus on leukocyte responses and release of permeability and oxidative stress media...
Article
Introduction. The Organ Care System (OCS) is a sophisticated platform to preserve, evaluate and recondition donated lungs for transplantation (LTx). The impact of OCS on inflammatory response is not known. Here we focus on leukocyte responses and release of neutrophil-derived permeability and oxidative stress mediators. Methods. Neutrophil kinetics...
Article
Full-text available
Rationale: Pulmonary aspergillosis is a lethal mould infection in the immunocompromised host. Understanding initial control of infection, and how this is altered in the immunocompromised host, is a key goal for understanding the pathogenesis of pulmonary aspergillosis. Objectives: To characterise the outcome of human macrophage infection with As...
Article
Background: Because of improved surgical expertise and intraoperative management, pleural disease (PD+) represents a relatively minor contraindication to lung transplantation (LTx). The presence of pleural abnormalities from previous procedures or pleural involvement from fungal or bacterial disease is not considered a limiting factor for LTx. How...
Article
Kidney failure after lung transplantation is a risk factor for chronic kidney disease. Calcineurin inhibitors are immunosuppressants which play a major role in terms of postoperative kidney failure after lung transplantation. We report our preliminary experience with the anti-interleukin-2 monoclonal antibody Basiliximab utilized as a “calcineurin...
Article
Full-text available
Objectives: Minimally invasive lung transplantation (MILT) via bilateral anterior thoracotomies has emerged as a novel surgical strategy with potential patient benefits when compared with transverse thoracosternotomy (clamshell incision, CS). The aim of this study is to compare MILT with CS by focusing on operative characteristics, postoperative o...
Article
Background: Limited data is available about lung transplantation (LTx) from donors suffering cardiac arrest (CA) prior to actual donation. Methods: A retrospective analysis of LTx performed between January 2007 and September 2012 was done with the focus on CA in donors. The recipients were grouped depending on the history of donor CA and CA dura...
Article
Background: The risk-benefit for utilizing cardio-pulmonary bypass (CPB) in lung transplantation (LTx) remains debatable. This study compares outcomes after LTx utilizing different CPB strategies- elective CPB vs. off-pump vs. off-pump with unplanned conversion to CPB. Methods: A total of 302 LTx performed over 7 years were divided into three gr...
Article
Invasive fungal infections are a major cause of mortality in solid-organ transplantation where steroids and calcineurin inhibitors form the core of immunosuppression. Our group has previously shown in established hydrocortisone-based mouse models of invasive aspergillosis that calcineurin inhibitors increase mortality through effects on the innate...
Article
Full-text available
Invasive fungal infections cause significant morbidity and mortality after lung transplantation. Fungal prophylaxis following lung transplantation is not standardised, with transplant centres utilising a variety of regimens. Posaconazole is a broad-spectrum antifungal triazole that requires further investigation within the setting of lung transplan...
Article
Background The management of patients in a cardiothoracic centre requires effective interaction between clinical care groups. CRRISiS (Clinical Risk Reduction in Simulated Settings) was developed to support this. These high-fidelity, simulation sessions involve the multidisciplinary-team across departments. A debrief structure focussing on human fa...
Article
Background Foundation Training Programme acts as a bridge from medical school to specialist training. The Royal College of Physicians refers to Foundation Training (FT) as “practical experience needed to work independently”,1 however many students feel under-prepared for this daunting step. High fidelity simulation may be a valuable tool in bridgin...
Article
Objective: As Gastrooesophageal-Reflux-Disease (GORD) affects long-term survival in lung transplant recipients the aim of this observational prospective study was to analyse the efficacy of The Reflux Symptom Index Questionnaire (RSI) compared to the Oesophageal Impedance Test. Methods: Both oesophageal impedance studies and RSI questionnaire we...
Article
Introduction: To explore the hypothesis that early ventilation strategies influence clinical outcomes in lung transplantation, we have examined our routine ventilation practices in terms of tidal volumes (Vt) and inflation pressures. Methods: A total of 124 bilateral lung transplants between 2010 and 2013 were retrospectively assigned to low (<6...
Article
Introduction: Kidney failure after lung transplantation (LTX) is a recognised risk factor for chronic kidney disease and worse long term outcomes. Calcineurin-inhibitors (CNI) play a major role in terms of possible kidney dysfunction after LTX in the early postoperative course, especially in combination with antimicrobial drugs. Sirolimus is not re...
Article
Aims and objectives: Pulmonary hypertension (PH) is a feature of patients with lung disease undergoing lung transplantation (LTx). Sildenafil use in these patients with 'group 3' PH is not routine, although it appears to benefit some patients. In addition, the presence of PH increases perioperative risk, and preclinical studies suggest sildenafil m...
Article
Introduction: Numerous platforms have been developed to assess human lungs for potential transplantation during ex vivo perfusion and ventilation. The role of imaging during ex vivo assessment has not yet been determined. Methods: Following the retrieval of lungs for potential transplantation, the organs were subsequently deemed unsuitable for clin...
Article
Background Traditionally, patients on extracorporeal membrane oxygenation (ECMO) are sedated and mechanically ventilated, which increases risk of complications related to immobility and mechanical ventilation. The purpose of this study was to assess the feasibility and highlight the benefits of a bridge to lung transplant (LTx) using "awake ECMO" s...
Article
Background Traditionally, patients on extracorporeal membrane oxygenation (ECMO) are sedated and mechanically ventilated, which increases risk of complications related to immobility and mechanical ventilation. The purpose of this study was to assess the feasibility and highlight the benefits of a bridge to lung transplant (LTx) using "awake ECMO" s...
Article
Objectives: This study was sought to compare outcomes after LTx using elective CPB versus off-pump LTx versus off-pump procedures where a conversion to a CPB was necessary. Methods: 302 LTx performed over 7 years were grouped as 'off-pump' group (n = 86), 'elective on-pump' group (n = 162) and 'conversion' group (n = 54). Preoperative donor and rec...
Article
Bronchiolitis obliterans syndrome (BOS) is the major cause of late graft failure after lung transplantation. The objective was to determine if de novo donor HLA specific antibodies (DSA) are associated with the development of BOS or patient survival. Data from 188 lung transplant recipients with a follow up period up to 8 years were analysed. HLA a...
Article
Background Lung transplantation (LTx) is a complex surgical procedure conventionally performed with clamps on recipient pulmonary artery (PA) and left atrial (LA) cuff, with or without cardio-pulmonary bypass. The clamps may be awkward to apply and maintain on these structures, potentially injure these structures, and may compromise the quality of...
Article
Lung transplantation (LTx) from “extended donor criteria” donors may reduce significantly organ shortage. However, its influence on results remains unclear. In this study, we evaluate retrospectively the results of LTx from donors outside standard criteria: PaO2/FiO2 ratio < 300 mmHg, age over 55 years, and history of smoking > 20 pack-years. Two h...
Article
Background The impact of Luminex detected HLA antibodies on outcomes after lung transplantation is unclear. Here we have performed a retrospective study of pre-transplant sera from 425 lung transplants performed between 1991 and 2003. Methods Pre-transplant sera, originally screened by complement dependent cytotoxicity (CDC) assays were retrospect...
Article
OBJECTIVES: Lung transplantation (LTx) from ''extended donor criteria" donors may reduce significantly organ shortage. However, it's influence on results remains unclear. In this study we evaluate retrospectively the results of LTx from donors outside standard criteria: PaO2/FiO2 ratio < 300 mmHg, age over 55 years and history of smoking > 20 pack-...
Article
Lung transplantation (LTx) is a complex surgical procedure conventionally performed with clamps on the recipient pulmonary artery (PA) and left atrial (LA) cuff, with or without cardiopulmonary bypass (CPB). The clamps may be awkward to apply and maintain on these structures, potentially causing injury and possibly compromising the quality of anast...
Article
We describe the case of a 29-year-old woman with end-stage chronic obstructive pulmonary disease secondary to vascular Ehlers-Danlos syndrome. Because of critical deterioration, respiratory arrest, and complete lung failure, she required urgent implantation of a venovenous extracorporeal membrane oxygenator as a bridge to lung transplantation. Afte...
Article
There is a lack of significant literature on provision of Supportive and Palliative care (SPC) for Lung transplant patients pre and post surgery. A baseline audit of patients was undertaken to identify SPC access in the last year of life. Patients who died in 2010 on the lung transplant waiting list or had lung or heart and lung transplants were au...