Lung transplantation is a life-saving therapy for adults with advanced lung diseases, such as interstitial lung disease and chronic obstructive pulmonary disease. The success of lung transplantation is limited by poor early and late outcomes. Primary graft dysfunction (PGD), a form of acute lung injury (ALI) occurring within 72 hours of lung transplantation, is the leading cause of death early after lung transplantation and contributes to chronic lung allograft dysfunction. We recently identified obesity as a novel risk factor for PGD. The mechanism underlying this association is not known, but obesity-related inflammation could contribute. Obesity is characterized by a chronic systemic inflammatory state due to the accumulation of pro-inflammatory adipose tissue macrophages (ATMs), T cells, and other immune cells. Adipocytes and ATMs secrete inflammatory mediators, chemoattractants, and adipokines, such as leptin, visfatin, and resistin, that could contribute to the development of ALI. We hypothesize that adipose tissue inflammation increases during lung transplant surgery and contributes to PGD, and that pro-inflammatory ATMs and T cells drive this process. To test our hypothesis, we propose leverage the existing infrastructure of the Lung Transplant Outcomes Group perform a prospective cohort study that includes (1) measurement of intrathoracic, visceral, and subcutaneous adipose tissue mass using quantitative CT imaging, (2) immunophenotyping of macrophages and T cells from intrathoracic adipose tissue and lymph nodes obtained immediately before and after lung transplantation, and (3) measurement of adipokines and cytokines in plasma and bronchoalveolar lavage (BAL) fluid and lymphocyte phenotypes in the circulating and lung compartments in participants at three lung transplant centers (Columbia, Penn, and Duke) to accomplish three Specific Aims:
Specific Aim 1 : Determine the associations of intrathoracic, visceral, and subcutaneous adipose tissue volume with the risk of PGD after lung transplantation;
Specific Aim 2 : Determine whether adipose tissue inflammation is associated with the risk of PGD;
and Specific Aim 3 : Determine whether plasma and BAL adipokine levels are associated with the risk of PGD. This application proposes to generate new knowledge on the role of adipose tissue inflammation in the development of PGD. The application is innovative in combining rigorous epidemiologic and translational approaches and the use of quantitative CT imaging of adipose tissue, which could help to improve the prediction of PGD risk and enhance transplant selection criteria. In addition, we propose to identify specific molecules that could be targeted in phase II clinical trials to decrease PGD risk and potentially improve outcomes after lung transplantation.

Public Health Relevance

One out of 5 adults who undergo lung transplantation dies within the first year of transplantation, most commonly as a consequence of damage to the new lungs early after transplantation. Overweight and obese adults undergoing lung transplantation are twice as likely as others to suffer from this early damage. We will determine if inflammation in fat tissue is responsible for this early damage so that we can develop treatments aimed at decreasing fat inflammation and thereby avoid damage to the transplanted lungs.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
Project #
Application #
Study Section
Infectious Diseases, Reproductive Health, Asthma and Pulmonary Conditions Study Section (IRAP)
Program Officer
Harabin, Andrea L
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Columbia University (N.Y.)
Internal Medicine/Medicine
Schools of Medicine
New York
United States
Zip Code
Singer, Jonathan P; Diamond, Joshua M; Anderson, Michaela R et al. (2018) Frailty phenotypes and mortality after lung transplantation: A prospective cohort study. Am J Transplant 18:1995-2004
Harhay, Michael O; Porcher, Raphaƫl; Cantu, Edward et al. (2018) An Alternative Approach for the Analysis of Time-to-Event and Survival Outcomes in Pulmonary Medicine. Am J Respir Crit Care Med 198:684-687
Cantu, Edward; Diamond, Joshua M; Suzuki, Yoshikazu et al. (2018) Quantitative Evidence for Revising the Definition of Primary Graft Dysfunction after Lung Transplant. Am J Respir Crit Care Med 197:235-243
Reilly, John P; Christie, Jason D; Meyer, Nuala J (2017) Fifty Years of Research in ARDS. Genomic Contributions and Opportunities. Am J Respir Crit Care Med 196:1113-1121
Pollack, Lauren R; Goldstein, Nathan E; Gonzalez, Wendy C et al. (2017) The Frailty Phenotype and Palliative Care Needs of Older Survivors of Critical Illness. J Am Geriatr Soc 65:1168-1175
Tong, Yubing; Udupa, Jayaram K; Torigian, Drew A et al. (2017) Chest Fat Quantification via CT Based on Standardized Anatomy Space in Adult Lung Transplant Candidates. PLoS One 12:e0168932
Baldwin, Matthew R; Singer, Jonathan P; Huang, Debbie et al. (2017) Refining Low Physical Activity Measurement Improves Frailty Assessment in Advanced Lung Disease and Survivors of Critical Illness. Ann Am Thorac Soc 14:1270-1279
Layton, Aimee M; Armstrong, Hilary F; Baldwin, Matthew R et al. (2017) Frailty and maximal exercise capacity in adult lung transplant candidates. Respir Med 131:70-76
Borders, Catherine F; Suzuki, Yoshikazu; Lasky, Jared et al. (2017) Massive donor transfusion potentially increases recipient mortality after lung transplantation. J Thorac Cardiovasc Surg 153:1197-1203.e2
Diamond, Joshua M; Arcasoy, Selim; McDonnough, Jamiela A et al. (2017) Adipose Gene Expression Profile Changes With Lung Allograft Reperfusion. Am J Transplant 17:239-245

Showing the most recent 10 out of 32 publications