Scholars@Duke
Lorenzo Zaffiri

Lorenzo Zaffiri

Adjunct Assistant Professor in the Department of Medicine
Medicine, Pulmonary, Allergy, and Critical Care Medicine
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Selected Publications

Impact of minimally invasive lung transplantation on early outcomes and analgesia use: A matched cohort study.

Journal Article J Heart Lung Transplant · August 2024 BACKGROUND: Minimally invasive (MI) approaches to lung transplantation (LTx) offer the prospect of faster recovery compared to traditional incisions, however, little data exist describing the impact of surgical technique on early outcomes and analgesia use ... Full text Link to item Cite

Lung transplantation outcomes in patients from socioeconomically distressed communities.

Journal Article J Heart Lung Transplant · December 2023 BACKGROUND: Previous studies have demonstrated racial and gender disparities in lung allocation, but contemporary data regarding socioeconomic disparities in post-transplant outcomes are lacking. We evaluated the impact of a composite socioeconomic disadva ... Full text Link to item Cite

Evaluation of Frailty Measures and Short-term Outcomes After Lung Transplantation.

Journal Article Chest · July 2023 BACKGROUND: Frailty, measured as a single construct, is associated variably with poor outcomes before and after lung transplantation. The usefulness of a comprehensive frailty assessment before transplantation is unknown. RESEARCH QUESTION: How are multipl ... Full text Link to item Cite

Evaluation of host cellular responses to Epstein-Barr virus (EBV) in adult lung transplant patients with EBV-associated diseases.

Journal Article J Med Virol · April 2023 Epstein-Barr virus (EBV) reactivation is commonly observed in lung transplant recipients (LTRs). However, cellular immune responses to EBV in adult LTRs have not been well described. We aimed to study CD4/CD8 ratio, EBV-specific T cells polyfunctional resp ... Full text Link to item Cite

Real-time transcription polymerase chain reaction cycle threshold values as criteria for utilization of incidental COVID-19 positive lung donors.

Journal Article J Heart Lung Transplant · March 2023 Shortage of organ donors is an ongoing limiting factor in lung transplantation (LT). Despite increasing prevalence of asymptomatic COVID-19 infection, positive COVID-19 testing from a potential donor remains a contraindication at many LT centers. In this r ... Full text Link to item Cite

Prognostic implications of and clinical risk factors for acute lung injury and organizing pneumonia after lung transplantation: Data from a multicenter prospective cohort study.

Journal Article Am J Transplant · December 2022 We determined prognostic implications of acute lung injury (ALI) and organizing pneumonia (OP), including timing relative to transplantation, in a multicenter lung recipient cohort. We sought to understand clinical risks that contribute to development of A ... Full text Link to item Cite

Cytomegalovirus prevention in thoracic organ transplantation: A single-center evaluation of letermovir prophylaxis.

Journal Article J Heart Lung Transplant · April 2022 BACKGROUND: Cytomegalovirus (CMV) infection is common following thoracic organ transplantation and causes substantial morbidity and mortality. Letermovir is a novel antiviral agent used off-label in this population for CMV prevention. Our goal was to under ... Full text Link to item Cite

Evidence of Epstein-Barr virus heterogeneous gene expression in adult lung transplant recipients with posttransplant lymphoproliferative disorder.

Journal Article J Med Virol · August 2021 Epstein-Barr virus (EBV)-driven posttransplant lymphoproliferative disorder (PTLD) is a serious complication following lung transplant. The extent to which the presence of EBV in PTLD tissue is associated with survival is uncertain. Moreover, whether the h ... Full text Link to item Cite

Desensitization and management of allograft rejection.

Journal Article Curr Opin Organ Transplant · June 1, 2021 PURPOSE OF REVIEW: Chronic lung allograft dysfunction (CLAD) limits the success of lung transplantation. Among the risk factors associated with CLAD, we recognize pretransplant circulating antibodies against the human leukocyte antigens (HLA), acute cellul ... Full text Link to item Cite

Transfusion Requirements during Lung Transplantation: Elective VA ECMO vs. Off-Pump

Conference JOURNAL OF HEART AND LUNG TRANSPLANTATION · 2021 Cite

Challenges in Lung Re-Transplantation Following Antibody-Mediated Rejection

Conference JOURNAL OF HEART AND LUNG TRANSPLANTATION · 2021 Cite

Incidence and outcome of post-transplant lymphoproliferative disorders in lung transplant patients: Analysis of ISHLT Registry.

Conference J Heart Lung Transplant · October 2020 BACKGROUND: Post-transplant lymphoproliferative disorder (PTLD) is a life-threatening complication following lung transplant. We studied incidence and risk factors for PTLD in adult lung transplant recipients (LTRs) using the International Society for Hear ... Full text Link to item Cite

Effects of a Goal Directed Transfusion Protocol on Severe Primary Graft Dysfunction after Lung Transplantation

Conference The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · April 1, 2020 PURPOSE: Transfusion during lung transplantation (LT) is linked to primary graft dysfunction (PGD) and worsened outcomes. Goal-directed protocols have improved outcomes in cardiac surgical populations and decreased transfusions in LT on cardiopulmonary byp ... Full text Cite

Perioperative Characteristics Associated with Transfusion-Free Lung Transplantation

Conference The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · April 1, 2020 PURPOSE: Blood transfusion during lung transplantation (LT) surgery is common. There is little evidence to identify potential candidates for transfusion-free LT surgery. We describe patient and procedural characteristics of LT patients in the era of ECMO a ... Full text Cite

Infection prophylaxis and management of viral infection.

Journal Article Ann Transl Med · March 2020 Viral infections are associated with significant morbidity and mortality in lung transplant recipients. Importantly, several viral infections have been associated with the development of chronic lung allograft dysfunction (CLAD). Community-acquired respira ... Full text Link to item Cite

Impact of Pre-Transplant Anti-Fibrotic Therapy for IPF Upon Lung Transplant Outcomes

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · 2020 Cite

Collagen type-V is a danger signal associated with primary graft dysfunction in lung transplantation.

Journal Article Transpl Immunol · October 2019 BACKGROUND: Primary graft dysfunction (PGD) is the leading cause of early mortality after lung transplantation. Anti-collagen type-V (col(V)) immunity has been observed in animal models of ischemia-reperfusion injury (IRI) and in PGD. We hypothesized that ... Full text Link to item Cite

Impact of minimally invasive lung transplantation on early outcomes and analgesia use: A matched cohort study.

Journal Article J Heart Lung Transplant · August 2024 BACKGROUND: Minimally invasive (MI) approaches to lung transplantation (LTx) offer the prospect of faster recovery compared to traditional incisions, however, little data exist describing the impact of surgical technique on early outcomes and analgesia use ... Full text Link to item Cite

Lung transplantation outcomes in patients from socioeconomically distressed communities.

Journal Article J Heart Lung Transplant · December 2023 BACKGROUND: Previous studies have demonstrated racial and gender disparities in lung allocation, but contemporary data regarding socioeconomic disparities in post-transplant outcomes are lacking. We evaluated the impact of a composite socioeconomic disadva ... Full text Link to item Cite

Evaluation of Frailty Measures and Short-term Outcomes After Lung Transplantation.

Journal Article Chest · July 2023 BACKGROUND: Frailty, measured as a single construct, is associated variably with poor outcomes before and after lung transplantation. The usefulness of a comprehensive frailty assessment before transplantation is unknown. RESEARCH QUESTION: How are multipl ... Full text Link to item Cite

Evaluation of host cellular responses to Epstein-Barr virus (EBV) in adult lung transplant patients with EBV-associated diseases.

Journal Article J Med Virol · April 2023 Epstein-Barr virus (EBV) reactivation is commonly observed in lung transplant recipients (LTRs). However, cellular immune responses to EBV in adult LTRs have not been well described. We aimed to study CD4/CD8 ratio, EBV-specific T cells polyfunctional resp ... Full text Link to item Cite

Real-time transcription polymerase chain reaction cycle threshold values as criteria for utilization of incidental COVID-19 positive lung donors.

Journal Article J Heart Lung Transplant · March 2023 Shortage of organ donors is an ongoing limiting factor in lung transplantation (LT). Despite increasing prevalence of asymptomatic COVID-19 infection, positive COVID-19 testing from a potential donor remains a contraindication at many LT centers. In this r ... Full text Link to item Cite

Prognostic implications of and clinical risk factors for acute lung injury and organizing pneumonia after lung transplantation: Data from a multicenter prospective cohort study.

Journal Article Am J Transplant · December 2022 We determined prognostic implications of acute lung injury (ALI) and organizing pneumonia (OP), including timing relative to transplantation, in a multicenter lung recipient cohort. We sought to understand clinical risks that contribute to development of A ... Full text Link to item Cite

Cytomegalovirus prevention in thoracic organ transplantation: A single-center evaluation of letermovir prophylaxis.

Journal Article J Heart Lung Transplant · April 2022 BACKGROUND: Cytomegalovirus (CMV) infection is common following thoracic organ transplantation and causes substantial morbidity and mortality. Letermovir is a novel antiviral agent used off-label in this population for CMV prevention. Our goal was to under ... Full text Link to item Cite

Evidence of Epstein-Barr virus heterogeneous gene expression in adult lung transplant recipients with posttransplant lymphoproliferative disorder.

Journal Article J Med Virol · August 2021 Epstein-Barr virus (EBV)-driven posttransplant lymphoproliferative disorder (PTLD) is a serious complication following lung transplant. The extent to which the presence of EBV in PTLD tissue is associated with survival is uncertain. Moreover, whether the h ... Full text Link to item Cite

Desensitization and management of allograft rejection.

Journal Article Curr Opin Organ Transplant · June 1, 2021 PURPOSE OF REVIEW: Chronic lung allograft dysfunction (CLAD) limits the success of lung transplantation. Among the risk factors associated with CLAD, we recognize pretransplant circulating antibodies against the human leukocyte antigens (HLA), acute cellul ... Full text Link to item Cite

Transfusion Requirements during Lung Transplantation: Elective VA ECMO vs. Off-Pump

Conference JOURNAL OF HEART AND LUNG TRANSPLANTATION · 2021 Cite

Challenges in Lung Re-Transplantation Following Antibody-Mediated Rejection

Conference JOURNAL OF HEART AND LUNG TRANSPLANTATION · 2021 Cite

Incidence and outcome of post-transplant lymphoproliferative disorders in lung transplant patients: Analysis of ISHLT Registry.

Conference J Heart Lung Transplant · October 2020 BACKGROUND: Post-transplant lymphoproliferative disorder (PTLD) is a life-threatening complication following lung transplant. We studied incidence and risk factors for PTLD in adult lung transplant recipients (LTRs) using the International Society for Hear ... Full text Link to item Cite

Effects of a Goal Directed Transfusion Protocol on Severe Primary Graft Dysfunction after Lung Transplantation

Conference The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · April 1, 2020 PURPOSE: Transfusion during lung transplantation (LT) is linked to primary graft dysfunction (PGD) and worsened outcomes. Goal-directed protocols have improved outcomes in cardiac surgical populations and decreased transfusions in LT on cardiopulmonary byp ... Full text Cite

Perioperative Characteristics Associated with Transfusion-Free Lung Transplantation

Conference The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · April 1, 2020 PURPOSE: Blood transfusion during lung transplantation (LT) surgery is common. There is little evidence to identify potential candidates for transfusion-free LT surgery. We describe patient and procedural characteristics of LT patients in the era of ECMO a ... Full text Cite

Infection prophylaxis and management of viral infection.

Journal Article Ann Transl Med · March 2020 Viral infections are associated with significant morbidity and mortality in lung transplant recipients. Importantly, several viral infections have been associated with the development of chronic lung allograft dysfunction (CLAD). Community-acquired respira ... Full text Link to item Cite

Impact of Pre-Transplant Anti-Fibrotic Therapy for IPF Upon Lung Transplant Outcomes

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · 2020 Cite

Collagen type-V is a danger signal associated with primary graft dysfunction in lung transplantation.

Journal Article Transpl Immunol · October 2019 BACKGROUND: Primary graft dysfunction (PGD) is the leading cause of early mortality after lung transplantation. Anti-collagen type-V (col(V)) immunity has been observed in animal models of ischemia-reperfusion injury (IRI) and in PGD. We hypothesized that ... Full text Link to item Cite

Early Rhinovirus Infection After Lung Transplantation - Simply the Innocent Bystander?

Conference The Journal of Heart and Lung Transplantation · April 2018 Full text Cite

Post-Transplant Lymphoproliferative Disorder: A Retrospective 17-Year Analysis

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · January 1, 2018 Link to item Cite

Pre-transplant Sensitization for Patient Awaiting Lung Transplant: Are We Concerned?

Journal Article Current Transplantation Reports · September 1, 2017 Purpose of Review: The goal of this paper is to highlight the changes in detection, management, and prognosis of pre-transplant sensitized candidates and recipients. Recent Findings: With improvements in technology, human leukocyte antigen (HLA) antibody t ... Full text Cite

The Effect of Paging Reminders on Fellowship Conference Attendance: A Multi-Program Randomized Crossover Study.

Journal Article J Grad Med Educ · July 2016 BACKGROUND: Educational conferences have long served as a foundation of medical education. Sending reminder text pages prior to the start of conferences is a method that may be employed to enhance conference attendance. OBJECTIVE: The goal of our study was ... Full text Link to item Cite

Donor-Derived Disseminated Toxoplasmosis In Lung Transplant Recipient

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · January 1, 2016 Link to item Cite

Innate-Like B1 B Cells Recognize Type V Collagen As A Danger Signal And Initiate Humoral Immune Response

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · January 1, 2016 Link to item Cite

Changing Patters Of Pneumocystis Jiroveci Pneumonia In Immunocompromised Patients

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · January 1, 2015 Link to item Cite

Recovery of interleukin-17 production from interleukin-15-stimulated CD4+ mononuclear cells in HIV-1-infected patients with sustained viral suppression.

Journal Article J Interferon Cytokine Res · January 2014 Interleukin-17 (IL-17) is a pro-inflammatory cytokine that is mainly produced by CD4+ T cells. The role of Th17 during the human immunodeficiency virus (HIV)-1 infection is still unclear, but HIV-1 infection can cause a preferential depletion of Th17 cells ... Full text Link to item Cite

Rare Case Of Cyanosis: Severe Acute Lidocaine-Induced Methemoglobinemia Due To Local Anesthetic

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · January 1, 2014 Link to item Cite

History of antibiotics: from fluoroquinolones to daptomycin (Part 2).

Journal Article J Invest Surg · August 2013 In the Modern Era, physicians attested to the reciprocal influence among a technologically advanced society, rapid scientific progresses in medicine, and the need for new antimicrobials. The results of these changes were not only seen in the prolongation o ... Full text Link to item Cite

Brain abscess induced by Propionibacterium acnes in a patient with severe chronic sinusitis.

Journal Article New Microbiol · July 2013 Propionibacterium acnes has long been considered a contaminant organism. However, recently the isolation of this emerging pathogen has become a more difficult clinical challenge. Infections of the central nervous system caused by P. acnes have been strongl ... Link to item Cite

Immune reconstitution inflammatory syndrome involving the central nervous system in a patient with HIV infection: a case report and review of literature.

Journal Article New Microbiol · January 2013 IRIS is described as a paradoxical deterioration of clinical status upon initiation of combined anti-retroviral therapy (cART) in patients with HIV infection. Immune reconstitution inflammatory syndrome (CNS-IRIS) involving the central nervous system is ra ... Link to item Cite

Acute postobstructive pulmonary edema caused by a massive substernal thyroid goiter: A case report and a brief literature review

Journal Article Critical Care and Shock · December 1, 2012 Acute Postobstructive Pulmonary Edema (APOPE) is rare form of non-cardiogenic pulmonary edema. APOPE is a manifestation of acute airway obstruction usually described following anesthesia in post-operative phase due to laryngospasm. We present a case of 58 ... Cite

History of antibiotics. From salvarsan to cephalosporins.

Journal Article J Invest Surg · April 2012 Infections have represented for a long time the leading cause of death in humans. During the 19th century, pneumonia, tuberculosis, diarrhea and diphtheria were considered the main causes of death in children and adults. Only in the late 19th century did i ... Full text Link to item Cite

HIV persistence in the gut mucosa of HIV-infected subjects undergoing antiretroviral therapy correlates with immune activation and increased levels of LPS.

Journal Article Curr HIV Res · April 2011 We investigated the relationship between viral persistence in the gut, microbial translocation, and T cell activation during chronic HIV infection. Plasma levels of LPS, fraction of circulating CD8+CD38+ T cells, and levels of HIV-DNA in rectosigmoid biops ... Full text Link to item Cite

Preexisting infection with human T-cell lymphotropic virus type 2 neither exacerbates nor attenuates simian immunodeficiency virus SIVmac251 infection in macaques.

Journal Article J Virol · March 2010 Coinfection with human T-cell lymphotropic virus type 2 (HTLV-2) and human immunodeficiency virus type 1 (HIV-1) has been reported to have either a slowed disease course or to have no effect on progression to AIDS. In this study, we generated a coinfection ... Full text Link to item Cite

The role of HIV-DNA testing in clinical practice.

Journal Article New Microbiol · January 2010 HIV-1 RNA levels and CD4+T lymphocyte counts are currently the standard markers used in clinical practice for the management of HIV infection. Nowadays it is also possible to monitor the evolution of HIV infection by measuring HIV-DNA. This measurement is ... Link to item Cite

Infectious aortitis and spondylodiscitis in patients with endovascular stents.

Journal Article Minerva Med · April 2009 The infection of endovascular stents remains one of the most problematic complications of aortic surgery. This article describes the case of a 61-year-old male with ascendant and descendent aorta endovascular stents, hospitalized for pyrexia, weight loss a ... Link to item Cite

Expression levels of TLRs involved in viral recognition in PBMCs from HIV-1-infected patients failing antiretroviral therapy.

Journal Article Intervirology · 2009 OBJECTIVE: The aim of this study was to evaluate whether gene expression of Toll-like receptor (TLR)-3, TLR4, TLR7 and TLR9 was impaired in patients with chronic HIV-1 infection who were failing to respond to antiretroviral therapy. METHODS: Transcripts en ... Full text Link to item Cite

Altered balance between Th17 and Th1 cells at mucosal sites predicts AIDS progression in simian immunodeficiency virus-infected macaques.

Journal Article Mucosal Immunol · July 2008 Loss of CD4(+) T cells in the gut is necessary but not sufficient to cause AIDS in animal models, raising the possibility that a differential loss of CD4(+) T-cell subtypes may be important. We found that CD4(+) T cells that produce interleukin (IL)-17, a ... Full text Link to item Cite

Simplified maintenance therapy with abacavir/lamivudine/zidovudine plus tenofovir after sustained HIV load suppression: four years of follow-up.

Journal Article HIV Clin Trials · 2007 PURPOSE: To assess the virologic and immunologic outcome of a treatment simplification strategy based on the substitution of protease inhibitor (PI)-based regimen with abacavir/lamivudine/zidovudine (ABC/3TC/ZDV, also known as trizivir or TZV) plus tenofov ... Full text Link to item Cite

Central role of interleukin-15 in human immunodeficiency virus (HIV)-infected patients with visceral leishmaniasis.

Journal Article Acta Trop · August 2006 To evaluate clinical and immunological parameters, interleukin (IL)-15 production and outcome of patients with visceral leishmaniasis (VL), including HIV positive patients, we analyzed 48 cases of VL. Clinical manifestations and response to therapy were si ... Full text Link to item Cite

Interleukin-15 enhances the secretion of IFN-gamma and CC chemokines by natural killer cells from HIV viremic and aviremic patients.

Journal Article Immunol Lett · March 15, 2006 Several lines of evidence documented a renewed interest in the role of natural killer (NK) cells in the innate immune control of HIV infection and disease progression. To further assess the role of NK cells as target for immunotherapy in HIV infection, we ... Full text Link to item Cite