scispace - formally typeset
Search or ask a question
Author

Jan D. Manzetti

Other affiliations: University of Pennsylvania
Bio: Jan D. Manzetti is an academic researcher from University of Pittsburgh. The author has contributed to research in topics: Transplantation & Lung transplantation. The author has an hindex of 10, co-authored 14 publications receiving 820 citations. Previous affiliations of Jan D. Manzetti include University of Pennsylvania.

Papers
More filters
Journal ArticleDOI
TL;DR: Recipients with obliterative bronchiolitis detected in the preclinical stage were significantly more likely to be in remission than recipients who had clinical disease at the time of diagnosis and results indicate that acute rejection is the most significant risk factor for development of obliteration and that obliteration responds to treatment with augmented immunosuppression when it is detected early by surveillance transbronchial biopsy.

412 citations

Journal ArticleDOI
TL;DR: To the extent that psychologic distress increases the likelihood of perceived physical limitations, timely identification and treatment of distress may help to maximize quality of life after lung and heart-lung transplantation.
Abstract: Background Many lung and heart–lung transplant recipients experience distressing physical symptoms and elevated physical impairment levels. Although post-transplant complications and secondary illnesses may largely account for these health limitations, patients’ psychosocial well-being may influence them as well. We examined the contribution of psychosocial variables to patients’ experience of physical symptoms and physical impairment. Methods The study consisted of a cross-sectional sample of 50 patients (36 lung, 14 heart–lung) at between 2 and 17 months post-transplant. They were interviewed to assess physical symptoms, current physical impairment and psychosocial well-being in the areas of mental health, sense of mastery and coping. Medical record reviews established the presence of medical complications and secondary illnesses concurrent with the interviews. Descriptive analyses examined the range of symptoms and levels of physical impairment experienced. Bivariate analyses and multivariate linear regression examined relationships between key variables. Results Average number of physical symptoms and level of physical impairment met or exceeded levels reported in other transplant samples. Elevated depressive and anxiety symptoms, a low sense of mastery, and the presence of concurrent medical complications were each associated with increased number of physical symptoms and physical impairment level. When the impact of concurrent medical complications was controlled, recipients with elevated psychologic distress remained significantly more likely to report more physical symptoms and higher physical impairment levels. Conclusions Patients’ physical health status may be influenced by many factors. To the extent that psychologic distress increases the likelihood of perceived physical limitations, timely identification and treatment of distress may help to maximize quality of life after lung and heart–lung transplantation.

76 citations

Journal ArticleDOI
TL;DR: Pretransplant psychiatric history, educational level, posttransplant caregiver support, and health concerns were the most important independent correlates of the recipients' psychological outcome.

63 citations

Journal Article
TL;DR: It is suggested that patients awaiting lung transplantation perceived improved quality of well-being and increased walk distance after participation in a health maintenance program, and education plus exercise conferred no benefits beyond those achieved by education alone.
Abstract: In addition to improved functional ability, patients who complete rehabilitation programs typically have positive psychologic changes, including increased motivation and an enhanced quality of life. Potentially, patients with end-stage lung disease awaiting a lung transplant can have similar benefits. However, no studies were identified that examined the impact of an exercise program on quality of life in patients awaiting lung transplantation. This pilot study was an initial step toward evaluating outcomes of a health maintenance program on exercise tolerance and quality of life. Subjects were nine lung transplant candidates who met lung transplant listing criteria and who were randomized to participate in a 6-week health maintenance program consisting of education alone or education plus exercise. Subjects completed cardiopulmonary exercise testing, a 6-minute walk, and the Quality of Well-being scale, Quality of Life Index, and Symptom Frequency/Symptom Distress scale before and after completion of the program. No significant between-group changes were seen. Quality of Well-being scores (p < 0.005) and 6-minute walk distance (p < 0.03) improved over time in both groups. Findings suggest that patients awaiting lung transplantation perceived improved quality of well-being and increased walk distance after participation in a health maintenance program. Education plus exercise conferred no benefits beyond those achieved by education alone. However, the number of subjects studied was small and duration of follow-up was limited.

62 citations

Journal ArticleDOI
TL;DR: Transplant team members are encouraged to be aware of and help patients refrain from using avoidant coping strategies, which are associated with poor health status and lower quality of life.
Abstract: Context—Lung transplant candidates face numerous health-related stressors. Although previous work has described the range of coping strategies candidates may use, whether those strategies are related to quality of life in physical functioning, emotional, and social domains has rarely been examined.Methods—Adult lung transplant candidates (N = 128) participated in semistructured interviews that included questions regarding global and domain-specific quality of life and a multidimensional assessment of coping with health-related problems. Demographic characteristics, health status, and other psychosocial variables were also assessed, and their effects were examined and controlled in multivariate analyses of the coping-quality-of-life relationship.Results—Respondents were most likely to use active, acceptance, and support-seeking strategies to cope with health problems. Self-blame or avoidance were rarely used. Although used least often, avoidant coping was the most strongly and consistently related to quali...

55 citations


Cited by
More filters
Journal ArticleDOI
TL;DR: It is argued that economic indicators were extremely important in the early stages of economic development, when the fulfillment of basic needs was the main issue and differences in well-being are less frequently due to income, and are more frequentlyDue to factors such as social relationships and enjoyment at work.
Abstract: Policy decisions at the organizational, corporate, and governmental levels should be more heavily influenced by issues related to well-being—people’s evaluations and feelings about their lives. Domestic policy currently focuses heavily on economic outcomes, although economic indicators omit, and even mislead about, much of what society values. We show that economic indicators have many shortcomings, and that measures of well-being point to important conclusions that are not apparent from economic indicators alone. For example, although economic output has risen steeply over the past decades, there has been no rise in life satisfaction during this period, and there has been a substantial increase in depression and distrust. We argue that economic indicators were extremely important in the early stages of economic development, when the fulfillment of basic needs was the main issue. As societies grow wealthy, however, differences in well-being are less frequently due to income, and are more frequently due to factors such as social relationships and enjoyment at work.

2,114 citations

Journal ArticleDOI
TL;DR: The molecular and biochemical characterization of HOs is reviewed, with a discussion on the mechanisms of signal transduction and gene regulation that mediate the induction of HO-1 by environmental stress, to lay a foundation for potential future clinical applications of these systems.
Abstract: The heme oxygenases, which consist of constitutive and inducible isozymes (HO-1, HO-2), catalyze the rate-limiting step in the metabolic conversion of heme to the bile pigments (i.e., biliverdin and bilirubin) and thus constitute a major intracellular source of iron and carbon monoxide (CO). In recent years, endogenously produced CO has been shown to possess intriguing signaling properties affecting numerous critical cellular functions including but not limited to inflammation, cellular proliferation, and apoptotic cell death. The era of gaseous molecules in biomedical research and human diseases initiated with the discovery that the endothelial cell-derived relaxing factor was identical to the gaseous molecule nitric oxide (NO). The discovery that endogenously produced gaseous molecules such as NO and now CO can impart potent physiological and biological effector functions truly represented a paradigm shift and unraveled new avenues of intense investigations. This review covers the molecular and biochemical characterization of HOs, with a discussion on the mechanisms of signal transduction and gene regulation that mediate the induction of HO-1 by environmental stress. Furthermore, the current understanding of the functional significance of HO shall be discussed from the perspective of each of the metabolic by-products, with a special emphasis on CO. Finally, this presentation aspires to lay a foundation for potential future clinical applications of these systems.

2,111 citations

Journal ArticleDOI
TL;DR: This document update and summarize new information obtained from this research and incorporate, where appropriate, the results into the BOS criteria.
Abstract: Bronchiolitis obliterans (BO) is a major cause of allograft dysfunction in lung and heart lung transplant recipients. Clinically, progressive airflow limitation develops because of small airway obstruction. The disease has a variable course. Some patients experience rapid loss of lung function and respiratory failure. Others experience either slow progression or intermittent loss of function with long plateaus during which pulmonary function is stable. Histologic confirmation is difficult because transbronchial biopsy specimens often are not sufficiently sensitive for diagnosis. Because BO is difficult to document histologically, in 1993 a committee sponsored by the International Society for Heart and Lung Transplantation (ISHLT) proposed a clinical description of BO, termed bronchiolitis obliterans syndrome (BOS) and defined by pulmonary function changes rather than histology. Although this system does not require histologic diagnosis, it does recognize it. Transplant centers worldwide have adopted the BOS system as a descriptor of lung allograft dysfunction. This allows centers to use a common language to compare program results. In the years since publication of the BOS system, transplant scientists have studied basic and clinical aspects of lung transplant BO. In this document, we update and summarize new information obtained from this research and incorporate, where appropriate, the results into the BOS criteria. The document will include the following topics: (1) criteria for BOS, (2) BOS considerations in pediatric patients, (3) risk factors for BOS, (4) pathology of BO, (5) surrogate markers for BOS, (6) confounding factors in making a BOS diagnosis, and (7) assessment of response to treatment of BOS.

1,228 citations

Journal ArticleDOI
TL;DR: This study seeks to update the definitions of CMV on the basis of recent developments in diagnostic techniques, as well as to add to these definitions the concept of indirect effects caused by CMV.
Abstract: Cytomegalovirus (CMV) infection and disease are important causes of morbidity and mortality among transplant recipients. For the purpose of developing consistent reporting of CMV in clinical trials, definitions of CMV infection and disease were developed and published. This study seeks to update the definitions of CMV on the basis of recent developments in diagnostic techniques, as well as to add to these definitions the concept of indirect effects caused by CMV.

1,206 citations

Journal ArticleDOI
TL;DR: Over the last decade, knowledge of the immune response to HCMV infection in healthy virus carriers and diseased individuals has allowed us to translate these findings to develop better diagnostic tools and therapeutic strategies, and the application of these emerging technologies in the clinical setting is likely to provide opportunities for better management of patients with H CMV-associated diseases.
Abstract: Summary: Following primary infection, human cytomegalovirus (HCMV) establishes lifelong latency and periodically reactivates without causing symptoms in healthy individuals. In the absence of an adequate host-derived immune response, this fine balance of permitting viral reactivation without causing pathogenesis is disrupted, and HCMV can subsequently cause invasive disease and an array of damaging indirect immunological effects. Over the last decade, our knowledge of the immune response to HCMV infection in healthy virus carriers and diseased individuals has allowed us to translate these findings to develop better diagnostic tools and therapeutic strategies. The application of these emerging technologies in the clinical setting is likely to provide opportunities for better management of patients with HCMV-associated diseases.

591 citations