Phadke, R

Abstract Purpose This analysis aims to provide a comprehensive overview of lung transplantation trends in the United States from January 1, 1988, through January 31, 2025. By examining key variables such as recipient ABO blood group, donor type (deceased or living), demographic factors, and geographic distribution, the goal is to highlight the evolution and current state of lung transplantation practices. Methods Data were obtained from the Organ Procurement and Transplantation Network (OPTN), encompassing all reported lung transplants during the specified time period. Relevant metrics included the number of transplants per year, recipient characteristics (blood type, race/ethnicity, gender, and age), donor type (deceased versus living), and state-level transplant volumes. Simple descriptive statistics (e.g., frequencies and percentages) were used to identify trends and capture the distribution of transplants among different demographic groups and geographic regions. Results A total of 55,435 lung transplants were performed in the United States between 1988 and early 2025. The vast majority (over 99%) utilized deceased donors, underscoring the limited role of living-donor lobar transplantation, with only 253 procedures reported nationally. Among recipients, ABO blood group O was the most common (∼45%), followed by group A (∼40%), group B (∼11%), and group AB (∼4%). Male recipients represented approximately 57% of transplants, while females accounted for 43%. Regarding race/ethnicity, White non-Hispanic patients constituted roughly 80% of all recipients, with Black non-Hispanic (8%) and Hispanic/Latino (8%) recipients forming smaller but significant proportions. Age distribution data revealed that individuals aged 50 to 64 years received nearly half of all lung transplants, and those over 65 years composed about a quarter of total recipients, reflecting a gradual shift in acceptance criteria favoring older adults. Geographically, California reported the highest volume of lung transplants, attributable to its large population and multiple high-volume transplant centers, while other states such as Florida, Ohio, North Carolina, and Missouri also demonstrated notable activity. Conclusion Lung transplantation in the United States has witnessed substantial expansion in both volume and scope since 1988, with the majority of procedures involving deceased donor lungs. A small number of living-donor lung transplants, while demonstrating innovative clinical possibilities, remains limited. The demographic profile of recipients continues to shift, evidenced by a growing proportion of older adults and a predominance of ABO type O and White, non-Hispanic recipients. Despite these advancements, persistent gaps in access, particularly among underrepresented racial and ethnic groups, highlight the need for further refinement in organ allocation policies and broader support services. This abstract is funded by: None

Abstract Rationale The diagnosis of interstitial lung disease (ILD) requires a multidisciplinary discussion (MDD), in which high-resolution computed tomography (HRCT) and histopathology play key roles. Genomic classifiers have recently been introduced for clinical use, in which lung tissue obtained via transbronchial forceps biopsy undergoes whole-transcriptome RNA sequencing followed by gene expression analysis. These molecular tools are particularly valuable in establishing a diagnosis of idiopathic pulmonary fibrosis (IPF) in patients without a definite usual interstitial pneumonia (UIP) pattern on imaging. Although genomic classifiers are increasingly utilized in clinical practice, data on their diagnostic performance continue to evolve, warranting an updated analysis of the current evidence. Methods A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Comprehensive search of PubMed, MEDLINE, Embase, Scopus and the Cochrane Library were performed through October 2025 using predefined terms including “genomic classifier,” “Envisia,” “UIP,” and “interstitial lung disease.” Eligible studies were which enrolled adult patients with ILD of uncertain etiology in whom genomic classifiers were compared with histopathologic or MDD based reference standards. True positive, false positive, false negative, and true negative data were extracted to calculate pooled estimates of sensitivity, specificity and the area under the receiver-operating characteristic curve (AUROC) using a random-effects bivariate model. Results Six studies comprising 347 patients met inclusion criteria, with sample sizes ranging from 24 to 98 participants. Across studies, sensitivity ranged from 59% to 85% and specificity from 75% to 100%. The pooled sensitivity was 68% (95% CI, 60-76%; P < 0.001) and specificity 77% (95% CI, 70-85%; P < 0.001), with an estimated AUROC of 0.73 (95% CI, 0.65-0.81) indicating discriminative performance. In two studies evaluating clinical impact, incorporation of genomic classifier data into MDD increased diagnostic confidence in ILD subtyping by 30-50%. No major adverse events related to transbronchial tissue acquisition were reported. Conclusions Genomic classifiers represent a promising, less invasive adjunct for identifying UIP patterns in ILD, demonstrating good overall diagnostic accuracy. Incorporating classifier results within MDD frameworks enhances diagnostic confidence and may reduce the need for surgical lung biopsy in appropriately selected patients. However, small study sizes, potential funding bias and limited accessibility highlight the need for larger, independently conducted prospective studies to further define their role in future IPF diagnostic algorithms. This abstract is funded by: None

Abstract Purpose This study aimed to analyze mortality trends among patients with pneumonia and chronic kidney disease in the United States from 1999 to 2020. By examining patterns across urbanization levels, racial and ethnic groups, geographic regions, and sex, the study sought to identify significant changes over time and potential disparities in mortality outcomes. Methods Mortality data were extracted from the CDC WONDER database for patients diagnosed with pneumonia (ICD-10: J09-J18) and chronic kidney disease (ICD-10: N18). Trends were analyzed using Annual Percent Change (APC) with 95% confidence intervals (CI). Joinpoint regression was utilized to identify significant shifts in mortality trends over time. The analysis was stratified by urbanization level (Large Central Metro, Large Fringe Metro, Medium Metro, Small Metro, Micropolitan), ethnicity (American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, White), census region (Northeast, Midwest, South, West), Hispanic origin (Hispanic or Latino, Not Hispanic or Latino), and sex (Female, Male). Results From 2018 to 2020, significant increases in mortality were observed across all demographic and geographic categories. Urban areas, particularly Large Central Metro (APC = 39.4026%, p = 0.0008) and Small Metro (APC = 37.0284%, p = 0.0004), experienced the most pronounced rises. Ethnic disparities were evident, with Black or African American (APC = 49.9199%, p < 0.000001) and Hispanic or Latino (APC = 61.5742%, p < 0.000001) populations showing the highest mortality increases. By census region, the Midwest (APC = 35.7843%, p = 0.0004) and South (APC = 34.7972%, p = 0.0016) had the most significant spikes. Both females (APC = 36.0664%, p = 0.0004) and males (APC = 35.1504%, p < 0.000001) experienced substantial mortality increases, with females showing slightly higher rates. Conclusion The findings reveal significant increases in mortality from 2018 to 2020 across all analyzed categories, with notable disparities among racial, ethnic, and geographic groups. These trends highlight the need for further investigation into underlying causes and targeted interventions to address inequities. Clinical implications The results underscore the importance of addressing disparities in healthcare access and outcomes, particularly for Black or African American and Hispanic or Latino populations. Clinicians should focus on early diagnosis, effective management of comorbidities, and equitable resource distribution to mitigate mortality risks in high-risk groups. This abstract is funded by: None

Abstract Introduction Aminoglycoside antibiotics are well known to cause cochlear and vestibular toxicity when used systemically. Inhaled tobramycin was developed to reduce systemic exposure and is considered safer with only rare reports of ototoxicity have been reported in patients with renal dysfunction. We describe a case of bilateral sensorineural hearing loss (SNHL) and tinnitus associated with inhaled tobramycin in a patient without renal impairment, emphasizing that even inhaled formulations can induce significant auditory toxicity in susceptible individuals. Case A 85 year old woman with Sjogren’s related interstitial lung disease and bronchiectasis who was chronically colonized by Pseudomonas aeruginosa was treated with inhaled tobramycin for recurrent infections. She had normal renal function and no prior aminoglycoside exposure. After approximately three months of inhaled therapy, she noted progressive bilateral hearing decline and high pitched tinnitus without vertigo or otalgia. Physical examination revealed clear ear canals and intact tympanic membranes. Baseline audiometry one year ago had demonstrated mild to moderately-severe bilateral SNHL. Repeat testing after tobramycin exposure showed worsening thresholds and reduced word recognition bilaterally. MRI of the brain and internal auditory canals was unremarkable. Serum creatinine remained normal throughout treatment. Inhaled tobramycin was discontinued, after which hearing loss stabilized. No further progression was observed on follow-up audiometry. Discussion Although systemic absorption from inhaled tobramycin is typically low, elderly and low-body-weight patients may accumulate sufficient serum levels to cause cochlear injury. Mechanisms include reactive oxygen species mediated hair cell toxicity and possible genetic susceptibility involving the mitochondrial 12S rRNA mutation. Prior reports of vestibulotoxicity and cochleotoxicity from inhaled tobramycin primarily involved patients with renal dysfunction, however, this case report demonstrates that toxicity can occur despite preserved renal function. Clinicians should maintain vigilance for otologic symptoms in patients receiving inhaled aminoglycosides. Baseline and periodic audiometric monitoring should be incorporated into chronic treatment protocols. This abstract is funded by: None