Yu Kuang Lai

All Publications

• How I diagnose and treat organizing pneumonia in hematopoietic cell transplant recipients. Blood Lai, Y. K., Sharifi, H., Hsu, J. L. 2024

  Abstract

  Organizing pneumonia (OP) is a known non-infectious pulmonary complication following allogeneic hematopoietic cell transplant (HCT) and represents a significant risk factor for non-relapse mortality in HCT recipients. Unlike bronchiolitis obliterans syndrome, it is not universally acknowledged as a distinctive pulmonary manifestation of chronic-graft-versus-host disease (cGVHD) and therefore, its diagnostic criteria and management approach is lacking. Given it shared similar clinical features, radiological and histological findings to OP in non-HCT population, the diagnostic approach and treatment strategy for OP in HCT recipient is largely adapted from the non-HCT population. In this paper, we aim to enhance the understanding of OP within the context of cGVHD following HCT, distinguish its clinical features and treatment strategy from non-HCT counterpart, thereby reinforcing its recognition as a pulmonary manifestation of GVHD. We will propose the diagnostic criteria and outline our approach in diagnosis and treatment strategy, highlighting the potential challenges that may arise in each process. Finally, we will discuss knowledge gaps in this field and identify the area of need for future research.

  View details for DOI 10.1182/blood.2023023249

  View details for PubMedID 38864640

• Portopulmonary Hypertension. Clinics in liver disease Lai, Y. K., Kwo, P. Y. 2023; 27 (1): 71-84

  Abstract

  PoPH is a well-recognized complication of portal hypertension with or without cirrhosis and is classified as a subset of PAH. Identification of PoPH is crucial as it has a major impact on prognosis and liver transplant candidacy. Echocardiogram is the initial screening tool of choice and the patient should proceed to RHC for confirmation. PAH-directed therapy is the treatment of choice, allowing the patient to achieve a hemodynamic threshold to undergo a liver transplant safely.

  View details for DOI 10.1016/j.cld.2022.08.002

  View details for PubMedID 36400468

• Epidemiology of lower respiratory tract infections and community-acquired respiratory viruses in patients with bronchiolitis obliterans syndrome after hematopoietic cell transplant: a retrospective cohort study. Transplantation and cellular therapy Epstein, D. J., Liang, E. C., Sharifi, H., Lai, Y. K., Arai, S., Graber-Naidich, A., Sundaram, V., Nelson, J., Hsu, J. L. 2022

  Abstract

  Among 55 patients with bronchiolitis obliterans syndrome, 34 (61.8%) developed lower respiratory tract infections, which were associated with impaired lung function and a trend toward increased mortality. Rhinovirus/enterovirus and Pseudomonas aeruginosa infections predominated; 10 (18.2%) patients developed non-tuberculous mycobacterial infections.

  View details for DOI 10.1016/j.jtct.2022.07.016

  View details for PubMedID 35872303

• Machine learning algorithms to differentiate among pulmonary complications after hematopoietic cell transplant. Chest Sharifi, H. n., Lai, Y. K., Guo, H. n., Hoppenfeld, M. n., Guenther, Z. D., Johnston, L. n., Brondstetter, T. n., Chhatwani, L. n., Nicolls, M. R., Hsu, J. L. 2020

  Abstract

  Pulmonary complications, including infections, are highly prevalent in patients after hematopoietic cell transplant with chronic graft-versus-host disease. These comorbid diseases can make the diagnosis of early lung graft-versus-host disease (bronchiolitis obliterans syndrome) challenging. A quantitative method to differentiate among these pulmonary diseases can address diagnostic challenges and facilitate earlier and more targeted therapy.We conducted a single center study of 66 patients with computed tomography chest scans analyzed with a quantitative imaging tool known as parametric response mapping. Parametric response mapping results were correlated with pulmonary function tests and clinical characteristics. Five parametric response mapping metrics were applied to K-means clustering and support vector machine models to distinguish among post-transplant lung complications solely from quantitative output.Compared to parametric response mapping, spirometry showed a moderate correlation with radiographic air trapping, and total lung capacity and residual volume showed a strong correlation with radiographic lung volumes. K-means clustering analysis distinguished 4 unique clusters. Clusters 2 and 3 represented obstructive physiology (encompassing 81% of patients with bronchiolitis obliterans syndrome) in increasing severity (percent air trapping 15.6% and 43.0%, respectively). Cluster 1 was dominated by normal lung, and cluster 4 was characterized by patients with parenchymal opacities. A support vector machine algorithm differentiated bronchiolitis obliterans syndrome with specificity of 88%, sensitivity of 83%, accuracy of 86% and an area under the receiver operating characteristic curve of 0.85.Our machine learning models offer a quantitative approach for the identification of bronchiolitis obliterans syndrome versus other lung diseases, including late pulmonary complications after hematopoietic cell transplant.

  View details for DOI 10.1016/j.chest.2020.02.076

  View details for PubMedID 32343962

• A Young Woman With a Rapidly GrowingThoracic Tumor. Chest Lai, Y. K., Holmes, B., Guo, H. H. 2019; 155 (5): e145–e148

  Abstract

  CASE PRESENTATION: A 38-year-old woman presented with 2months of dry cough, progressiveshortness of breath, central chest pain, nausea, vomiting, and dizziness. She was previously healthy and was not taking any medications. She denied fever, night sweats, or weight loss. She had a two pack-year smoking history and had quit smoking at 27 years of age. She denied drug use and had no recent travel history. Family history was pertinent for ovarian cancer, breast cancer, and colon cancer.

  View details for DOI 10.1016/j.chest.2018.12.014

  View details for PubMedID 31060712

• The Intralobular Gradient as Seen in Re-Expansion Pulmonary Edema. Radiology. Cardiothoracic imaging Lai, Y. K., Lindholm, P. n., Guo, H. H. 2019; 1 (5): e190084

  View details for DOI 10.1148/ryct.2019190084

  View details for PubMedID 33778531

  View details for PubMedCentralID PMC7977743