Bio

Honors & Awards


  • Medical Honor Society, Alpha Omega Alpha (AOA) (2008)
  • Medical Honor Society, Gold Humanism (2008)
  • KL2 Career Development Award, Spectrum, Stanford Center for Clinical and Translational Research and Education (2014)

Education & Certifications


  • MD, University of Minnesota Medical School, Medicine (2009)
  • Intern, University of California San Francisco, Internal Medicine (2010)
  • Resident, University of California San Francisco, Internal Medicine (2012)
  • Fellow, Stanford University, Pulmonary and Critical Care Medicine (2015)

Publications

Journal Articles


  • Invasive mold infections in lung and heart-lung transplant recipients: Stanford University experience TRANSPLANT INFECTIOUS DISEASE Vazquez, R., Vazquez-Guillamet, M. C., Suarez, J., Mooney, J., Montoya, J. G., Dhillon, G. S. 2015; 17 (2): 259-266

    Abstract

    Recipients of lung transplantation (LT) and heart-lung transplantation (HLT) are at increased risk of infection, including invasive mold infections (IMIs). The clinical presentation, radiographic correlates, and outcomes of Aspergillus and non-Aspergillus IMIs in this population have not been well documented.LT and HLT recipients diagnosed with IMIs between 1990 and 2012 were identified using the Stanford Translational Research Integrated Database Environment and Stanford LT and HLT clinical database. Recipient clinical and radiographic characteristics were obtained via retrospective review of medical records and compared between Aspergillus and non-Aspergillus mold recipients. Risk factors for mortality were identified using multivariate logistic regression analysis.During the study period, 87 (14%) transplant recipients were diagnosed with IMIs. Aspergillus species were isolated in 63 (72%) and non-Aspergillus molds in 24 (28%) recipients. No significant difference was seen in presenting symptoms or radiographic findings between Aspergillus and non-Aspergillus mold recipients. Median time to diagnosis was 363 days in the Aspergillus group and 419 days in the non-Aspergillus group, with dissemination occurring only within the non-Aspergillus group (12.5%). Overall 90-day and 1-year mortality following IMI was 24% and 44%. One-year mortality was increased in the non-Aspergillus group (39.5% vs. 60.5%, P = 0.03).There is significant overlap in risk factors, presentation, and radiographic patterns in IMI in LT or HLT recipients. Non-Aspergillus molds were more likely to present late, with disseminated disease, and portend increased 1-year mortality. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1111/tid.12362

    View details for Web of Science ID 000352219400011

    View details for PubMedID 25648194

  • Increased Resource Use in Lung Transplant Admissions in the Lung Allocation Score Era AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE Maxwelll, B. G., Mooney, J. J., Lee, P. H., Levitt, J. E., Chhatwani, L., Nicolls, M. R., Zamora, M. R., Valentine, V., Weill, D., Dhillon, G. S. 2015; 191 (3): 302-308

    Abstract

    Rationale: In 2005, the lung allocation score (LAS) was implemented to prioritize organ allocation to minimize waiting-list mortality and maximize one-year survival. It resulted in transplantation of older and sicker patients without changing one-year survival. Its effect on resource utilization is unknown. Objective: To determine changes in resource utilization over time in lung transplant admissions Methods: Solid organ transplant recipients were identified within the Nationwide Inpatient Sample (NIS) data from 2000 to 2011. Joinpoint regression methodology was performed to identify a time point of change in mean total hospital charges amongst lung transplant and other solid organ transplant recipients. Two temporal lung transplant recipient cohorts identified by joinpoint regression were compared for baseline characteristics and resource utilization, including total charges for index hospitalization, charges per day, length of stay, discharge disposition, tracheostomy, and need for extracorporeal membrane oxygenation (ECMO). Measurements and Main Results: A significant point of increased total hospital charges occurred for lung transplant recipients in 2005, corresponding to LAS implementation, that was not seen in other solid organ transplant recipients. Total transplant hospital charges increased by 40% in the post-LAS cohort [$569,942 ($53,229) vs. $407,489 ($28,360)] along with an increased median length of stay, daily charges, and discharge disposition other than to home. Post-LAS recipients also had higher post-transplant utilization of ECMO (OR 2.35, 95% CI 1.56, 3.55) and higher incidence of tracheostomy (OR 1.52, 95% CI 1.22, 1.89). Conclusions: LAS implementation is associated with a significant increase in resource utilization during index hospitalization for lung transplant.

    View details for DOI 10.1164/rccm.201408-1562OC

    View details for Web of Science ID 000348827000014

    View details for PubMedID 25517213

  • Understanding the lung allocation score for the non-transplant pulmonologista Current Pulmonology Reports Mooney, J. J., Gries, C. J. 2015
  • Predicting Survival Across Chronic Interstitial Lung Disease The ILD-GAP Model CHEST Ryerson, C. J., Vittinghoff, E., Ley, B., Lee, J. S., Mooney, J. J., Jones, K. D., Elicker, B. M., Wolters, P. J., Koth, L. L., King, T. E., Collard, H. R. 2014; 145 (4): 723-728

    Abstract

    Risk prediction is challenging in chronic interstitial lung disease (ILD) because of heterogeneity in disease-specific and patient-specific variables. Our objective was to determine whether mortality is accurately predicted in patients with chronic ILD using the GAP model, a clinical prediction model based on sex, age, and lung physiology, that was previously validated in patients with idiopathic pulmonary fibrosis.Patients with idiopathic pulmonary fibrosis (n=307), chronic hypersensitivity pneumonitis (n=206), connective tissue disease-associated ILD (n=281), idiopathic nonspecific interstitial pneumonia (n=45), or unclassifiable ILD (n=173) were selected from an ongoing database (N=1,012). Performance of the previously validated GAP model was compared with novel prediction models in each ILD subtype and the combined cohort. Patients with follow-up pulmonary function data were used for longitudinal model validation.The GAP model had good performance in all ILD subtypes (c-index, 74.6 in the combined cohort), which was maintained at all stages of disease severity and during follow-up evaluation. The GAP model had similar performance compared with alternative prediction models. A modified ILD-GAP Index was developed for application across all ILD subtypes to provide disease-specific survival estimates using a single risk prediction model. This was done by adding a disease subtype variable that accounted for better adjusted survival in connective tissue disease-associated ILD, chronic hypersensitivity pneumonitis, and idiopathic nonspecific interstitial pneumonia.The GAP model accurately predicts risk of death in chronic ILD. The ILD-GAP model accurately predicts mortality in major chronic ILD subtypes and at all stages of disease.

    View details for DOI 10.1378/chest.13-1474

    View details for Web of Science ID 000334097700014

    View details for PubMedID 24114524

  • Surgical lung biopsy over bronchoalveolar lavage in chronic hypersensitivity pneumonitis. American journal of respiratory and critical care medicine Mooney, J. J., Koth, L. L. 2014; 189 (3): 371-372

    View details for DOI 10.1164/rccm.201309-1736LE

    View details for PubMedID 24484347

  • Lung Transplantation for Hypersensitivity Pneumonitis. Chest Kern, R. M., Singer, J. P., Koth, L., Mooney, J., Golden, J., Hays, S., Greenland, J., Wolters, P., Ghio, E., Jones, K. D., Leard, L., Kukreja, J., Blanc, P. D. 2014

    Abstract

    Background:Hypersensitivity pneumonitis (HP) is an inhaled antigen-mediated interstitial lung disease (ILD). Advanced disease may lead to lung transplantation. There are no published studies addressing lung transplant outcomes in HP. We characterized HP outcomes compared to referents undergoing lung transplantation for idiopathic pulmonary fibrosis (IPF). Methods:To identify HP cases, we reviewed records for all ILD lung transplantation cases at our institution from 2000-2013. We compared clinical characteristics, survival, and acute and chronic rejection for lung transplant recipients with HP to IPF referents. We also reviewed diagnoses of HP discovered only by explant pathology and looked for evidence of recurrent HP after transplant. Survival was compared using Kaplan-Meier methods and Cox proportional hazard modeling. Results:We analyzed 31 subjects with HP and 91 with IPF among 183 cases undergoing lung transplantation for ILD. Survival at 1, 3, and 5 years after lung transplant in HP compared to IPF was 96%, 89% and 89% vs. 86%, 67%, and 49%, respectively. HP subjects manifested a reduced adjusted risk of death compared to IPF subjects (HR 0.25, 95% CI 0.08-0.74; p=0.013). Of the 31 cases, the diagnosis of HP was unexpectedly made at explant in 5 (16%). Two subjects developed recurrent HP in their allografts. Conclusions:Overall, subjects with HP have excellent medium-term survival after lung transplantation and, relative to IPF, a reduced risk of death. HP may be initially discovered only by review of the explant pathology. Notably, HP may recur in the allograft.Hypersensitivity pneumonitis (HP) is an inhaled antigen-mediated interstitial lung disease (ILD). Advanced disease may lead to lung transplantation. There are no published studies addressing lung transplant outcomes in HP. We characterized HP outcomes compared to referents undergoing lung transplantation for idiopathic pulmonary fibrosis (IPF).To identify HP cases, we reviewed records for all ILD lung transplantation cases at our institution from 2000-2013. We compared clinical characteristics, survival, and acute and chronic rejection for lung transplant recipients with HP to IPF referents. We also reviewed diagnoses of HP discovered only by explant pathology and looked for evidence of recurrent HP after transplant. Survival was compared using Kaplan-Meier methods and Cox proportional hazard modeling.We analyzed 31 subjects with HP and 91 with IPF among 183 cases undergoing lung transplantation for ILD. Survival at 1, 3, and 5 years after lung transplant in HP compared to IPF was 96%, 89% and 89% vs. 86%, 67%, and 49%, respectively. HP subjects manifested a reduced adjusted risk of death compared to IPF subjects (HR 0.25, 95% CI 0.08-0.74; p=0.013). Of the 31 cases, the diagnosis of HP was unexpectedly made at explant in 5 (16%). Two subjects developed recurrent HP in their allografts.Overall, subjects with HP have excellent medium-term survival after lung transplantation and, relative to IPF, a reduced risk of death. HP may be initially discovered only by review of the explant pathology. Notably, HP may recur in the allograft.

    View details for DOI 10.1378/chest.14-1543

    View details for PubMedID 25412059

  • Impact of the Lung Allocation Score on Survival Beyond 1 Year. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons Maxwell, B. G., Levitt, J. E., Goldstein, B. A., Mooney, J. J., Nicolls, M. R., Zamora, M., Valentine, V., Weill, D., Dhillon, G. S. 2014

    Abstract

    Implementation of the lung allocation score (LAS) in 2005 led to transplantation of older and sicker patients without altering 1-year survival. However, long-term survival has not been assessed and emphasizing the 1-year survival metric may actually sustain 1-year survival while not reflecting worsening longer-term survival. Therefore, we assessed overall and conditional 1-year survival; and the effect of crossing the 1-year threshold on hazard of death in three temporal cohorts: historical (1995-2000), pre-LAS (2001-2005) and post-LAS (2005-2010). One-year survival post-LAS remained similar to pre-LAS (83.1% vs. 82.1%) and better than historical controls (75%). Overall survival in the pre- and post-LAS cohorts was also similar. However, long-term survival among patients surviving beyond 1 year was worse than pre-LAS and similar to historical controls. Also, the hazard of death increased significantly in months 13 (1.44, 95% CI 1.10-1.87) and 14 (1.43, 95% CI 1.09-1.87) post-LAS but not in the other cohorts. While implementation of the LAS has not reduced overall survival, decreased survival among patients surviving beyond 1 year in the post-LAS cohort and the increased mortality occurring immediately after 1 year suggest a potential negative long-term effect of the LAS and an unintended consequence of increased emphasis on the 1-year survival metric.

    View details for DOI 10.1111/ajt.12903

    View details for PubMedID 25208599

  • Prevalence and prognosis of unclassifiable interstitial lung disease EUROPEAN RESPIRATORY JOURNAL Ryerson, C. J., Urbania, T. H., Richeldi, L., Mooney, J. J., Lee, J. S., Jones, K. D., Elicker, B. M., Koth, L. L., King, T. E., Wolters, P. J., Collard, H. R. 2013; 42 (3): 750-757

    Abstract

    The aim of this study was to determine the prevalence, characteristics and outcomes of patients with unclassifiable interstitial lung disease (ILD) and to develop a simple method of predicting disease behaviour. Unclassifiable ILD patients were identified from an ongoing longitudinal cohort. Unclassifiable ILD was diagnosed after a multidisciplinary review did not secure a specific ILD diagnosis. Clinical characteristics and outcomes were compared with idiopathic pulmonary fibrosis (IPF) and non-IPF ILDs. Independent predictors of mortality were determined using Cox proportional-hazards analysis to identify subgroups with distinct disease behaviour. Unclassifiable ILD was diagnosed in 10% of the ILD cohort (132 out of 1370 patients). The most common reason for being unclassifiable was missing histopathological assessment due to a high risk of surgical lung biopsy. Demographic and physiological features of unclassifiable ILD were intermediate between IPF and non-IPF disease controls. Unclassifiable ILD had longer survival rates when compared to IPF on adjusted analysis (hazard ratio 0.62, p = 0.04) and similar survival compared to non-IPF ILDs (hazard ratio 1.54, p = 0.12). Independent predictors of survival in unclassifiable ILD included diffusion capacity of the lung for carbon monoxide (p = 0.001) and a radiological fibrosis score (p = 0.02). Unclassifiable ILD represents approximately 10% of ILD cases and has a heterogeneous clinical course, which can be predicted using clinical and radiological variables.

    View details for DOI 10.1183/09031936.00131912

    View details for Web of Science ID 000326160500025

    View details for PubMedID 23222877

  • Radiographic Fibrosis Score Predicts Survival in Hypersensitivity Pneumonitis CHEST Mooney, J. J., Elicker, B. M., Urbania, T. H., Agarwal, M. R., Ryerson, C. J., Nguyen, M. L., Woodruff, P. G., Jones, K. D., Collard, H. R., King, T. E., Koth, L. L. 2013; 144 (2): 586-592

    Abstract

    It is unknown if the radiographic fibrosis score predicts mortality in persistent hypersensitivity pneumonitis (HP) and if survival is similar to that observed in idiopathic pulmonary fibrosis (IPF) when adjusting for the extent of radiographic fibrosis.We reviewed records from 177 patients with HP and 224 patients with IPF whose diagnoses were established by multidisciplinary consensus. Two thoracic radiologists scored high-resolution CT (HRCT) scan lung images. Independent predictors of transplant-free survival were determined using a Cox proportional hazards analysis. Kaplan-Meier survival curves were constructed, stratified by disease as well as fibrosis score.HRCT scan fibrosis score and radiographic reticulation independently predicted time to death or lung transplantation. Clinical predictors included a history of cigarette smoking, auscultatory crackles on lung examination, baseline FVC, and FEV1/FVC ratio. The majority of HP deaths occurred in patients with both radiographic reticulation and auscultatory crackles on examination, compared with patients with only one of these manifestations (P < .0001). Patients with IPF had worse survival than those with HP at any given degree of radiographic fibrosis (hazard ratio 2.31; P < .01).Survival in patients with HP was superior to that of those with IPF with similar degrees of radiographic fibrosis. The combination of auscultatory crackles and radiographic reticulation identified patients with HP who had a particularly poor outcome.

    View details for DOI 10.1378/chest.12-2623

    View details for Web of Science ID 000323021400035

    View details for PubMedID 23392130

  • Ninety-day mortality and major complications are not affected by use of lung allocation score JOURNAL OF HEART AND LUNG TRANSPLANTATION McCue, J. D., Mooney, J., Quail, J., Arrington, A., Herrington, C., Dahlberg, P. S. 2008; 27 (2): 192-196

    Abstract

    In May 2005 the Organ Procurement Transplant Network (OPTN) and United Network for Organ Sharing (UNOS) implemented the donor lung allocation score (LAS) system to prioritize organ allocation among prospective transplant recipients. The purpose of our study was to determine the impact of LAS implementation on 90-day survival, early complications and incidence of severe primary graft dysfunction (PGD) after the transplant procedure.Early outcomes among 78 patients receiving transplants after the initiation of the scoring system were compared with those of the 78 previous patients. Survival rates at 90 days and 1 year were the primary end-points of the study. Arterial blood-gas measurements were collected for all patients at the time of ICU arrival and at 12, 24 and 48 hours after surgery to determine the distribution of International Society of Heart and Lung Transplant (ISHLT) PGD grade. Major complications within 30 days post-transplant were recorded.We found a small but significant 1-year survival advantage among post-LAS implementation patients, which was largely due to decreased early mortality in comparison to the control cohort. The incidence of ISHLT Grade 3 PGD measured within the first 24 hours after transplant did not differ between groups, nor was there an increase in the rate of major post-operative complications.Implementation of the LAS system has not been associated with an increase in early mortality, immediate PGD or major complications.

    View details for DOI 10.1016/j.healun.2007.11.001

    View details for Web of Science ID 000253258800008

    View details for PubMedID 18267226

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