Stuart C. Sweet, M.D., Ph.D.  scsweet@wustl.edu

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W. McKim Marriott Professor of Pediatrics, Division of Allergy, Immunology and Pulmonary Medicine
Medical Director, Pediatric Lung Transplant Program, Division of Allergy, Immunology, and Pulmonary Medicine
Allergy, Immunology and Pulmonary Medicine

phone: (314) 454-2694

Clinical Interests

Dr. Sweet received his undergraduate, graduate and medical degrees at the University of Michigan. He was a pediatric resident and pediatric pulmonology fellow at Washington University before joining the faculty in 1996. Dr. Sweet became medical director of the Pediatric Lung Transplant Program in 1999. He is board certified in Pediatric Pulmonology by the American Board of Pediatrics. Past honors include the Parker B. Francis Fellowship in Pulmonary Research, Scholar of the Child Health Research Center of Excellence in Developmental Biology, Washington University, Medical Scientist Award for Excellence, University of Michigan. Professional Societies include the International Society for Heart and Lung Transplantation, the American Thoracic Society and the American Academy of Pediatrics. Dr. Sweet's primary research is focused on improved understanding of the important factors determining outcome after lung transplantation in children. He is PI of an NIH funded multicenter collaborative study of the role B-cell immunity plays in lung transplant outcomes.Dr. Sweet has held multiple leadership roles in the Organ Transplantation and Procurement Network (OPTN) / United Network for Organ Sharing (UNOS) including Chair of the Pediatric Transplantation Committee and Policy Oversight Committee as well as Secretary and President of the OPTN/UNOS Board of Directors. He has also held multiple leadership roles in the International Society for Heart and Lung Transplantation (ISHLT) including Secretary/Treasurer and Vice-President of the ISHLT Board. Finally, he is a Past President of the Missouri Chapter of the American Academy of Pediatrics (AAP) and past Chair of the AAP National Nominating Committee. Dr. Sweet's other interests include ethics and policies related to organ allocation and the use of information technology in medicine.

Education

  • BS, University of Michigan College of Literature, Science and Arts1981
  • PhD, University of Michigan Horace H. Rackham School of Graduate Studies1989
  • MD, University of Michigan Medical School1990

Training

  • Research Fellow, University of Michigan Medical School1989 - 1990
  • House Officer, University of Michigan Medical School 1990 - 1990
  • Pediatric Resident, St. Louis Children's Hospital1990 - 1993
  • Pediatric Pulmonology Fellow, St. Louis Children's Hospital, Washington University School of Medicine1993 - 1996

Licensure and Board Certification

  • 1993 - 2007American Board of Pediatrics (recertified 2000, expired 2007)
  • 1995 - PresMO
  • 1998 - PresAmerican Board of Pediatrics, Sub Board of Pediatric Pulmonology
  • 2020 - PresIL

Honors and Awards

  • Freshman Chemistry Achievement Award, University of Michigan1978
  • William J. Branstrom Freshman Prize, University of Michigan1978
  • James B. Angell Scholar, University of Michigan1979 - 1980
  • Class Honors, University of Michigan1979 - 1981
  • Phi Beta Kappa1980
  • B.S. (chemistry) with highest distinction, highest honors in chemistry and high honors in physics, University of Michigan1981
  • Roger B. Vanko Memorial Award for outstanding honors chemistry major, University of Michigan1981
  • Society of Nuclear Medicine student fellowship1982
  • Fellow, Medical Scientist Training Program, University of Michigan1982 - 1989
  • Burton L. Baker Cancer Research Fellowship, Michigan Cancer Institute1986 - 1987
  • M.D. with distinction in research, University of Michigan1989
  • Medical Scientist Award for Excellence, University of Michigan1990
  • Scholar of the Child Health Research Center of Excellence in Developmental Biology, Washington University1996 - 1997
  • Parker B. Francis Fellowship in Pulmonary Research1996 - 1997

Recent Publications view all (113)


  1. Epidemiology and persistence of rhinovirus in pediatric lung transplantation. Transpl Infect Dis. 2020;e13422. PMID:32686323 
  2. Ethical considerations regarding heart and lung transplantation and mechanical circulatory support during the COVID-19 pandemic: an ISHLT COVID-19 Task Force statement. J Heart Lung Transplant. 2020;39(7):619-626. PMCID:PMC7195343  PMID:32505492 
  3. Impact and Implications following the November 2017 Emergency Change to the United States Lung Allocation Policy. Ann Am Thorac Soc. 2020. PMID:32068435 
  4. Usefulness of gene expression profiling of bronchoalveolar lavage cells in acute lung allograft rejection. J Heart Lung Transplant. 2019;38(8):845-855. PMCID:PMC6663624  PMID:31122726 
  5. Absence of evidence that respiratory viral infections influence pediatric lung transplantation outcomes: Results of the CTOTC-03 study. Am J Transplant. 2019. PMID:31216376 
  6. Perceived barriers to medication adherence remain stable following solid organ transplantation. Pediatr Transplant. 2019;23(3):e13361. PMCID:PMC6652201  PMID:31332928 
  7. Unintended consequences of changes to lung allocation policy. Am J Transplant. 2019. PMID:30758137 
  8. Improving the Affordability of Prescription Medications for People with Chronic Respiratory Disease. An Official American Thoracic Society Policy Statement. Am J Respir Crit Care Med. 2018;198(11):1367-1374. PMID:30601674 
  9. Sensitization in Transplantation: Assessment of Risk (STAR) 2017 Working Group Meeting Report. Am J Transplant. 2018;18(7):1604-1614. PMID:29603613 
  10. Infants with Atypical Presentations of Alveolar Capillary Dysplasia with Misalignment of the Pulmonary Veins Who Underwent Bilateral Lung Transplantation. J Pediatr. 2017. PMID:29198536 
  11. Assessing the impact of program volume and composition on waiting list outcomes in pediatric lung transplantation. J Heart Lung Transplant. 2017;36(11):1180-1182. PMID:28705645 
  12. The impact of conventional and nonconventional inhalants on children and adolescents. Pediatr Pulmonol. 2017. PMID:29084362 
  13. Anellovirus loads are associated with outcomes in pediatric lung transplantation. Pediatr Transplant. 2017. PMID:29082660 
  14. Risk and outcomes of pulmonary fungal infection after pediatric lung transplantation. Clin Transplant. 2017. PMID:28871606 
  15. Epstein-Barr viral loads do not predict post-transplant lymphoproliferative disorder in pediatric lung transplant recipients: A multicenter prospective cohort study. Pediatr Transplant. 2017;21(6). PMCID:PMC5568922  PMID:28639398 
  16. Pediatric Lung Transplantation. Respir Care. 2017;62(6):776-798. PMID:28546378 
  17. Outcomes of Lung Transplantation for Infants and Children with Genetic Disorders of Surfactant Metabolism. J Pediatr. 2017;184:157-164.e2. PMCID:PMC5443678  PMID:28215425 
  18. What makes a good pediatric transplant lung: Insights from in vivo lung morphometry with hyperpolarized 3 He magnetic resonance imaging. Pediatr Transplant. 2017;21(3). PMCID:PMC5378594  PMID:28120553 
  19. Improved waitlist and transplant outcomes for pediatric lung transplantation after implementation of the lung allocation score. J Heart Lung Transplant. 2017;36(5):520-528. PMID:27866928 
  20. Transplant center volume and outcomes in lung transplantation for cystic fibrosis. Transpl Int. 2017;30(4):371-377. PMID:28012223 
  21. Role of Circulating microRNAs in the Immunopathogenesis of Rejection Following Pediatric Lung Transplantation. Transplantation. 2016. PMCID:PMC5462875  PMID:27941431 
  22. Antibody-mediated rejection of the lung: A consensus report of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2016;35(4):397-406. PMID:27044531 
  23. Recommendations for utilization of the paracorporeal lung assist device in neonates and young children with pulmonary hypertension. Pediatr Transplant. 2016;20(2):256-70. doi:10.1111/petr.12673  PMID:26899454 
  24. Perceived barriers to medication adherence in pediatric and adolescent solid organ transplantation. Pediatr Transplant. 2016;20(2):307-15. PMID:26670870 
  25. Current State of Pediatric Lung Transplantation. Lung. 2015;193(5):629-37. doi:10.1007/s00408-015-9765-z  PMID:26238859 
  26. The International Society for Heart and Lung Transplantation Registries in the Era of Big Data With Global Reach. J Heart Lung Transplant. 2015;34(10):1225-32. doi:10.1016/j.healun.2015.08.001  PMID:26454736 
  27. Diffuse Lung Disease in Biopsied Children 2 to 18 Years of Age. Application of the chILD Classification Scheme. Ann Am Thorac Soc. 2015;12(10):1498-505. PMCID:PMC4627419  PMID:26291470 
  28. Electronic Cigarette Use in Middle and High School Students Triples from 2013 to 2014. Am J Respir Crit Care Med. 2015;192(3):276-8. doi:10.1164/rccm.201505-0898ED  PMID:26230233 
  29. Pediatric Deceased Donation-A Report of the Transplantation Society Meeting in Geneva. Transplantation. 2015. doi:10.1097/TP.0000000000000758  PMID:25996634 
  30. Bronchiolitis obliterans syndrome is not specific for bronchiolitis obliterans in pediatric lung transplant. J Heart Lung Transplant. 2015;34(4):516-21. doi:10.1016/j.healun.2014.10.004  PMID:25499141 
  31. An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome. Eur Respir J. 2014;44(6):1479-503. PMID:25359357 
  32. Multicenter comparison of laboratory performance in cytomegalovirus and Epstein-Barr virus viral load testing using international standards. Clin Transplant. 2014;28(12):1416-23. doi:10.1111/ctr.12473  PMID:25303316 
  33. Paracorporeal lung assist devices as a bridge to recovery or lung transplantation in neonates and young children. J Thorac Cardiovasc Surg. 2014;147(1):420-6. doi:10.1016/j.jtcvs.2013.08.078  PMID:24199759 
  34. Rationing lung transplants. N Engl J Med. 2013;369(21):2064-5. doi:10.1056/NEJMc1311946#SA1  PMID:24256395 
  35. An official American Thoracic Society clinical practice guideline: classification, evaluation, and management of childhood interstitial lung disease in infancy. Am J Respir Crit Care Med. 2013;188(3):376-94. PMCID:PMC3778735  PMID:23905526 
  36. Measurement of donor-specific HLA antibodies following plasma exchange therapy predicts clinical outcome in pediatric heart and lung transplant recipients with antibody-mediated rejection. J Clin Apher. 2013;28(4):301-8. doi:10.1002/jca.21270  PMID:23426730 
  37. Induction therapy in lung transplantation. Transpl Int. 2013;26(7):696-703. doi:10.1111/tri.12115  PMID:23701023 
  38. Lung transplant is a viable treatment option for patients with congenital and acquired pulmonary vein stenosis. J Heart Lung Transplant. 2013;32(6):621-5. doi:10.1016/j.healun.2013.03.002  PMID:23701851 
  39. Neonatal paracorporeal lung assist device for respiratory failure. Ann Thorac Surg. 2013;95(2):692-4. doi:10.1016/j.athoracsur.2012.05.128  PMID:23336880 
  40. Body mass index and its effect on outcome in children after lung transplantation. J Heart Lung Transplant. 2013;32(2):196-201. doi:10.1016/j.healun.2012.11.002  PMID:23200225 
  41. Human polyomaviruses in children undergoing transplantation, United States, 2008-2010. Emerg Infect Dis. 2012;18(10):1676-9. doi:10.3201/eid1810.120359  PMCID:PMC3471627  PMID:23017293 
  42. RSV prevention and treatment in pediatric lung transplant patients: a survey of current practices among the International Pediatric Lung Transplant Collaborative. Pediatr Transplant. 2012;16(6):638-44. doi:10.1111/j.1399-3046.2012.01744.x  PMID:22738242 
  43. Report of a consensus conference on transplant program quality and surveillance. Am J Transplant. 2012;12(8):1988-96. doi:10.1111/j.1600-6143.2012.04130.x  PMID:22682114 
  44. Lung transplantation in children with idiopathic pulmonary arterial hypertension: an 18-year experience. J Heart Lung Transplant. 2011;30(10):1148-52. doi:10.1016/j.healun.2011.04.009  PMID:21620736 
  45. First experience with a paracorporeal artificial lung in a small child with pulmonary hypertension. J Thorac Cardiovasc Surg. 2011;141(6):e48-50. doi:10.1016/j.jtcvs.2011.02.005  PMID:21420104 
  46. Extracorporeal membrane oxygenation in pediatric lung transplantation. J Thorac Cardiovasc Surg. 2010;140(2):427-32. doi:10.1016/j.jtcvs.2010.04.012  PMID:20538306 
  47. Minimal acute rejection in pediatric lung transplantation--does it matter? Pediatr Transplant. 2010;14(4):534-9. doi:10.1111/j.1399-3046.2009.01268.x  PMCID:PMC2888626  PMID:20059725 
  48. Lung transplantation in the United States, 1999-2008. Am J Transplant. 2010;10(4 Pt 2):1047-68. doi:10.1111/j.1600-6143.2010.03055.x  PMID:20420652 
  49. Lung transplantation for cystic fibrosis. Proc Am Thorac Soc. 2009;6(8):619-33. doi:10.1513/pats.2009008-088TL  PMCID:PMC2797068  PMID:20008865 
  50. Aquagenic wrinkling of the palms in cystic fibrosis: comparison with controls and genotype-phenotype correlations. Arch Dermatol. 2009;145(11):1296-9. doi:10.1001/archdermatol.2009.260  PMID:19917960 
  51. Update on pediatric lung allocation in the United States. Pediatr Transplant. 2009;13(7):808-13. doi:10.1111/j.1399-3046.2009.01237.x  PMID:19832794 
  52. Dismal lung transplant outcomes in children with tetralogy of Fallot with pulmonary atresia compared to Eisenmenger syndrome or pulmonary vein stenosis. J Heart Lung Transplant. 2009;28(11):1221-5. doi:10.1016/j.healun.2009.07.010  PMID:19783168 
  53. Cytomegalovirus immunoglobulin decreases the risk of cytomegalovirus infection but not disease after pediatric lung transplantation. J Heart Lung Transplant. 2009;28(10):1050-6. doi:10.1016/j.healun.2009.04.032  PMCID:PMC2771443  PMID:19782286 
  54. Respiratory viral infections within one year after pediatric lung transplant. Transpl Infect Dis. 2009;11(4):304-12. doi:10.1111/j.1399-3062.2009.00397.x  PMID:19422670 
  55. Generic drug immunosuppression in thoracic transplantation: an ISHLT educational advisory. J Heart Lung Transplant. 2009;28(7):655-60. PMID:19560691 
  56. The risk, prevention, and outcome of cytomegalovirus after pediatric lung transplantation. Transplantation. 2009;87(10):1541-8. doi:10.1097/TP.0b013e3181a492e8  PMCID:PMC2726779  PMID:19461492 
  57. Lung transplantation in infants and toddlers from 1990 to 2004 at St. Louis Children's Hospital. Am J Transplant. 2009;9(4):719-26. doi:10.1111/j.1600-6143.2009.02552.x  PMID:19344463 
  58. Lung transplantation in the United States, 1998-2007. Am J Transplant. 2009;9(4 Pt 2):942-58. doi:10.1111/j.1600-6143.2009.02569.x  PMID:19341417 
  59. Pediatric lung transplantation. Proc Am Thorac Soc. 2009;6(1):122-7. doi:10.1513/pats.200808-095GO  PMID:19131537 
  60. Preventable death: children on the transplant waiting list. Am J Transplant. 2008;8(12):2491-5. doi:10.1111/j.1600-6143.2008.02443.x  PMID:18976303 
  61. Selection of cystic fibrosis patients for lung transplantation. Curr Opin Pulm Med. 2008;14(6):589-94. doi:10.1097/MCP.0b013e328313e3d4  PMID:18812837 
  62. Increased mortality after pulmonary fungal infection within the first year after pediatric lung transplantation. J Heart Lung Transplant. 2008;27(6):655-61. doi:10.1016/j.healun.2008.03.010  PMCID:PMC2447528  PMID:18503966 
  63. Lung transplantation and survival in children with cystic fibrosis. N Engl J Med. 2008;358(16):1754; author reply 1755. PMID:18426004 
  64. A national conference to determine research priorities in pediatric solid organ transplantation. Pediatr Transplant. 2008;12(2):153-66. PMID:18345550 
  65. Lung transplantation and survival in children with cystic fibrosis: solid statistics--flawed interpretation. Pediatr Transplant. 2008;12(2):129-36. doi:10.1111/j.1399-3046.2008.00924.x  PMID:18307660 
  66. Lower incidence of bronchiolitis obliterans in pediatric liver-lung transplant recipients with cystic fibrosis. Transplantation. 2007;83(11):1435-9. doi:10.1097/01.tp.0000266067.44499.07  PMID:17565316 
  67. Safety and efficacy of prolonged cytomegalovirus prophylaxis with intravenous ganciclovir in pediatric and young adult lung transplant recipients. Pediatr Transplant. 2007;11(3):312-8. doi:10.1111/j.1399-3046.2006.00626.x  PMCID:PMC1930168  PMID:17430489 
  68. Pre-transplant mechanical ventilation increases short-term morbidity and mortality in pediatric patients with cystic fibrosis. J Heart Lung Transplant. 2007;26(2):127-31. doi:10.1016/j.healun.2006.11.597  PMID:17258145 
  69. American Society of Transplantation executive summary on pediatric lung transplantation. Am J Transplant. 2007;7(2):285-92. doi:10.1111/j.1600-6143.2006.01612.x  PMID:17109726 
  70. Model for end-stage liver disease (MELD) exception for cystic fibrosis. Liver Transpl. 2006;12(12 Suppl 3):S98-9. doi:10.1002/lt.20967  PMID:17123272 
  71. Pediatric living donor lobar lung transplantation. Pediatr Transplant. 2006;10(7):861-8. doi:10.1111/j.1399-3046.2006.00559.x  PMID:17032437 
  72. Long-term outcomes after infant lung transplantation for surfactant protein B deficiency related to other causes of respiratory failure. J Pediatr. 2006;149(4):548-53. doi:10.1016/j.jpeds.2006.06.004  PMID:17011330 
  73. Preferred methods of excess hair removal in pediatric patients with lung transplantation. J Am Acad Dermatol. 2006;55(2):320-3. doi:10.1016/j.jaad.2006.03.031  PMID:16844521 
  74. Living donor lobar grafts improve pediatric lung retransplantation survival. J Thorac Cardiovasc Surg. 2006;131(5):1142-7. doi:10.1016/j.jtcvs.2005.08.074  PMID:16678602 
  75. Otolaryngological manifestations of posttransplant lymphoproliferative disorder in pediatric thoracic transplant patients. Int J Pediatr Otorhinolaryngol. 2006;70(2):303-10. doi:10.1016/j.ijporl.2005.07.011  PMID:16125255 
  76. Not so fast--don't deprive children with cystic fibrosis of the option for lung transplantation. Am J Respir Crit Care Med. 2006;173(2):246-7; author reply 247-8. doi:10.1164/ajrccm.173.2.246a  PMID:16391305 
  77. Bronchial airway anastomotic complications after pediatric lung transplantation: incidence, cause, management, and outcome. J Thorac Cardiovasc Surg. 2006;131(1):198-203. doi:10.1016/j.jtcvs.2005.06.053  PMID:16399312 
  78. Development of the new lung allocation system in the United States. Am J Transplant. 2006;6(5 Pt 2):1212-27. doi:10.1111/j.1600-6143.2006.01276.x  PMID:16613597 
  79. Pediatric transplantation in the United States, 1995-2004. Am J Transplant. 2006;6(5 Pt 2):1132-52. doi:10.1111/j.1600-6143.2006.01271.x  PMID:16613592 
  80. Role of open lung biopsy in lung transplant recipients in a single children's hospital: a 13-year experience. J Thorac Cardiovasc Surg. 2006;131(1):204-8. doi:10.1016/j.jtcvs.2005.07.059  PMID:16399313 
  81. Progressive chronic kidney disease after pediatric lung transplantation. Am J Transplant. 2005;5(7):1739-47. doi:10.1111/j.1600-6143.2005.00930.x  PMID:15943634 
  82. Sinonasal posttransplant lymphoproliferative disorder in pediatric lung transplant patients. Otolaryngol Head Neck Surg. 2005;133(1):38-41. doi:10.1016/j.otohns.2005.03.064  PMID:16025050 
  83. Primary graft dysfunction and other selected complications of lung transplantation: A single-center experience of 983 patients. J Thorac Cardiovasc Surg. 2005;129(6):1421-9. doi:10.1016/j.jtcvs.2005.01.022  PMID:15942587 
  84. Epidemiology of bloodstream infections in the first year after pediatric lung transplantation. Pediatr Infect Dis J. 2005;24(4):324-30. PMID:15818292 
  85. Pediatric transplantation, 1994-2003. Am J Transplant. 2005;5(4 Pt 2):887-903. doi:10.1111/j.1600-6135.2005.00834.x  PMID:15760416 
  86. Repair of congenital heart lesions combined with lung transplantation for the treatment of severe pulmonary hypertension: a 13-year experience. J Thorac Cardiovasc Surg. 2005;129(3):661-9. doi:10.1016/j.jtcvs.2004.07.058  PMID:15746752 
  87. Variability in standard care for cytomegalovirus prevention and detection in pediatric lung transplantation: survey of eight pediatric lung transplant programs. Pediatr Transplant. 2003;7(6):469-73. PMID:14870896 
  88. CT of posttransplantation lymphoproliferative disorder in pediatric recipients of lung allograft. AJR Am J Roentgenol. 2003;181(4):1125-31. doi:10.2214/ajr.181.4.1811125  PMID:14500243 
  89. Bilateral lung transplantation for pulmonary hypoplasia caused by congenital diaphragmatic hernia. J Thorac Cardiovasc Surg. 2003;126(1):295-7. PMID:12878973 
  90. Cytomegalovirus viremia associated with death or retransplantation in pediatric lung-transplant recipients. Transplantation. 2003;75(9):1538-43. doi:10.1097/01.TP.0000061607.07985.BD  PMID:12792511 
  91. Lung transplantation in children following treatment for malignancy. J Heart Lung Transplant. 2003;22(2):154-60. PMID:12581763 
  92. Concomitant allorecognition of mismatched donor HLA class I- and class II-derived peptides in pediatric lung transplant recipients with bronchiolitis obliterans syndrome. J Heart Lung Transplant. 2003;22(1):35-43. PMID:12531411 
  93. Lung transplantation in children. Ann Surg. 2002;236(3):270-6. doi:10.1097/01.SLA.0000027173.38874.31  PMCID:PMC1422580  PMID:12192313 
  94. Rejection is reduced in thoracic organ recipients when transplanted in the first year of life. J Heart Lung Transplant. 2002;21(3):311-8. PMID:11897518 
  95. Lung transplantation for pulmonary vascular disease. Ann Thorac Surg. 2002;73(1):209-17; discussion 217-9. PMID:11834012 
  96. Post-lung transplantation bronchiolitis obliterans syndrome: usefulness of expiratory thin-section CT for diagnosis. Radiology. 2001;220(2):455-62. doi:10.1148/radiology.220.2.r01au19455  PMID:11477251 
  97. Pediatric lung transplantation and CMV pneumonitis: a ten year experience. J Heart Lung Transplant. 2001;20(2):221. PMID:11250411 
  98. Pediatric living donor lung transplantation: psychosocial considerations. J Heart Lung Transplant. 2001;20(2):245. PMID:11250481 
  99. Lung transplantation in children following treatment for mallignancy. J Heart Lung Transplant. 2001;20(2):221. PMID:11250412 
  100. Interleukin-2-receptor blockade with daclizumab decreases the incidence of acute rejection in pediatric lung transplant recipients. J Heart Lung Transplant. 2001;20(2):221-222. PMID:11250413 
  101. Posttransplant lymphoproliferative disease in children: correlation of histology to clinical behavior. J Pediatr Hematol Oncol. 2001;23(1):14-8. PMID:11196263 
  102. High incidence of posttransplant lymphoproliferative disease in pediatric patients with cystic fibrosis. Am J Respir Crit Care Med. 2000;161(4 Pt 1):1252-5. doi:10.1164/ajrccm.161.4.9901013  PMID:10764320 
  103. Lung transplantation in very young infants. J Thorac Cardiovasc Surg. 1999;118(5):796-804. PMID:10534684 
  104. Lung retransplantation in children. Ann Thorac Surg. 1998;66(1):199-203; discussion 203-4. PMID:9692464 
  105. Pediatric and adult lung transplantation for cystic fibrosis. J Thorac Cardiovasc Surg. 1998;115(2):404-13; discussion 413-4. doi:10.1016/S0022-5223(98)70285-5  PMID:9475536 
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