Episoder
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This month, JHLT: The Podcast reissues our September 2023 tribute to former Editor-in-Chief, Dr. Daniel R. Goldstein. Dr. Goldstein stepped down from his role for health reasons in July 2023; he had been diagnosed with an advanced salivary gland malignancy and felt he would be unable to continue serving JHLT and the International Society for Heart and Lung Transplantation (ISHLT) to his characteristically demanding standard.
Sadly, Dr. Goldstein died on 21 May, 2024, at the age of 56, leaving behind his wife, 2 children, an extended family, and a larger universe of colleagues, collaborators, and mentees who greatly benefited from his equanimity, wisdom, and commitment to his passions.
The tribute, recorded in August 2023, features Michelle Kittleson, MD, PhD, then-Interim Editor-in-Chief of JHLT; Andrew Gelman, PhD, Deputy Editor at JHLT; Andrew Fisher, FRCP, PhD, past president of ISHLT and Past Chair of the Publications Oversight Committee; Daniel Tyrrell, PhD, a former post-doc of Dr. Goldsteinâs; and Judy Chen, PhD, a former immunology PhD student in Dr. Goldsteinâs lab.
Two funds were created to allow friends and colleagues to memorialize Dr. Goldstein: the Michigan Biology of Cardiovascular Aging Leadership Development Fund at the Frankel Cardiovascular Center (https://giving.umich.edu/give/393178) and the Adenoid Cystic Carcinoma Foundation (https://accrf.org).
The JHLT has also re-published Dr. Goldsteinâs farewell message in the September 2024 issue of the Journal. You can read it here: https://www.jhltonline.org/article/S1053-2498(24)01741-8/fulltext
Follow along at www.jhltonline.org/current, or, if youâre an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation. Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
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In this special episode of JHLT: The Podcast, the Digital Media Editors connect with Joseph Rogers, MD, the new Editor-in-Chief of JHLT.
In the conversation, Dr. Rogers shares more about his vision for the Journal, how he plans to tackle the challenges and opportunities facing the publication, and a little about his life both inside and outside of medicine.
In addition to being the new Editor-in-Chief, Dr. Rogers is the President and CEO of the Texas Heart Institute in Houston, a past president of the ISHLT, and a prolific contributor to the field of heart and lung transplantation.
For the latest studies from JHLT, visit www.jhltonline.org/current, or, if youâre an ISHLT member, access your Journal membership at www.ishlt.org/jhlt.
Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
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On the second August episode of JHLT: The Podcast, the Digital Media Editors discuss a paper from the August issue of JHLT, entitled âA modular simulation framework for organ allocation.âThe episode is hosted by Digital Media Editor Erika Lease, MD, FCCP, a transplant pulmonologist from the University of Washington.
The guests for this episode are first author Johnie Rose, MD, PhD, of the Center for Community Health Integration at Case Western Reserve University School of Medicine, and lead author Maryam Valapour, MD, MPP, of the Department of Pulmonary Medicine at the Cleveland Clinic.
In the episode, Drs. Rose and Valapour share the findings from their study, and tackle questions about the limitations of simulation models, what makes their COMET model different from past Simulation Allocation Models (SAMs), and why they made the project open-source.
Follow along at www.jhltonline.org/current, or, if youâre an ISHLT member, access your Journal membership at www.ishlt.org/jhlt.
Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
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On this episode of JHLT: The Podcast, the JHLT Digital Media Editors discuss a brand new consensus document from the ISHLT entitled âStrategies to Prevent Hemocompatibility Related Adverse Events in Patients with a Durable, Continuous-Flow Ventricular Assist Device.â The episode is hosted by Digital Media Editor Erika Lease, MD, FCCP, a transplant pulmonologist from the University of Washington.
The consensus documentâs lead author, Ian Hollis, PharmD, a heart failure pharmacist and Associate Professor from the University of North Carolina in Chapel Hill, joins the podcast to discuss the document. During the discussion, heâs reunited with co-author and JHLT Podcast co-host Van-Khue Ton, MD, for a lively discussion of the documentâs findings and takeaways.
If you work with heart failure patients with durable VADs, youâll want to listen to this episodeâand check out the complete document at ISHLT.
Stay tuned for a second episode later this month, where weâll be talking about a modular simulation framework for organ allocation.
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On this episode of JHLT: The Podcast, the JHLT Digital Media Editors explore two studies from the July issue of The Journal of Heart and Lung Transplantation. Digital Media Editor Marty Tam, MD, a transplant cardiologist from the University of Michigan in Ann Arbor, hosts this episode.
First, Dr. Tam and Digital Media Editor Erika Lease, MD, FCCP, interview their first guest, Daniel Calabrese, MD, first author on the study âMacrophage and CD8 T cell discordance are associated with acute lung allograft dysfunction progression.â The studyâs authors sought to tackle challenges behind early detection of chronic lung allograft dysfunction (CLAD) by identifying biomarkers associated with acute lung allograft dysfunction (ALAD) progression to CLAD.
To do this, they collected bronchoalveolar lavage (BAL) cells at the time of ALAD diagnosis and performed single cell RNA sequencing to identify significant differences in 26 unique cell populations across groups, with discordant CD8 T cells and macrophages providing the best discrimination between ALAD with decline from ALAD with recovery and controls.
Dr. Calabrese discusses how his team identified the diagnostic criteria, why the biomarkers might lead ALAD to progress to CLAD, and how the findings might lead to early targeted therapies.
Next, Dr. Tam joins and Digital Media Editor Khue Ton, MD and David Schibilsky, MD, to interview their next guest, David DâAlessandro, MD, the Surgical Director of Cardiac Transplantation and MCS at Massachusetts General Hospital in Boston. Dr. DâAlessandro was the first author on the study âImpact of controlled hypothermic preservation on outcomes following heart transplantation,â which sought to assess the impact of the Paragonix SherpaPak Cardiac Transport System, a device allowing controlled hypothermic preservation, on rates of primary graft dysfunction (PGD) and post-transplant mortality.
The key finding was that controlled hypothermic preservation was associated with a lower incidence of severe PGD â 6.6% compared to ice storage at 10.4%. In the conversation, Dr. DâAlessandro answers questions about the need for innovation over traditional ice cold storage, the greatest advantages of controlled hypothermic approaches, and the next steps in this research.
Follow along at www.jhltonline.org/current, or, if youâre an ISHLT member, access your Journal membership at www.ishlt.org/jhlt.
Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
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On this episode of JHLT: The Podcast, the JHLT Digital Media Editors explore two studies from the June issue of The Journal of Heart and Lung Transplantation. Digital Media Editor Van-Khue Ton, MD, a transplant cardiologist from Massachusetts General Hospital, hosts this episode.
First, Dr. Ton and Digital Media Editor Marty Tam, MD, interview their first guests, first author Matthew Carey, MD, MBA, and senior author Justin Fried, MD, both of the Columbia University Irving Medical Center in New York City, on their study âAortic Root Thrombosis in patients with HeartMate 3 left ventricular assist device support.â
This retrospective study of all patients receiving a HeartMate 3 LVAD at a single center between November 2014 and August 2020. The study evaluated findings related to patients with aortic root thrombosis, classified as having at least 1 echocardiogram or contrast-enhanced CT scan with thrombus. In the population of 197 patients, 19 had aortic root thrombus, which was ultimately associated with an increased risk of developing significant aortic regurgitation during the study period.
Drs. Carey and Fried discuss whether aortic valve opening is associated with increased risk of aortic root thrombus, how to balance the bleeding-thrombosis scale in patients, and how the study fits in the context of prior generations of LVAD.
Next, Dr. Ton joins and Digital Media Editor Erika Lease, MD, FCCP, to interview, Jacqueline DesJardin, MD, a Fellow in the department of medicine at the University of California San Francisco. Dr. DesJardin is first author on the study âInvestigating the âsex paradoxâ in pulmonary arterial hypertension: Results from the Pulmonary Hypertension Association Registry (PHAR).â
PHAR is a multicenter US-based registry of patients with PAH, and this study analyzed 1,891 patients from the registry, 1,425 (75%) of whom were female. At baseline, compared to men, women had worse functional status and worse hemodynamics. Women were more likely to be on triple therapy or parenteral prostacyclin therapies at baseline. Interestingly, women had better survival than men, even after adjusting for numerous variables.
In the discussion, Dr. DesJardin explains what collider stratification bias is, and how it may illuminate the complex epidemiological system that creates this disparity. She shares the three potential causal models posed in the study, and considers how the study might be followed up.
Follow along at www.jhltonline.org/current, or, if youâre an ISHLT member, access your Journal membership at www.ishlt.org/jhlt.
Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
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On this episode of JHLT: The Podcast, the JHLT Digital Media Editors explore two studies from the May issue of The Journal of Heart and Lung Transplantation. Digital Media Editor David Schibilsky, MD, a cardiothoracic surgeon from Freiburg, Germany, hosts this episode.
First, Dr. Schibilsky and Digital Media Editor Erika Lease, MD, interview their first guest, Helen A. Hannan, the podcastâs first-ever undergraduate pre-medical guest, from the University of Michigan. Helen was the lead author on the study âRacial and Gender Disparities in Transplantation of Hepatitis C+ Hearts and Lungs.â The study noted that prior research in utilization of kidneys from donors with Hepatitis C had shown disparities due to gender and educationâand wanted to see if this was the case in heart and lung donors as well.
Drs. Schibilsky and Lease chat with Helen about the findings of the study, including some of the interesting differences shown between heart and lung recipients, and the ramifications for better patient discussions at the clinical level.
Next, Dr. Schibilsky and Digital Media Editor Marty Tam, MD, interview their next guest, Lauren Truby, MD, of the University of Texas Southwestern Medical Center in Dallas. Dr. Truby is the podcastâs first return guest, having appeared on the show near the end of 2021. This time, sheâs featured as first author on the study âMetabolomic profiling during ex situ normothermic perfusion before heart transplantation defines patterns of substrate utilization and correlates with markers of allograft injury.â The paper explores cardiac metabolism of donor hearts during recovery using an ex situ normothermic perfusion system (NRP).
Dr. Truby provides an in depth look at the projectâs logisticsâwhich she calls a âlabor of loveââits multi-point findings, and whatâs next in this line of research.
Follow along at www.jhltonline.org/current, or, if youâre an ISHLT member, access your Journal membership at www.ishlt.org/jhlt.
Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
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On this episode of JHLT: The Podcast, the JHLT Digital Media Editors explore two studies from the April issue of The Journal of Heart and Lung Transplantation. Digital Media Editor Erika Lease, MD, a transplant pulmonologist at the University of Washington in Seattle, hosts this episode.
First, Dr. Lease and Digital Media Editor Van-Khue Ton, MD interview their first guests, Paul J. Scheel III, MD and Steven Hsu, MD, both of Johns Hopkins University. Dr. Scheel was first author and Dr. Hsu was senior author on the study âOccult right ventricular dysfunction and right ventricular-vascular uncoupling in left ventricular assist device recipients.â The main finding of the study is that LVAD recipients have depressed intrinsic RV contractility and reduced RV compensation.
Drs. Scheel and Hsu give an overview of RV pressure-volume loops and their measurements, and discuss the impact of LVAD on intrinsic RV contractility, contractile reserve, and vascular coupling. If you want to know how these findings are important to clinical care, youâll need to listen to the episode!
Next, Dr. Lease and Digital Media Editor David Schibilsky, MD, interview their next guest, Joshua Diamond, MD, of the University of Pennsylvania. Dr. Diamond was first author on the study âDevelopment and validation of primary graft dysfunction predictive algorithm for lung transplant candidates.â The authors of the study set out to develop a clinically useful and generalizable PGD prediction model to aid in clinical decision making.
Dr. Diamond discusses the factors they considered in building the model, the modelâs strengths over other approaches, and its limitations. Tune in to learn more!
Follow along at www.jhltonline.org/current, or, if youâre an ISHLT member, access your Journal membership at www.ishlt.org/jhlt.
Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
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On this episode of JHLT: The Podcast, the JHLT Digital Media Editors explore two studies from the March issue of The Journal of Heart and Lung Transplantation. Digital Media Editor Marty Tam, MD, an advanced heart failure and transplant cardiologist at University of Michigan in Ann Arbor, hosts this episode.
First, Dr. Tam and Digital Media Editor David Schibilsky, MD interview their first guests, Fiorella Calabrese, MD and Francesca Lunardi, MD, ScD, PhD, of University of Padova, in Padova Italy. Dr. Lunardi was first author and Dr. Calabrese was senior author on the study âAssessing the role of phosphorylated S6 ribosomal protein in the pathological diagnosis of pulmonary antibody-mediated rejection.â In the conversation, Drs. Calabrese and Lunardi share the main challenges in the current diagnostic algorithm for AMR in lung transplantation, and why this protein expression may be a future mainstay in evaluating patients with this condition.
Next, Dr. Tam and Digital Media Editor Van-Khue Ton, MD, interview their next guest, Benjamin Mackie, MD, of Tampa General Hospital. Dr. Mackie was senior author on the study âRelationship between blood and tissue-based rejection-related transcripts in heart transplantation.â In the conversation, Dr. Mackie shares the current state of rejection assessment, including new, non-invasive modalities, and how the relation between these diagnostic methods may inform clinical practice.
Follow along at www.jhltonline.org/current, or, if youâre an ISHLT member, access your Journal membership at www.ishlt.org/jhlt.
Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
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On this episode of JHLT: The Podcast, the JHLT Digital Media Editors explore two studies from the February issue of The Journal of Heart and Lung Transplantation. Digital Media Editor Van-Khue Ton, MD, a transplant cardiologist at Massachusetts General Hospital, hosts this episode.
First, Dr. Ton and Digital Media Editor Erika Lease, MD interview their first guest, David Jenkins, FRCS(Cth), of the Royal Papworth Hospital in Cambridge, UK. Dr. Jenkins was senior author on the study âPerioperative extracorporeal membrane oxygenation support for pulmonary endarterectomy: A 17-year experience from the UK national cohort.â In the conversation, Dr. Jenkins shares the major determinants of mortality in this patient population, differences between survivors and non-survivors, and the CTEPH classification systems involved.
Next, Dr. Ton is joined by Digital Media Editor Marty Tam, MD, to interview their next guest, Kevin Chen, a 4th year general surgery resident at Cedars-Sinai Medical Center. Dr. Chen was a first author on the study âHeart transplantation in patients from socioeconomically distressed communities.â Drs. Ton and Tam lead a lively discussion about this important paper, including the methodology behind the indices used to categorize patients, and the million-dollar question: why did patients from distressed communities fare more poorly?
Follow along at www.jhltonline.org/current, or, if youâre an ISHLT member, access your Journal membership at www.ishlt.org/jhlt.
Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
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Welcome to 2024! The JHLT Digital Media Editors kick off the new year with a look back at the best of the best from 2023 â specifically, a few of the guidelines and consensus statements from the International Society for Heart and Lung Transplantation that appeared in The Journal of Heart and Lung Transplantation this past year.
Digital Media Editor David Schibilsky, MD, a cardiothoracic surgeon from Freiburg, Germany, hosts this episode.
First, Digital Media Editor Marty Tam, MD, reviews the updated Heart Transplantation guidelines, published in JHLT at the start of 2023. Whatâs changed in the decade plus since the 2010 guidelines were published? For starters, thereâs more than 200 new or updated recommendations in this document, and Dr. Tam walks you through some of the highlights.
Next, Digital Media Editor Erika Lease, MD, shares the new reproductive health guidelines for transplant patientsâsomething thatâs relevant to just about everyone working in the cardiothoracic transplantation space. Dr. Lease steps through this much-needed consensus statement and some of its key takeaways.
Finally, Dr. Schibilsky joins his fellow Digital Media Editor Van-Khue Ton, MD, for a discussion about the MCS guidelines, another 10 year update on a massiveâand massively importantâdocument. Drs. Schibilsky and Ton share their favorite parts of the guideline, and do a little imagining about what might be present in the next major update for MCS.
Follow along at www.jhltonline.org/current, or check out all of the ISHLTâs Standards and Guidelines documents at https://ishlt.org/publications-resources/professional-resources/standards-guidelines.
Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
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In our final episode of 2023, the JHLT Digital Media Editors have two manuscripts from the December 2023 issue of The Journal of Heart and Lung Transplantation! Digital Media Editor Erika Lease, MD, transplant pulmonologist at the University of Washington in Seattle, hosts this episode.
First, a free-ranging conversation with first author Mark E. Snyder, MD, and senior author John F. McDyer, MD, on their teamâs study âImpact of age and telomere length on circulating T cells and rejection risk after lung transplantation for idiopathic pulmonary fibrosis.â
A subset of patients with idiopathic pulmonary fibrosis (IPF) have a heritable, age-adjusted short telomere length. Mutations in telomere length can manifest as T-cell dysfunction and immunodeficiency. As T-cells are involved in the development of acute cellular rejection (ACR), the authors hypothesized that the combination of age and telomere length would impact the degree of ACR burden in lung transplant recipientsâand indeed, the authors found that lung transplant recipients with IPF and short telomere length had premature âagingâ of their circulating T-Cells. There was a significant decline in early ACR burden with increasing age, found only in those with short telomere length.
How might these findings impact immunosuppression regimens in clinical practice? What follow-up studies to they have planned? In the discussion, Drs. Snyder and McDyer, both of UPMC in Pittsburgh, discuss all these possibilities, as well as the the work of their collaborator, Jonathan K. Alder, PhD, as inspiration for the study.
Next, the editors explored âEarly optical coherence tomography evaluation of donor-transmitted atherosclerosis and cardiac allograft vasculopathy: insights from a prospective, single-center study,â in a discussion with senior author Snehal R. Patel, MD, of the Montefiore Medical Center in New York.
Cardiac allograft vasculopathy (CAV) remains a major cause of death in heart transplant recipients, and donor-transmitted atherosclerosis (defined as a maximal intimal thickness of >/= 0.5mm on baseline intravascular ultrasound (IVUS) early after transplant) is believed to carry a greater risk for the development of CAV. Dr. Patelâs team, however, hypothesized that optical coherence tomography (OCT) may have advantages over IVUS as an imaging modality due to its higher resolution. In this prospective, observational study, the authors assessed the prognostic role of OCT, and found that transplant recipients whose OCT imaging showed advanced plaque characteristics had a significantly higher event rate after a mean follow up of 3.3 years. OCT was also an independent predictor of clinic events, while maximal intimal thickness of >/= 0.5mm was not.
In the episode, Dr. Patel shares the key features of OCT that may make it of clinical use, the three risk categories developed for the study, and what the follow-ups might be.
Follow along at www.jhltonline.org/current, or, if youâre an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation. Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
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Itâs pulmonary hypertension month on JHLT: The Podcast! The JHLT Digital Media Editors explore two PVD-related manuscripts from the November issue of The Journal of Heart and Lung Transplantation. Digital Media Editor Marty Tam, MD, assistant professor in the division of cardiovascular medicine at the University of Michigan, hosts this episode.
First, hear from first author Zvonimir Rako, MD, on his teamâs study âClinical and functional relevance of right ventricular contraction patterns in pulmonary hypertension.â
The right ventricle (RV) has a complex contraction pattern. For patients with pulmonary hypertension (PH), right ventricular to pulmonary artery (RV-PA) coupling is important when considering how the RV responds to increases in afterload. Uncoupling occurs with progressive disease and the degree of uncoupling can be derived from pressureâvolume loop analysis as the ratio between end-systolic and arterial elastance (Ees/Ea).
In this exploratory analysis of the prospective EXERTION study, the authors determined the relationship between RV contraction patterns and RV-PA coupling in patients with PH. They also correlated RV contraction patterns to hemodynamic risk profiles. For details on what the study found about how PH programs can use the results in their practice, listen to the discussion in the episode.
Next, the editors explored the study âImpact of sex on outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension.â The podcast hosted first author Justin C.Y. Chan, MD, MPhil and senior author Marc de Perrot, MD, MSc, FRCSC.
The impact of sex on long-term outcomes after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension (CTEPH) has remained unclear. The authors of this study sought to evaluate the early and long-term outcomes after pulmonary endarterectomy to see if sex had an impact on the risk of residual pulmonary hypertension and need for targeted PH medical therapy.
For details on what this retrospective single-center study found, including the mechanics of sex differences and the potential changes to clinical approach, check out the episode.
Follow along at www.jhltonline.org/current, or, if youâre an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation. Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
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The JHLT Digital Media Editors explore two manuscripts from the October issue of The Journal of Heart and Lung Transplantationâthe first on lung transplantation in patients with stacked risks, and the second on bacterial pathogens found at driveline exit sites in patients with ventricular assist devices. Digital Media Editor Marty Tam, MD, assistant professor in the division of cardiovascular medicine at the University of Michigan, hosts this episode.
First, hear from senior author Edward Cantu, MD, MSCE, on his teamâs study âTransplanting candidates with stacked risks negatively affects outcomes.â
Lung transplant centers are increasingly evaluating patients with multiple risk factors for adverse post-transplant outcomes, yet there is little data of the effects of these risks as they stack. The authors of the study used the UNOS registry data linked to the National Inpatient Sample (NIS) to create a national encounter-level sample of healthcare data in the United States, then applied a probabilistic matching algorithm using 7 variables and determined associations between mortality, length of stay, total charges, and disposition with the number of comorbidities.
For details on what the study found about how these risks affected patient successâbased on factors like mortality, length of stay, duration of mechanical ventilation, need for ECMO-salvage, total charges, and discharge to a skilled nursing facilityâlisten to the discussion in the episode.
Next, the editors explored the study âDynamics of bacterial pathogens at the driveline exit site in patients with ventricular assist devices: A prospective, observational, single-center cohort study.â While the authors werenât able to join the episode, editors corresponded with senior author Monika FĂŒrholz, MD, from the Bern University Hospital in Switzerland, before recording, and shared some of her insights.
Driveline exit site infections commonly occur in patients with LVADs, and can be a source of recurrent or deeper infections. Bacterial colonization of driveline exit sites has not been well studied, and transition from colonization to infection is also not well understood. The authors of this paper sought to address this by conducting a prospective, observational, single-center cohort study which included systematic and routine collection of driveline exit site skin swabs being taken between June 2019 and December 2021, even in the absence of suspected driveline infection. Bacteria were identified and a subset of the samples underwent whole-genome sequencing.
For details on what the study found, including a discussion of how the study findings might impact current practice, check out the episode.
Follow along at www.jhltonline.org/current, or, if youâre an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation. Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
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In this special issue of JHLT: The Podcast, the JHLT Digital Media Editors explore just one studyâand devote the second half of the episode as a tribute to recently retired Editor-in-Chief, Dr. Daniel R. Goldstein. Digital Media Editor Van-Khue Ton, MD, heart failure and transplant cardiologist at Massachusetts General Hospital, hosts this episode.
First, hear from senior author William F. Parker, MD, MS, PhD, on his teamâs study âAssociation of high-priority exceptions with waitlist mortality among heart transplant candidates.â Dr. Parker is a pulmonary and critical care physician, health services researcher, and clinical medical ethicist, and he runs a R01 funded lab focusing on the allocation of scarce healthcare resources.
In the study, Dr. Parker and colleagues set out to examine the Scientific Registry of Transplant Recipients (SRTR) to compare medical urgency of heart transplant patients listed with exception vs. those listed according to standard guidelines. The studyâs main finding: after controlling for status as a time-varying covariate, candidates with an exception had a 45% lower hazard of waitlist mortality compared with standard criteria candidates. The Digital Media Editors want to know all the details and talk with Dr. Parker about the wait-list mortality and post-transplant survival of status 1, 2, 3, and 4 candidates, plus what next steps could be in ensuring a fair allocation system.
The episodeâs special tribute to Dr. Daniel R. Goldstein features Michelle Kittleson, MD, PhD, Interim Editor-in-Chief of JHLT; Andrew Gelman, PhD, Deputy Editor at JHLT; Andrew Fisher, FRCP, PhD, past president of ISHLT and Chair of the Publications Oversight Committee; Daniel Tyrrell, PhD, a former post-doc of Dr. Goldsteinâs; and Judy Chen, PhD, a former immunology PhD student in Dr. Goldsteinâs lab.
These heartfelt tributes to Dr. Goldstein are worth a listenâand we thank Dr. Goldstein for his vision and leadership at the Journal.
Follow along at www.jhltonline.org/current, or, if youâre an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation. Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
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The JHLT Digital Media Editors explore two manuscripts from the August issue of The Journal of Heart and Lung Transplantationâthe first on immunosuppression in pediatric heart transplantation, and the second TA-NRP in DCD lung transplantation. Digital Media Editor Van-Khue Ton, MD, heart failure and transplant cardiologist at Massachusetts General Hospital, hosts this episode.
First, hear from senior author Steven C. Greenway, MSc, MD, on his teamâs study âSingle-drug immunosuppression is associated with noninferior medium-term survival in pediatric heart transplant recipients.â Dr. Greenway shares his journey from enzyme biochemistry in mollusks, snails, and frogs to pediatric cardiology, then outlines the results of the paper.
The study queried the Pediatric Heart Transplant Societyâs registry to determine the efficacy and safety of monotherapy immunosuppression. The results showed better graft survival and less coronary allograft vasculopathy in the monotherapy group, even after adjusted for age at transplant, sex, neonatal transplant, infection, PTLD, and etiology of cardiomyopathy. Dr. Greenway and the digital media editors discuss the burning questions that obviously arise from the studyâs findings, the limitations of the paper, and what follow-up studies might start generating the answers that might eventually change clinical practice.
Next, the editors welcome first author Jad Malas, MD, to discuss the paper âThe impact of thoracoabdominal normothermic regional perfusion on early outcomes in donation after circulatory death lung transplantation.â This study utilized the United Network of Organ Sharing (UNOS) database to identify DCD donors whose heart was procured in order to evaluate lung utilization rates and early post-lung transplant outcomes. Lung utilization was similar between the groupsâ14.9% for the NRP group and 13.8% for direct procurement. Post-lung transplant rates of ECMO and mechanical ventilation at 72 hours were not statistically different, and 6-month survival was equivalent.
Dr. Malas and the Digital Media Editors discuss the studyâs findings and implications, including exploring the background of NRPâs relationship to lung allografts, differences in assessment or procurement techniques, and what might be needed to further evaluate this procurement technique for lung allografts.
Follow along at www.jhltonline.org/current, or, if youâre an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation. Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
This episode of JHLT: The Podcast, but not the studies within, is sponsored by Natera.
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The JHLT Digital Media Editors explore two manuscripts from the July issue of The Journal of Heart and Lung Transplantationâone on heart transplantation and one on lung transplantation. Digital Media Editor Marty C. Tam, MD, Assistant Professor at the University of Michigan, hosts this episode.
First, hear from co-first author Kevin Chen, MD, on his teamâs study âDonation after circulatory death heart procurement strategy impacts utilization and outcomes of concurrently procured abdominal organs,â which comes from Cedars-Sinai. The study looks into the results of DCD organ donation depending on the technique used at procurement, mainly comparing ex-situ normothermic organ perfusion with thoracoabdominal normothermic regional perfusion (TA-NRP).
Digital Media Editors David Schibilsky, MD, and Van-Khue Ton, MD, have questions on the relationship between DCD liver and kidney procurement and heart procurement strategies, why TA-NRP livers and kidneys might differ, and the lower incidence of delayed graft function in DCD kidney transplants with TA-NRP. Dr. Chen also shares some thoughts about how this work might be incorporated into clinical practice.
Next, the editors welcome first author Jonathan P. Singer, MD, MS, from UCSF, to discuss the paper âDevelopment of the Lung Transplant Frailty Scale (LT-FS).â Based on previous work, Dr. Singer and his colleagues set out to develop a novel frailty scale specifically for lung transplant candidates with improved performance characteristics over other frailty scales. The authors developed three lung transplant frailty measures and compared the construct and predictive validity to the existing short physical performance battery (SPPB) and the fried frailty phenotype (FFP). Their LT-FS models exhibited superior construct and predictive validity to these measuresâand the addition of muscle mass and biomarkers further improved the modelâs performance.
Digital Media Editor Erika Lease, MD, digs in with Dr. Singer on the main findings of the study. Whatâs unique about patients with advanced lung disease that makes them need a more specific frailty scale? How does the LT-FS outshine prior models? And what are the barriers to implementing a new model like this one in a transplant center?
Follow along at www.jhltonline.org/current, or, if youâre an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation. Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
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On the June episode of JHLT: The Podcast, the Digital Media Editors explore two manuscripts from the June issue of The Journal of Heart and Lung Transplantation, with authors from the US and Denmark.
First, hear from senior author Steven R. Hays, MD, on his teamâs study âDesign and implementation of a digital health home spirometry intervention for remote monitoring of lung transplant function,â which explores digital health and comes out of UCSF. In the study, the authors developed an automated digital health intervention using Bluetooth-enabled home spirometers to monitor for complications after lung transplantation. Using a chat-based application, patients could perform home spirometry, answer symptom queries, and receive patient education. The program could also alert both the patient and center providers to substantial decreases in FEV1 from baselineâand any other concerning symptoms.
Dr. Hays and Digital Media Editors Erika Lease, MD, and Van-Khue Ton, MD, PhD, discuss how COVID-19 created a serendipitous moment to fund the study, and some of the most valuable lessons from the rollout of the program, including creating efficiencies among the transplant team, proper resourcing, and next steps for perfecting the program.
Next, the editors welcome first author Niels Moeslund, MD, PhD, from Aarhus University in Denmark, to discuss the paper, âEx-situ oxygenated hypothermic machine perfusion in donation after circulatory death heart transplantation following either direct procurement or in-situ normothermic regional perfusion.â In the study, authors set out to explore the use of oxygenated hypothermic machine perfusion as an alternative to in-situ normothermic regional perfusion or ex-situ normothermic machine perfusion of DCD hearts. They used a porcine model to simulate a DCD setting, and performed either normothermic regional perfusion and static cold storage; normothermic regional perfusion with hypothermic machine perfusion with the XVIVO heart preservation system; or direct procurement with hypothermic machine perfusionâall before heart transplantation was performed.
Digital Media Editor David Schibilsky, MD, digs in with Dr. Moeslund on the main findings of the study, in which HMP hearts showed better contractility after transplantation despite significantly lower inotropic support. Why? Dr. Moeslund shares that the hypothermia of HMP keeps metabolic activity low while myocytes are being replenished, creating maximum potential for energy restoration.
Follow along at www.jhltonline.org/current, or, if youâre an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation. Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
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On Mayâs JHLT: The Podcast, we feature two manuscripts from the May issue of The Journal of Heart and Lung Transplantation.
First, the editors explore a study entitled âDonor hyperoxia is a novel risk factor for severe cardiac primary graft dysfyunction,â which comes from Kransdorf and colleagues at Cedars Sinai Medical Center in Los Angeles.
The editors welcome first author Evan Kransdorf, MD, PhD, to share how he transitioned from oncology to heart failure and transplantation, and to talk about the findings of the study. The Digital Media Editors want to know how machine learning came to be a part of the study, what other donor-specific predictors might contribute to severe PGD, and whether DCD and DBD donors had different outcomes.
Next, the editors welcome first author Danny Ramzy, MD, PhD, from the UTHealth McGovern School of Medicine in Houston to discuss the paper, âImproved clinical outcomes associated with the Impella 5.5 compared to the Impella 5.0 in contemporary cardiogenic shock and heart failure patients.â
The digital media editors dig in with Dr. Ramzy on why Impella 5.5 has better outcomes and if this outcome holds in multivariable models, why the survival outcomes were so much higher than published survivals for patients with cardiogenic shock, and what follow up studies might get the answers theyâre looking for.
Follow along at www.jhltonline.org/current, or, if youâre an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation. Donât already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
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El podcast de JHLTenEspañol: presentamos por primera vez un podcast de JHLT en Español, conducido por Marta Farrero, MD, PhD, en el que repasamos 4 artĂculos destacados de 2022, cada uno centrado en el foco de interĂ©s de las redes interdisciplinarias de ISHLT.
El artĂculo sobre soporte circulatorio se titula âLa recuperaciĂłn de la funciĂłn ventricular se asocia con mejores resultados en asistencia ventricularâ, con Cameron Olsen, MD, como primer firmante, y es comentado por el SebastiĂĄn Rojas, MD. Se analiza el impacto clĂnico favorable de la recuperaciĂłn de la fracciĂłn de eyecciĂłn por encima del 40% en una cohorte retrospectiva de pacientes con implante de asistencia ventricular de larga duraciĂłn.
El artĂculo sobre trasplante pulmonar se titula âSĂndrome del injerto restrictivo vs bronquiolitis obliterante: caracterizaciĂłn inmunolĂłgica y molecular de exosomas circulantesâ, con Sandhya Bansal, PhD primer firmante, comentado por Alejandro Bertolotti, MD. Este trabajo se propone tratar de caracterizar la patogenia del rechazo crĂłnico analizando el contenido de molĂ©culas proinflamatorias y potencialmente inmunogĂ©nicas contenidas en exosomas aislados del plasma de receptore de trasplante pulmonar.
El artĂculo sobre hipertensiĂłn pulmonar se titula âEscalas de riesgo y predicciĂłn clĂnica en hipertensiĂłn arterial pulmonar, un anĂĄlisis del freedom-EVâ con de Raymond L. Benza, MD como primer firmante y Roberto Bernardo, MD, MS para realizar los comentarios. En este subanĂĄlisis se observa como las escalas de riesgo de los pacientes con hipertensiĂłn pulmonar mejoran tras la administraciĂłn de treprostinil oral.
El cuarto y Ășltimo artĂculo se titula âMicroRNA circulante y rechazo mediado por anticuerpos en el trasplante cardĂacoâ, con Palak Shah, MD, MS como primer firmante y comentado por Vanessa Blumer, MD. En este trabajo se identificĂł quĂ© microRNA se asocian a rechazo celular y mediado por anticuerpos, permitiendo hacer el diagnĂłstico con una buena sensibilidad y especificidad.
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