JHLT: The Podcast

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 “Occult right ventricular dysfunction and right ventricular-vascular uncoupling in left ventricular assist device recipients.” 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, you’ll 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 “Development and validation of primary graft dysfunction predictive algorithm for lung transplant candidates.” 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 model’s strengths over other approaches, and its limitations. Tune in to learn more!   Follow along at www.jhltonline.org/current, or, if you’re an ISHLT member, access your Journal membership at www.ishlt.org/jhlt.   Don’t 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.    

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 “Assessing the role of phosphorylated S6 ribosomal protein in the pathological diagnosis of pulmonary antibody-mediated rejection.” 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 “Relationship between blood and tissue-based rejection-related transcripts in heart transplantation.” 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 you’re an ISHLT member, access your Journal membership at www.ishlt.org/jhlt.   Don’t 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.

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 “Perioperative extracorporeal membrane oxygenation support for pulmonary endarterectomy: A 17-year experience from the UK national cohort.” 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 “Heart transplantation in patients from socioeconomically distressed communities.” 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 you’re an ISHLT member, access your Journal membership at www.ishlt.org/jhlt.   Don’t 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.

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 – 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. What’s changed in the decade plus since the 2010 guidelines were published? For starters, there’s 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 patients—something that’s 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 massive—and massively important—document. 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 ISHLT’s Standards and Guidelines documents at https://ishlt.org/publications-resources/professional-resources/standards-guidelines.   Don’t 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.    

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 team’s study “Impact of age and telomere length on circulating T cells and rejection risk after lung transplantation for idiopathic pulmonary fibrosis.”   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 recipients—and indeed, the authors found that lung transplant recipients with IPF and short telomere length had premature “aging” 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 “Early optical coherence tomography evaluation of donor-transmitted atherosclerosis and cardiac allograft vasculopathy: insights from a prospective, single-center study,” 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. Patel’s 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 you’re an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation.  Don’t 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.    

It’s 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 team’s study “Clinical and functional relevance of right ventricular contraction patterns in pulmonary hypertension.”   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 pressure–volume 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 “Impact of sex on outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension.” 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 you’re an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation.  Don’t 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.

The JHLT Digital Media Editors explore two manuscripts from the October issue of The Journal of Heart and Lung Transplantation—the 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 team’s study “Transplanting candidates with stacked risks negatively affects outcomes.”   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 success—based on factors like mortality, length of stay, duration of mechanical ventilation, need for ECMO-salvage, total charges, and discharge to a skilled nursing facility—listen to the discussion in the episode.   Next, the editors explored the study “Dynamics of bacterial pathogens at the driveline exit site in patients with ventricular assist devices: A prospective, observational, single-center cohort study.” While the authors weren’t able to join the episode, editors corresponded with senior author Monika Fürholz, 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 you’re an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation.  Don’t 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.    

In this special issue of JHLT: The Podcast, the JHLT Digital Media Editors explore just one study—and 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 team’s study “Association of high-priority exceptions with waitlist mortality among heart transplant candidates.” 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 study’s 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 episode’s 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. Goldstein’s; and Judy Chen, PhD, a former immunology PhD student in Dr. Goldstein’s lab.   These heartfelt tributes to Dr. Goldstein are worth a listen—and we thank Dr. Goldstein for his vision and leadership at the Journal.   Follow along at www.jhltonline.org/current, or, if you’re an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation.  Don’t 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.    

The JHLT Digital Media Editors explore two manuscripts from the August issue of The Journal of Heart and Lung Transplantation—the 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 team’s study “Single-drug immunosuppression is associated with noninferior medium-term survival in pediatric heart transplant recipients.” 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 Society’s 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 study’s 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 “The impact of thoracoabdominal normothermic regional perfusion on early outcomes in donation after circulatory death lung transplantation.” 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 groups—14.9% 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 study’s findings and implications, including exploring the background of NRP’s 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 you’re an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation.  Don’t 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.

The JHLT Digital Media Editors explore two manuscripts from the July issue of The Journal of Heart and Lung Transplantation—one 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 team’s study “Donation after circulatory death heart procurement strategy impacts utilization and outcomes of concurrently procured abdominal organs,” 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 “Development of the Lung Transplant Frailty Scale (LT-FS).” 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 measures—and the addition of muscle mass and biomarkers further improved the model’s performance.   Digital Media Editor Erika Lease, MD, digs in with Dr. Singer on the main findings of the study. What’s 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 you’re an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation.  Don’t 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.    

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 team’s study “Design and implementation of a digital health home spirometry intervention for remote monitoring of lung transplant function,” 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 baseline—and 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, “Ex-situ oxygenated hypothermic machine perfusion in donation after circulatory death heart transplantation following either direct procurement or in-situ normothermic regional perfusion.” 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 perfusion—all 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 you’re an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation.  Don’t 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.

On May’s 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 “Donor hyperoxia is a novel risk factor for severe cardiac primary graft dysfyunction,” 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, “Improved clinical outcomes associated with the Impella 5.5 compared to the Impella 5.0 in contemporary cardiogenic shock and heart failure patients.”   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 they’re looking for.   Follow along at www.jhltonline.org/current, or, if you’re an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation.  Don’t 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.    

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 artículos destacados de 2022, cada uno centrado en el foco de interés de las redes interdisciplinarias de ISHLT. El artículo sobre soporte circulatorio se titula “La recuperación de la función ventricular se asocia con mejores resultados en asistencia ventricular”, con Cameron Olsen, MD, como primer firmante, y es comentado por el Sebastián Rojas, MD. Se analiza el impacto clínico favorable de la recuperación de la fracción de eyección por encima del 40% en una cohorte retrospectiva de pacientes con implante de asistencia ventricular de larga duración. El artículo sobre trasplante pulmonar se titula “Síndrome del injerto restrictivo vs bronquiolitis obliterante: caracterización inmunológica y molecular de exosomas circulantes”, con Sandhya Bansal, PhD primer firmante, comentado por Alejandro Bertolotti, MD. Este trabajo se propone tratar de caracterizar la patogenia del rechazo crónico analizando el contenido de moléculas proinflamatorias y potencialmente inmunogénicas contenidas en exosomas aislados del plasma de receptore de trasplante pulmonar. El artículo sobre hipertensión pulmonar se titula “Escalas de riesgo y predicción clínica en hipertensión arterial pulmonar, un análisis del freedom-EV” con de Raymond L. Benza, MD como primer firmante y Roberto Bernardo, MD, MS para realizar los comentarios. En este subanálisis se observa como las escalas de riesgo de los pacientes con hipertensión pulmonar mejoran tras la administración de treprostinil oral. El cuarto y último artículo se titula “MicroRNA circulante y rechazo mediado por anticuerpos en el trasplante cardíaco”, con Palak Shah, MD, MS como primer firmante y comentado por Vanessa Blumer, MD. En este trabajo se identificó qué microRNA se asocian a rechazo celular y mediado por anticuerpos, permitiendo hacer el diagnóstico con una buena sensibilidad y especificidad.

It’s another COVID-19 special on this month’s JHLT: The Podcast, which features two articles on COVID-19 and thoracic organ transplantation from the April issue of The Journal of Heart and Lung Transplantation.   First, the editors explore a study entitled “Heart transplantation for COVID-19 myopathy in the United States,” which comes from Gill and colleagues at Cedars Sinai Medical Center in Los Angeles.   The editors welcome first author George Gill, MD, to share what brought him from the United Kingdom to the States, and to talk about the findings of the study. The Digital Media Editors want to know how COVID-19 myocarditis impacts immune response in transplantation, how Dr. Gill manages different etiologies of cardiomyopathy, and some of the limitations of the study.   Next, the editors welcome senior author Nicolaus Schwerk, MD, from Hannover Medical School in Germany to discuss the paper, “COVID-19 in pediatric lung transplant recipients: Clinical Course and outcome.”   Dr. Schwerk is an expert in rare diffuse parenchymal lung diseases and end stage lung diseases, as well as congenital thoracic malformations in children, and performs lung transplantation. This single-center study investigated the impact of SARS-COV-2 infection on pediatric lung transplant recipients between March 2020 and June 2022 at Hannover Medical Center. The key finding of the study was that the COVID-19-positive pediatric lung transplant recipients did remarkably well.   The digital media editors dig in with Dr. Schwerk on the pace of COVID-19 infections in Europe, why antivirals are used differently in pediatric patients, and why pediatric patients typically experience a more mild course of disease.   Follow along at www.jhltonline.org/current, or, if you’re an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation.  Don’t 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 month’s JHLT: The Podcast is hosted by Digital Media Editor David Schibilsky, MD, who leads a discussion of two studies from the March issue of The Journal of Heart and Lung Transplantation—and the first authors who presented them.   First, the editors explore a study entitled “Angiopoietin 2 and hsCRP are associated with pulmonary hemodynamics and long-term mortality respectively in CTEPH—Results from a prospective discovery and validation biomarker study,” which comes from Hadinnapola and colleagues at the Papworth group in Cambridge, UK.   The editors welcome Charaka Hadinnapola, MA, MB, BChir, first author on the CTEPH study, to share the rationale in performing the research, its main findings, the changing understanding of the pathobiology of pulmonary arterial hypertension, and how Ang2 and hsCRP fit into the bigger cytokine picture in CTEPD and CTEPH patients.   Next, the editors welcome author J.K. Peel, MD, MSc, from the University of Toronto to discuss the paper her first authored, “Determining the impact of ex-vivo lung perfusion on hospital costs for lung transplantation: a retrospective cohort study.”   This retrospective, before-after, propensity-score weighted cohort study explores how EVLP affects hospital costs and the associated transplant procedures, intending to evaluate whether the benefits of EVLP offset its additional cost. Dr. Peel shares what changes occurred at his center during the study period, how the results compare to other published evidence on EVLP costs, and whether the results are transferable to smaller centers.   Follow along at www.jhltonline.org/current, or, if you’re an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation.  Don’t 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 month on JHLT: The Podcast, the JHLT Digital Media Editors review two studies from the February issue of The Journal of Heart and Lung Transplantation—and bring in a couple of experts to help them make sense of some new technology.   First, the editors explore a pre-clinical study entitled “The dynamic cellular landscape of grafts with acute rejection after heart transplantation,” which comes from Kong and colleagues at Zhejiang University in Hangzhou, China.   Single cell technologies are emerging as non-biased techniques to discover novel biological pathways in a variety of pre-clinical models and in human tissue both in health and disease. To help the editors—and you!—understand single cell approaches and this study, JHLT editors Ben Kopecky, MD, PhD and Kory Lavine, MD, PhD, from the Washington University St. Louis, appear in the episode to explore the methodology and what the study tells us.   Second, the editors welcome author Sam Rayner, MD from the University of Washington in Seattle, USA, to discuss the paper by Hirsch and colleagues, “Circulating markers of inflammation and angiogenesis and clinical outcomes across subtypes of pulmonary arterial hypertension.”   When considering differences in pathophysiology of the subtypes of PAH, changes in biomarkers in angiogenesis and inflammation may provide useful insights and potential therapeutic targets. The authors of this study prospectively looked at 33 biomarkers of angiogenesis and inflammation in a cohort of patients across various PAH etiologies, and made correlations to clinical outcomes.   Follow along at www.jhltonline.org/current, or, if you’re an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation.  Don’t 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.    

JHLT: The Podcast kicks off 2023 with a look back at 2022. Daniel R. Goldstein, MD, Editor-in-Chief of JHLT, joins the JHLT Digital Media Editors for a recap of the past year of The Journal of Heart and Lung Transplantation.   Studies include: Pérez-Carrillo, et al, “Diagnostic value of serum miR-144-3p for the detection of acute cellular rejection in heart transplant patients.” Feb 2022 JHLT Han, et al, “Impact of using higher-risk donor hearts for candidates with pre-transplant mechanical circulatory support.” Feb 2022 JHLT Jackson, et al, “Heart transplant outcomes in cardiac sarcoidosis.” Jan 2022 JHLT Ribeiro, et al, “Ex vivo treatment of cytomegalovirus in human donor lungs using a novel chemokine-based immunotoxin.” Mar 2022 JHLT Moshkelgosha, et al, “Interferon-stimulated and metallothionein expressing macrophages are associated with acute and chronic allograft dysfunction after lung transplantation.” Nov 2022 JHLT   Follow along at www.jhltonline.org/current, or, if you’re an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation.  Don’t 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 month on JHLT The Podcast, JHLT Digital Media Editor Marty Tam, MD, takes over hosting duties to present two papers from the December issue of The Journal of Heart and Lung Transplantation. Listen now to hear study authors discuss their work, their studies, and next steps for their research. First, we welcome first author Jorge V. López-Ibor, MD, and senior author Javier Segovia-Cubero, MD, PhD, about their team’s study from Hospital Universitario Puerto de Hierro Majadahonda entitled “Role of TGF-β1 +869T>C polymorphism in renal dysfunction one year after heart transplantation.” Drs. López-Ibor and Segovia-Cubero share some background on their work and their areas of research before diving into the study. The study analyzed 355 adult patients for renal dysfunction a year post-heart transplant and suggested a protective role for the TGF- β1 + 869CC genotypes in the development of chronic kidney disease (CKD) in heart transplant patients on calcineurin inhibitors (CNIs). Next, Tsuyoshi Takahashi, MD, PhD, from Washington University, shares details on the study “A comparison of outcomes after lung transplantation between European and North American centers.” Dr. Takahashi begins by discussing his global journey in thoracic surgery, including some of the differences between being a surgeon in the United States and Japan. The study used the ISHLT Thoracic Organ Registry to complete a retrospective, comparative cohort analysis of adult patients undergoing deceased donor lung transplant in North America and Europe between January 2006 and December 2016. It compared overall survival between North American and European transplant centers in a propensity score matched analysis, suggesting a higher 5-year survival for European centers. Dr. Takahashi answers questions about the many factors contributing to these variances. Follow along in the December issue at www.jhltonline.org/current, or, if you’re an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation.  Don’t 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 Enzyvant.

This month on JHLT The Podcast, JHLT Digital Media Editor Van-Khue Ton, MD, takes over hosting duties to present two unique papers from the November issue of The Journal of Heart and Lung Transplantation. Listen now to hear study authors discuss their work, their studies, and next steps for their research. First, we welcome first author Megan M. Collins, MD, about her team’s study from the University of Utah entitled “Attitudes & practices surrounding pregnancy post heart transplantation among pediatric providers.” Dr. Collins shares her journey from being an undergraduate economics major to her current career in pediatrics, including how strategy and game theory have helped her better understand her patients and thrive during her pediatric cardiology fellowship. The study itself is exceptionally important as more pediatric heart transplant recipients reach adulthood and become interested in family planning. The study consisted of confidential and voluntary web surveys of pediatric heart transplant doctors, exploring their behaviors and policies around pregnancy and family planning. Next, R. James White, MD, from the division of Pulmonary and Critical Care Medicine at the University of Rochester Medical Center, shares details on the study “Contemporary Risk Scores Predict Clinical Worsening in Pulmonary Arterial Hypertension – An Analysis of FREEDOM-EV.” Dr. White is the senior author on the study, and discusses how he became interested in risk scores for pulmonary arterial hypertension, including some of the exciting data that they reveal. Prior to this study, none of the event-driven trials in PAH had previously incorporated serial assessment of risk scores like hemodynamics, laboratory values, exercise tolerance, and symptoms at baseline. Using data from the FREEDOM-EV trial, the study retrospectively compared the discriminant power of 4 risk scores, REVEAL 2.0, REVEAL Lite 2, 4-strata COMPERA 2.0, and the non-invasive French risk assessment, in predicting patients’ clinical worsening at baseline and at a 12-week follow up. You won’t want to miss Dr. White’s insights on this comparison! Follow along in the November issue at www.jhltonline.org/current, or, if you’re an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation.  Don’t 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 Altavant Sciences.

For this month’s episode, JHLT The Podcast explores two impactful studies from the October issue of The Journal of Heart and Lung Transplantation. The episode is hosted by Daniel R. Goldstein, MD, Editor-in-Chief of JHLT, who is joined by the JHLT Digital Media Editors. Listen now to hear study authors discuss their work, their studies, and next steps for their research. First, the editors speak with first author Michael Harhay, PhD (pictured left) and senior author Edward Cantu, MD (pictured right), about their study from the University of Pennsylvania entitled “Epidemiology, risk factors and outcomes of lung retransplantation: an analysis of the ISHLT Transplant Registry.” Dr. Goldstein and Erika Lease, MD, interview Drs. Harhay and Cantu about the study. The objective of the study was to leverage the ISHLT Thoracic Transplant registry using an updated cohort of patients that underwent lung retransplantation to obtain an updated summary of the epidemiology of lung retransplantation; to examine the importance of the time between primary transplantation and retransplantation on outcomes after retransplantation; and to identify risk factors of mortality following lung retransplantation. Next, we hear from Anne Dipchand, MD (pictured), Professor of Pediatrics and Pediatric Cardiologist at the Hospital for Sick Children in Toronto, Canada, who is senior author on the study, “Eplet matching in pediatric heart transplantation: The SickKids experience.” Dr. Goldstein and David Schibilsky, MD, discuss the study with Dr. Dipchand. This single-center retrospective study measured allograft survival in 77 patients while performing HLA typing, antigen mismatch, and eplet mismatch analysis, with the goal of comparing the molecular level HLA matching with antigen level HL matching in post-heart transplant outcomes in children. Follow along in the October issue at www.jhltonline.org/current, or, if you’re an ISHLT member, log in at ishlt.org/journal-of-heart-lung-transplantation.  Don’t 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.