JHLT: The Podcast – Détails, épisodes et analyse

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 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 the second August episode of JHLT: The Podcast, the Digital Media Editors discuss a paper from the August issue of JHLT, entitled “A modular simulation framework for organ allocation.”The 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 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.

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.