Health Topics – Johns Hopkins Medicine Podcasts

Anchor lead: The time people must wait to receive a liver transplant may now be shorter, Elizabeth Tracey reports

Liver transplants are most often needed because someone’s liver is damaged due to alcohol use, so centers used to require potential liver recipients with this history to remain abstinent from alcohol for six months prior to transplant. No more, says Andrew Cameron, director of organ transplantation at Johns Hopkins.

Cameron: The most common indication for liver transplant now is previous alcohol use. Results after transplant are fantastic. Previously we had a rule that there was a six month waiting period to make you eligible for a liver transplant. We now know that there are better ways to figure out who will do well after liver transplant. Things like do you have insight into the nature of the problem? Do you have good family support? Do you have a willingness, if you didn’t have a waiting period before transplant, to have a rehabilitation period after transplant? :34

Cameron says such strategies may improve overall outcomes for people who need a liver transplant. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What are the considerations in matching lungs to recipients? Elizabeth Tracey reports

Matching lungs available for transplant to the appropriate recipient is a complex business, with a multitude of factors requiring integration. That’s according to Errol Bush, surgical director of lung transplantation at Johns Hopkins.

Bush: When we’re considering an organ that may be suitable for a potential recipient we want to make sure that the blood types are correct, that the size matches, and that the organ function is adequate for the intended recipient. In lung transplantation the mechanism of injury for the donor is usually a traumatic incident, and during the process of that trauma or injury, the donors actually sometimes develop a pneumonia where they have actual physical damage to the lungs. Most of these injuries are recoverable.  :30

Bush says the good news is a technique called ex vivo lung perfusion may help make many more organs available for people who need them, as well as expanding the time window during which transplants can take place. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Organs for transplant may now be maintained much longer outside the body, Elizabeth Tracey reports

Ex vivo perfusion is a way to maintain organs such as lungs or livers outside the body for some time, giving surgeons a chance to assess how well they are functioning, allow them to heal from injury, and extend the time window for transplant. Andrew Cameron, director of organ transplantation at Johns Hopkins, explains.

Cameron: It’s the idea of a liver or a kidney in a box. So the way we’ve done it for fifty years is to take the organs out and keep them cold. And the organs are essentially slowly dying and we have a window of six hours eight hours to get it in. it’s not what we’re going to do anymore. In the future we’re going to take the organs and keep them alive. They’re going to be perfused with blood that carries oxygen and they theoretically could stay out of a body indefinitely. There’s the case of a liver that was outside of a body for seven days.  :31

Cameron hopes the technique will render many more organs suitable for transplant. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: New technology may allow more lung transplants, Elizabeth Tracey reports

Obtaining lungs suitable for transplant may now be easier with a technology that helps maintain the organs outside the body. Errol Bush, surgical director of lung transplantation at Johns Hopkins, explains.

Bush: We are now using other strategies that may capitalize on using organs that we might not have considered through a strategy called ex vivo lung perfusion. Ex vivo lung perfusion is a relatively recent technology that allow us to recover organs that were considered marginal, place them on a device where they have perfusion as well as being ventilated, so its basically being in a lung incubator, and then we’re able to monitor those organs, assess those organs, and resuscitate them, to a point that they can then be used for transplant.  :32

Ex vivo lung perfusion involves technology similar to a heart-lung machine. Bush is optimistic that utilization of the technique could greatly reduce the number of people currently on the waiting lists for lungs. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: People who are awaiting kidney transplants now have at least two options, Elizabeth Tracey reports

Many people who need a kidney have had their surgeries delayed by recent events, but now those constraints are starting to ease.  Andrew Cameron, director of organ transplantation at Johns Hopkins, says more kidneys than ever are available.

Cameron: Of the 100,000 Americans waiting 80,000 are waiting for a kidney. There’s two great ways to get a kidney transplant. One is cadaveric donation, somebody that’s died and agreed to donate their organs and the other way is from a living donor. From the folks that donate after they pass away we used to discard some of those organs because they had sustained some injury or if they have hepatitis C or maybe even if the donor had HIV. We now understand that there are safe ways to use those kidneys and they function as well or better than the other kidneys we’ve already been using.  :35

Cameron says utilizing all of these strategies should help reduce the length of the waiting list for kidney transplants. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Could rinsing the nose and other strategies stave off Sars-CoV2 infection? Elizabeth Tracey reports

Target tissue for Sars-CoV2 may be what’s called the olfactory epithelium in the upper part of the nose, the same tissue that’s responsible for our sense of smell. Andrew Lane, director of rhinology and sinus surgery at Johns Hopkins, says the fact that people lose their sense of smell with this virus points to this area.

Lane: Most of the air you breath comes in through your nose. It’s the common portal for viral infections. The virus infects the lining cells of the nose and the whole nasal cavity, causing a lot of inflammation which blocks the breathing and makes you make mucus. The fact that this virus doesn’t seem to cause these symptoms would make you think that maybe the virus is bypassing the part of the nose that’s responsible for the breathing passages and works its way up deeper into the nose where the olfactory- the sense of smell tissue it, that tissue has slightly different types of cells in it, cells that are very specialized for the olfactory system.  :30

Lane says protective strategies like rinsing the nose could potentially be helpful in dislodging the virus from this tissue and either stopping infection or dramatically reducing the number of viral particles. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Does loss of sense of smell point to the exact tissue where Sars-CoV2 takes hold? Elizabeth Tracey reports

Where exactly does Sars-CoV2 infect the body? It may be the tissue that enables your sense of smell, called the olfactory epithelium. That’s according to Andrew Lane, director of rhinology and sinus surgery at Johns Hopkins.

Lane: People would ask why do you lose your sense of smell with this infection? And people who have viral infections in general might lose their sense of smell as part of it and typically its in the setting of a stuffy nose. In this disease COVID 19 the really interesting part of it is that 5% or less of people with COVID-19 complain of a runny nose or stuffiness or typical cold symptoms. People specifically say oh I’ve only lost my sense of smell but I have no other nasal symptoms suggesting to me and a lot of other people that maybe the virus is actually infecting the olfactory tissue.  :32

Lane says that one receptor known to be used by the virus is present at a much greater concentration in the olfactory epithelium than elsewhere, so the idea that infection takes place there makes sense. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Assessing the severity of loss of smell is possible, Elizabeth Tracey reports

Testing your sense of smell may indicate just how acute the loss might be, and could also have some predictive value when it comes to COVID-19 infection. That’s according to Andrew Lane, director of rhinology and sinus surgery at Johns Hopkins.

Lane: What you’d want to do is to ask people if they’ve had a change in their sense of smell and taste, and you’d also want to do some type of objective testing which can vary from a scratch and sniff type book where you identify the odors to breathing in odors on a almost looks like a marking pen, you can ask people whether or not they can detect it down to a lower level, determine whether someone’s sense of smell if not completely lost is partially lost. In an ideal world you would be able to put people through their olfactory Olympics. From there you could find out what its predictive value is, both for whether you have the disease or for potentially your prognosis.  :34

Lane says people can also informally test their own sense of smell at home using common things like lemons. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: It seems that loss of the sense of smell may be useful in tracking the spread of COVID-19, Elizabeth Tracey reports

When the COVID-19 pandemic began, Google searches showed that people in areas where the virus was spreading were searching for ‘loss of smell.’ Andrew Lane, director of rhinology and sinus surgery at Johns Hopkins, says this led to researchers asking the question directly.

Lane: In doing phone surveys, when you ask people who may or may not have the disease, have you had an acute, sudden loss of your sense of smell? And a surprising number of people, more than you would think under normal circumstances, would say yes. How do you confirm that? The availability of testing hasn’t been enough to be able to then go and confirm that that person has loss of sense of smell due to infection with the Sars-CoV2 virus. You don’t know, but you can say that if normally, some small percentage of the population loses their sense of smell, there are some, it happens, but its not a very large percentage of people.   :32

Lane says as testing becomes more readily accessible, confirmation of the loss of smell as a predictor will be possible. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What does loss of smell tell us about COVID-19? Elizabeth Tracey reports

Loss of smell is one symptom of COVID-19 infection, but it’s unclear whether that takes place early for many and then may continue in those who develop more severe disease. That’s according to Andrew Lane, director of rhinology and sinus surgery at Johns Hopkins.

Lane: As patients begin to describe their symptoms or people weren’t sure if they had the disease or not started to report their symptoms it became evident that there was a lot of olfactory loss going on. That can range from complete loss of smell to something more subtle like sometimes a decrease in your sense of smell or a change in your sense of smell. Currently the numbers are hard to tease apart so of the patients who are very sick who come in to the hospital, a very large percentage of them have olfactory loss, whether or not it was an early symptom is kind of hard to tell at that point they’ve already presented with it.  :32

Lane says loss of smell now is listed as a common symptom of COVID-19 infection by the CDC and that those who experience it should at least self-isolate and pay attention to their symptoms. At Johns Hopkins, I’m Elizabeth Tracey.