JHLT: The Podcast

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 "Aortic Root Thrombosis in patients with HeartMate 3 left ventricular assist device support."

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 "Investigating the "sex paradox" in pulmonary arterial hypertension: Results from the Pulmonary Hypertension Association Registry (PHAR)."

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 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 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 podcast's first-ever undergraduate pre-medical guest, from the University of Michigan. Helen was the lead author on the study "Racial and Gender Disparities in Transplantation of Hepatitis C+ Hearts and Lungs." The study noted that prior research in utilization of kidneys from donors with Hepatitis C had shown disparities due to gender and education—and 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 podcast's first return guest, having appeared on the show near the end of 2021. This time, she's featured as first author on the study "Metabolomic profiling during ex situ normothermic perfusion before heart transplantation defines patterns of substrate utilization and correlates with markers of allograft injury." 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 project's logistics—which she calls a "labor of love"—its multi-point findings, and what's next in this line of research.

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 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.