JHLT: The Podcast

The Journal of Heart and Lung Transplantation podcast features editor Daniel Goldstein, MD, in round table talks with the JHLT's digital media editors.

Episode 52: State of the art review on aortic Insufficiency in durable LVADs 11/20/2024

Episode 51: Can you be pragmatic about tMCS in Acute RV Failure? 11/06/2024

Episode 50: Age matching lung donors and recipients in Europe 10/16/2024

Episode 49: The Evaluation and Care of Cardiac Transplant Candidates 10/02/2024

Episode 48: A Tribute to Daniel R Goldstein 09/13/2024

Episode 47: An Interview with JHLT EIC Joe Rogers 09/04/2024

Episode 46: August 2024 08/14/2024

Episode 45: August 2024 08/07/2024

Episode 44: July 2024 07/03/2024

Episode 44: July 2024 On this episode of JHLT: The Podcast, the JHLT Digital Media Editors explore two studies from the July issue of The Journal of Heart and Lung Transplantation. Digital Media Editor Marty Tam, MD, a transplant cardiologist from the University of Michigan in Ann Arbor, hosts this episode. First, Dr. Tam and Digital Media Editor Erika Lease, MD, FCCP, interview their first guest, Daniel Calabrese, MD, first author on the study “.” The study’s authors sought to tackle challenges behind early detection of chronic lung allograft dysfunction (CLAD) by identifying biomarkers associated with acute lung allograft dysfunction (ALAD) progression to CLAD. To do this, they collected bronchoalveolar lavage (BAL) cells at the time of ALAD diagnosis and performed single cell RNA sequencing to identify significant differences in 26 unique cell populations across groups, with discordant CD8 T cells and macrophages providing the best discrimination between ALAD with decline from ALAD with recovery and controls. Dr. Calabrese discusses how his team identified the diagnostic criteria, why the biomarkers might lead ALAD to progress to CLAD, and how the findings might lead to early targeted therapies. Next, Dr. Tam joins and Digital Media Editor Khue Ton, MD and David Schibilsky, MD, to interview their next guest, David D’Alessandro, MD, the Surgical Director of Cardiac Transplantation and MCS at Massachusetts General Hospital in Boston. Dr. D’Alessandro was the first author on the study “,” which sought to assess the impact of the Paragonix SherpaPak Cardiac Transport System, a device allowing controlled hypothermic preservation, on rates of primary graft dysfunction (PGD) and post-transplant mortality. The key finding was that controlled hypothermic preservation was associated with a lower incidence of severe PGD – 6.6% compared to ice storage at 10.4%. In the conversation, Dr. D’Alessandro answers questions about the need for innovation over traditional ice cold storage, the greatest advantages of controlled hypothermic approaches, and the next steps in this research. Follow along at , or, if you’re an ISHLT member, access your Journal membership at . Don’t already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at for a free subscription, or subscribe today at . /episode/index/show/thejhlt/id/31979052

Episode 43: June 2024 06/05/2024

Episode 43: June 2024 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 “.” 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 “.” 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 , or, if you’re an ISHLT member, access your Journal membership at . Don’t already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at for a free subscription, or subscribe today at . /episode/index/show/thejhlt/id/31601037

Episode 42: May 2024 05/01/2024

Episode 41: April 2024 04/03/2024

Episode 40: March 2024 03/06/2024

Episode 39: February 2024 02/07/2024

Episode 38: January 2024 01/03/2024

Episode 37: December 2023 12/06/2023

Episode 37: December 2023 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 “.” 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 “,” 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 , or, if you’re an ISHLT member, log in at . Don’t already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at for a free subscription, or subscribe today at . /episode/index/show/thejhlt/id/28939878

Episode 36: November 2023 11/01/2023

Episode 36: November 2023 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 “.” 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 “.” 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 , or, if you’re an ISHLT member, log in at . Don’t already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at for a free subscription, or subscribe today at . /episode/index/show/thejhlt/id/28461506

Episode 35: October 2023 10/04/2023

Episode 35: October 2023 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 “.” 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 “.” 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 , or, if you’re an ISHLT member, log in at . Don’t already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at for a free subscription, or subscribe today at . /episode/index/show/thejhlt/id/28214246

Episode 34: September 2023 09/06/2023

Episode 34: September 2023 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 “.” 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 , or, if you’re an ISHLT member, log in at . Don’t already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at for a free subscription, or subscribe today at . /episode/index/show/thejhlt/id/27944358

Episode 33: August 2023 08/02/2023

Episode 33: August 2023 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 “.” 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 “.” 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 , or, if you’re an ISHLT member, log in at . Don’t already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at for a free subscription, or subscribe today at . This episode of JHLT: The Podcast, but not the studies within, is sponsored by . /episode/index/show/thejhlt/id/27627330

Episode 32: July 2023 07/05/2023

Episode 32: July 2023 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 “,” 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 “.” 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 , or, if you’re an ISHLT member, log in at . Don’t already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at for a free subscription, or subscribe today at . /episode/index/show/thejhlt/id/27354666

Episode 31: June 2023 06/07/2023

Episode 31: June 2023 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 “,” 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, “.” 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 , or, if you’re an ISHLT member, log in at . Don’t already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at for a free subscription, or subscribe today at . /episode/index/show/thejhlt/id/27047556

Episode 30: May 2023 05/03/2023

El podcast de JHLT en Español: Abril 2023 04/12/2023

Episode 28: April 2023 04/05/2023

Episode 27: March 2023 03/01/2023

Episode 26: February 2023 02/01/2023

Episode 25: January 2023 01/04/2023

Episode 24: December 2022 12/07/2022

Episode 24: December 2022 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 “.” 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 “.” 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 , or, if you’re an ISHLT member, log in at . Don’t already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at for a free subscription, or subscribe today at . This episode of JHLT: The Podcast, but not the studies within, is sponsored by . /episode/index/show/thejhlt/id/25229958

Episode 23: November 2022 11/02/2022

Episode 23: November 2022 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 “.” 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 “.” 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 , or, if you’re an ISHLT member, log in at . Don’t already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at for a free subscription, or subscribe today at . This episode of JHLT: The Podcast, but not the studies within, is sponsored by . /episode/index/show/thejhlt/id/24854754

JHLT: The Podcast

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