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Reposted by Sirus Jesudasen, MD

International Society for Heart and Lung Transplantation (ISHLT) @ishlt.bsky.social · 15/05/2025

📣 The 2024 report from the #ISHLT International #Thoracic Organ #Transplant Registry is now available online to members. This official relaunch of the registry includes new data from 12 global partners covering heart/lung transplantations 1992-2024. Download the report here: bit.ly/3FaIkzo

#ISHLT #TTX Registry Chair Rebecca Cogswell addresses the audience at #ISHLT2025

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

Brian Keller (@lungtxdoc.bsky.social) Sravanthi Nandavaram Rene Bermea Katy Black Camille Kotton (@kottonnelson.bsky.social) Nathaniel Langer Asishana Osho Ali Rabi Sarah Mervis Jackie Clark Kaitlyn Grieves Sarah Lands Robin Haverly Erin Vuijik

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

What an amazing showing by the MGH Lung Transplant program at #ISHLT2025! Proud to be contributing to Lung Transplant science with session moderation, oral presentations, posters, and connecting with colleagues from across the world #MGH #LungTxp #Transplantsky #Pulmsky #ISHLT @mgh-id.bsky.social

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Reposted by Sirus Jesudasen, MD

Joanna Schaenman, MD, PhD @jschaenmanmd.bsky.social · 29/04/2025

How to define AMR and ACR in #lungtransplantation ? Standing room only at #ISHLT Acute Lung Allograft Dysfunction suggests that many share this question ! @ishlt.bsky.social #transplantresearch

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

Updated UK review of adult lung transplants 🫁♻️: - 📈 90d mortality (☠️): DCD, higher BMI, recipient DM - 📈 1y ☠️: ⬆️ BMI, low eGFR recipient, D+R- for CMV, ischemia time (non-linear peak ~8h) - 📈 5y ☠️: ⬆️ BMI, recipient ethnic minority, hospitalized recipient at txp ~ Sally Rushton (UK NHS)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

How do the various CKD polygenic risk scores retrospectively risk-stratify for mortality & eGFR decline after lung transplant 🫁♻️ for patients with CKD 🫘? - 📈 PGS scores associated with long-term mortality - 📈 PGS708 associated with eGFR decline following transplant ~ Dr. Shashaty (UPenn)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

Is there a difference in lung cancer risk 🦀 after lung transplant for single 🫁♻️ vs bilateral 🫁♻️🫁 transplant in OPTN COPD/ILD data? - Higher risk to develop post-transplant cancer in single 🫁♻️ - Age, smoking history, and prior lung cancer associated with post-transplant cancer ~ Dr. Chang (NYU)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

Bilateral lung transplant 🫁♻️🫁 for lung-limited malignancy 🦀: - Prospective registry w/ refractory NSCLC (n=10) - ≤ Stage 4a lung cancer - n=1 recurrence after 2 years - Survival comparable to historic institutional data (non-malignant 🫁♻️ cases) ~ Dr. Yang (Northwestern)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

Lung Transplant 🫁♻️ for GvHD 🤺 after allogeneic stem cell transplant 🥚 looking at OPTN data during LAS era: ✅ much better survival with more modern data (48.6% at 5 years) than that reported in various historical case series ~ Dr. Casillan (Hopkins)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

Pulmonary Alveolar Proteinosis (PAP) in lung transplant 🫁♻️: Retrospective cohort of contacted transplant centers across the world 🗺️ (n=60). - Survival: 86.5% at 1 year, 66.6% at 5 years - PAP recurrence: 15% (4% by 1 year after ♻️) - Similar survival for + & - PAP recurrence ~ Dr. Schwarz (Vienna)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

Wrapping up the final session at #ISHLT2025, we will lastly hear on outcomes in specific and complex patient populations. Highlights from the oral session on Lung Transplant Outcomes 🫁♻️: Considerations for Specific Patient Populations 🧩! #Transplantsky #LungTxp #Pulmsky

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

What is the landscape 🗺️ for NRP 🤖 in lung transplantation 🫁♻️ occurring from DCD 🫀? Different options (Abdominal / A, Thoraco-Abdominal / TA, or rapid retrieval ⚡️) & different rules across the 🌎 ➡️ lots of heterogeneity ~ Dr. Campo-Cañaeral de la Cruz (Madrid)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

What makes lung procurement 🫁 from a DCD donor 🫀 more challenging than DBD 🧠? Quite a lot! - Donor characteristics - Logistics (resource intensity and "dry runs") - Limited protocols / guidelines - Technique options (?re-intubation, ?EVLP, ?NRP) ~ Dr. Kukreja (UCSF)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

When is the right way to declare a potential donor for DCD actually deceased ☠️? - In most countries, 5 minutes after circulatory arrest ⏰; but longer in others. - Key 🔑 to ensure we are not ❌ interfering with death process through transplant ♻️. ~ Dr. Rubino (Royal Papworth)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

How should we neuro-prognosticate for DCD 🫀 offers? Many options: from the original tool 🛠️ from the University of Wisconsin to the more modern DCD-N score (with more recent external validation!). Consider incorporating neuro-imaging findings 🩻! ~ Dr. Murala (UWSW)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

How can we increase donor 🫁 availability in DCD 🫀? 1) Maximize referrals & prognosticate every potential donor 2) Consider lower P:F (& EVLP!) 3) Palliative therapies indicated with a final transition of care to comfort measures (just as we do for non-donors!) ~ Dr. Neyrinck (Leuven)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

Next up at #ISHLT2025: Exploring DCD donors 🫀 - how we navigate uncertainty, decision making, & challenges. Discover how DCD offers a vital chance 🎲 to many patients waiting for lung transplant 🫁♻️. #Transplantsky #LungTxp #Pulmsky

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

Closing out the session, what happens in cases of donor lungs 🫁♻️ where 1+ centers declined ❌ for DCD unexpected to pass/arrest (UNOS Code 753)? Of potential donors coded unlikely to pass at 1+ centers, 60% donated 1+ organs and 18.2% had lungs implanted into a recipient! ~ Brian Jafari (UTSW)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

Has the CAS score reduced disparities for our lung transplant candidates suffering from pulmonary hypertension 🩸💂? Improved transplant rates compared to the most recent LAS scoring 📈, but signs of worsening waitlist mortality under CAS 📉 ~ Dr. Sonnick (NYU)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

How has CAS impacted donor lung 🫁 allocation with regards to geographic disparities? In CAS, an Overall improved transplant rates 📈 with a reduction in wait-list mortality. That said, things are worse under CAS for centers with lower Donor Lung Availability 📉 ~ Dr. Benvenuto (Columbia)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

How has transitioning to CAS for donor lung 🫁 allocation impacted racial disparities in lung allocation? Racial disparities were reduced in CAS for both transplant rates ♻️ and waitlist mortality ☠️! ~ Stephanie McKay (UCLA)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

If we take a second look at donor lung 🫁♻️ offers initially declined ❌ at the same large-volume center, can we ultimately perform more successful transplants ✅? Of 880 donors initially declined, 34 additional transplants performed ✅📈; no difference in early outcomes! ~ Dr. Gil-Barturen (Toronto)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

We are now seeing some use of TA-NRP 🪢 during procurements - how do donor lungs 🫁♻️ function when it has been used? Reviewing n=15 cases in 🇮🇹, they found 13% PGD3 at 72 hours and 20% mortality thus far. To be seen how things emerge with greater numbers! ~ Dr. Schiavon (Padua)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 30/04/2025

To start our final day of #ISHLT2025, we are ready to explore donor lung 🫁 allocation focusing on the present CAS era 🕰️. Highlights ✨ from the #ISHLT2025 oral session on Donor Lung Allocation with CAS and Beyond! #Transplantsky #LungTxp #Pulmsky

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

Finally, how does CMV 👾 emerge relative to ppx (multi-center, n=785)? 28% with 1+ episode of CMV. No specific breakthrough time-point, though most post-ppx CMV within 3 months - particularly for CMV mismatch or with augmented immunosuppression (steroids or T-cell therapy) ~ Dr. Snyder (Duke)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

How can implementing a PCR screening protocol for mollicutes 🫘🦠 change outcomes after lung transplant 🫁♻️? Screening: Patients not always symptomatic upon detection; shorter hospital LOS since screening implementation ~ Dr. Menon (UCLA)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

What biomarkers or clinical characteristics may associate with post-viral infection CLAD (post-RVI CLAD) 👾❌? Multiple associations 📈: greatest for days post-transplant (> worse), influenza, & severity (symptoms). Signal for plasma DCP1A associating with post-RVI CLAD ~ Dr. Morrell (UWashington)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

If our lung transplant recipients 🫁♻️ do develop RSV resulting in admission, how do things go? Younger age and oral ribavirin each associated with use of mechanical ventilation 💨; no clear risk factors for 90d mortality ~ Dr. Mendoza (Utah) @alemendoza.bsky.social

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

Novel vaccines 💉 targeting F protein for RSV 👾 work in the general population, but how well do they perform in lung transplant recipients 🫁♻️? Vaccination well tolerated, though MMF and age each can negatively impact vaccine response ~ Dr. Hannaford (Brigham)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

Matched cohort study 📖 for lung transplant recipients 🫁♻️ (n=1257) and healthy Ontario adults (n > 10k) regarding NTM disease outcomes in each sub-population. No association for 1-year mortality but long-term mortality was worse in 🫁♻️ (more if a rapidly growing NTM) ~ Dr. Hosseini (Toronto)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

Rounding out the day, with lung transplant 🫁♻️ in particular we have to fight off all sorts of infections 🦠👾🥊. Highlights ✨ from the #ISHLT2025 oral session on Treating #LungTxp Infections: #TxID #Pulmsky #Transplantsky

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

Exercise rehabilitation 🏃‍♂️ may be key 🔑 to good transplant outcomes ♻️ and to fight off frailty 🦽. Possible on ECMO with a VERY careful team 🪢🏃‍♂️. In-bed exercises an option when ambulation is not ~ Dr. Walsh (Prince Charles)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

Many options to target anti-coagulation on ECMO 🩸🪢, especially in the real 🌎. ACT, anti-Xa, aPTT, and older viscoelastic asssays (VEA 🤖) all options, but newer VEA 🤖 a promising tool 🛠️ that may target coagulopathy more specifically in the future! ~ Dr. Vajter (Motol)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

The novel use of ECMO 🪢 without ventilation ❌💨 as a bridge to transplant (BTT) a growing option 🪢🌉♻️. Different circuits based on patient condition (especially pHTN!) including VV 💨, adding RV support 🫁🫀, VA 🫀, and VAV 🫁🫀🫁 - but start with less when you can! ~ Dr. Ganapathi (Ohio State)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

Incredible strides forward in ECMO use 🪢 around the time of lung transplant 🫁♻️: Improving survival and a growing role for bridging from a critically ill state 🤒🌉🥳. Some potential criteria when considering lung transplant when on ECMO. HLA sensitization can occur during ECMO ~ Dr. Dilling (Loyola)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

Between sick patients 🤒 pre-transplant, hemodynamic support intra-OR 🔪, and bridging support after #LungTxp 🌉, ECLS and #ECMO are critical modern tools 🛠️. Very appreciative for perspectives at #ISHLT2025 on how to best plan & manage these systems for our 🫁♻️ pts as follows: #transplantsky #pulmsky

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

Appreciate the moderation by Dr. Demarest (Vanderbilt) & Dr. Magnusson (Sahlgrenska)!

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

How may surgical approach and incision 🔪 affect our patient's experience and outcomes? Perhaps bilateral thoracotomy > clamshell in the short-term 🤺, with similar longer-term survival in the months-years after ♻️ ~ Dr. Aigner (Vienna)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

How has ECMO 🪢 allowed us to make new strides? A growing tool 🛠️ that serves all sorts of 🫁 transplant ♻️ patient scenarios, and provides a way to sometimes skip cardiopulmonary bypass ~ Dr. Gómez-de-Antonio (Puerta de Hierro Majadahonda)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

Many thanks to Dr. Raivio (Helskinki) and Dr. Novysedlák (Charles Uni) for their moderation!

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

When should we be prepping the robot 🤖 for #LungTxp 🫁♻️? The more space the better (ex: COPD or native lungs with air trapping and a larger chest cavity 💨), start simple, and more importantly learn from the experiences of our colleagues! ~ Dr. Jauregui (Vall d'Hebron)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

Building 👷‍♀️ a robotic lung transplant program 🤖🫁♻️: it takes tools 🛠️, careful preparation, and a village (and don't forget the 🤖!) ~ Dr. Chang (NYU)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 29/04/2025

Small ideas 💡 in the OR can lead to giant leaps 🐾 in what we provide for our lung transplant patients 🫁♻️: Excited to learn about operative advances in #LungTxp through this Symposium at #ISHLT2025! #Transplantsky #Transplant

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Sirus Jesudasen, MD @sirusjj.bsky.social · 28/04/2025

Single-center retrospective cohort (n=923) for outcomes based upon BLAD. Worse 5-year survival for BLAD (p=0.002), true for single LTxp in ILD (ILD native disease) but not single LTxp in OLD (Obstructive native disease). Stage of BLAD associated with increasing HR 📈 for mortality ☠️ ~ Dr. Lari (UCLA)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 28/04/2025

UNOS database (2010-2024) for categorized time duration on VV-ECMO pre-transplant: 72.8% cases with <= 30d of ECMO. LAS greater for longer ECMO runs. Disease recovery low w/o txp ♻️ (5% in >180d VV-ECMO group). Overall no difference in 1-year survival for time on VV-ECMO ~ Dr. Crane (Louisville)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 28/04/2025

UNOS/OPTN database (2005-2024) for adult transplants: donor (~55 yo) and recipient (~60s yo) age groupings did not independently predict mortality / in-hospital mortality / PGD3; comorbidities may better guide outcomes compared to donor or recipient age ~ Dr. Walsh (Ohio State)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 28/04/2025

Dynamic hyperpolarized xenon-129 MRI to compare lungs (Healthy 🫁 vs COPD vs Transplanted vs CLAD). Reduced gas exchange and diminished gravitational gradient in both COPD & CLAD, and perhaps some differences in lung transplant compared to healthy 🫁 ~ Mostafa Ismail (UPenn)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 28/04/2025

NORTh STAR trial: Non-ablative oligofractionated radiation therapy (NORT) for early 🫁 cancer prior to 🫁 transplant. n=9 with 7 transplanted (median 58 days). Feasible pre-transplant, with n=1 cancer recurrence (Stage IIIA @10m) ~ Dr. Issard (Hôpital Marie‑Lannelongue) @justiss.bsky.social

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Sirus Jesudasen, MD @sirusjj.bsky.social · 28/04/2025

LTOG-AKI multicenter (5) cohort (n=1622) exploring AKI ⚡️🫘 and mortality ☠️. 12-month mortality and incident CKD increased substantially with increasing AKI stage 📈 - across centers and after confounder adjustment ~ Dr. Shashaty (UPenn)

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Sirus Jesudasen, MD @sirusjj.bsky.social · 28/04/2025

Single center retrospective (n=342) with survival >29d after lung transplant for bronchial stenosis: 34 (9.9%) with stenosis. More 72h PGD3 (also an independent predictor), and Hospital/ICU LoS. Pneumonia 🦠 and GNR/Pseudomonas presence also associated ~ Dr. Coppolino (Brigham)

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