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Reposted by Sirus Jesudasen, MD

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

📣 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 · Apr 30

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 · Apr 30

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 · Apr 29

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 · Apr 30

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)

Sirus Jesudasen, MD @sirusjj.bsky.social · Apr 30

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 · Apr 30

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 · Apr 30

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 · Apr 30

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 · Apr 30

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 · Apr 30

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 · Apr 30

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)

Sirus Jesudasen, MD @sirusjj.bsky.social · Apr 30

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 · Apr 30

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 · Apr 30

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 · Apr 30

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 · Apr 30

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 · Apr 30

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)

Sirus Jesudasen, MD @sirusjj.bsky.social · Apr 30

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 · Apr 30

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 · Apr 30

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 · Apr 30

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 · Apr 30

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 · Apr 30

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 · Apr 29

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)