Tuesday, September 8, 2020, from 2:00 PM ET to 3:00 PM ET • Hosted jointly by the TCC & TxPharm Communities of Practice

"Effects of mTOR inhibitor–related proteinuria on progression of cardiac allograft vasculopathy and outcomes among heart transplant recipients."
(Am J Transplant. 2020 Jun 18. doi: 10.1111/ajt.16155. Online ahead of print.)

In this article:
[The authors] previously described the use of sirolimus (SRL) as primary immunosuppression following heart transplantation (HT). The advantages of this approach include attenuation of cardiac allograft vasculopathy (CAV), improvement in glomerular filtration rate (GFR), and reduced malignancy. However, in some patients SRL may cause significant proteinuria. [The authors] sought to investigate the prognostic value of proteinuria after conversion to SRL. CAV progression and adverse clinical events were studied... [Results] indicate that proteinuria is a marker of baseline renal dysfunction, and that HT recipients who develop proteinuria after conversion to SRL have less attenuation of CAV progression and higher mortality risk.

Speaker:
Richard Daly, MD • Mayo Clinic College of Medicine, Rochester, MN

Moderator:
Douglas Jennings, PharmD, FACC, FAHA, FHFSA • Long Island University, Brooklyn, NY

AST/AJT Journal Clubs are free for both members and non-members. Pre-registration is required.

Speakers:
Kelly Schlendorf, MD, MHS • Assistant Professor of Medicine, Vanderbilt Heart and Vascular Institute, Nashville, TN
Marcelo Cypel MD, MSc, FACS, FRCSC • Associate Professor of Surgery, University of Toronto (UHN), Toronto, ON

Moderator:
Daniel Kaul, MD • Professor of Internal Medicine, University of Michigan, Ann Arbor, MI

After participating in this webinar, the attendee will be able to:

1. Understand the evolution of and current state of knowledge using HCV donors (NAT+/-) for heart transplantation
2. Understand the evolution of and current state of knowledge using HCV donors (NAT+/-) for lung transplantation
3. Describe future directions for utilization of HCV donors (NAT+/-) for thoracic organ transplantation

AST would like to thank the Infectious Disease (IDCOP), Kidney Pancreas (KPCOP), and Liver and Intestinal (LICOP) Communities of Practice for each recommending "HCV" as a topic for the 2019-2020 T3 series. The concept was expanded into two HCV NAT+/- sessions, one covering "HCV NAT+/- in Abdominal Organ Transplantation" and another covering "HCV NAT+/- in Thoracic Organ Transplantation." 

Tuesday, February 18, 2020 from 2:00 PM ET to 3:00 PM ET • Hosted by the Thoracic and Critical Care Community of Practice (TCC COP)

"An early investigation of outcomes with the new 2018 donor heart allocation system in the United States."
(J Heart Lung Transplant. 2020 Jan;39(1):1-4. doi: 10.1016/j.healun.2019.11.002. Epub 2019 Nov 20.)

In this article:
Since 2005, the United States donor heart allocation system assigned patients awaiting transplantation with measurably distinct outcomes into a single high urgency priority status. In this old system, patients in cardiogenic shock as well as ambulatory stable patients with complications of a left ventricular assist device (LVAD) were allocated to a similar status of highest urgency and competed equally for donor organs. This led to overcrowding of the list within this high urgency status category with consequent prolongation of waiting times and concerns of inequity in allocation across several geographic regions. In response to this issue, and to provide greater opportunity for candidates disadvantaged by the allocation system (such as those with congenital heart disease or restrictive cardiomyopathy syndromes), the donor heart allocation system was redesigned in the United States on October 18, 2018. [In the new system,] patients in cardiogenic shock and supported with therapy such as extracorporeal membrane oxygenation (ECMO) or other non-dischargeable biventricular mechanical circulatory support were assigned to the highest urgency status, whereas those with lesser degrees of support were distributed into a descending rank order of priority in urgency.... [The authors now] report on early outcomes of this transition to the new 2018 allocation system within the United States.

Speakers:
Mandeep Mehra, MD • Brigham and Women's Hospital, Boston, MA

Moderator:
Shelley Hall, MD, FACC, FHFSA, FAST • Baylor University Medical Center, Dallas, TX

AST/AJT Journal Clubs are free to both AST and non-AST members, but registration is required. Please feel free to share the registration link with colleagues and fellows who may be interested in the discussion.