Sirus Jesudasen, MD
@sirusjj.bsky.social
Born in England and raised in Texas. Fellow in PCCM at MGH/BIDMC. Aspiring transplant pulmonologist. Opinions my own!
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
#MGH #LungTxp #Transplantsky #Pulmsky #ISHLT
@mgh-id.bsky.social
April 30, 2025 at 10:46 PM
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
#MGH #LungTxp #Transplantsky #Pulmsky #ISHLT
@mgh-id.bsky.social
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)
Different options (Abdominal / A, Thoraco-Abdominal / TA, or rapid retrieval ⚡️) & different rules across the 🌎 ➡️ lots of heterogeneity
~ Dr. Campo-Cañaeral de la Cruz (Madrid)
April 30, 2025 at 4:22 PM
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)
Different options (Abdominal / A, Thoraco-Abdominal / TA, or rapid retrieval ⚡️) & different rules across the 🌎 ➡️ lots of heterogeneity
~ Dr. Campo-Cañaeral de la Cruz (Madrid)
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)
- Donor characteristics
- Logistics (resource intensity and "dry runs")
- Limited protocols / guidelines
- Technique options (?re-intubation, ?EVLP, ?NRP)
~ Dr. Kukreja (UCSF)
April 30, 2025 at 4:06 PM
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)
- Donor characteristics
- Logistics (resource intensity and "dry runs")
- Limited protocols / guidelines
- Technique options (?re-intubation, ?EVLP, ?NRP)
~ Dr. Kukreja (UCSF)
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)
- 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)
April 30, 2025 at 3:50 PM
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)
- 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)
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)
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)
April 30, 2025 at 3:41 PM
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)
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)
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)
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)
April 30, 2025 at 3:28 PM
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)
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)
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)
April 29, 2025 at 6:15 PM
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)
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)
April 29, 2025 at 5:59 PM
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)
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)
April 29, 2025 at 5:47 PM
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)
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)
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)
April 29, 2025 at 5:33 PM
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)
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)
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)
April 29, 2025 at 1:27 PM
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)
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)
April 29, 2025 at 1:06 PM
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)
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)
April 29, 2025 at 12:39 PM
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)
Building 👷♀️ a robotic lung transplant program 🤖🫁♻️: it takes tools 🛠️, careful preparation, and a village (and don't forget the 🤖!) ~ Dr. Chang (NYU)
April 29, 2025 at 12:39 PM
Building 👷♀️ a robotic lung transplant program 🤖🫁♻️: it takes tools 🛠️, careful preparation, and a village (and don't forget the 🤖!) ~ Dr. Chang (NYU)
Can EVLP 🤖📦 give us a chance to immunomodulate donor 🫁 for ♻️?
Multiple vector options - viral 👾 and non-viral 🧪. Intra-tracheal 💨 or iv 💉 gene therapy during EVLP are ground-breaking approaches. CRISPR-Cas modification of donor lungs a promising potential offshoot! ~ Dr. Hartwig (Duke)
Multiple vector options - viral 👾 and non-viral 🧪. Intra-tracheal 💨 or iv 💉 gene therapy during EVLP are ground-breaking approaches. CRISPR-Cas modification of donor lungs a promising potential offshoot! ~ Dr. Hartwig (Duke)
April 28, 2025 at 6:21 PM
Can EVLP 🤖📦 give us a chance to immunomodulate donor 🫁 for ♻️?
Multiple vector options - viral 👾 and non-viral 🧪. Intra-tracheal 💨 or iv 💉 gene therapy during EVLP are ground-breaking approaches. CRISPR-Cas modification of donor lungs a promising potential offshoot! ~ Dr. Hartwig (Duke)
Multiple vector options - viral 👾 and non-viral 🧪. Intra-tracheal 💨 or iv 💉 gene therapy during EVLP are ground-breaking approaches. CRISPR-Cas modification of donor lungs a promising potential offshoot! ~ Dr. Hartwig (Duke)
EVLP 🤖📦 gives us a chance to reduce infection inoculum prior to lung transplant 🫁♻️. A chance to introduce high dose focal antibiotics 💉, or remove endotoxins 🤮. Light therapy ☀️ can reduce burden of non-curable viruses (ex: HBV) in donor 🫁. Potential tools 🛠️ for the future! ~ Dr. Woolley (Brigham)
April 28, 2025 at 6:05 PM
EVLP 🤖📦 gives us a chance to reduce infection inoculum prior to lung transplant 🫁♻️. A chance to introduce high dose focal antibiotics 💉, or remove endotoxins 🤮. Light therapy ☀️ can reduce burden of non-curable viruses (ex: HBV) in donor 🫁. Potential tools 🛠️ for the future! ~ Dr. Woolley (Brigham)
Does EVLP increase ♻️ challenges via edema 💦?
EVLP 🤖📦 involves "perfusion" → can drive more inflammatory response 🔥📈. Watch 🫁 function closely - space for additional biomarkers 🩸 & composite evaluation tools 📋. EVLP management in 💦: modify circuit, perfusate, or ventilation 💨! ~ Dr. Rosso (Milan)
EVLP 🤖📦 involves "perfusion" → can drive more inflammatory response 🔥📈. Watch 🫁 function closely - space for additional biomarkers 🩸 & composite evaluation tools 📋. EVLP management in 💦: modify circuit, perfusate, or ventilation 💨! ~ Dr. Rosso (Milan)
April 28, 2025 at 5:47 PM
Does EVLP increase ♻️ challenges via edema 💦?
EVLP 🤖📦 involves "perfusion" → can drive more inflammatory response 🔥📈. Watch 🫁 function closely - space for additional biomarkers 🩸 & composite evaluation tools 📋. EVLP management in 💦: modify circuit, perfusate, or ventilation 💨! ~ Dr. Rosso (Milan)
EVLP 🤖📦 involves "perfusion" → can drive more inflammatory response 🔥📈. Watch 🫁 function closely - space for additional biomarkers 🩸 & composite evaluation tools 📋. EVLP management in 💦: modify circuit, perfusate, or ventilation 💨! ~ Dr. Rosso (Milan)
Active donor management is key 🔑 to a good outcome: consider using ventilation, bronchoscopy, and diuresis to optimize 🫁 as you plan for ♻️ procurement. 10°C storage can allow prolonged preservation time and day-shifting OR times. EVLP 🤖📦 can further open our options ~ Dr. Coppolino (Brigham)
April 28, 2025 at 5:33 PM
Active donor management is key 🔑 to a good outcome: consider using ventilation, bronchoscopy, and diuresis to optimize 🫁 as you plan for ♻️ procurement. 10°C storage can allow prolonged preservation time and day-shifting OR times. EVLP 🤖📦 can further open our options ~ Dr. Coppolino (Brigham)
The relationship between malnutrition, sarcopenia, and frailty is 🔑 in determining lung transplant candidates 🫁♻️ and modifiable! It’s about more than just BMI ⚖️: trajectory 📉 & energy intake ⚡️ matter. Consider screening tools 🥞📋 and early dietician referral ~ Donna Hickling (Prince Charles)
April 28, 2025 at 1:08 PM
The relationship between malnutrition, sarcopenia, and frailty is 🔑 in determining lung transplant candidates 🫁♻️ and modifiable! It’s about more than just BMI ⚖️: trajectory 📉 & energy intake ⚡️ matter. Consider screening tools 🥞📋 and early dietician referral ~ Donna Hickling (Prince Charles)
Risk for vaccine-preventable infections (VPI 💉) in lung txp 🫁♻️ > other solid organ txp. Bad immunogenicity for 💉 after solid organ ♻️, especially lung / in first 6m after ♻️ / with MMF >2g daily. TTV load 👾 may give more insight! Give 💉 >6w before Txp when you can ~ Dr. Verschuuren (UMC Netherlands)
April 28, 2025 at 12:55 PM
Risk for vaccine-preventable infections (VPI 💉) in lung txp 🫁♻️ > other solid organ txp. Bad immunogenicity for 💉 after solid organ ♻️, especially lung / in first 6m after ♻️ / with MMF >2g daily. TTV load 👾 may give more insight! Give 💉 >6w before Txp when you can ~ Dr. Verschuuren (UMC Netherlands)
Pediatric cancer may drive lung complications earlier in life 🫁😷 - especially after stem cell txp 🧪♻️. GvHD after 🧪♻️ drives a significant need for lung transplant 🫁♻️ in some patients. Limited data but non-inferior outcomes when 🫁♻️ performed! ~ Dr. Greer (Hannover)
April 28, 2025 at 12:41 PM
Pediatric cancer may drive lung complications earlier in life 🫁😷 - especially after stem cell txp 🧪♻️. GvHD after 🧪♻️ drives a significant need for lung transplant 🫁♻️ in some patients. Limited data but non-inferior outcomes when 🫁♻️ performed! ~ Dr. Greer (Hannover)
Psychosocial assessment 📋 crucial for transplant evaluation❓♻️, but may be intimidating to patients. Many tools to systematically evaluate, though none clearly best and caution in using a "score": TERS, PACT, SIPAT, & P-TRI. Different considerations for children 🐥 ~ Dr. Anthony (Hosp Sick Children)
April 28, 2025 at 12:28 PM
Psychosocial assessment 📋 crucial for transplant evaluation❓♻️, but may be intimidating to patients. Many tools to systematically evaluate, though none clearly best and caution in using a "score": TERS, PACT, SIPAT, & P-TRI. Different considerations for children 🐥 ~ Dr. Anthony (Hosp Sick Children)
Much potential for our lung transplant patients 🫁♻️ via technology 🤖 for remote care / monitoring / education. Home monitoring & televisits with benefits such as cost-savings 💰, with similar or improved outcomes! Telerehab more nuanced to implement ~ Dr. Velleca (Cedars)
April 28, 2025 at 12:14 PM
Much potential for our lung transplant patients 🫁♻️ via technology 🤖 for remote care / monitoring / education. Home monitoring & televisits with benefits such as cost-savings 💰, with similar or improved outcomes! Telerehab more nuanced to implement ~ Dr. Velleca (Cedars)
As lung transplant 🫁♻️ may involve a donor-recipient age mismatch, are there worse outcomes in older-aged (≥38y) donor lungs used in pediatric recipients 🐓🐥? Retrospectively, perhaps worse survival on a dichotomous comparison ~ Dr. Casillan (JHU)
April 27, 2025 at 9:42 PM
As lung transplant 🫁♻️ may involve a donor-recipient age mismatch, are there worse outcomes in older-aged (≥38y) donor lungs used in pediatric recipients 🐓🐥? Retrospectively, perhaps worse survival on a dichotomous comparison ~ Dr. Casillan (JHU)
Less lung utilization for transplant 🫁♻️ from donors deceased after drowning (DDD) - are outcomes different with their ultimate use? Retrospective propensity matching (UNOS STAR registry):
Similar outcomes & mortality -> an impetus to keep considering DDD lungs ~ Dr. Balasubramanian (Mayo Clinic)
Similar outcomes & mortality -> an impetus to keep considering DDD lungs ~ Dr. Balasubramanian (Mayo Clinic)
April 27, 2025 at 9:29 PM
Less lung utilization for transplant 🫁♻️ from donors deceased after drowning (DDD) - are outcomes different with their ultimate use? Retrospective propensity matching (UNOS STAR registry):
Similar outcomes & mortality -> an impetus to keep considering DDD lungs ~ Dr. Balasubramanian (Mayo Clinic)
Similar outcomes & mortality -> an impetus to keep considering DDD lungs ~ Dr. Balasubramanian (Mayo Clinic)