Cardiologist has helped grow UR Medicine heart transplant program, which recently celebrated a record number of transplants — 40. He discusses why there have been more transplants locally
By Chris Motola
Q: UR Medicine recently made news for having performed 40 heart transplants in 2023, 82% more than the previous year. What’s your role in this?
A: I am one of the heart failure cardiologists. My team has many members. The cardiologists help to manage the patient both before and after the transplants. We manage their heart failure and then, after they get their transplant, help make sure they’re taking their medicines correctly, doing their biopsies, keeping an eye on how their progressing. The surgeons do the actual transplant. We also have transplant coordinators who play a very vital role in the post-operative care — seeing the patients in clinics, adjusting their medications. And, of course, we also have financial counselors, dietitian, psychologists and social workers. So it really takes a village, a lot of people working together to make sure patients are getting a benefit from their transplant.
Q: How long have you been with the program?
A: I’ve been with the program since October 2003. Transplants started in 2001 at the University of Rochester. And we’ve been growing the program since then. We did 40 transplants last year, which is a record for us. There are several factors that led to increasing numbers of transplants, not just for our center, but across the country. One of the reasons for that is we can now use hearts from patients with hepatitis C. That’s a big change because in the past we couldn’t use them because that would mean the recipients would get hepatitis C. That comes with a lot of bad side effects like liver disease. Now we have a cure for it, so we’re able to use those hearts.
Q: How common of an issue was that?
A: So one of the tragedies is that the opioid epidemic has produced a lot of donors, many of which had hepatitis C as well. So those are hearts that we’re able to use now. The relationship with donors has also changed. Fifty years ago a lot of donors were from motor vehicle accidents. You don’t see that as much anymore. So now donations are more commonly from donors who died of stroke or an overdose. You may have also heard of something called DCD, donation after circulatory death. That’s also started to be used. That’s where patients don’t necessarily have to have experienced brain death to become donors. So that’s also increased the number of transplants we’re seeing around the country.
Q: What are some examples of DCD?
A: So these are patients who have a critical illness and are about to die. They’re often on a breathing machine. They’re taken off. We wait for them to pass and then we harvest their hearts. Whereas before there was the requirement of brain death that patients had to meet.
Q: What’s the prognosis look like for a heart transplant recipient these days?
A: The biggest challenges are really in the first year. The patients who survive the first year have a longer life expectancy. This is sort of old data because it’s being updated, but the median survival rate was around 11 years. For those who survived the first year, the median life expectancy was 13 years. There are some signals that suggest that’s improving. There are patients who have lived 30 years. We still have ways to go to improve survival. Issues patients may have include rejection and infection, and cancers can be another issue. These can be cancers of different organs or lymphoma. The issue is due to immunosuppression which doesn’t necessarily cause the cancers, but doesn’t help.
Q: What kinds of conditions are generally treated with heart transplants?
A: Patients may have coronary heart disease. They may have had a large myocardial infarction. There may be a familial process. Some families have multiple members who have needed heart transplants. Some patients may have an inflammatory process called myocarditis. There’s a weakness that can develop in the heart related to pregnancy. And, finally, there’s congenital heart disease. So patients who are born with heart disease or defects. And while treatment and survival rates for congenital heart disease is improving, their hearts may fail over time, so they may eventually need a heart transplant.
Q: How did you personally become interested in this subspecialty?
A: I always found the mechanics of the heart interesting. Heart failure has high mortality, but with sudden onset heart failure you can potentially get patients better in a short period of time. I always found that fascinating. And then with heart transplants, the fact that you can remove a heart from one patient and implant it into another patient is really remarkable.
Q: Do you do any work with devices?
A: Yes. I’m actually the director of the LVAD (left ventricular assist device) program here at Rochester. They are great devices for patients who have end-stage heart failure. So what we try to do is find the right treatment for each patient. For some, LVAD might be the best treatment, for some it may be a transplant. For some it could be medicine. But some patients do very, very well on LVADs.
Lifelines
Name: Jeffrey D. Alexis, M.D.
Position: Medical director of the Left Ventricular Assist Device Program at University of Rochester School of Medicine and Dentistry
Hometown: Brooklyn
Education: Harvard Medical School
Affiliations: University of Rochester Medical Center
Organizations: American College of Cardiology, Heart Failure Society of America, International Society of Heart and Lung Transplantation, American Heart Association, Association of Black Cardiologists
Family: Wife (Christine), three children
Hobbies: Watching sports, bicycling, reading