PSHP 2026 Residency Conference

Purpose: To evaluate the real-world patterns and outcomes of amiodarone therapy in lung transplant recipients who develop new-onset post-operative atrial arrhythmias (POAA) after surgery. 
Methods: This is a retrospective, single-center chart review of 46 lung transplant recipients at Temple University Hospital from September 1, 2021 to August 31, 2025, who were discharged on amiodarone due to new-onset atrial arrhythmia. The cumulative amiodarone dose received and the total number of days of amiodarone use were calculated using information from the electronic medical record. Secondary endpoints included incidence of amiodarone induced pulmonary toxicity; discontinuation of amiodarone due to pulmonary toxicity, thyroid dysfunction, or hepatotoxicity; incidence of readmissions due to arrhythmias; and risk factors associated with atrial arrhythmias after lung transplant. Data collection included baseline characteristics, rate control therapy, anticoagulation, and information regarding electrophysiology (EP) follow-up. Descriptive statistics were utilized to analyze the data. 
Results: Amiodarone therapy was used for longer than six months in 10/46 patients. The average cumulative amiodarone dose was 29,228 mg, 95% CI [26,069, 32,387] and average duration of amiodarone was 100 days, 95% CI [86, 115]. There were no reports of amiodarone-induced pulmonary toxicity. Amiodarone was discontinued for one patient that was found to have elevated liver enzymes attributed to amiodarone. Two patients had elevated TSH levels attributed to amiodarone, but the medication was not discontinued. Twenty-five patients followed up with EP at an average of 88 days after discharge. Risk factors for the patient population evaluated included 88% over the age of 60 years, 78% male, and 56% with a history of coronary artery disease (CAD). 
Conclusion: Lung transplant recipients face increased risk of POAA. Amiodarone was generally well tolerated in this cohort, with short treatment durations and no cases of pulmonary toxicity. Limited adverse effects occurred, including one discontinuation for hepatotoxicity and two cases of thyroid dysfunction. Consideration should be given to defining optimal treatment duration, adverse effect monitoring, EP follow-up, and assessment of risk factors. 

Purpose: Evaluate the impact of low-dose fluconazole (LDF) versus clotrimazole (CTZ) on tacrolimus (TAC) trough levels, dose adjustments needed to maintain serum levels, and prophylaxis (ppx) of oropharyngeal candidiasis (OC).
Methods: This was a single-center, IRB-exempt, retrospective chart review at Jefferson Einstein Philadelphia Hospital including adult kidney transplant recipients (KTRs) transplanted between 4/1/23 - 4/30/25, who received TAC and OC ppx. They were excluded if they had a multiorgan transplant, history of gastric bypass, concomitant CYP inhibitors/inducers, or positive yeast donor cultures. KTRs received rabbit antithymocyte globulin, mycophenolate, and steroids per protocol. KTRs were stratified based on antifungal received. TAC trough levels were monitored throughout with a difference of >1.5 ng/mL determined to be clinically significant. The primary endpoint was the change in the TAC trough level 7 days after discontinuation of OC ppx. Secondary endpoints included the change in the TAC trough level 14 days after discontinuation, incidence of OC at 30 and 60 days, and the impact of sex, race, and early steroid withdrawal on TAC levels.
Results: Of 139 KTRs, 112 were included in the final analysis, with 71 in the CTZ group and 41 in the LDF group. The mean difference in TAC level change between CTZ and LDF was 1.83 ng/mL 7 days after discontinuation of OC ppx [95% CI (0.4, 3.3); p = 0.0123]. The mean TAC level change on day 7 in the CTZ group was -2.52 ng/mL [95% CI (-3.5, -1.6); p<0.001] and -0.69 ng/mL in the LDF group [95% CI (-1.5, -0.2); p = 0.166]. The mean dose of TAC increased from 6.6 mg to 9.4 mg in CTZ KTRs 14 days after discontinuation while LDF KTRs remained stable. There was a larger TAC level decrease seen in the steroid-free KTRs only in the CTZ group. There were no differences between sex and race. No patients developed OC.
Conclusion: Among KTRs that received OC ppx, there was a larger reduction in tacrolimus trough levels following discontinuation of clotrimazole than with low-dose fluconazole. Both antifungals were effective in preventing OC. This data suggests that low-dose fluconazole is preferred to clotrimazole to minimize drug-drug interactions among KTRs started on tacrolimus for immunosuppression with no difference in OC ppx efficacy.

Purpose: This study aimed to determine the incidence of solid organ transplant recipients receiving insulin therapy following taper to maintenance corticosteroid dose, which is around the 6-month mark at our institution


Methods: This single-center retrospective study included adult heart or lung transplant recipients transplanted between September 1, 2023, and September 1, 2024, with at least 6 months of follow-up. Patients with a history of prior or multi-organ solid organ transplantation, or those who did not survive 6 months post-transplant, were excluded. The primary outcome was the proportion of patients remaining on insulin therapy at 6 months post-transplant. Secondary outcomes included use of non-insulin antihyperglycemic agents, median corticosteroid dose at 6 months, incidence of treated acute rejection episodes, occurrence of hyperglycemia-related infections, and HbA1c trends during the follow-up period. Descriptive statistics were used to analyze the baseline characteristics, primary, and secondary outcomes. Time-to-event analysis was performed to evaluate the association between patient subgroups and time to insulin discontinuation.


Results: During the study period, 102 patients were screened and 91 met inclusion criteria (36 heart, 55 lung). Overall, 21% had prior diabetes and 47% had endocrinology follow-up. At 2 weeks post-transplant, 80% of patients required insulin with a median prednisone dose of 30 mg. By 6 months, this declined to 41.8% with a median dose of 10 mg. Time-to-event analysis demonstrated that prior diabetes (log-rank p=0.009) and endocrinology follow-up (p<0.001) were associated with delayed insulin discontinuation. Steroid discontinuation, rejection treatment, and transplant type were not significantly associated with time to insulin discontinuation.


Conclusion: A substantial proportion of patients remained on insulin therapy at the time of steroid weaning, although the incidence declined across successive follow-up periods over the first post-transplant year. This trend likely reflects the progressive reduction in corticosteroid dosing over time following transplantation.


IRB Approval: IRB #859535