The Value of Individual Instruction in a High-Volume Transplantation Environment

Organ transplantation offers patients a life-changing opportunity. Still, these procedures can come with complications including infections.

Temple University Hospital and its larger health system is one of the more prolific institutions in the nation when it comes to transplantation. Temple’s lung transplant team has performed over 1,500 lung or heart/lung transplants since its founding. Additionally, Temple’s program performed Philadelphia’s first heart transplant in 1984, and since that time they have performed over 2,500 organ transplants. The Temple Health system also includes Fox Chase Cancer Center and a bone marrow transplant program.

Aaron Mishkin, MD, associate professor of medicine, Lewis Katz School of Medicine at Temple University, director of Transplant Diseases, Temple University Hospital, points to the 1 on 1 interaction ID fellows receive and the high volume of transplant care being provided at Temple as ways the program differentiates itself from others.

“Our fellows are very lucky that they have a high-volume tertiary, or some would even say, a quaternary referral center here at Temple. They have the opportunity to rotate with 1 of several dedicated transplant infectious disease attendings on our inpatient transplant infectious disease service,” Mishkin said. “Usually, that's a 1-on-1 type interaction where we have 1 infectious disease fellow, working with 1 infectious disease attending and having that small environment is really nice to get to know the fellows, and so that they feel comfortable learning, asking a lot of those questions. Sometimes, we do have other rotating fellows, like a heart failure cardiology fellow or even a pulmonary fellow with a specialized interest in transplantation.”

Additionally, Temple has dedicated outpatient clinic hours for patients getting preoperative transplant evaluations or postoperative follow-ups.

With the volume and variety of transplants being performed at Temple, Mishkin and his team will see a number of different infections and pathologies.

“Because we have such a large number of lung transplant patients and also the referral base for other complicated pulmonary conditions, we see a lot of very interesting pulmonary infections…We see the typical types of complications and infections associated with organ transplantations that can include resistant and refractory cytomegalovirus as well as Nocardia infections, invasive fungal pneumonias, and I also see a fair number of nontuberculous mycobacterial infections as part of our routine care.”

Temple is extensively involved in research involving transplant-related infections. Mishkin is the incoming chair for the American Society of Transplantation multidrug resistant organism working group, and as such, he will partner with different institutions, and conduct retrospective cohort studies.

“We have a study that will be kicking off shortly looking at trends in resistant and refractory cytomegalovirus, as well as Candida auris and nontuberculous mycobacterial infections. We've also been fortunate enough to partner with some other groups here at Temple to do clinical research and even some early phase 2 and phase 3 drug programs,” he said.

Mishkin’s own path to Temple took a circuitous route. He had done interviews for the fellowship program at both Temple and an institution in New York. He chose the latter due to family-specific needs, but never forgot his interview experience at Temple.

“I remember being struck by how warm, how collegial the division was. And that really is something that, for me, kept such a positive outlook—such a nice feeling for the group here at Temple….throughout my training, I always thought back to what would it have been like if I had ended up at Temple. When a job opportunity became available at Temple, I jumped on it because I had such a positive experience during my interview and had such a favorable impression,” Mishkin said.

In tomorrow's episode, Heather Clauss MD, discusses why Temple has hired many of its former fellows and the importance of mentorship.