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Becker’s Healthcare Podcast
Translating Research Into Real-World Impact for Patients with Complex Lung Disease
00:10:58
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- [00:00]
A
Hi everyone, this is Lucas Voss with Becker's Healthcare. Thanks so much for tuning in to the Becker's Healthcare podcast series. It's great to have you. I'm excited to be joined by Dr. Gerant Kreiner. He's the Chair and Professor of Thoracic medicine and Surgery at the Lewis Katz School of Medicine at Temple University and Director of the Temple Lung center, also Temple Health. An internationally recognized leader in pulmonary and critical care medicine, Dr. Cranor has spent decades advancing research and clinical innovation in COPD and emphysema. He has led numerous multicenter clinical trials including including several landmark studies like StatCOB and Liberate. And he has been instrumental in developing novel therapies such as lung volume reduction technologies and endobronchial valves. With deep expertise spanning academic leadership, NIH advisory roles and industry collaboration, Dr. Kreiner brings a unique perspective on translating research into real world impact for patients with complex lung disease. And that's exactly what we're going to be talking about today. Dr. Kreiner, thanks so much for being here. Welcome.
- [00:57]
B
Oh, thank you very much, Lucas.
- [00:59]
A
It's great to have you. Apart from your obvious recognitions here, you also are a record holder. Temple Health broken all time record in 2025 with 179 lung transplants and your program has led the nation in volume for several years now. What's been your strategy behind that growth and how have you built the infrastructure to support it?
- [01:23]
B
Well, thanks for the question and the compliment. A program like this that's really based on multidisciplinary care requires many individuals from many different disciplines working together seamlessly to try to help patients with advanced lung disease who have exhausted all options for medical or non transplant interventions to improve their clinical condition. We have a large volume of patients with advanced lung disease that come to us for novel treatments because they've really capitalized and maxed out on medical treatments less than that. So that results in a large number of patients with copd, emphysema, interstitial lung diseases who otherwise are still declining from their disease despite even these novel therapies. One of the things that's important with transplant, it's the epitome of a team sport that everyone works tirelessly and integrated closely together to try to maximize the patient's physical and medical condition, such that transplant, which is a significant intervention, both the transplant procedure itself and the post transplant care can occur with a level of success that the patient and the providers want to achieve. So it's really a large group of individuals working together As a team, you
- [02:48]
A
just spoke to the infrastructure that it takes, right, the teamwork that it takes to make this happen, which is so crucial. How does then data factor into that infrastructure, making that all happen? And how are you using it to then also drive operational decisions at scale?
- [03:08]
B
Well, there's a lot that needs to be done in terms of hospital administration, have the space and the OR timing and the personnel and the or anesthesia, the ICUs to take care of patients. We at any one time, we have about 40 patients transplanted in the hospital. The way transplant works is that there might be a day or two or three where there's no transplants done, and then there's a day when there's two or three transplants that needs to be done. So you need to be able to handle the volume, handle the surge. There's patients that need urgent procedures in the emergency room or in the hospital itself, and we need to be able to perform those procedures around the clock as the patient needs seven days a week. So we have a large team of physicians in pulmonary and critical care, surgical staff, anesthesia extender staff, with physicians, with nurse practitioners who are key in a rehab team that works seven days a week, pharmacists, psychologists, et cetera, that really can make this form thrust intervention. Plus, when patients come to us, we like to basically evaluate them expeditiously. They're sick patients overall, so we like to come in, bring them in and have an evaluation that can be done urgently. Depending on if patients are sick within three to five days, who are hospitalized, or patients that are outpatients, it's usually about two to three weeks. Then bring those patients to a multidisciplinary committee within about two to three weeks, have a decision for the patient going forward where we think their care plan is, and they get the patient listed based on the listing protocols and the algorithms for CAS score. In the US half of our patients are transplanted within two months and half of them are longer based on score or other factors such as blood group and antibody history.
- [05:00]
A
Now, you mentioned again the teamwork that it takes to make this all happen, and you've outlined just who is all involved with this. And certainly, again, that teamwork piece is so important in success for health systems looking to grow their transplant programs. Apart from that teamwork, what is the most underestimated organizational challenge and what role do partnerships play in overcoming some of those challenges?
- [05:23]
B
Well, you have to really work with hospital administration so that they understand what the infrastructure is. You have to support not only only your primary group that you represent, but you need to be able to really support everyone. Because to make a program like this work, I mentioned a lot of different departments, but there's people in the lab, pathology, the people that are transportation, people that clean the rooms, patients that are the pulmonary function or CT techs. You need to try to think of them as human beings that you need to support them so they feel engaged and really want to work with the program. So that's one thing. The second thing is transplant patients just don't appear because you're a center that does transplants. You have to have that advanced lung program that's there to serve as a pipeline for patients. But also if patients come in and they're not a candidate for transplant, you have to have some therapy that you can provide that patient to help them with their disease course and be really encompassing in the care. You just can't be a transplant program. It's that or nothing. You have to be able to offer other solutions for patients that perhaps transplant's not right for them or too much for them, or they can't really focus on what needs to be done. So you have to really be encompassing of what the patient care needs. The whole goal of a transplant program is to take care of patients who are sick and then have an unmet clinical need and be able to provide a solution for them.
- [06:58]
A
Now, as that patient acuity rises and again donor criteria expanding as well, how do you balance program growth than with quality and outcomes? And again, what are some of those investments that are most critical to sustaining this high volume without compromising excellence?
- [07:18]
B
Yeah, so volume isn't the factor that drives a program. It's quality outcomes, not for the short term, but for the long term. That's number one. There is some expertise value for volume because it's not like you do it occasionally, you do it a lot and everybody is involved with doing a lot. So there's a certain amount of experience, expertise, you treat enough patients, you see nuances that occur in an individual patient and you learn from that as a group to improve it the next time you see it overall. So you're right in a sense that the numbers don't matter. It's the quality that matters. When you get up to a scale of patients who are coming to be evaluated for transplant, or patients that receive transplant and then the post transplant care, it's a staircase ladder that develops and you have to be able to take care of that 12, 15, 1800 surviving transplant patients that you need to really have structured programs that maximize your outcome in Lung transplant patients. One of the major nemesis for them is chronic lung allograft dysfunction. And having an integrated program to monitor these patients in a long, long term to be able to detect early manifestations of that disorder, adjust the treatment that the patient's receiving, to try to abrogate that complication and to do clinical research and to try to find some novel therapies that would improve that outcome or things that we need to do as a program. And that's what we do.
- [08:54]
A
You just mentioned the research part, and I want to come back to your work at Temple and the work that Temple does in general. Looking ahead, what role does academic medicine play in driving innovation here? Right. Refining care models, enabling responsible program growth. And again, what advice would you offer leaders trying to scale this?
- [09:15]
B
Well, to run a program like this, and there's similar other programs in pulmonary medicine that you could think of that are similar to this, like ICU care, for example. By itself, it's really trying to put the patient first. I think one of the things I learned in my fellowship and in my training, that a good doctor treats a disease, a great doctor treats the patient. And that's the thing in general, to think about how you can do all aspects of care for a patient that's going to improve their outcome overall. So I think it's building a program that's based on evidence based medicine, contribute to developing that evidence to support the therapies that are done for patients, and try to do that in the safest and humane manner, because that's what we need to be as physicians. We need to put the patient first, we need to be compassionate, we need to be smart enough about the disease, and we need to be able to treat all patients in a compassionate and thorough medical manner.
- [10:12]
A
Dr. Kreiner, so great to have you. Want to turn the floor over to you. Anything else you would like to share that we haven't covered? Anything else you'd like to mention?
- [10:19]
B
No, I think that having more programs engaged in patients with advanced lung disease will improve those patients. And I think the future is try to do our best to study and research these diseases so we can change the trajectory so that patients won't need as much transplant in the future because they're not developing the severe ramifications of a really dire pulmonary condition.
- [10:42]
A
Dr. Kreine, it's so great to have you. Thanks for being here.
- [10:45]
B
Okay, thank you, Lucas.
- [10:46]
A
And we also want to thank our podcast sponsor, Temple Health. You can tune into more podcasts from Becker's Healthcare by visiting our podcast page@beckershospitalreview.com.