0:00

Hi everyone, welcome

0:03

to February, a

0:05

culture podcast about

0:08

all things infectious

0:11

disease. We use council questions

0:13

to dive into ID clinical reasoning, diagnostics,

0:15

and antimicrobial management. I'm Sarah Dong, your

0:17

host to Edna Medpete's ID doc. I

0:20

have three guests with me today. I'm

0:22

super excited to introduce. I'll start with

0:24

Dr. Chelsea Goresline. Chelsea is a transplant

0:27

ID physician and assistant professor at

0:29

the University of Kansas Medical Center

0:31

in Kansas City. She completed her

0:33

internal medicine residency general and

0:36

transplant ID fellowship training at

0:38

Vanderbilt University Medical Center in

0:40

Nashville. Next we have Dr. Courtney

0:42

Harris who is a transplant ID physician

0:44

and assistant professor at the

0:47

Medical University of South Carolina

0:49

in Charleston, which is my alumni.

0:51

She completed her residency and chief

0:53

residency at Mayo Clinic in Minnesota,

0:55

followed by general and transplant ID

0:57

fellowship at the combined program of

1:00

Brigham and Women's Hospital in Boston.

1:02

Hey, this is Courtney Harris. And our third

1:04

member today is Dr. Rebecca Kumar. She

1:06

is a transplant ID physician and

1:08

assistant professor at Medstar Georgetown University

1:11

Hospital in the Division of

1:13

Infectious Diseases in Tropical Medicine.

1:15

She completed her internal medicine

1:18

residency at Medstar Georgetown

1:20

University Hospital in Washington DC,

1:22

followed by fellowship and infectious

1:24

diseases at Northwestern University in Chicago.

1:26

Hey, this is Rebecca's. Welcome. So

1:28

as everyone's favorite cultured podcast, we

1:31

like. to kick off the episode

1:33

by asking you to share a

1:35

little piece of culture, something that

1:37

you've enjoyed recently. I

1:39

can go first. If I wasn't in

1:41

medicine, I would be in the arts,

1:43

so I couldn't pick one thing,

1:45

but I picked two. So my

1:47

favorite band right now is Fontaine's

1:49

DC. They are from Ireland. They're

1:51

like a proper rock band. I'm

1:53

obsessed with the lead singer's voice.

1:56

It's so great. The lyrics are

1:58

poetry. I love the music. I

2:00

got to see them last year

2:02

and I'm going to see them

2:04

again next month and I'm just

2:06

really really excited for it. And

2:08

then the second thing is totally

2:10

obsessed with the TV show Severance

2:13

on Apple TV right now, cannot

2:15

get enough of it. Psychological thriller,

2:17

a little bit of workplace comedy,

2:19

a little bit of sci-fi, just

2:21

incredible. front to back my husband

2:24

and I cannot stop reading theories

2:26

about it. It's just such a

2:28

great time. Severance is so good

2:30

and I haven't had anyone to

2:32

talk to you about it and it's

2:34

even driving me crazy. It's amazing.

2:37

So good. So I can

2:39

go next. My sister introduced me

2:41

to fantasy books as well as

2:43

Chelsea on this call. And so

2:45

I am currently starting the seventh

2:48

book of the Throne of Glass

2:50

series, which has been a slog

2:52

and it is amazing. It's like

2:54

a fantasy novel series following like

2:57

a teenage assassin trying to take

2:59

down a corrupt kingdom with a

3:01

tyrannical ruler. Like it's wonderful. So

3:03

I'm very excited to like finish

3:05

the series out strong. Great series.

3:08

The piece of culture that I'm

3:10

really enjoying right now is White

3:12

Lotus. At the time of recording,

3:14

I think the third episode has

3:16

just aired. I'm also obsessed with

3:19

like reading fan theories online and

3:21

trying to figure out what the

3:23

deal with Rick is. So that's

3:25

really what's been occupying my time

3:27

off service. Oh, this is so

3:29

great. Now everyone can see why

3:32

I invited you guys. We

3:34

have such shared cultural interest.

3:36

Well, today is a fun episode.

3:38

As an also young or junior

3:40

transplant ID doc, I've been excited

3:42

to meet you guys and have

3:45

been following along with the transplant

3:47

ID early career network and efforts

3:49

from that. And so before we talk

3:51

through the goal of the episode

3:54

today and some of our console

3:56

questions, I was hoping actually you

3:58

could tell people about. the network

4:00

in case they aren't familiar. Yeah, so I

4:02

founded the Transplant ID Early Care Network during

4:05

the pandemic. It was really lonely time, I

4:07

think, for all of us. Really is a

4:09

way to do virtual networking for trainees who

4:11

were interested in Transplant ID. And then a

4:14

couple years ago, when I transitioned to faculty

4:16

at KUMC, I recruited help from Courtney and

4:18

Rebecca, and really we wanted to expand the

4:20

scope of what this was able to offer,

4:23

not just for trainees, but also for early

4:25

career faculty as well. And with Courtney's help,

4:27

we really introduced a lot of new medical

4:29

education. activities, which a lot of this has

4:32

been based on social media. And then we've

4:34

subsequently formed a partnership with the Transplant ID

4:36

journal and we've published numerous papers now, mostly

4:39

with practical pragmatic tips for trainees and early

4:41

career faculty that are really based off of

4:43

these activities. And now we are starting to

4:45

transition into doing more in-person live events at

4:48

conferences. So be on the lookout for those

4:50

in 2025. Love it. And we're going to

4:52

put links to those papers. So a large...

4:54

portion of our job in transplant ID is

4:57

giving advice on risk of infection related to

4:59

organ transplantation. And one part of that is

5:01

something that most people call donor call. So

5:03

when a surgeon or a transplant coordinator or

5:06

someone from the transplant team calls and asks

5:08

about the suitability of an organ for transplant,

5:10

I want to highlight one of those articles

5:13

that you mentioned that has come out through

5:15

the early career network and we're going to

5:17

walk through some scenarios today to give examples

5:19

of the thought process. Maybe before we give

5:22

a clinical example, you can talk a little

5:24

bit about donor call in general for those

5:26

who maybe aren't used to participating. Yeah, so

5:28

this is when a surgeon or a transplant

5:31

coordinator will call and ask about the suitability

5:33

of an organ for a transplant. So when

5:35

I was a transplant fellow, I would occasionally

5:37

field these calls and then sometimes would discuss

5:40

them when my attending would receive them, but

5:42

I never received formal training on how to

5:44

approach these. And actually my colleague Rachel Sigler,

5:47

she worked pretty hard to develop a mock

5:49

donor call educational activity while she was a

5:51

fellow and we loved this idea. We really

5:53

wanted to collaborate with her and build on

5:56

what she started so that others could actually

5:58

use this as a template if they're also

6:00

trying to teach this in a structured setting.

6:02

So what we ended up doing from the

6:05

early career network is we created a series

6:07

then of five donor call examples and posted

6:09

one example like donor call scenario to social

6:11

media in the morning. At that time we

6:14

were using X or Twitter and then over

6:16

the course of the day let the transplant

6:18

community kind of comment on what they would

6:21

do and then in evening posted the resolution

6:23

to the case with some teaching points. So

6:25

we saw a lot of engagement with this

6:27

approach and many followers commented daily like and

6:30

it was nice to see kind of that

6:32

wide variety approaches and how people approaching so

6:34

differently, things that are standard, you know, dosing

6:36

is different, how long you treat is different.

6:39

So it was really nice to kind of

6:41

see, you know, some of the really great

6:43

leaders in our field have different approaches to

6:45

donor calls, which I think really shows the

6:48

variability, which is why it's always good to

6:50

discuss these with our trainees. Yeah, and something

6:52

that we felt really strongly about when we

6:55

wrote the paper was that we really wanted

6:57

to develop a framework to help trainees and

6:59

early career faculty think about how to prepare

7:01

for these coals. And so this would include

7:04

what are the appropriate follow-up questions to ask

7:06

and what are the important non-infectious considerations that

7:08

you should be thinking about when you accept

7:10

a donor. I think key among them is

7:13

just this idea that there's a risk to

7:15

the recipients if we... keep them on the

7:17

wait list for longer, waiting for that perfect,

7:19

absolutely perfect organ. So I think weighing that

7:22

risk of a possible donor-derived infection with the

7:24

risk associated with mortality on the wait list

7:26

is really what's a key driving principle in

7:29

donor call. I think one of the other

7:31

things about donor calls too is it's very

7:33

easy to get flustered when you're on the

7:35

phone like answering questions. So it's good to

7:38

have a really stepwise approach. every time you

7:40

approach it. So if you check out our

7:42

paper, table one, there's really good steps to

7:44

how to consider these offers in a stepwise

7:47

manner. So you ask donor specific questions like

7:49

their medical, social history, any recent micro, their

7:51

hospital course for the donor, then recipient specific

7:53

questions like. you know, what kind of immunity

7:56

do they have? What vaccines have they received?

7:58

What kind of underlying medical conditions do they

8:00

have? And then, you know, what is the

8:03

transmissibility? So in, for example, a donor has

8:05

a urinary tract infection, is the transplanted organ,

8:07

the kidneys or the heart? Because that matters.

8:09

And then has the donor been treated? So

8:12

what's the treatment of the donor? And then

8:14

can you treat the recipient? Who's on 10?

8:16

mechanical support and has a high mortality in

8:18

the coming days and has a low likelihood

8:21

of receiving another offer, then you know maybe

8:23

there is a risk but maybe that risk

8:25

is much lower than them having a fatality

8:27

on the waitlist waiting for another offer. So

8:30

I think that's kind of our stepwise way

8:32

to approach them. Perfect. All right. Well, we

8:34

have the pager or the cell phone, whatever

8:37

people are using. I'm going to go through

8:39

a couple of donor calls today. So I'll

8:41

start with call number one. You receive an

8:43

offer for a liver transplant from a donor

8:46

in Georgia. The donor is a 35-year-old previously

8:48

healthy woman who is hospitalized after injuries related

8:50

to trauma from a car accident. Encephalopathy was

8:52

noted during the hospitalization and she was subsequently

8:55

declared brain dead. There were some varying reports

8:57

from family on the preceding symptoms before the...

8:59

happened, so maybe fever, maybe she'd been more

9:01

tired and fatigued recently. There was no fever

9:04

documented during the hospitalization and the labs on

9:06

admission were not suggestive of infection. So what

9:08

questions do you have? I think one of

9:11

the hard things about donor call is just

9:13

the fact that in, in essence, it is

9:15

essentially a game of telephone where you get

9:17

the information from somebody else who's gotten it

9:20

secondhand from a family member who may or

9:22

may not know everything about going on with

9:24

the donor. So one of the key things

9:26

that I'm thinking about when I hear the

9:29

coordinator call and mention that there's encephalopathy is

9:31

what's the underlying cause of this altered mental

9:33

status. And any time there's an unknown ideology,

9:35

I think one of the big things that

9:38

we almost always recommend is a lumbar puncture.

9:40

And really... in a patient who's presenting with

9:42

fever and altered mental status, you want that

9:45

lumber puncture before you accept the organ because

9:47

we really don't know if there's possibly some

9:49

sort of viral meningitis or something else that

9:51

could be easily transmitted from the donor to

9:54

the recipient. And so, and I didn't quite

9:56

catch, sorry, what time of year did this

9:58

happen? It's summertime. It's summertime. So I think

10:00

one of the big things that we'd be

10:03

worried about would be something like West Nile.

10:05

And then the other things that you need

10:07

to consider when you're assessing the donor is

10:09

where's the donor from? So are there any

10:12

outbreaks ongoing in Georgia at this time at

10:14

this particular time of year? One of the

10:16

things that we talk about in our paper

10:19

is related to the fusarium meningitis outbreak that

10:21

happened in 2023 related to patients going to...

10:23

Mexico to get plastic surgery. And another thing

10:25

to consider at the time of reporting is

10:28

this big measles outbreak that's going on in

10:30

the US. So all of these things are

10:32

considerations when we're assessing the suitability of this

10:34

donor. So that's sort of the things that

10:37

I'm thinking about right now. So I would

10:39

ask for this lumbar puncture, I would make

10:41

sure because it's summertime that we check for

10:43

West Nile and get the cell count everything

10:46

else with it, and based on the results,

10:48

we would make our decision. Because of the

10:50

time of year, if the lumbar puncture, if

10:52

it cannot be done, I think that this

10:55

would be an organ that I would recommend

10:57

declining because we don't know why the patient's

10:59

encephalopathy is quite worrisome when you get a

11:02

donor call. All right, okay, perfect. And everyone

11:04

should know that these are sort of cases

11:06

created for education, so they're not fully fleshed

11:08

out. We kind of just want to go

11:11

through the thought process of getting donor calls.

11:13

So, all right, your pager goes off again,

11:15

and you call them back, and they say,

11:17

we've received an offer for a kidney transplant

11:20

donor, who we just found out has an

11:22

anaerbacter cluecate and the urine. The sensitivities that

11:24

we have so far are Cepheme, MIC-32, which

11:26

is resistant. Our peptezo is resistant. The mere

11:29

penem is susceptible. The MIC is less than

11:31

0.5. Vertipenem was intermediate with an MIC of

11:33

1, and Cephthazdeam abubactam is sensitive with an

11:36

MIC of 4. The donor has decreasing pressure

11:38

requirements and improving white butso count and creatinine

11:40

and all vitals are within normal limits. They

11:42

also have information that the blood cultures from

11:45

two days ago are negative to date and

11:47

the patient is now on day two of

11:49

mere penam for the isolate. So they're just

11:51

wondering what do you think? Are you worried

11:54

about accepting? Yeah, so this is a pretty

11:56

common scenario that we run into with our

11:58

kidney transplant recipients because patients can have bacteria

12:00

in the urine. It's not necessarily a reason

12:03

we should decline an organ, but there are

12:05

a few things that we would want to

12:07

make sure that the donor has been set

12:10

up with and then appropriately treat the recipient

12:12

as well. So for the most part, we

12:14

would want patients or donors to have received

12:16

at least 24 to 48 hours of appropriate

12:19

antibiotic therapy prior to procurement. And then looking

12:21

at the recipient, we would want to treat

12:23

them with it. you know, seven or so

12:25

days of targeted therapy, I think this can

12:28

also vary depending on what institution you work

12:30

at and how long you will treat the

12:32

patient. And also things like whether there was

12:34

bacteria present can impact that duration as well.

12:37

But I think this case is nice too

12:39

because it also highlights that you have to

12:41

be familiar with resistance patterns, not just the

12:44

principles of how to treat a recipient. So

12:46

for instance in this case, the enter a

12:48

factor is mere penemps. susceptible, but it's erudipenum

12:50

intermediate. So in some cases, that might give

12:53

you pause, but then if you know that

12:55

an arabacter species can actually have a low-level

12:57

erudipenum mono resistance, and this doesn't necessarily preclude

12:59

the use of myropenum, that makes this case

13:02

a little bit more approachable and easier to

13:04

say, okay, we're gonna go ahead and give

13:06

the recipient myropenum to treat them. And then

13:08

we'll call out that the IDSA has published

13:11

some updates to their MDR gram-negative treatment recommendations

13:13

in the past couple years. So those can

13:15

always be a great resource when you're looking

13:18

at tough cases like this. And then I

13:20

know at least at my institution, we also

13:22

have developed our own internal guidelines on how

13:24

to approach these organisms. So those can be

13:27

helpful as well. Excellent. All right. Well, we're

13:29

getting another. Another call, you get the message

13:31

that our patient who received a lung transplant

13:33

last week is doing great, but we were

13:36

just informed that the donor had a positive

13:38

strongeloidies antibody. So do we need to do

13:40

anything about this? So this case is a

13:42

little bit different since the patient has already

13:45

received their transplant, but donor-derived infection with strongeloidies

13:47

typically occurs within 90 days after transplant when

13:49

immunosuppression is the highest. So here we're going

13:52

to worry about hyperinfection syndrome. which can impact

13:54

the lungs and the GI tract and can

13:56

be devastating to recipients. The rapid larval migration

13:58

and risk for ARDS, GI bleeding, can be

14:01

severe and the mortality rates up to 35%.

14:03

So despite this, we can safely accept organs

14:05

from donors who have positive strongy exposures as

14:07

effective treatment exists. It really isn't gonna interact

14:10

with a lot of the other medications. So

14:12

if a donor or recipient is positive for

14:14

strontiolities, we can just go ahead and treat.

14:16

Treatment, there's a little bit of a debate

14:19

about how many doses you need to give.

14:21

You can either give two doses over two

14:23

days and whether that's enough or whether secondary

14:26

dosing in two weeks and repeating those two

14:28

doses is necessary. But regardless, it's recommended to

14:30

give the recipient ivermectin, which again is well

14:32

tolerated with minimal drug interactions. And it's notable

14:35

too that a positive Stranji IGG in a

14:37

pre-transplant recipient doesn't give them any protective immunity.

14:39

So even if they were treated pre-transplant for

14:41

their positive Stranji, if their donor is positive,

14:44

I would go ahead and retreat them. And

14:46

while Stranji is kind of prevalent in Africa,

14:48

Asia, Latin America is kind of the teaching.

14:50

There are pockets of MDINicity in the US,

14:53

especially in the eastern US. So where I

14:55

practice at MUUSC in South Carolina. And we've

14:57

actually, like, looked, there was a prior team

15:00

that looked at this. Ruth Edekunle from MOSC

15:02

here, her and our prior team studied universal

15:04

screening in our heart transplants over a shorter

15:06

period of time and found that our heart

15:09

transplants had near 11% strangy positive. and a

15:11

good percentage of our donors have not had

15:13

travel outside the United States. So, you know,

15:15

we're now actually studying over a five-year period

15:18

of universal screening and heart transplant, whether or

15:20

not the rate is really this high, but

15:22

I suspect that it is. And so because

15:24

of this, we've started screening all of our

15:27

solid organ transplants for astrology. So I think

15:29

having an increasing vigilance for this infection transmission

15:31

in the US is really important. I love

15:34

hearing what other other centers are doing and

15:36

comparing and contrasting. That's awesome. Okay, well, we

15:38

have another call. Our fourth case here, the

15:40

lung transplant coordinator calls to let you know

15:43

that the OPO just notified us that the

15:45

donor we want to take has, quote, fungus

15:47

and the sputum. The donor is a 45-year-old

15:49

incarcerated man from California. He has a hemoglobin

15:52

A1C of 14, but no smoking history. Cause

15:54

of death was suicide. So can we take

15:56

this organ? The procurement team is pressurant. and

15:58

the recipient has just arrived at the hospital.

16:01

And for additional information on the recipient, it

16:03

is a 24-year-old patient with cystic fibrosis. I

16:05

think this case is super fun. It's like

16:08

doing a consult just with a donor call.

16:10

So this case really presses you to know

16:12

what the differential for a fungus on a

16:14

sputum culture is and really what other information.

16:17

need to obtain from

16:19

the OPO to help

16:21

you decide if you

16:23

should accept this organ

16:26

or not. And so

16:28

differential for fungus is

16:30

going to be broad,

16:32

right? So there's endemic

16:35

mycosis, there's molds, there's

16:37

yeast, but we would

16:39

only want to accept

16:42

this organ if we

16:44

know what the fungus

16:46

is and there's a

16:48

good treatment option for

16:51

it. So in this

16:53

case, we asked the

16:55

OPO, hey, can you

16:57

identify what the fungus

17:00

is? And they were

17:02

not able to identify

17:04

it. And so this

17:06

organ would be declined

17:09

because we really just

17:11

don't know what we're

17:13

dealing with. The setup

17:16

for this case is

17:18

that the donor had

17:20

coxidioides with risk factors

17:22

being uncontrolled diabetes, residents

17:25

in California. And I

17:27

think this is important

17:29

because coxidioides, we do

17:31

not have universal recommendations

17:34

for donor screening. And

17:36

so as someone who

17:38

is getting these donor

17:40

calls, you really have

17:43

to be mindful of

17:45

where is the donor

17:47

located? What are their

17:50

radiographic findings, which is

17:52

available in the US

17:54

through UNET? And also

17:56

other things like ventilator

17:59

settings or respiratory status

18:01

of the donor, which

18:03

that OPO can provide

18:05

to you if you

18:08

ask. And the reason

18:10

that we care about

18:12

this so much is

18:14

because donor -derived infections

18:17

with coxidioides can also

18:19

be very devastating, disseminated

18:21

disease. And so if

18:24

we knew that the

18:26

donor had coxidioides, we

18:28

really wouldn't want to

18:30

be taking organs from

18:33

them unless we know

18:35

that the infection is

18:37

under control or hopefully

18:39

cleared. But if we

18:42

also knew that the

18:44

donor had a prior

18:46

history of it, we

18:48

could actually also give

18:51

preemptive azole therapy to

18:53

the recipients to then

18:55

prevent that risk of

18:58

transmission and harm to

19:00

the recipient. And then

19:02

also if we do

19:04

detect a case of

19:07

donor -derived infection, then we

19:09

would want all of

19:11

the other recipients to

19:13

be treated for coxidioides

19:16

as well, just because

19:18

this fungus is quite

19:20

transmissible and associated with

19:22

high mortality. And I

19:25

realize I may have

19:27

said OPO earlier and

19:29

never defined it otherwise.

19:31

So just to explain,

19:34

OPO stands for Organ

19:36

Procurement Organization. And so

19:38

the last thing I

19:41

want to do is

19:43

for us to have

19:45

a transplant ID episode

19:47

using acronyms and not

19:50

explaining them, especially because

19:52

we're trying to shed

19:54

some light on the

19:56

behind -the -scene aspects of

19:59

transplant. So these are just a few

20:01

example calls and it's a really big

20:03

topic, but I hope at least people

20:05

have a starting framework on approaching donor

20:07

call. And I wanted to see if

20:09

you guys have any other take-home points

20:11

that you'd like to share, whether that's

20:13

about taking donor call or donor-derived infections.

20:15

Even if after you take dinner

20:17

call, everything seems fine that you

20:20

should keep an eye out for

20:22

possible donor-derived infections after transplant, this

20:24

can happen. You know, the classic

20:26

teaching is anywhere from... like in that

20:28

first 30 days after transplant, but

20:30

we have seen issues with donor-derived

20:32

infections months after. We recently had

20:35

a case of Bartella. Quintana endocarditis

20:37

in our recipient who was completely

20:39

asymptomatic but got it from his

20:41

donor. And the only reason we

20:43

found out was because the other

20:45

recipient was ill and the opio

20:47

was notified and then we were

20:49

able to screen our donor. And

20:52

then I think another key takeaway

20:54

would be that it's really important

20:56

for anyone you're seeing. that's infected

20:58

in the early, or even like mid to

21:00

late post transplant period, kind of the first

21:02

few months to go on donor net. You

21:04

know, you should have access to donor net

21:06

at your institution if you're a transplant ID

21:08

provider, or if you're taking care of transplant

21:10

patients to be able to look in the

21:12

chart, be able to review the imaging, the

21:14

labs, and all the findings from the donor.

21:16

And you can see a lot of the

21:18

social history there to kind of think about

21:20

what things the donor may have put your

21:22

recipient at risk for. Yeah, agree. I think

21:25

any time we get a consult on

21:27

someone who's within the first few months

21:29

of transplant, there's something unusual going on,

21:31

I think the first step should really

21:34

be going back to the donor and

21:36

reviewing that in more detail to make

21:38

sure nothing was missed because yeah, there

21:40

are some later onset donor-derived infections that

21:43

can still be pretty bad. And

21:45

interestingly, you know, where I practice

21:47

in the Midwest, there was a few

21:49

years ago a cluster of erychia donor

21:51

derived infection, which was pretty wicked and

21:53

wild. And so I think being aware

21:56

of what region you're practicing in and

21:58

what hyperspecific regional things might. be at

22:00

risk is also important too. Yeah and

22:02

the other thing to keep in mind is

22:04

also for any of these donor calls

22:06

it's okay to talk to other people

22:09

like within your division or even outside

22:11

of your division you're always welcome to

22:13

reach out to myself Courtney or Chelsea

22:15

or Sarah if you have questions because

22:17

you know we take these calls and

22:19

we're happy to help. And there's a

22:22

lot of nuance and so we have

22:24

a group thread. that we are always

22:26

asking each other at other institutions about

22:28

our cases like Rebecca and Chelsea and

22:30

many of our other friends. Alan Koff

22:32

has helped us with lots of these

22:34

donor calls, but it's nice to have

22:36

a group and a big network to

22:38

ask, which makes me feel better about

22:40

my decisions. So thank you guys, and I

22:42

love you. And I think that's a really nice

22:44

way for us to sort of start the

22:46

conclusions, which is reaching out to your colleagues,

22:48

because these questions are not easy, and

22:51

there's often a lot of nuance in

22:53

center specific things that it helps to

22:55

bounce off of someone else. But yeah,

22:57

so maybe the last thing I'll close

23:00

with is just asking you guys for

23:02

those people who are interested in transplant

23:04

ID or maybe hearing more from the early

23:06

career network. Is there anything that you

23:08

would direct people to to get started

23:10

or get involved? Yeah, so if

23:12

you want to check out more interesting

23:15

content from our group, the Transatlantic Early

23:17

Career Network, you can find us active

23:19

now on Blue Sky. And we also

23:21

have several other papers, as Sarah mentioned

23:23

earlier, that you may find of interest.

23:25

Most of these are targeted trainees and

23:28

young faculty to kind of figure out

23:30

how to help you navigate the field

23:32

of transplantity. So this includes like securing

23:34

your first transplant ID job and helping

23:36

negotiate for that position, how to perform

23:39

a transplant ID pre-transplan evaluation. how to

23:41

write and collaborate on a transplant ID

23:43

protocol, which is a lot of what

23:45

we do in our non-clinical time with

23:47

the transplant teams, how to understand the

23:49

nuances of transplant ID trading, whether this

23:51

is tracks or formal years. There's formal

23:53

third year fellowships that you could do

23:55

in transplantity or you can do a

23:57

track within your program. So there's a

23:59

lot of different. between those, how to

24:01

become your best transplant ID

24:04

steward, aka being an MVP

24:06

like Chelsea. And then also how to

24:08

incorporate and be involved in social media

24:10

and transplant ID interacting with our group

24:12

and others. We have a paper on

24:14

that as well. So we really aim

24:16

to create this content to make the

24:18

field of transplant ID accessible to all

24:20

because while it's been around a while

24:22

it's been around a while, it's evolving,

24:24

it's growing. And I think there are

24:27

a lot of us who are in

24:29

our early careers who are so interested

24:31

in helping develop the field. And I

24:33

think reaching out to our group if

24:35

you want to be involved. people involved

24:37

and create great events and content for

24:39

you all going forward. Thanks again

24:41

to Rebecca, Courtney, and Chelsea for

24:44

joining Febral today. Don't forget to check

24:46

out the website Febral Podcast.com

24:48

where you'll find the console notes

24:50

which are written supplements to the

24:52

episodes with links to references including

24:54

the papers that we've mentioned. Our

24:57

library of ID Infographics and a

24:59

link to our merch store. Febral

25:01

is produced with support from the

25:03

infectious diseases society of America, IDSA.

25:05

Please reach out if you have

25:07

any suggestions for future shows or want to

25:09

be more involved with February. Thanks for listening.

25:12

Stay safe and I'll see you next time.