Selected Podcast

The Heart Transplant Program at the UK Transplant Center

The heart transplant program at UK Transplant Center offers comprehensive care for transplant patients. Andrew Kolodziej, MD  shares what conditions lead to transplant, as well as indications for referral to a transplant center. He discusses what the process looks like when a patient gets to UK's transplant center and what makes the heart transplantation program at UK stand apart from others in the state as well as the nation.
The Heart Transplant Program at the UK Transplant Center
Featured Speaker:
Andrew Kolodziej, MD
Dr. Andrew R. Kolodziej obtained his medical degree from Ross University School of Medicine in Miramar, Fla. He then completed a residency in internal medicine through Yale University School of Medicine at Norwalk Hospital in Norwalk, Conn., where he also served as a chief resident. He completed cardiovascular training, which included both general cardiology and a fellowship in advanced heart failure and transplant, here at the University of Kentucky. 

Learn more about Andrew Kolodziej, MD

Melanie Cole, MS (Host): For carefully selected patients, heart transplantation offers markedly improved survival and quality of life. The heart transplant program at UK Transplant Center offers comprehensive care for transplant patients. My guest today is Dr. Andrew Kolodziej. He’s the medical director of the heart transplantation at UK Health. Dr. Kolodziej, thank you for joining us today. Tell us a little bit about heart transplant, how common it is, and how many are performed generally on a yearly basis.

Andrew Kolodziej MD (Guest): So our program started around 25 years ago. On and off we’ve transplanted on an average of around 10 patients up until 2015 where we did about just over 40 patients, 43 patients or so for three years. Then that tapered off a little bit because of new allocation system where we’ve done 29 last year. We’re still on the road, probably reaching the same amount this year having done around 19 so far.

Host: So UK’s history with heart transplants is significant now at this point. Tell us a little bit about some of the indications for referral to a transplant center.

Dr. Kolodziej:    Absolutely. So there is a good mnemonic to keep in mind. ‘I need help’. So I standing for anybody who is on inotropes such as dobutamine, [inaudible]. At which point, they're obviously already deemed to be advanced heart failure patient who should be referred to advanced heart failure clinic and a transplant center that can offer both transplant options as well as left ventricular assist device. Or any other temporary mechanical circulatory support to get them to transplant. The second would be NYHA class, or N in I need help where patients are persistently in NYHA class 304 despite appropriate guideline directed medical therapy. Followed by E for end organ dysfunction, such as patients who are believed to have not only congested liver or cardiorenal syndrome who should probably be evaluated for inotropic support or temporary mechanical circulatory support to prove that those truly are reversable end organ injuries.

The second E in ‘I need help’ would be for ejection fraction, which is ejection fraction of less than 25%. This is all based on guidelines. D for defibrillator shocks. Meaning that the patient despite appropriate guideline directed medical therapy and perhaps antiarrhythmic therapy has recurrent ventricular tachycardia or any other ventricular arrhythmias resulting in appropriate defibrillator shocks. That’s certainly an indication for transplant.

In ‘I need help’ mnemonic, H stands for hospitalizations meaning that at least there’s one to two heart failure directed hospitalizations in the last 12 months is a potential advanced heart failure patient who should be probably evaluated by a transplant center. E in the help portion stands for edema or escalating diuretics. Usually thought to be around 160 milligrams of Lasix perhaps twice a day. Or, more specifically, if patients are loop diuretic resistant and certainly need rehospitalizations for IV therapy. L stands for low blood pressure where that is a limiting factor for guideline directed medical therapy. Most certainly advanced heart failure patients and need to be evaluated at a transplant center. Finally P for prognostic medication. But that would possibly go along with low blood pressure where you cannot up titrate guideline directed medical therapy such as ACE inhibitors or arbs or beta blockers. That would require a patient to be at least evaluated by a transplant center.

Host: What a great pneumonic. Thank you for explaining that so well. Dr. Kolodziej, what does the process look like when a patient does get referred to UK’s transplant center? Tell us about your team and your multidisciplinary approach. Who’s involved?

Dr. Kolodziej:    So often I get a personal phone call or one of our nurse coordinators gets ahold of the referral. We strive to bring the patient in to at least get to know them, meet them in clinic within two weeks of the referral. This is followed by potentially either admission from the clinic depending on their decompensated state and decision to go through evaluation. We usually try and either [inaudible] or have the initial Red Heart catheterization performed to determine how dysfunctional the myocardium is. Anybody with an index of less than two usually we will reevaluate for potentially placing on inotropic support, usually [inaudible] because that allows us to up titrate other oral [inaudible] reducing agents. Then ultimately once we go through the evaluation which normally takes around two to three days including CAT scans, blood work that look for autoimmune components that looks for clotting deficiencies and such as well as infectious components such as hepatitis and HIV.

Then we meet with our transplant committee. That includes all of our transplant surgeons, all of our heart failure and transplant cardiologists as well as physical therapists who, by that time, should have had a chance to meet the patient. As well as dieticians, social workers, our nurse practitioners, and our financial advisors. We take their suggestions to make a decision of whether they are a good transplant candidate or an LVAD candidate.

Host: So then tell us based on what you just described, and if they are a transplant candidate as opposed to an LVAD candidate. Tell us a little bit about the estimated post-transplant survival? How is it used? What does their prognosis look like? What have been your outcomes?

Dr. Kolodziej:    So since cyclosporin has come to light in the 80’s, we’ve come a long way in not only patient but as well as organ survival.  Now the immediate survival across the country is around 13 years. The expected patient survival in one year is close to 90%, and we exceed that number. It is pretty similar for organ survival in one year as well, which we also exceed based on the national expected.

Host: Now, as we wrap up, tell other providers what makes the heart transplant program at UK stand apart from others in the state as well as the nation. While you're doing that, Dr. Kolodziej, please tell us about the future of cardiac transplantation and some of the issues that you see on the horizon. Shortage of donor organs that might have fueled a search for alternative therapies for a failing heart. Where do you see it going in the next 10 years or so?

Dr. Kolodziej:    So because of the new allocation system, donor availability has become more scare because now we tend to share those organs with a lot more states around us. Fortunately, our program and our surgeons are aggressive where we do employ temporary mechanical circulatory support such as not only balloon pumps, but surgically implanted percutaneous left ventricular assist devices such as Impella 5.0. As well as we recently have been employing more of a bedside cardiopulmonary bypass technology such as extracorporeal membrane oxygenation, or ECMO, which places the patient at a higher level of listing. We are ELSO, which is the governing body for ECMO. We are ELSO center of excellence, and both of our surgeons are critical care cardiologists as well as our advanced heart failure cardiologist are well versed in that technology and taking care of these patients.

In addition to our extensive not only mechanical circulatory support team as well as pre and post-transplant team. I believe we are up to par with the largest centers around the country. Certainly our numbers prove it. We are doing around 30 transplants per year and are both organ and patient survival well exceeds that of expected national expected.

Host: So just a final thought, Dr. Kolodziej, what would you like other providers to know about referral to the UK heart transplantation center?

Dr. Kolodziej:    Yes. I can't stress enough that if you think the patient may potentially be an advanced heart failure patient, send them. Send them early. Even though we may think they're early, at least we have them met the rest of the team, talked about them. If they do decompensate quickly, we are ready to act.

Host: Thank you so much Dr. Kolodziej for joining us today, and what a fascinating topic. Thank you for providing other providers information on referral and what they can expect from the UK transplant center. That wraps up another episode of UK HealthCast with the University of Kentucky Healthcare. To find a UK Healthcare specialist of service, a physician can refer a patient to UK Healthcare with UK MDs at 1-800-888-5533. Head on over to our website at for more information on heart transplantation at UK. Until next time, I'm Melanie Cole.