Scholars@Duke
Madeleine Rose Heldman

Madeleine Rose Heldman

Assistant Professor of Medicine
Medicine, Infectious Diseases
madeleine.heldman@duke.edu
315 Trent Drive, Hanes House Room 170, Durham, NC 27710

Selected Publications

HOPE in every breath and heartbeat: Understanding transplant eligibility, access barriers, and clinical outcomes in thoracic transplantation in persons with HIV.

Journal Article JHLT Open · May 2025 BACKGROUND: Persons with human immunodeficiency virus (PWH) are living longer, leading to increased end-organ disease from chronic illness. Organ transplantation improves survival in patients with end-organ disease yet remains a constrained resource due to ... Full text Link to item Cite

Outcomes of lung transplantation from SARS-CoV-2 positive donors during the Omicron wave.

Journal Article JHLT Open · May 2025 Early observations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) transmission via lung transplantation have led to frequent discard of lungs from donors with positive SARS-CoV-2 tests. We compared survival between lung transplant recipien ... Full text Link to item Cite

Plasma microbial cell-free DNA Metagenomic Sequencing for Diagnosis of Invasive Fungal Diseases Among High Risk Outpatient and Inpatient Immunocompromised Hosts.

Journal Article Clin Infect Dis · April 3, 2025 BACKGROUND: New and minimally-invasive tools to aid the diagnosis of invasive fungal diseases (IFD) are urgently needed as the immunocompromised population at highest risk increases. Advancements in molecular technology have rendered new diagnostics more r ... Full text Link to item Cite

Limited utility of Epstein-Barr virus (EBV) surveillance for predicting post-transplant lymphoproliferative disorders in adult EBV seropositive lung transplant recipients.

Journal Article J Clin Virol · February 2025 BACKGROUND: EBV DNAemia surveillance, with reduction of immunosuppression at certain viral load (VL) thresholds, is a common practice for mitigating progression from EBV DNAemia to post-transplant lymphoproliferative disorder (PTLD) in lung transplant reci ... Full text Link to item Cite

Epidemiology of Infections in Lung Transplant Recipients Treated With Belatacept.

Journal Article Transpl Infect Dis · 2025 BACKGROUND: Belatacept is a costimulatory blocker that can be used to prevent and treat rejection in lung transplant recipients (LuTRs). The epidemiology of infections in belatacept-treated LuTRs has not been systematically evaluated. METHODS: We performed ... Full text Link to item Cite

Contemporary Cytomegalovirus (CMV) Infections in Low-Risk CMV Seronegative Recipients of Solid Organ Transplants From CMV Seronegative Donors (D-/R-): Time to Reexamine Donor CMV Serostatus.

Journal Article Clin Transplant · January 2025 BACKGROUND: Early posttransplant cytomegalovirus (CMV) infections in CMV seronegative solid organ transplant recipients (SOTR) with CMV seronegative donors (D-/R-) are often attributed transfusion-transmitted CMV. The prevalence of false-negative donor CMV ... Full text Link to item Cite

Current and future strategies for the prevention and treatment of cytomegalovirus infections in transplantation.

Journal Article Clin Infect Dis · November 4, 2024 Successful prevention and treatment of cytomegalovirus (CMV) infection remains a central focus of clinical care in solid organ and allogeneic hematopoietic cell transplantation. Over the past 5 years, pivotal clinical trials have created new paradigms in C ... Full text Link to item Cite

Kaposi Sarcoma of the Cardiac Allograft in a Heart Transplant Recipient

Journal Article Annals of Internal Medicine Clinical Cases · November 1, 2024 Kaposi sarcoma (KS) is a neoplasm derived from human herpesvirus-8 (HHV-8)–infected cells that often presents with mucocutaneous, gastrointestinal, or pulmonary lesions. We report an unusual case of KS involving a cardiac allograft in a heart transplant re ... Full text Cite

Clinical Utility of Plasma Microbial Cell-Free DNA Sequencing Among Immunocompromised Patients With Pneumonia.

Journal Article Open Forum Infect Dis · August 2024 BACKGROUND: Plasma microbial cell-free DNA (mcfDNA) sequencing can establish the etiology of multiple infectious syndromes by identifying microbial DNA in plasma. However, data are needed to define the clinical scenarios where this tool offers the highest ... Full text Link to item Cite

Real-World Experience With Maribavir for Treatment of Cytomegalovirus Infection in High-Risk Solid Organ Transplant Recipients.

Journal Article Open Forum Infect Dis · July 2024 We evaluated use of maribavir (MBV) for treatment of 15 episodes of refractory/resistant cytomegalovirus infection in 13 solid organ transplant recipients. Treatment failure due to treatment-emergent MBV resistance or early virological recurrence after MBV ... Full text Link to item Cite

A practical guide to real-world implementation of pre-emptive therapy for Cytomegalovirus disease prevention in high-risk seronegative liver transplant recipients with seropositive donors.

Journal Article Transpl Infect Dis · June 2024 The Comparison of Antiviral Preventative Strategies In Liver Transplant (CAPSIL) study showed pre-emptive therapy (PET) to be superior to antiviral prophylaxis for Cytomegalovirus (CMV) disease prevention in high-risk CMV seronegative liver transplant reci ... Full text Link to item Cite

Persistent fever after coronavirus disease 2019 in liver/kidney transplant recipient.

Journal Article Transpl Infect Dis · June 2024 In this case, a 64-year-old male with a history of simultaneous orthotopic liver transplant and cadaveric renal transplant presented five years prior presented with persistent fevers two days after a positive SARS-CoV-2 nasal PCR. A CT scan of the chest on ... Full text Link to item Cite

Serial Quantitation of Plasma Microbial Cell-Free DNA Before and After Diagnosis of Pulmonary Invasive Mold Infections After Hematopoietic Cell Transplant.

Journal Article J Infect Dis · February 14, 2024 BACKGROUND: Plasma microbial cell-free DNA sequencing (mcfDNA-Seq) is a noninvasive test for microbial diagnosis of invasive mold infection (IMI). The utility of mcfDNA-Seq for predicting IMI onset and the clinical implications of mcfDNA concentrations are ... Full text Link to item Cite

Updates in Cytomegalovirus Prevention and Treatment in Solid Organ Transplantation.

Journal Article Infect Dis Clin North Am · September 2023 The authors summarize recent updates in the prevention and management of cytomegalovirus (CMV) in solid organ transplant (SOT) recipients with a focus on CMV seronegative recipients of organs from seropositive donors (CMV D+/R-) who are at highest risk of ... Full text Link to item Cite

Real-world effectiveness of preemptive therapy (PET) for cytomegalovirus (CMV) disease prevention in CMV high-risk donor seropositive/recipient seronegative (D+R-) liver transplant recipients (LTxR).

Journal Article Transpl Infect Dis · April 2023 BACKGROUND: Despite superiority of preemptive therapy (PET) compared to universal prophylaxis for prevention of cytomegalovirus (CMV) disease in the CAPSIL randomized trial among CMV D+R- liver transplant recipients (LTxRs), real-world effectiveness may be ... Full text Link to item Cite

Combined assessment of Epstein-Barr virus viral capsid antigen and Epstein-Barr virus nuclear antigen-1 serology for post-transplant lymphoproliferative disorder risk stratification in adult solid organ transplant recipients.

Journal Article Transpl Infect Dis · December 2022 BACKGROUND: Epstein-Barr virus (EBV) seronegative solid organ transplant recipients (SOTRs) are at increased risk for post-transplant lymphoproliferative disorder (PTLD). Assays for EBV serostatus assess antibody to both EBV viral capsid antigen (VCA) and ... Full text Link to item Cite

Assessing and restoring adaptive immunity to HSV, VZV, and HHV-6 in solid organ and hematopoietic cell transplant recipients.

Journal Article Clin Microbiol Infect · October 2022 BACKGROUND: Herpes simplex virus (HSV) 1 and 2, varicella zoster virus (VZV), and human herpesvirus 6 (HHV-6) cause severe infections in immunocompromised hosts. Interventions to optimize virus-specific adaptive immunity may have advantages over antivirals ... Full text Link to item Cite

Delayed mortality among solid organ transplant recipients hospitalized for COVID-19.

Journal Article Clin Infect Dis · February 25, 2022 INTRODUCTION: Most studies of solid organ transplant (SOT) recipients with COVID-19 focus on outcomes within one month of illness onset. Delayed mortality in SOT recipients hospitalized for COVID-19 has not been fully examined. METHODS: We used data from a ... Full text Open Access Link to item Cite

Changing trends in mortality among solid organ transplant recipients hospitalized for COVID-19 during the course of the pandemic.

Journal Article Am J Transplant · January 2022 Mortality among patients hospitalized for COVID-19 has declined over the course of the pandemic. Mortality trends specifically in solid organ transplant recipients (SOTR) are unknown. Using data from a multicenter registry of SOTR hospitalized for COVID-19 ... Full text Open Access Link to item Cite

Epstein-Barr virus posttransplant lymphoproliferative disorder: update on management and outcomes.

Journal Article Curr Opin Infect Dis · December 1, 2021 PURPOSE OF REVIEW: Management of Epstein-Barr virus posttransplant lymphoproliferative disorder (EBV PTLD) is complex, involving risk stratification, prevention and/or preemptive measures involving monitoring EBV DNAemia and balancing treatment options, us ... Full text Link to item Cite

Multiple liver lesions in a lung transplant recipient

Journal Article American Journal of Transplantation · November 1, 2021 Full text Cite

CMV and HSV Pneumonia After Immunosuppressive Agents for Treatment of Cytokine Release Syndrome Due to Chimeric Antigen Receptor-modified T (CAR-T)-Cell Immunotherapy.

Journal Article J Immunother · November 2021 Pneumonia due to cytomegalovirus and herpes simplex virus-1 caused substantial morbidity after hematopoietic cell transplantation before the institution of preventative approaches. End-organ disease from herpesviruses is poorly described after chimeric ant ... Full text Link to item Cite

Association of Inherited Chromosomally Integrated Human Herpesvirus 6 with Neurologic Symptoms and Management after Allogeneic Hematopoietic Cell Transplantation.

Journal Article Transplant Cell Ther · September 2021 Reactivation of human herpesvirus 6 (HHV-6) after allogeneic hematopoietic cell transplantation (HCT) is associated with neurologic complications, but the impact of donor and/or recipient inherited chromosomally integrated HHV-6 (iciHHV-6) on post-HCT cent ... Full text Link to item Cite

COVID-19 in hospitalized lung and non-lung solid organ transplant recipients: A comparative analysis from a multicenter study.

Journal Article Am J Transplant · August 2021 Lung transplant recipients (LTR) with coronavirus disease 2019 (COVID-19) may have higher mortality than non-lung solid organ transplant recipients (SOTR), but direct comparisons are limited. Risk factors for mortality specifically in LTR have not been exp ... Full text Link to item Cite

Immunosuppression in solid organ transplant recipients with Covid-19: More data, but still complicated.

Journal Article Transpl Infect Dis · August 2021 "Outcomes of COVID-19 in solid organ transplant (SOT) recipients: a matched cohort study" by Pereira et al found similar 28 day mortality among hospitalized SOT recipients and comorbidity matched controls, shedding light on the relationship between immunos ... Full text Open Access Link to item Cite

Treatment of multidrug-resistant gram-negative bacilli after solid organ transplant: Outcomes and complications.

Journal Article Transpl Infect Dis · February 2021 BACKGROUND: Infections caused by multidrug-resistant gram-negative bacilli (GNB) cause significant morbidity and mortality in solid organ transplant (SOT) recipients. METHODS: We retrospectively collected data from all SOT recipients at a single center fro ... Full text Link to item Cite

Pre- and post-transplant bacterial infections in liver transplant recipients.

Journal Article Transpl Infect Dis · October 2019 BACKGROUND: Early (<1 month) bacterial infection after liver transplant is a major cause of morbidity and mortality among liver transplant recipients. We investigated the impact of pre-transplant bacterial infection on early post-transplant bacterial infec ... Full text Link to item Cite

Bacterial infections

Chapter · January 8, 2018 Bacterial infections are the most significant infectious source of morbidity and mortality in cirrhotic patients. Bacteria infections result is both acute decompensation in chronic liver disease and mortality in patients with decompensated cirrhosis. Spont ... Full text Cite

Use of Six-Minute Walk Test to Measure Functional Capacity After Liver Transplantation.

Journal Article Phys Ther · September 2016 BACKGROUND: Functional impairment is common in people with chronic liver disease (CLD), and improvement is expected following liver transplantation (LT). The Six-Minute Walk Test (6MWT) is an objective measure of functional performance. OBJECTIVE: The aims ... Full text Link to item Cite

National survey of adult transplant hepatologists on the pediatric-to-adult care transition after liver transplantation.

Journal Article Liver Transpl · February 2015 Adult transplant hepatologists face challenges in providing care to young adults who received liver transplants during childhood. Because prior studies have focused mainly on pediatric providers, understanding these issues from the perspective of the adult ... Full text Link to item Cite

Absolute quantitation of endogenous proteins with precision and accuracy using a capillary Western system.

Journal Article Anal Biochem · November 1, 2013 Precise and accurate quantification of protein expression levels in a complex biological setting is challenging. Here, we describe a method for absolute quantitation of endogenous proteins in cell lysates using an automated capillary immunoassay system, th ... Full text Link to item Cite

Capillary isoelectric-focusing immunoassays to study dynamic oncoprotein phosphorylation and drug response to targeted therapies in non-small cell lung cancer.

Journal Article Mol Cancer Ther · November 2013 Developing proteomic biomarkers is valuable for evaluating therapeutic effects of drugs and generating better treatment strategies. However, conventional protein analysis is often challenging due to inadequate sample size of clinical specimens, lack of ass ... Full text Link to item Cite

Biological profile of the less lipophilic and synthetically more accessible bryostatin 7 closely resembles that of bryostatin 1.

Journal Article ACS Chem Biol · April 19, 2013 The bryostatins are a group of 20 macrolides isolated by Pettit and co-workers from the marine organism Bugula neritina. Bryostatin 1, the flagship member of the family, has been the subject of intense chemical and biological investigations due to its rema ... Full text Link to item Cite

Abstract 5521: Application of an automated capillary isoelectric-focusing immunoassay to study dynamic oncoprotein phosphorylation in non-small cell lung cancer and for evaluating drug response to targeted therapies.

Conference Cancer Research · April 15, 2013 AbstractMolecular targeted therapy is widely used to treat non-small cell lung cancer (NSCLC) and genomic analysis has been commonly used to identify patients who may benefit from targeted therapies. Neverth ... Full text Cite

A fully automated capillary western system for absolute quantitation of endogenous PKC proteins: An approach to correlate protein quantity with function.

Conference Journal of Clinical Oncology · October 20, 2012 31 Background: The human prostate cell line LNCaP and the human myelocytic leukemia cell line U937 differ dramatically in their responses to the two protein kinase C (PKC) targeted ligands phorbol 12-myristate 13-acetate (PMA) an ... Full text Cite

A nanofluidic immunoassay system to develop proteomic responsive biomarkers in non-small cell lung cancer.

Conference Journal of Clinical Oncology · October 20, 2012 27 Background: Molecular targeted therapy is widely used to treat non-small cell lung cancer (NSCLC). However, errors in predicting response to targeted therapies are 20-30%, based on sequencing or FISH, and patient specimen are ... Full text Cite

Biological responses to TGF-β in the mammary epithelium show a complex dependency on Smad3 gene dosage with important implications for tumor progression.

Journal Article Mol Cancer Res · October 2012 TGF-β plays a dual role in epithelial carcinogenesis with the potential to either suppress or promote tumor progression. We found that levels of Smad3 mRNA, a critical mediator of TGF-β signaling, are reduced by approximately 60% in human breast cancer. We ... Full text Link to item Cite