About

Joshua M. Diamond, MD, MSCE, is an Adjunct Associate Professor of Medicine in the Pulmonary, Allergy, and Critical Care Department at the University of Pennsylvania. He serves as the Associate Medical Director of the Penn Lung Transplant Program and is the Director of the Clinical Research Track within the Pulmonary Critical Care Fellowship training program. His clinical practice focuses on Advanced Lung Disease and Lung Transplantation, primarily managing patients before and after lung transplantation at the Penn Lung Center. His research is centered on translational studies of clinical and genetic risk factors for Primary Graft Dysfunction (PGD) and chronic rejection following lung transplantation. His work aims to understand the mechanisms of PGD and Bronchiolitis Obliterans Syndrome (BOS), with the goal of developing therapies to improve long-term survival of lung transplant recipients. His primary research interest involves evaluating the role of innate immune activation in the development of post-lung transplant PGD and chronic rejection, as well as integrating data on innate immune activation with the microbiome of lung transplant recipients.

Research topics

• Medicine
• Surgery
• Internal medicine
• Anesthesia

Selected publications

• Considerations for Endpoints in Lung Transplant Clinical Trials: Perspective on the ISHLT Consensus Statement

  The Journal of Heart and Lung Transplantation · 2026-01-16

  article
  PublisherDOI

• Integrating data across oscillatory power bands predicts the seizure onset zone in focal epilepsies

  Brain Communications · 2026-01-01 · 1 citations

  articleOpen access

  Abstract Accurate identification of the seizure onset zone (SOZ) using intracranial electroencephalography (iEEG) remains challenging. Although diverse methods have leveraged spectral features to classify patient outcomes, few approaches focus on identifying individual electrodes within the SOZ or integrate a broad spectrum of frequency ranges within a single model. We developed an interpretable machine learning model that integrates power across delta, theta, alpha, beta, gamma and high-gamma frequencies over time to identify the SOZ. For 1511 electrodes implanted across 21 patients, we computed the mean spectral power in each frequency band for the first 20 s after seizure onset and analysed the differences in power between SOZ and non-SOZ electrodes. In patients who were seizure free after surgery (n = 14), electrodes within the SOZ showed significantly higher area under the curve (AUC) for mean power over time in the first 20 s after seizure onset compared to electrodes outside the SOZ in the alpha (P = 0.0272), beta (P = 0.0263), gamma (P = 0.0013) and high gamma (P = 0.0086) ranges. Additionally, electrodes within the SOZ in patients who became seizure free after surgery had significantly higher AUC compared to equivalent electrodes in patients who did not become seizure free after surgery (n = 7) in the gamma (P = 0.0145) and high gamma (P = 0.0024) power ranges. We trained a stacked random forest ensemble model using these features over time to label electrodes within the SOZ. Leave-one-out patient cross-validation of the machine learning model yielded a 96.6% positive predictive value and 99.9% specificity for identifying electrodes within the SOZ. Our dataset included a diverse array of seizure onset patterns, which were all classified accurately by the model. A second model was trained to predict post-operative seizure freedom, yielding 95.2% accuracy for predicting seizure outcome based on a planned resection. This two-model design mirrors clinical workflow, first localizing SOZ electrodes to support surgical planning and then predicting outcomes based on a surgical plan. An advantage of our interpretable machine learning approach is the ability to interrogate our models to understand how predictions are made. For electrode classification, the model weighed beta (0.66 ± 0.07), high gamma (0.54 ± 0.06) and delta (0.51 ± 0.06) power bands most heavily. Viewing the model’s frequency band weights over time reveals that the model identified a pattern resembling the ‘fingerprint of the epileptogenic zone’, reinforcing the importance of this dominant fundamental neurophysiologic signature of seizure onset.

  PublisherDOI

• Clinical features associated with chronic lung allograft dysfunction progression in a multicenter cohort

  American Journal of Respiratory and Critical Care Medicine · 2026-01-23 · 2 citations

  articleOpen access

  RATIONALE: Clinical features that impact outcomes in lung recipients with chronic lung allograft dysfunction (CLAD) are uncertain and limited by existing approaches to phenotyping that rely on measures inconsistently performed or not standardized across centers. OBJECTIVE: We used data from the prospective multicenter Lung Transplant Outcomes Group (LTOG) cohort study to determine if routine, objective clinical measures at CLAD diagnosis impact progression to graft loss (death/retransplantation). METHODS: The analysis included 2386 adult lung recipients from 9 US centers. Probable CLAD was defined according to International Society for Heart and Lung Transplantation criteria. Cox models were fit for time from probable CLAD to graft loss as a function of each clinical feature of interest including CLAD stage (1-4), CLAD timing (early-onset, <2 years posttransplant), FVC loss (FVCCLAD/FVCBest <0.8), and FEV1/FVC ratio <0.7. Models included a random effect for center and were adjusted for recipient age, sex, transplant type, and native lung disease. MEASUREMENTS AND MAIN RESULTS: Probable CLAD developed in 1418 patients (59.4%). At onset, 80.7% had stage 1 CLAD, 41.3% had early-onset CLAD, 35.8% had FVC loss, and 46.5% had an FEV1/FVC ratio <0.7. In adjusted analyses, patients with CLAD stage ≥2, early-onset CLAD, and FVC loss had significantly higher hazards for graft loss, while FEV1/FVC <0.7 was associated with reduced graft loss risk. CONCLUSIONS: We provide compelling evidence that routine, objective measures at CLAD onset inform CLAD progression risk. Such stratification of disease behavior is important to patient prognostication and may inform the design of future CLAD trials.

  PublisherOA PDFDOI

• Utility of donor-derived cell-free DNA testing after lung transplantation in the precision medicine era

  The Journal of Heart and Lung Transplantation · 2026-04-01

  article
  PublisherDOI

• Prolonged Invasive Mechanical Ventilation is Associated With Decreased Survival After Lung Transplantation Among Recipients With Primary Graft Dysfunction: A Lung Transplant Outcomes Group Study

  Clinical Transplantation · 2026-01-01 · 1 citations

  articleOpen access

  INTRODUCTION: Prolonged invasive mechanical ventilation (IMV) after lung transplantation is an appealing early prognostic outcome as it can be reproducibly assessed both prospectively and retrospectively. Whether use of IMV at 72 h after lung transplantation is associated with post-transplant graft survival is unknown. METHODS: We performed a retrospective cohort study of 1511 participants in the multi-center Lung Transplant Outcomes Group cohort (2011-2018). Using Cox proportional hazards models and restricted mean survival time, we investigated whether IMV at 72 h was associated with post-transplant graft survival. We secondarily evaluated whether IMV at 72 h was concordant with severe primary graft dysfunction (PGD). RESULTS: Participants requiring IMV at 72 h after transplant were sicker at transplantation (higher lung allocation score [LAS], increased extracorporeal membrane oxygenation, or IMV bridge) and more likely to have severe PGD. Use of IMV at 72 h was associated with 55% (95% CI 26%-92%) increased hazards of death or re-transplantation after adjustment for age, ECMO, diagnosis, LAS, and intra-operative transfusion. The association between IMV and graft survival was modified by severe PGD (p-for interaction 0.002) but not by pre-transplant ECMO (p-for interaction 0.88) or pre-transplant IMV (p-for interaction 0.92). IMV was associated with increased risk of death or re-transplantation among those with PGD (HR 2.35, 95% CI 1.43-3.85) but not among those without PGD (HR 1.04, 95% CI 0.77-1.41). CONCLUSION: Requirement of IMV at 72 h is an important early post-transplant outcome associated with post-transplant survival. This appears driven by those with severe PGD.

  PublisherOA PDFDOI

• SUN-323 Metastasis to the Clivus - a Unique Presentation of Metastatic Medullary Thyroid Cancer Associated with Multiple Endocrine Neoplasia Type 2A

  Journal of the Endocrine Society · 2025-10-01

  articleOpen access

  Abstract Disclosure: D. Al-Souri: None. E. Chuki: None. P. Chittiboina: None. D. Smart: None. J. Diamond: None. M. Laws: None. P. Veeraraghavan: None. S. Gubbi: None. J. Klubo-Gwiezdzinska: None. Introduction: Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor arising from parafollicular C cells of the thyroid that can be associated with Multiple Endocrine Neoplasia type 2 (MEN2 A and MEN2B), driven by germline RET proto-oncogene pathogenic variants. Managing advanced metastatic MTC in MEN2A patients poses clinical challenges due to its aggressive nature and propensity for widespread metastasis, especially in patients with high-risk RET pathogenic variants. We present one such patient with an unusual metastatic site, emphasizing the diagnostic, therapeutic, and follow-up strategies. Clinical Case: A 49-year-old female with MEN2A (germline RET C634Y pathogenic variant with 4 family members affected by MEN2A) and a history of MTC was referred for evaluation of disease progression. In 2010, she underwent a total thyroidectomy for a 3.8 cm MTC, without modified neck dissection, given the presence of widespread metastatic disease to the liver, bones, and persistent neck lymphadenopathy. In 2013, the patient also had right total adrenalectomy and partial left adrenalectomy for bilateral pheochromocytomas. Subsequently, based on a failed ACTH stimulation test, she was diagnosed with adrenal insufficiency after complaints of persistently low blood pressure and low energy. The patient also reported intermittent dizziness and headaches but without neurological deficits Comprehensive evaluation including biochemical and imaging studies (CT neck/chest/abdomen/pelvis, FDG PET, MRI brain) in 2024 revealed new metastasis to the clivus. Calcitonin levels were markedly elevated (22,931 pg/mL). Given a unique presentation with the expansile clivus lesion, a sublabial transsphenoidal resection was performed, and postoperative imaging revealed that near total resection was achieved. Postoperatively, the patient developed transient cranial nerve VI paresis, managed with high-dose corticosteroids, followed by physiologic hydrocortisone replacement. Subsequent management includes radiotherapy planned for January 2025 and therapy with RET inhibitor. Conclusions: This case highlights the aggressive behavior of a subset of MTCs, with clivus involvement being an unusual metastatic site. Clival metastases are extremely rare, representing only 0.04% of all intracranial tumors and most commonly originating from prostate cancer and gastrointestinal malignancies. There are only two reported cases of papillary thyroid cancer with clival metastases, while our patient represents the first reported metastatic disease to the clivus from MTC. Managing MEN2A with metastatic disease and bilateral pheochromocytomas presents unique challenges requiring a multidisciplinary approach. Surgical resection remains pivotal, but adjunctive therapies should be considered based on disease progression. Presentation: Sunday, July 13, 2025

  PublisherOA PDFDOI

• Lung transplant for CF: Low lung bacterial burden and immune mediators in year one associate with CLAD development

  Journal of Cystic Fibrosis · 2025-10-10

  article
  PublisherDOI

• The determinants of multifocal premature ventricular contractions and ventricular arrhythmia risk in mitral valve prolapse

  European Heart Journal · 2025-11-01

  article

  Abstract Background Multifocal premature ventricular contractions (PVCs) are associated with an increased risk of complex ventricular arrhythmias. The determinants of multifocal PVCs in patients with mitral valve prolapse (MVP) remain unclear. We hypothesized that cardiovascular comorbidities are associated with multifocal PVCs in patients with MVP. Purpose To investigate the role of cardiovascular structural and functional abnormalities in predicting multifocal PVCs and the risk of complex or frequent ventricular ectopy (cfVE) in patients with MVP. Methods We analyzed 12-lead ECGs from 191 patients with MVP to record the sites of PVC origin. Electronic medical records were queried to abstract data on cardiovascular comorbidities. Mitral regurgitation (MR) severity was assessed on transthoracic echocardiography. cfVE was defined as two or more PVCs on a single 10-second strip, or &amp;gt;1% PVC burden or non-sustained ventricular tachycardia (NSVT) on Holter monitoring. Results The median (IQR) age was 67 (56 – 75) years and 111 (58.1%) were females. 33 (17.3%) patients experienced multifocal PVCs. Those with multifocal PVCs were older (median age: 71 [63 - 78] years vs. 66 [55 - 74] years, p=0.01), had higher prevalence of atrial fibrillation (18 [54.6%] vs. 41 [25.9%], p=0.001), coronary artery disease (10 [30.3%] vs. 20 [12.7%], p=0.01), congestive heart failure (12 [36.4%] vs. 15 [9.5%], p=0.0003) and moderate-to-severe MR (15 [45.5%] vs. 41 [25.6%], p=0.03). Congestive heart failure was an independent predictor of multifocal PVCs (OR: 3.29; 1.23 - 8.74, p=0.02). Multifocal PVCs were associated with an increased arrhythmia burden (&amp;gt;1% PVC burden on 24-hour ambulatory monitoring, 17 [58.6%] vs. 30 [21.7%], p=0.0001) and cfVE risk (23 [69.7%] vs. 49 [31.1%], p&amp;lt;0.0001). Conclusion We found that in patients with MVP, underlying structural heart disease was associated with multifocal PVCs, which were, in turn, linked to a higher risk of ventricular arrhythmias. These findings suggest that MVP patients with underlying structural heart disease constitute a high ventricular arrhythmia risk subgroup.MVP patients with &amp; w/o multifocal PVCs

  PublisherDOI

• Retransplant- and bronchiolitis obliterans syndrome–free survival among COVID lung transplant recipients: a national cohort study

  Annals of the American Thoracic Society · 2025-10-24

  article

  RATIONALE: There are limited longer-term follow-up data on bronchiolitis obliterans (BOS)- and retransplant-free survival among patients who underwent lung transplantation for COVID-related lung disease. OBJECTIVES: To evaluate overall, retransplant-free, and BOS- and retransplant-free survival in a national cohort of COVID lung transplant recipients (LTRs). METHODS: We identified all US adult LTRs in the Scientific Registry of Transplant Recipients who underwent transplant for COVID-related lung disease between August 2020 and February 2025. We used propensity score matching (PSM) to construct balanced cohorts of COVID LTRs and non-COVID group D (restrictive lung disease) LTRs, comparing overall, transplant-free, and BOS- and retransplant-free survival in the 2 populations. RESULTS: There were 605 LTRs with COVID lung disease and 8809 with non-COVID group D diagnoses. Among patients with at least a 3-year follow-up time, survival was 79.1% in COVID LTRs and 73.7% in non-COVID LTRs. In a PSM cohort of 451 matched pairs, overall survival (LTR; hazard ratio [HR], 0.81; 95% CI, 0.60-1.10; P = .17) and retransplant-free survival (HR, 0.81; 95% CI, 0.60-1.09; P = .16) did not differ between the groups. Among non-COVID LTRs, 51 (16.0%) developed BOS, and 56 (16.3%) COVID LTRs developed BOS. Overall, 122 (33.7%) non-COVID LTRs died, were retransplanted, or developed BOS, and 110 (29.1%) COVID LTRs died, were retransplanted, or developed BOS. COVID LTRs had improved retransplant- and BOS-free survival compared to non-COVID LTRs (HR, 0.76; 95% CI, 0.58-0.98; P = .04), driven by 8 fewer deaths in the COVID LTR cohort. COVID acute respiratory distress syndrome LTRs had similar overall, retransplant-free, and BOS- and retransplant survival as COVID fibrosis LTRs. CONCLUSIONS: In this national cohort study, there was no significant difference in overall and retransplant-free survival for COVID LTRs compared to non-COVID, restrictive lung disease LTRs at a median follow-up time of 2.5 years. COVID LTRs, however, had slightly lower hazard for BOS- and retransplant-free survival.

  PublisherDOI

• Assessment of Post-Transplant Lung Function Alterations Using Free-Breathing Hyperpolarized Xenon MRI

  Proceedings on CD-ROM - International Society for Magnetic Resonance in Medicine. Scientific Meeting and Exhibition/Proceedings of the International Society for Magnetic Resonance in Medicine, Scientific Meeting and Exhibition · 2025-09-16

  article

  Motivation: CLAD is the leading cause of long-term mortality in lung transplant (LTX) recipients, often diagnosed only after irreversible lung damage has occurred. Goal(s): To evaluate the effectiveness of dynamic Hyperpolarized Xenon-129 MRI in detecting early gas exchange abnormalities post LTX. Approach: We imaged lung transplant recipients, healthy controls, and COPD patients using dynamic HP-Xe MRI during free-breathing. Results: LTX recipients showed gradual declines and loss of gravitational gradients of the DP/GP over time, indicating impaired gas exchange even when appearing healthy. CLAD patients exhibited increased intraregional heterogeneity and diminished gravitational gradients, similar to patients with emphysema. Impact: The findings suggest that dynamic HP-Xe MRI is a sensitive tool for detecting early pulmonary function alterations in lung transplant recipients that traditional imaging methods might miss. This could enable earlier diagnosis and intervention of CLAD, potentially improving long-term survival.

  PublisherDOI

Recent grants

• NIH Grant P01AM017328

  NIH · $2.2M · 1989

• NIH Grant K23HL121406

  NIH · $629k · 2018

Frequent coauthors

• Jason D. Christie

  University of Pennsylvania

  191 shared

• Edward Cantu

  Pulmonary and Allergy Associates

  102 shared

• David J. Lederer

  Regeneron (United States)

  74 shared

• M. Crespo

  Hospital of the University of Pennsylvania

  73 shared

• Rupal J. Shah

  University of Toronto

  69 shared

• Steven M. Kawut

  University of Pennsylvania

  64 shared

• Jonathan B. Orens

  Johns Hopkins University

  63 shared

• Scott M. Palmer

  Clinical Research Institute

  59 shared

Labs

• Joshua M. Diamond LabPI