THIS MONTH'S FOCUS:

PULMONARY TRANSPLANTATION &
INFECTIOUS DISEASES

(PDF VERSION)


Many thanks to Tereza Martinu, Middy Estabrook and Macé Schuurmans
(Pulm Tx and ID Council Links Liaisons) for coordinating the focus content for this issue.




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VINCENT'S SUPER, OLYMPIC VALENTINE'S SENSE:

For the month of February 2014, we have what might be the most expensive television program in America, Super Bowl XLVIII; the 22nd Winter Olympics on the World's stage; Valentine's Day and President's Day, mostly commemorating George Washington and Abraham Lincoln. Because of this sports-filled February and in keeping with our focus on improving communication, the Editor's Corner will provide you some everyday language derived from the vocabulary of sports, but I will punt on this for now.

In this issue of the ISHLT Links for the month of February 2014, we focus on lung transplantation and infectious diseases. Keith Meyer from the University of Wisconsin School of Medicine refines and defines our classification of BOS. The unchanging outcomes over the years have kept lung transplant specialists whittling away at the various expressions of allograft dysfunction. With clearer definitions of what has been observed over the years by splitting the old lump of BOS into seemingly more meaningful parts may actually allow us to lump our findings into the split categories of phenotypic expressions of allograft injury leading to more suitable and future investigations. Nevertheless, most lung recipients will have architecturally distorted airways down to the bronchioles in their allografts rendering them all the more vulnerable to infection along with their chronic immunosuppression. Read more →



ISHLT 2014

• Annual Meeting website
• Academy website
Online Registration
• 2014 Preliminary Program

IN THE SPOTLIGHT:


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ISHLT 2014 in Sunsational San Diego!

This article features highlights from the 34th Annual Meeting related to Infectious Diseases and Pulmonary Transplantation. Find out which sessions will be of most interest to you, and plan your trip to San Diego TODAY! Read more →




FOCUS ARTICLES:



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BOS Phenotypes and Classification

by Keith Meyer

When I took on the position of medical director for our University of Wisconsin lung transplant program as it started up in 1988, I faced a steep learning curve. Not only could a host of things go awry up front for lung transplant recipients in the peri-operative period, but the successfully transplanted patient could subsequently develop a plethora of complications that would threaten their allograft function and their post-transplant survival. As the art and science of lung transplantation evolved, it became clear that many patients would have a chronic decline in their lung function and that lung biopsies frequently showed histopathologic changes of obliterative bronchiolitis (OB). Read more →



Exploring the Respiratory Mycobiome

by Dana Willner and Daniel Chambers

Fungal infections can lead to serious complications following lung transplantation. Specifically, there is strong evidence that colonization with Aspergillus species is a risk factor for chronic rejection and bronchiolitis obliterans syndrome (BOS). Aspergillosis has been reported as the most common post-transplant invasive fungal infection in lung transplant recipients, but reports of infections with emergent pathogens such as non-albicans Candida and zygomycoses are increasing. However, how these infections occur as well as the complex interplay between fungi, bacteria, and viruses resident in the respiratory tract is only just beginning to be elucidated. Read more →



Cold Weather Tips for Lung Transplant Patients

Lung transplant nurse practitioner and ISHLT Member Kevin Carney, MSN, CRNP, CCTC recommends strategies to help transplant patients stay healthy through this chilly season. Read more...

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Who, When, With What and For How Long? Management of Nontuberculous Mycobacteria in Lung Transplantation

by Eileen Maziarz

A 68 year-old patient with pulmonary fibrosis, who underwent single lung transplant, is found to have Mycobacterium abscessus isolated (smear negative) from the 1-month surveillance bronchoscopy. Post-transplant course has been without notable complications. He has no symptoms and pulmonary function tests continue to improve. Exam reveals stable dry crackles on examination of native lung, clear examination on the allograft side and a well-healed thoracotomy incision. The remaining pre- and post-transplant respiratory cultures are otherwise negative. Read more →

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Pre-transplant Vaccination: a Model for Optimal Patient Care

by Deepali Kumar

Vaccines have been the single most important public health intervention in the last century. Vaccination of transplant candidates and recipients is sometimes given little thought especially when the urgency of transplant and the transplant workup takes precedence. However, immunization is a very simple way to prevent hospitalization and mortality in transplant recipients and should be a routine part of our pre-transplant evaluation. The benefits of immunization can start immediately. Consider the relatively common scenario of a donor with previous Hepatitis B infection (anti-HBc positive and anti-HBs positive). Read more →

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Cytomegalovirus Prevention Strategies: All Are Not Created Equal, But Some More Unequal Than Others

by Luciano Potena

Cytomegalovirus (CMV) infection remains a major issue in the management of heart transplant recipients. The availability of highly effective oral antiviral drugs supported a generalized anti-CMV prophylaxis approach—with several lines of evidence suggesting a protective effect of prophylaxis against indirect CMV-mediated graft injury. However, the onset of under-diagnosed late CMV infection reveals that in some patients an important negative counterbalance to the desired protection of universal prophylaxis. Indeed, a careful clinical practice approach highlights wide variability in CMV-related scenarios raising doubts on the real effectiveness of a prolonged "all for all" CMV prophylaxis strategy. Read more →



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Fecal Transplants in the World of Solid Organ Transplantation: A Revolutionary Treatment for Recurrent C.diff or an Infectious Nightmare Waiting in the Wings?

by Cameron Wolfe

At first, it's hard not to be revolted at the idea of a fecal microbiota transplant (FMT). Yet, increasingly robust data suggests it is a remarkably effective treatment for recurrent Clostridium difficile colitis. Although there are limited reports of FMT in patients with solid organ transplants, the increasing frequency of C.diff infections in the general community and the increased morbidity and mortality in immunosuppressed hosts mandates transplant clinicians familiarize themselves with the technique. Read more →




NEWS AND ANNOUNCEMENTS:



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Extend your Global Reach with an ISHLT International Traveling Scholarship

by Andrew Fisher and Daniel R Goldstein

The ISHLT community extends to every corner of the globe and our members offer world leading expertise in every aspect of heart and lung transplantation, mechanical circulatory support, pulmonary hypertension and management of the failing heart or lungs. We encourage you to take advantage of being part of this amazing community by applying for an ISHLT International Traveling Scholarship. Read more →



OUTTA THIS WORLD LINKS:


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Interesting, Inspiring and Intriguing Links from Around the Globe

From heart-warming to heart-breaking ... from outstanding to outlandish ... these stories of new beating hearts, beating the odds, breaking new barriers and breathing new life—from Australia, Canada, France, Ireland, the United Kingdom and the United States—are sure to inspire and intrigue you. Read more →



TATTLING LINKS:


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ISHLT Members in the News

This month's ISHLT members in the news include: Jan Pirk from the Czech Republic, Waleed Saleh from Saudi Arabia, Markus Wilhelm from Switzerland, Sir Magdi Yacoub from the United Kingdom, and Josef Stehlik, Andrew Kao, Cesar Keller, Lee Goldberg, Richard Daly, Keshava Rajagopal, Michael Eberlein, Stephanie Moore, Valluvan Jeevanandam, David Taylor, Michael Acker, Mary Walsh, Katsuhide Maeda, David Rosenthal, Nirav Raval, Jeffrey Feinstein, O Howard Frazier, David D'Alessandro, Joshua Sonett, Jennifer Cowger, Scott Scheinin, Matthias Loebe, Tajinder Singh, Donna Mancini, Hannah Copeland, Yoshiya Toyoda from the United States. Read more →



LAUGHING LINKS:


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Far From Finished

The Incomparable Bill Cosby

Charlie Chaplin. Groucho Marx. Richard Pryor. Over the past century, few entertainers have achieved the legendary status of William H. Cosby Jr. His successes span five decades and virtually all media, remarkable accomplishments for a kid who emerged from humble beginnings in a Philly project. In the 1960s, his stand-up act was a coast-to-coast sensation, spawning a string of hilarious, best-selling comedy albums, which went on to win eight Gold Records, five Platinum records and five Grammy Awards. His role on TV's I Spy made him the first African-American to co-star in a dramatic series, breaking television's racial barrier and winning three Emmy Awards. Read more →



EDITOR'S CORNER:


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Expressions from the Love of Sports

by Vincent Valentine

There are many words, expressions, analogies and metaphors from the language of sports enmeshed in everyday conversation of English vocabulary that largely go unnoticed. For example, children in the English world experience "time outs" because they are misbehaving or in need of a break from playing, which comes from sports. Also, when involved in a discussion outside your purview, you might consider "sitting on the sidelines" or "sit this one out." In so doing, you position yourself as a spectator or as a substitute currently not playing in this discussion. These expressions come from many sports, including football. Read more →




Contact

Vincent G Valentine, MD
Editor-in-Chief
vgvalent@utmb.edu


Editorial Staff



"The heart of marriage is memories; and if the two of you happen to have the same ones and can savor your reruns, then your marriage is a gift from the gods."

— Bill Cosby

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Disclaimer: Any opinion, conclusion or recommendation published by the Links is the sole expression of the writer(s) and does not necessarily reflect the views of the ISHLT.