THIS MONTH'S FOCUS:

HEART FAILURE & TRANSPLANTATION
PATHOLOGY

(PDF VERSION)

Many thanks to David Nelson and Brandon Larsen for coordinating the content for this month's issue.




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VINCENT'S THANKSGIVING SENSE:

In this issue, the spotlight is beamed on Too Little, Too Late by Malone Hill, III and Vincent Valentine. There is a Strategic Planning Update and a gentle reminder of the ISHLT Grants & Awards Applications Now Online - APPLY TODAY! Dr Monica Colvin-Adams poses the question, Would You Take This Donor?, as the Heart Failure and Transplantation (HFTX) Council sets to launch a Donor Selection and Management Discussion Forum on December 1, 2015. This announcement is followed by Desensitization Strategies In Heart Transplantation - Where are we now? By Jignesh Patel and Cardiogenic Shock - In the Era of Advanced Short Term Mechanical Circulatory Support by Michael Koerner and Aly El-Banayosy, both on behalf of the HFTx Council. From the Pathology Council we have the insightful report by Brandon Larsen entitled Updates from the Pathology Council: Now, Our Precious Efforts are CLAD in AMR! For Special Interest, we have Tereza Martinu's Aspen Lung Conference announcement.

In keeping with our November tradition, let us be reminded of our commitment to our patients through Lincoln's dedicatory piece from last year's Links on Dedication and Thanksgiving. As the theme of Volume 7 of the Links continues on with US President's with Lincoln in mind we suggest that you review the humble Second Inaugural Address by Lincoln from 1865 with the motif of...With malice toward none, with charity for all... This segues into America's tradition on How U.S. President's Got Thanksgiving Together by Alexandra Martirossian, Malone Hill, III, and Vincent Valentine and Leftovers by Alexandra Martirossian and Vincent Valentine. Finally, yours truly takes us from the 23rd to the 27 President of the United States at the turn of the 19th into the 20th Century in the Editor's Corner - From Little Ben and Uncle Jumbo to a Teddy Bear and a Big Lub.


LAST CHANCE TO SUBMIT YOUR ABSTRACT!

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Deadline:
November 3, 2015


Notification of Acceptance or Rejection of all submitted and finalized abstracts will be sent via email to the primary author in January 2016. For more information about abstract submission, visit ishlt.org/meetings/abstracts.asp

Special thanks are in order for Malone "Trey" Hill and Alexandra Martirossian third-year medical students at UTMB for their contributions in this issue. Trey is a native Texan who received a BS degree in Finance from the University of Virginia in Charlottesville. He worked for the oil and gas industry before pursuing his studies in medicine. Alexandra is a Texas girl who graduated Valedictorian from Springtown High School and with Honors from UT in Austin who received a BS in Neurobiology. She is an impassioned cook and experiments with new recipes. Let's give a heartfelt ISHLT thanks to both Trey and Alexandra for their dedication and outstanding efforts.

Vincent Valentine, MD
Links Editor-in-Chief



IN THE SPOTLIGHT:


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Too Little, Too Late

Malone V. Hill, III
Vincent Valentine, MD

I had just started my job as an Anesthesia Tech in 2011 when our patient died in the operating room. After a relatively minor procedure for removal of a jaw mass, we transferred the 55-year-old patient from the operating table to his bed. Noting circumoral cyanosis, the anesthesiologist resumed masking the patient, but the pulse oximeter showed continued desaturation. Checking the cable connection and calling other anesthesia personnel into the room delayed our journey to the cardiac cath lab, where an emergent procedure found complete occlusion of the patient's LAD. Read more →



STRATEGIC PLANNING UPDATE

In April 2015, ISHLT launched a strategic planning process to look at the direction the field is moving and to develop a new Strategic Framework to guide the Society over the next 5 years. The initiative is being led by a steering committee of six: Duane Davis, ISHLT President; Maryl Johnson, ISHLT President-Elect; Stuart Sweet, ISHLT Secretary/Treasurer; David Taylor, ISHLT Past President; Andreas Zuckermann, ISHLT Member; and Amanda Rowe, ISHLT Executive Director. The first phase of this process has been to gather data and best thinking from multiple sources primarily within the organization: ISHLT members, Board Members, and Council Members, as well as from a few leaders in the field. The collected data came from 404 responses to a membership survey, 15 one-on-one interviews with leaders in the field, and the engagement of the 11 Scientific Councils. Read more →



ISHLT NEWS AND ANNOUNCEMENTS:



ISHLT Grants & Awards Applications Now Online - APPLY TODAY!

The 2016 Grants & Awards applications are now available online at www.ishlt.org/awards. The deadline for applications is Friday, January 15, 2016. Grants will be awarded at the ISHLT 36th Annual Meeting and Scientific Sessions, April 27-30, 2016 in Washington, DC.




HEART FAILURE & TRANSPLANTATION:



Would You Take This Donor?

Monica M. Colvin-Adams, MD

links imageSelecting the appropriate donor for a given recipient is perhaps the most crucial factor in determining post-transplant outcomes. Conferences, statements, and manuscripts abound yet still have not clarified the nuances of optimal donor and recipient matching. With little data to guide us, we often formulate decisions based on prior experience and use the multiple hit theory to provide rationale when a donor just doesn't seem right, "Well...it's a female into a male, she used cocaine three years ago, and was hypertensive. One small hit is ok, but three small hits? Maybe we shouldn't take it." Then we poll additional colleagues, "Would you have taken this donor?" Read more →

Desensitization Strategies In Heart Transplantation - Where are we now?

Jignesh K. Patel, MD, PhD

links imageHyperacute rejection, although fortunately rare, is still the most feared complication after heart transplantation due to its rapidity of onset, severity and almost universally fatal outcome. The predominant risk factor for its development is the presence of circulating donor-specific cytotoxic antibodies in the recipient at the time of transplantation. Even in the absence of hyperacute rejection, sensitized patients are at increased risk of rejection, development of allograpft vasculopathy and graft loss. The challenge of the sensitized patient awaiting transplantation is that in order to avoid risk of rejectio, the donor pool is limited to only compatible donors. This results in a prolonged and often prohibitive waiting time on the wait-list and a consequent increase in wait-list mortality. Read more →



Cardiogenic Shock - In the Era of Advanced Short Term Mechanical Circulatory Support

Michael M. Koerner, MD, PhD
Aly El-Banayosy, MD

If not treated in a sufficient and timely manner cardiogenic shock (CS) is known to have still a high morbidity and mortality instead of improvements in the therapy eg of acute myocardial infarction (MI) and CS. In 1967 Killip classified the severity of derangement after myocardial infarction into four groups: no heart failure, heart failure, severe heart failure with frank pulmonary edema, and cardiogenic shock (CS): signs including hypotension with a systolic blood pressure (BP) 90 mmHg or less, evidence of peripheral vasoconstriction: oliguria, cyanosis, diaphoresis, and heart failure - often with pulmonary edema. Read more →



PATHOLOGY:



Updates from the Pathology Council: Now, Our Precious Efforts are CLAD in AMR!

Branden T. Larsen, MD, PhD

links imageThe Pathology Council has been busy in 2015! As in recent years, antibody-mediated rejection (AMR) has remained a strong focus of our Council's discussions and research efforts. Over the last year, we have seen a number of important clinical studies from members of our Council and others, which further refine our understanding of the biology of AMR in the heart and lung, and the utility, reproducibility, and limitations of various biopsy modalities for diagnosing AMR. There is also considerable and growing interest in the pathology of chronic lung allograft dysfunction (CLAD), as well as "mixed rejection" in the heart. These topics will likely remain a focus of our efforts over the coming year and beyond. Read more →




OF SPECIAL INTEREST:



THE ASPEN LUNG CONFERENCE 2016: "Lung Transplantation: Opportunities for Repair and Regeneration" June 8-11, 2016 @ The Gant Conference Center, Aspen, Colorado

links imageDear ISHLT Membership:
We are pleased to announce that the 59th Thomas L. Petty Aspen Lung Conference will be devoted to lung transplantation! The Aspen Lung Conference is one of the most respected and innovative meetings in the North American lung research community at large: With a focus on clinical problems affecting the lung, the Aspen Lung Conference blends cutting-edge basic and clinical research in a setting that facilitates extensive discussion amongst participants. This is the very first time that lung transplantation will be the topic of discussion. Read more →



How U.S. Presidents Got Thanksgiving Together

Alexandra N. Martirossian
Malone V. Hill, III
Vincent Valentine, MD

Every November in the United States, people all over the country take a break from their busy routines to celebrate a holiday laced with tradition known as Thanksgiving. On the fourth Thursday of the month, family and friends from near and far will gather together for a grand feast with a menu classically composed of roasted turkey, mashed potatoes, gravy, stuffing, cranberry sauce, green bean casserole, and pumpkin pie. From a romanticized perspective, Thanksgiving is a time to cherish time with loved ones and to reflect on all of life's blessings. However, in modern times, the concept of Thanksgiving has expanded beyond traditional values and has become very much commercialized. Read more →



Leftovers

Alexandra N. Martirossian
Vincent Valentine, MD

As the holidays draw ever nearer, perhaps people all over the world will brace themselves for a grueling season of feasting. On Thanksgiving Day in the United States, kitchens will be overflowing with the edible goodness of roasted turkey, stuffing, gravy, cranberry sauce, mashed potatoes, sweet potatoes, green bean casserole, and Grandma's famous pumpkin pie. After uncomfortably tight waistbands herald the end of the feast, the preparers of the meal will be faced with a new challenge: what to do with all the leftovers. Purists will argue that leftovers must be consumed in their original form whereas the more adventurous eaters may transform the ingredients into a new dish entirely. Read more →




EDITOR'S CORNER:

From Little Ben and Uncle Jumbo to a Teddy Bear and a Big Lub

Vincent Valentine, MD

links imageBenjamin Harrison was born in North Bend, Ohio on August 20, 1833. Despite being from one of America's oldest and most distinguished families, he grew up on a modest farm. He attended Miami University in Oxford, Ohio and studied law in Cincinnati. He was nicknamed, "Little Ben" during the Civil War because he stood only 5'6" tall. Little Ben was discharged as a breveted brigadier general following the Union victory in 1865. He became a brilliant lawyer in Indianapolis, Indiana and was elected to the United States Senate in 1880 where he championed the rights of Native Americans, Civil War Veterans and homesteaders and advocated for high tariff. Read more →





Contact

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


Editorial Staff


"If you can't say something nice, don't say nothin' at all"
— Thumper from Disney's Bambi

"If you can't say something good about someone, sit right here by me"
— Alice Roosevelt Longworth

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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.