Many thanks to Tereza Martinu, Amresh Raina and Jorge Silva Enciso for coordinating the content for this month's issue.

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In this 5th Halloween issue since I have been Editor-in-Chief of the ISHLT Links newsletter, we continue to creep along with the historic and biographic tales of the leaders of America. And for what reason? You might ask. We have been down the road to Prague, Montreal, San Diego and Nice; and we guided ourselves on the culture of these respective great cities which resulted in successful annual meetings. Perhaps yours truly uses this resource to improve his knowledge and his daughter's knowledge of American History, true. Perhaps yours truly cares enough to share with those interested in learning more about American History, true. Perhaps with a bit of reflection we can learn about how to become effective leaders through the elected Presidents in American History who either spent some time or actually lived in Washington, DC as we pave our way to the once eerie swamp around the Potomac River, her tidal basins and reflection pools.

The focus of Issue 6 for Volume 7 of the Links comes from the Pulmonary, Pulmonary Hypertension as well as the Junior Faculty & Trainees Councils. The Spotlight article announces the availability of the newly released 2016 Preliminary Program. Next, we have our news and announcements, encouraging you to extend your global reach by applying for the International Traveling Scholarship.

Whitney Brown and Adam Cochrane from the Inova Fairfax Advanced Lung Disease and Transplant Program illuminate us with the combination cystic fibrosis transmembrane conductance regulator modulator (lumacaftor/ivacaftor) and the effect this therapy has for a common, incurable and lethal genetic disease, cystic fibrosis. Hrishikesh Kulkarni then examines the challenges in Lung Transplantation for anti-synthetase syndrome associated interstitial lung disease with a few points about patients afflicted with other connective tissue diseases. Also, Omar Mohamedaly from Duke and one of our former International Traveling Scholars, Caroline Patterson from the Papworth Hospital in Cambridge, allude to Charles Dickens great tale (or is it his tail) with reference to Lung Allograft Allocation across the World. Following which are reports Veronica Franco of Ohio State and Anjali Vaidya of U Penn. Dr Franco emphasizes the importance of well-trained experts to manage patients with pulmonary hypertension in her summary on Physician Training in Pulmonary Hypertension while Dr Vaidya updates on the truth and fallacy of drug and toxin in induced PAH. David Iturbe from the Hospital Universitario Marques de Valdecilla in Santander Spain finishes this month's focus articles with a brief treatise on antibody mediated in lung transplantation.

Of special interest is an announcement for the Aspen Lung Conference 2016 if you dare to go there, you should if your interest lies in lung transplantation. If you care to dare to go in there, that is in this issue's Editor's Corner with the next focus on the ongoing series of America's leaders from over 100 years ago and it haunting past. Once you complete your perusal from the Man of Action to the Veto President along with the other summaries of the American Presidents for Volume 7 in the Links, you will now be halfway through the elected Leaders from American History with an emerging pattern, at least in my mind. Then, we direct your attention to the other side of the corner with selected key figures who shaped 19th Century America for the "cause" as we look ahead and not away to Washington DC.

links imageNo ghosts, no witches, no goblins, no creepy crawlers and no make-up, it will be tricks and treats for Halloween in 2015. Enjoy the pumpkins! For refreshers on Halloween from the ISHLT, refer to all the October Issues of the past in Volume 3 (Fourth Prague Adventure of Mr/S XYZ at ISHLT 2012: From a Haunted Castle to Rusalka and Collaboration, Conformity and Consensus), Volume 4 (October, ISHLT and Tom Sawyer!), Volume 5 (Vincent's Phobophobic Sense) and Volume 6 (Vincent's Halloween Sense and Halloween Links).

Vincent Valentine, MD
Links Editor-in-Chief


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The ISHLT 2016 Preliminary Program is Here!

Plan your trip now to attend the ISHLT 2016 Annual Meeting and Scientific Sessions! The 2016 Preliminary Program has everything you need to get started.

Download the Preliminary Program PDF or
View the Preliminary Program Flipbook (great for android users)

Inside you will find information on meeting registration, hotel reservations, CME, program highlights, schedule at-a-glance, timetables, Academies and Annual Meeting invited program content, as well as plenty of enticing photos and descriptions of what the USA's capital city has to offer.

Register TODAY and take advantage of the Early Bird Registration discount! For more information, visit the Annual Meeting and Academy webpages, or Read more →


Extend your Global Reach with an ISHLT International Traveling Scholarship

links image 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 →


Orkambi™ For Cystic Fibrosis Before and After Lung Transplantation

A. Whitney Brown, MD
Adam B. Cochrane, PharmD, BCPS

Orkambi™ (lumacaftor 200 mg/ivacaftor 125 mg) was approved in the U.S. in July 2015 to treat cystic fibrosis (CF) in patients 12 years and older in patients who are homozygous for the most common CF mutation delF508. This genotype accounts for approximately half of the CF population in the U.S. and a large percentage of patients worldwide. Because lumacaftor/ivacaftor has not been extensively tested in CF patients other than those homozygous for the delF508 mutation, patients must have a confirmed genotype prior to starting treatment. Read more →

Challenges in Lung Transplantation for Anti-Synthetase Syndrome Associated Interstitial Lung Disease

Hrishikesh S. Kulkarni, MD
Chad Witt, MD

links image35-65% of patients with connective tissue diseases (CTD) such as scleroderma, rheumatoid arthritis, myositis, systemic lupus erythematosus and mixed connective tissue disease develop interstitial lung disease (ILD), depending on patient selection and detection methods [1]. According to the 2014 Report from the International Society for Heart and Lung Transplantation Registry, 1.4% of total transplants between January 1995 to June 2013 were done for CTD (586/41900) [2]. However, while grouped together under the "CTD-ILD" umbrella, each of these diseases presents unique challenges in the management of a potential lung transplant recipient [3]. Read more →

A Tale of Two Systems: Adult Lung Allograft Allocation Across the World

Omar H. Mohamedaly, MD
Caroline M. Patterson, BMBS, BMedSci, MRCP

First, two disclaimers: 1. There are probably almost as many nuanced versions of a lung allograft allocation system as there are countries (or cooperative groups of countries) performing lung transplantation; however, existing systems can generally be categorized according to whether or not they center on a net-benefit assessment. 2. While not exactly a tale of "the best of times" and "the worst of times,"1 the analogy holds true considering that we might be entering a new phase of streamlining and improving lung allograft allocation in a scientifically and ethically sound fashion. Read more →


Physician Training in Pulmonary Hypertension

Veronica Franco, MD

links imagePulmonary hypertension affects approximately 25 million individuals worldwide and causes premature disability and death from right ventricular (RV) failure. Specific pulmonary vasodilator medications are only indicated in patients with pulmonary arterial hypertension (PAH). Long-term mortality remains high despite considerable advances in medical therapy for PAH, largely as a result of right heart failure. There remains an unacceptable long delay from the onset of clinical symptoms to diagnosis, of approximately 2-3 years. Read more →

Update on Drug and Toxin Induced PAH - Truth and Fallacy

Anjali Vaidya, MD

links imagePulmonary arterial hypertension (PAH) is a rare and often fatal disease, commonly affecting middle-age women. It is commonly thought to be idiopathic or familial, or associated with important comorbid conditions including, but not limited to, connective tissue disease, portal hypertension, HIV, and congenital heart disease. An important and increasingly recognized cause of PAH includes exogenous exposures to drugs and toxins. Historically, these toxins predominantly included anorexic drugs. Aminorex fumarate was a cause of PAH in parts of central Europe in the 1960s. Additional anorexic drugs were identified in the 1990s, specifically dexfenfluramine and fenfluramine (initially with a cluster of patients in France). Read more →


Antibody Mediated Rejection

David Iturbe, MD

Lung transplantation (LT) is a treatment option for patients with end-stage lung disease. Long-term survival, however, remains significantly worse in comparison to other solid organ transplants. Outcomes are limited by recurrent immunologic events contributing to chronic lung allograft dysfunction (CLAD), the very specifics of which remain unknown to this day. Antibody-mediated rejection (AMR) is recognized as a form of rejection following kidney and heart transplantation with well-established diagnostic criteria regarding histopathology, immunopathology and serology, however, such strong evidence is somewhat lacking in regards to LT. Read more →


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 →


From the Man of Action to the Veto President

Vincent Valentine, MD

Hiram Ulysses Grant was erroneously listed as Ulysses Simpson Grant when recommended for the U.S. Military Academy at West Point. This son of a leather tanner was born in Point Pleasant, Ohio on April 27, 1822. Following graduation from West Point in 1843, he started his military career and fought in the Mexican War then resigned in 1854. He later accepted command of a company of Illinois volunteers in 1861 just after the outset of the Civil War. Within a year, he rose to brigadier general and achieved national fame for his efforts at the Battle of Fort Donelson in Tennessee. Read more →

Selected Key Figures who Shaped 19th Century America

Vincent Valentine, MD

John Marshall was a veteran of the Revolutionary War, a congressman and Secretary of State. Above all, he was the "Great Chief Justice." From 1801-1835, his vision and leadership established the Supreme Court as the defender of the Constitution. Marshall was appointed Chief Justice by President John Adams. Up to that time, the Court had been a weak collection of political appointees. Each judge issued an individual opinion on cases brought before him. Determined to forge a strong Court, Marshall established a new policy called "the opinion of the Court." Under this policy, a forceful majority ruling was issued in each case. One of the Marshall Court's most important rulings dealt with the 1803 case Marbury vs Madison. Read more →


Vincent G Valentine, MD

Editorial Staff

"It's good sportsmanship to not pick up lost golf balls while they are still rolling."
— Mark Twain

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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.