THIS MONTH'S FOCUS:

BASIC SCIENCE & TRANSLATIONAL RESEARCH
PULMONARY TRANSPLANTATION

(PDF VERSION)




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ALLAN'S AUSTRALIAN SENSE: NOW IS THE WINTER OF OUR CONTENT

Well, it is winter down-under and a very pleasant one indeed. Currently 72°F in Sydney. So why should we be content rather than discontent or even malcontent? Firstly, apologies to the bard for borrowing or perhaps one should say, appropriating, his title. Surely contentment is a state of mind but it also implies substance or content. It also implies reflection and that is exactly the purpose of an editorial and perhaps a large part of the purpose of an organ such as the LINKS. For a number of years now, our worthy Editor in Chief, Dr. Vincent Valentine has variably amused us, challenged us and educated us scientifically and in a literary sense with his erudite editorials on a broad range of topics. Rest assured that the present effort is not an attempt to emulate those editorials but to provide a slightly different perspective. It will not be focused on the lung, despite the topics enclosed within this particular edition of the LINKS and my avowed predilection for that fascinating organ. Conversely, the express challenge for all of us is to read widely and consider aspects broadly relevant to organs, devices and conditions outside our immediate purview. We should also embrace scientific and translational aspects as exemplified by the programming at our annual scientific meeting and in our academic publications. It is, of course, one of the abiding strengths of the ISHLT that we all have the opportunity of learning from each other and of using that knowledge to the benefit of our patients in areas that are somewhat outside our immediate field of vision. Furthermore, the very nature of the ISHLT demands us to respect the 'I' in the acronym and reminds us all that we should look beyond our local borders and develop a global vision of how we can best promote excellence in the diagnosis and management of advanced lung and heart diseases throughout the world, using all of the therapeutic strategies, devices and transplant technologies available in our contemporary armamentarium. The process is underway and I2C2 is growing.

So exactly why should we be content? Importantly, being content does not imply being complacent. We should never rest on our laurels but always pursue excellence in our clinical and academic spheres. Contentment implies a reasoned balance between our actions, our aspirations and our attainments. It implies that we have achieved as a Society and as a discipline, an appropriate level of success for our efforts. However, success always brings more work, which in itself is a worthwhile reward. So where are we now and where have we been? Where are our patients and where were they when we started this journey? At this stage, a number of us are privileged to care for patients we transplanted more than 20 years ago, who live productive lives to their satisfaction and fulfilment. Consider, that with all the risks and limitations of immunosuppression, infection and rejection in all of its guises, we have recipients who are 25 years post-transplant. While there may not be many, it is exactly these trail blazers who act as sentinels to remind our patients that there is hope for their future, hope for their survival and that there is a real promise of a potential that they did not envisage prior to transplantation. It is therefore imperative that we continue to extend the same level of care and attention to our long term survivors as our recent transplant recipients. That imperative serves the dual purpose of maximizing their own personal good, but also preserves hope for those who look to them as beacons of their own future.

The other great area of contentment lies in the breadth and depth of the community of transplant clinicians and scientists who now create a critical mass that is beginning to address and solve many of the problems of the past that once seemed almost impossible. Indeed, as we grow our knowledge base and populate our community with the best and brightest clinicians and scientists, we, as a Society of likeminded individuals, working for the common good, share in creating hope for a better future.

So, what is the difference between discontent and content? Perhaps it is focus, perhaps it is balance, perhaps it is finally realizing that each piece in a jig-saw-puzzle helps to clarify the whole picture.

Allan Glanville, MBBS, MD, FRACP



IN THE SPOTLIGHT:


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First 100 Days in Office

Maryl Johnson, MD
ISHLT President

It will be difficult in this short space to provide you with even a condensed version of all that has been happening in the ISHLT during the first 100 days of my presidency, but I will give it a try! It has been a true privilege to get to know many ISHLT members better and to work closely with you in beginning to implement the priority goals outlined in our strategic plan. I have also had the opportunity to work closely with Jeff Teuteberg and the Symposium Planning Committee for the 2017 ISHLT Annual Scientific Sessions. I won't say too much about this here as I don't want to steal Jeff's thunder. However, thanks to submissions from Councils and society members there were nearly 150 symposium proposals to choose from, so you can count on an another excellent program in San Diego. The time to start planning your abstract submissions and your trip to San Diego so that you do not miss out on the education and networking opportunities is NOW. Read more →



Program Committee Update

Jeff Teuteberg, MD
2017 Program Chair

Well it is hard to believe, but all of symposia for the 2017 are now complete! The 2017 Program Committee met in Montreal on July 16th and 17th and have put together 50 symposia and 3 plenary sessions for what promises to be an engaging, provocative and educational meeting. I wanted to take a moment to thank the membership and councils for submitting 152 symposia for the committee to review. I also would like to congratulate the Program Committee for the daunting task of distilling all of the submissions into a final program and the leadership of the liaisons for their collegiality, flexibility and timeliness. It also helped that the Committee knew how and when to let its collective hair down and enjoy our downtime. Lastly, and perhaps most importantly, I cannot thank the ISHLT staff enough for all of their time and dedication. Putting the program together is a remarkably complex task that lasts throughout the entire year, a task which they handle with grace, aplomb and good humor. Read more →



ISHLT NEWS AND ANNOUNCEMENTS:



ISHLT Call for Nominations to the Board of Directors

links imageDr. Duane Davis, MD, Chair of the Governance Committee, invites the nomination of qualified ISHLT members to serve as Directors on the ISHLT Board of Directors. There are four open positions for Director on the ISHLT Board of Directors. Completed nomination packets must be submitted to the ISHLT HQ Office by 5:00 PM US Eastern Time on September 15, 2016. Nominees desiring to be favorably considered for a Director position should have had significant involvement in and service to ISHLT. Additionally, the nominee should have demonstrated ability to think strategically, work effectively within a collective decision-making body, and have knowledge of or experience with organizational governance. Read more →



Safety Information Concerning Infections Associated with Heater-Cooler Devices

Food and Drug Administration

The U.S. Food and Drug Administration has published safety information to heighten awareness about infections associated with heater-cooler devices and steps health care providers and health facilities can take to mitigate risks to patients. There is the potential for nontuberculous mycobacteria (NTM) organisms found in water to grow in the water tanks of the heater-cooler device. Contaminated water from the heater-cooler device has the potential to aerosolize into the operating room during surgery, and this may lead to infection primarily in cardiovascular patients undergoing open-chest surgical procedures. Read more →




FOCUSING ON BASIC SCIENCE & TRANLATIONAL RESEARCH:



CRISPR-Cas9 in Heart Failure and Transplantation

Diana Kim
Howard Eisen, MD

It has been on the cover of Time magazine. So, to help you answer questions that your patients may raise after reading that article, we will review the important, developing field of gene editing. As we think about the future of heart failure and transplantation, it is important to maintain a keen eye for technologies that will impact our future patients. The foresight to anticipate and be ready for changes in heart failure and transplantation comes from understanding the scientific underpinnings and potential for new therapies. In this context, molecular biologists have recently discovered one of the most potentially transformative technologies seen in years. Read more →




FOCUSING ON PULMONARY TRANPSLANTATION:



Molecular Diagnostics in Lung Transplantation

Kieran Halloran, MD

links imageDiagnostics is one of the most significant issues facing the field of lung transplantation. In almost every other domain - donor utilization, bridging, surgical issues - major challenges have been met with meaningful solutions, but the diagnostic toolset available to the transplant clinician has only minimally evolved (1-3). Our ability to accurately and reproducibly recognize histologic T cell mediated rejection (TCMR) in the transbronchial biopsy (TBB) is limited, while the histology of antibody mediated rejection (ABMR) remains almost entirely elusive (4,5). Some of this is related to intrinsic limitations of histology, but this is further complicated by the risks and morbidity of TBB, preventing the sickest patients from being biopsied (6). Read more →



Preventing Primary Graft Dysfunction Before Transplantation

Andrea Mariscal de Alba, MD

links imagePrimary graft dysfunction (PGD) is an acute lung injury syndrome that occurs within the first 3 days of the post- transplant period, and is the most serious early complication after lung transplantation (1-3). It is characterized by lung edema, radiographic pulmonary infiltrates and hypoxemia. Clinically and pathologically, the syndrome behaves in many ways similar to the Acute Respiratory Distress Syndrome (ARDS) (4). The incidence of severe PGD is 11-25% (1,5) and it is associated with a 20-30% mortality rate in the first month after lung transplant and it is also associated with worse long-term survival (2,5,6). The specific pathophysiologic mechanisms resulting in PGD remain unknown and represent a very active area of investigation. Read more →




SPECIAL INTEREST:



Donor Call

Maryanne Chrisant, MD

On the corner of 84th and Park I press the pay-phone
to my head until my ear hurts to better hear the story.
A donor call: a bad end for some adolescent
whose size and blood are a good match for my patient
dying in the ICU way up-town
waiting for a heart. Read more →




EDITOR'S CORNER:

The Professional Patient: From the Heart with Lungs

"Professional Patient", I wonder what the job description would look like for that position. "Seeking candidate with a vibrant personality and a tough exterior to handle unpredictable health issues while trying to enjoy life. Positive outlook preferred. Health routine compliance a must." The fact is, this job is bestowed upon all patients who receive an organ transplant, regardless of the organ or original disease. As all patients are so often told prior to their transplant, getting a transplant is literally trading one disease for another. The set of problems from your original disease will be left behind in the dust, just a memory of the patient's former life. The issues that can arise post-transplant are manageable yet unpredictable. Every patient is different so there is no telling the life a transplant patient might be heading into. Read more →





Contact

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


Editorial Staff


"You are so brave and quiet I forget you are suffering."
— Ernest Hemingway

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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.