THIS MONTH'S FOCUS:

PULMONARY HYPERTENSION
HEART FAILURE & TRANSPLANTATION

(PDF VERSION)

Many thanks to Amresh Raina & David Nelson for coordinating the content for this month's issue.




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VINCENT'S VALENTINE SENSE:

The events in the United States for February include: Groundhog Day, the Super Bowl, Valentine's Day, the Academy Awards and of course there is President's Day. Originally President's Day was a venerated observance of Washington's Birthday (February 22) for most of the 1800s, it wasn't until 1879 when President Rutherford B Hayes signed this day into law as a federal holiday. Today, President's Day is celebrated on third Monday of the Month as a patriotic celebration and remembrance of all Presidents, and of course to bolster retail sales. As we continue on the road less traveled these days to Washington, D.C., three articles on the next series of the United States Presidents are presented to you. In the Spotlight for this month we have the first two, one on JFK and the other on LBJ. Next, is an update on the strategic planning process. After that, Brian Houston and Ryan Tedford start Pulmonary Transplantation off with Making the Call: Pulmonary Hypertension in Cardiac Transplant Candidates followed by Manreet Kanwar's report on The Challenges of Launching a CTEPH Program and Jean Magazzu's perspective to Take A Deep Breath: A Patient's Perspective on the Diagnosis of CTEPH, Surgery and Life Beyond. In Heart Failure & Transplantation, is Grant Paulsen's Influenza Vaccine Update - Episode II, Adults are People Too, Joyce Cheng and Oscar Colegio's Nicotinamide for Chemoprevention of Cutaneous Squamous Cell Carcinoma in Solid Organ Transplant Recipients and Daniel Kim's A Personal Approach to "Asymptomatic" Donor Specific Antibodies or Fodder for Academic Deliberations. As Special Interest pieces, we have the Aspen Lung Conference Call for Abstracts, BSTR Bright Lights: A New Approach to Stratifying Cytomegalovirus CMV Risk by Daniel Chambers and James K Polk, ISHLT and What to do in Washington, DC by Pam Combs. For the Editor's Corner is the article on the next three presidents after JFK and LBJ, Unfinished Defeated Presidents Because They Never Quit which encapsulates Richard Nixon, Gerald Ford and Jimmy Carter. All five of these Presidents, JFK, LBJ, Nixon, Ford and Carter deserve their own independent summary, however it seems at least from my perspective and in my lifetime, America has had a vexing fascination more so on JFK and LBJ, and arguably with Tricky Dick. All five did have something in common, they served in the Navy. More appropriately and additionally, all five had been the "The Man in the Arena," as excerpted from Teddy Roosevelt's speech at the Sorbonne in Paris, France on April 23, 1910.

"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat."

When my memory of these five Presidents truly began is debatable. I was merely two years and three months old when JFK was assassinated. But one anecdote I must share with you. It was Wednesday morning, June 5, 1968 when my mother dropped my brother and me off at my grandmother's on her way to work just before 7 AM. A routine that we had become accustomed to for some time. My grandmother went to the kitchen to fix breakfast while my we turned on the Zenith black and white television. Our regularly scheduled program was interrupted with a recording of the assassination attempt of Senator Robert Kennedy. I ran to the kitchen, shouting "maw-maw, maw-maw, Kennedy's been shot!" Her response, "again!" Many times, I've share this response with my grandmother and family and many times with rapturous laughter. Was my grandmother, age 56 at the time referring to another Kennedy assassination after Jack Kennedy; another assassination, Martin Luther King, Jr had just been assassination some two months ago; or the humor of it was that Jack was shot again? Jack had been previously assassinated in 1963. Surely, she was unaware of Bobby being shot roughly 2:15 AM CST at the Ambassador Hotel in California just less than 5 hours before we were dropped off. My grandfather was not due home until 3 PM, he was working a 16-hour turnaround at Exxon refinery, Esso at the time in Baton Rouge, Louisiana. Incidentally, the only other sitting US Senator assassinated was Huey P Long at the State Capitol Building in Baton Rouge by Dr Carl Weiss.

Vincent Valentine, MD
Links Editor-in-Chief



IN THE SPOTLIGHT:


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JFK

Vincent Valentine, MD

From a wealthy, powerful and politically prominent Irish Catholic Family, John Fitzgerald Kennedy, nicknamed Jack, was born in Brookline, Massachusetts on May 29, 1917. As with all other presidents, his family shaped his life and career. Read more →


LBJ

Vincent Valentine, MD

Lyndon Baines Johnson was born on August 27, 1908 in Stonewall, Texas. After attending high school in nearby Johnson City and graduating from Texas State University in 1930, Johnson attended law school at Georgetown University in 1934. Always mindful of his own impoverished childhood, he devoted himself in bringing dignity and justice to the poor. Read more →



STRATEGIC PLANNING UPDATE

ISHLT has been engaged in an iterative strategic planning process since April 2015 with the goal to develop a 5-year Strategic Framework. This process has involved collecting input from ISHLT members including current and past leaders, via surveys, conferences calls, and online community discussions. The Board of Directors and the Strategic planning Task Force met for a day in October to begin evaluating the information collected. A diverse group of 21 Society leaders and staff met in Coral Gables, FL in January 2016 to consider all of the data collection findings and discussions to date, and to draft a Strategic Framework for the Society. The meeting was facilitated by Susan Meier, Principal of Meier and Associates. Read more →



PULMONARY HYPERTENSION:



Making the Call: Pulmonary Hypertension in Cardiac Transplant Candidates

Brian A. Houston, MD
Ryan J. Tedford, MD

I hang up the phone and sigh. I've just gotten the call that every transplant cardiologist dreads. "We're coming out with an RVAD," our surgeon told me, sounding as weary as expected given the operative implications of that statement. The patient who had smiled so broadly today after I told her that a donor heart was available now is now suffering from acute RV failure after orthotopic heart transplant (OHT) and faces a much more difficult road to complete recovery. Even in the current era, acute right ventricular failure accounts for a significant proportion of the morbidity and mortality after OHT. While many factors play a role in the development of acute RV failure (donor organ selection and preservation, ischemic time, donor-recipient size matching), the most prominent is the pre-existence of pulmonary hypertension (PH) in the recipient. Read more →



The Challenges of Launching a CTEPH Program

Manreet Kanwar, MD

links imageChronic thromboembolic pulmonary hypertension (CTEPH) continues to present a diagnostic and therapeutic challenge for both patients and physicians - with issues ranging from delay in appropriate diagnosis, inadequate use of screening tools and determination of appropriate treatment strategy. Even though CTEPH remains a rare disease, the delivery of its care has been transformed from experts at highly specialized centers to a broad spectrum of providers with varying degrees of expertise, leading to non-uniformity of care. As a result, early access to expert centers and assurances of optimal patient-care have become increasingly relevant concerns. Read more →



Take A Deep Breath: A Patient's Perspective on the Diagnosis of CTEPH, Surgery and Life Beyond

Jean Magazzu

Truly, my story begins at birth. But since that was so long ago, I won't bore you with that level of detail. However, after hearing this story most people respond by asking, "How did that happen?!" and we end up going back to 1967. But for now, I'll start in 2007...
Around the time I turned 40 in 2007, I began having intermittent periods of shortness of breath. I assumed it was caused by an allergen and ignored the symptoms that would years later lead to one of the scariest moments of my life. In early 2011, at the very young age of 44, I experienced this same shortness of breath accompanied by a wet cough. My PCP's diagnosis was bronchitis, so she put me on antibiotics and prescribed an inhaler. After a few weeks and two more courses of antibiotics with no improvement, my shortness of breath became severe - a conversation or short walk across the room took my breath away. Read more →



HEART FAILURE & TRANSPLANTATION:



Influenza Vaccine Update - Episode II, Adults are People Too

Grant Paulsen, MD

links imageVery little in life is ever simple or clear-cut; that is doubly true when discussing vaccines and transplant patients. Upon further review, there may be benefit to discussing some of the specific options available for influenza vaccination in adults. The FDA currently has 21 different influenza vaccines licensed for distribution in the US [1]. That's a bit much to keep up with, even for an Infectious Disease physician, not to mention someone that doesn't spend all of their waking hours trying to keep track of the differences in flu vaccine between manufacturers. The goal here is to focus on a few key points and try to simplify that list of twenty-one vaccines a bit. Read more →



Nicotinamide for Chemoprevention of Cutaneous Squamous Cell Carcinoma in Solid Organ Transplant Recipients

Joyce Y. Cheng, BS
Oscar R. Colegio, MD, PhD

Immunosuppressed solid organ transplant recipients have a ~100-fold increased risk of cutaneous squamous cell carcinoma compared with the general population. Given that deaths from cutaneous squamous cell carcinoma in the United States white population were estimated to approximate the deaths from malignant melanoma in 2012 [1], it follows that mortality due to cutaneous squamous cell carcinoma would have been even greater among solid organ transplant recipients. A recent large population-based study of cancer mortality in solid organ transplant recipients in Ontario, Canada, found that, of all cancers, skin cancer was responsible for the highest incremental risk of death in solid organ transplant recipients, with a standardized mortality ratio of 29.82 (95% confidence interval, 18.23-46.10)[2]. Read more →



A Personal Approach to "Asymptomatic" Donor Specific Antibodies or Fodder for Academic Deliberations

Daniel Kim, MD, FRCPC

links imageThe downside of proposing an approach to a contentious topic is that there will be no shortage of experts ready to point out the errors of my ways. Alternatively, by the time someone actually proves me wrong, my eloquent discourse will have been long buried in the electronic wasteland of past LINKS issues. So, comforted by assured future anonymity, I share my thoughts on the conundrum of clinically silent donor specific HLA antibodies (DSA). Not long ago, I attempted this and quickly found myself staring at the face of someone utterly confused, yet too generous, or perhaps too afraid to stop me. With that in mind, I will narrow the scope of my discussion to DSAs in the post-transplant recipient, evading issues around pre-transplant DSAs, methodological nuances or non HLA antibodies. Read more →



OF SPECIAL INTEREST:



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

links imageWe 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 that affect the lung, the Aspen Lung Conference blends cutting-edge basic and clinical research in a setting that facilitates extensive discussion amongst the participants. This is the very first time that lung transplantation will be the topic of discussion. Read more →



James K Polk, ISHLT and What to do in Washington, DC

Pam Combs, PhD, RN

links imageHere are some tips to do while in Washington D.C. ISHLT Annual Conference by following the tenure of James Knox Polk, America's least known presidents of all time.
Attend as many sessions/events to learn and meet many people:
James Knox Polk was the eleventh United States President from 1845 to 1849. He was born on 1795 in Mecklenburg County, North Carolina. Polk achieved nearly everything he stated he wanted to in his platform; however, some critics consider Polk as "the one who missed great opportunities." Read more →




ISHLT NEWS AND ANNOUNCEMENTS:



BSTR Bright Lights

BSTR Bright Lights is a web-based forum for the submission of significant contributions (manuscripts) and reviews of these contributions to place the significance in context for clinicians. The Council is interested in increasing the interaction of its liaisons and their respective councils with the BSTR Council. As BSTR touches all aspects of transplantation, we believe that each council will have important and meaningful contributions that we could leverage and make available to our membership through this webpage. If you are interested in providing a manuscript review for future posting, please contact the BSTR Council Chair. View this month's contribution →




EDITOR'S CORNER:

Unfinished Defeated Presidents Because They Never Quit

Vincent Valentine, MD

links imageRichard Milhous Nixon was born in Yorba Linda, California on January 9, 1913. As a result of struggling in poverty with his family, Nixon developed focus, tenacity and ambition early on and worked his way with brilliance through Whittier College and Duke Law School. While working as an attorney in Whittier, California, he married Thelma Catherine "Pat" Ryan in 1940 and had two daughters, Patricia and Julie. After serving as a Navy lieutenant commander in World War II, he was elected to the House of Representatives and then to the Senate in California. In 1952, Eisenhower chose Nixon to be his Vice-President, a position he held for eight years. Nixon lost to JFK by a razor's edge in the 1960 Presidential race, but in 1968 he ran again and became the 37th President of the United States. Read more →





Contact

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


Editorial Staff


"Leadership is the art of getting someone to do something you want done because he wants to do it."
— Dwight D Eisenhower

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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.