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At least north of the equator the changing climate is ever so hotter. And with that we have in the heat of the spotlight an update from our illustrious President, Maryl Johnson, as the ISHLT continues with strategic changes for the better. A fireworks celebration is an order with a shout-out to all of us as Mandeep Mehra reports the upward trajectory of our impact factor to 7.509 for the JHLT in 2015 - a 13% increase in one year, double digits here we come. The party continues with the success of the IMACS and the Global Evolution of Mechanical Circulatory Support by Jim Kirklin. As we go global, we must remain weary as our patients go global. Marcus Pereira reminds us to educate our patients on the importance of preparedness for overseas travel. If unheeded, Corey Hussain shares with us that some lung recipients may run out of air from perhaps going viral. Ever more globally could be the effect the "Andromeda Strain" of bacteria has on us (for those of you who might have read the must read important novel by Michael Crichton) as described by Stephanie Pouch who charges all of us to be the stewards of antimicrobials. David Nelson provides us an update on Donor Management Research with the harmonization of double randomization while Sangeeta Bhorade shares the contemporary questions in lung transplantation from the San Francisco ATS meeting. Maryanne Chrisant graces us with two poems from her heart. Finally, with changes and improvements in the air, we bring the updated ISHLT Links Newsletter's Mission and Vision with clear and exciting course charted for 2020.

Vincent Valentine, MD
Links Editor-in-Chief


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An Update from Your President

Maryl Johnson, MD

It hasn't even been two months since many of us were together in Washington D.C., but there has been a lot happening in the ISHLT and I want to take this opportunity to share some of these things with you, our members. Shortly after the Annual Meeting, Dr. Carla Baan resigned her position on the Board of Directors due to other commitments not allowing adequate time for her to actively participate. We want to thank Carla for her past contributions to the ISHLT and look forward to her ongoing participation as an ISHLT member. Read more →


2015 JHLT Impact Factors Released

Mandeep Mehra, MD, MBBS, FACC, FACP

links imageI am pleased to announce that the 2015 Journal Impact Factors were released today and JHLT (Journal of Heart and Lung Transplantation) has continued its strong upward trajectory.

Our new Impact Factor is 7.509 which has risen from 6.650 last year. We received 8,788 citations in this review period compared to 8,562 last year showing a robust increasing trend.

We continue to rank 1/25 in Transplantation (AJT IF this year was 5.669), have now moved to 2/199 in surgery, increased to 5/58 in respiratory medicine and 8/124 in the very competitive cardiovascular category (beating all heart failure journal including JACC-HF, Circulation- HF and the European Journal of HF)

Thanks again for your support of the Journal and its leadership.


Running Out of Air: Chronic Lung Allograft Dysfunction due to Respiratory Viral Infections

Corey Hussain

links imageChronic lung allograft dysfunction (CLAD) is nomenclature that consists of a syndrome of progressive loss of function and graft loss that was originally described in heart-lung transplant recipients in 1984 [1]. It is an irreversible cause of long term allograft failure and death affecting up to 45% to 75% of patients within five years after a lung transplant [2]. It is recognized as consisting of two distinct phenotypes, blronchiolitis obliterans syndrome (BOS) and restrictive CLAD (R-CLAD). A considerable number of risk factors have been associated with CLAD. These have historically included alloimmune rejection events; acute allograft injury as well as non-immune evens like gastroesophageal reflux and air pollution [3]. Read more →

Thoracic Transplantation on the Cusp of the Post-Antibiotic Era

Stephanie Pouch, MD

links imageThe lead article in the May 21, 2016 issue of The Economist, entitled "When the Drugs Don't Work," was, in my opinion, brilliant [1]. As a transplant infectious diseases specialist, I think about antimicrobial resistance on a daily basis. I often find myself needing to use older, toxic antimicrobials in combinations that have not been systematically evaluated in clinical trials in an attempt to manage multidrug resistant infections, such as those due to carbapenem-resistant Enterobacteriaceae. We are often able to effectively treat these infections; however, antimicrobials such as the polymyxins and aminoglycosides, especially when used in conjunction with calcineurin inhibitors, can lead to toxicities such as kidney injury, which may in turn have deleterious downstream effects on patient and graft outcomes. Read more →

When Your Transplant Recipient Travels Overseas

Marcus Pereira, MD, MPH

"Thank you doc, I'm glad my heart transplant is doing fine. I'll see you next time. Oh and by the way, I'm travelling with my friends to the Brazilian Amazon in a month. Should I take anything for that?" Most providers have been in that situation and that sense of bewilderment that takes you over is unshakeable. As the number of heart transplant recipients grows each year, with many of them living longer and healthier lives, travelling has become more frequent. In this globalized world, many transplant recipients are increasingly choosing international destinations [1]. While an exciting and rewarding undertaking, travelling overseas represents unique challenges to transplant recipients and must be carefully evaluated by the transplant team. For one, transplant recipients are at a significantly higher risk of contracting opportunistic and travel related infections [2-4]. Second, they are less likely to respond to important travel related vaccines [5]. Read more →


Donor Management Research Update and Double Randomization

David Nelson, MD

links imageDonor management research is critical to transplant recipients. Immunomodulating effects of pre-procurement injury not only affects the incidence and severity of primary graft dysfunction but also could promote antibody-mediated rejection. Donor management meaningfully influences organ utilization, early graft function, and long-term graft survival. It therefore directly affects wait-list deaths, costs (postop ICU care), and transplant benefits (quality of life and graft longevity). As previously reported in Links, two HRSA funded consensus conferences were held (Donor Intervention Research Expert Panel November 2014, Crystal City and May 2015, Philadelphia) to define barriers to donor management research and explore their possible solutions. Read more →

Special Interest:

IMACS and the Global Evolution of Mechanical Circulatory Support

James Kirklin, MD

links imageAfter three years of global data collection, the ISHLT Registry for Mechanical Circulatory Support (IMACS) is poised to report the global evolution of Mechanical Circulatory Support (MCS) therapies. Thirty-one countries are currently represented in the IMACS database. Total patient enrollment now exceeds 10,000 patients, supporting the IMACS mission of promoting scientific investigations and publications based on analyses of the international MCS experience. Nearly one-third of patients are actively listed for transplantation, whereas over 40% received a durable device with the intention of long-term or "destination" therapy. Isolated left ventricular support has been utilized in over 90% of patients. The most common age group is 50 to 69 years, accounting for nearly 60% of patients. More than 80% of patients at the time of implant are inotrope dependent and often in rapid circulatory decline. Penetration into ambulatory heart failure has been limited, accounting for less than 5% of patients at implant. Read more →

"Contemporary Questions in Lung Transplantation" Poster Discussion Session: American Thoracic Society May 2016

Sangeeta Bhorade, MD

links imageDuring the American Thoracic Society (ATS) meeting in May, several interesting and relevant topics were discussed in the poster session "Contemporary questions in lung transplantation". The topics were broad - ranging from persistent questions on the benefit of surveillance bronchoscopies in the lung transplant population while others addressed newer issues regarding the adequacy of the lung allocation scoring system and the concept of body composition, frailty and outcomes after lung transplantation. Here are some intriguing musings from this ATS session: Potential improvements in the Lung Allocation system gained favored responses... In two separate abstracts, Mooney and colleagues showed that both broader geographic sharing in patients with LAS > 50 and multiple listed lung transplant candidates decreased waitlist mortality suggesting that these may be important alterations to incorporate into the LAS. On the other hand, Nunley et al. showed that small changes in the LAS while listed may actually decrease chances for waitlisted patients to get transplanted. Read more →

Poems from ISHLT

Maryanne Chrisant, MD

Maryanne Chrisant, our newest Associate Editor has provided us with two poems that she has written over the years. Please enjoy both by clicking the links below.


The ISHLT Links Newsletter: Its Mission and Vision 2020

Vincent Valentine, MD

links imageThe ISHLT Links Newsletter is a reflection of what the ISHLT represents and how we perform as a group. Because the Links is free for all the world to see for anyone with internet access, we are transparent and accountable for its content. Although there could be downsides, with proper decorum and appropriateness, the upsides surpass the downsides. The Links is an educational vehicle for not only for the ISHLT but for the world, especially for patients and families dealing with heart and lung problems that may need replacement or transplantation or have already been replaced or transplanted. The Links provides each member an opportunity to contribute which allows our ISHLT community to come together in harmony and with synergy by sharing knowledge, stories, wisdom, opinions, ideas, activities and more. Along with the necessary technological advances for the science of what we do, the Links affords us the opportunity to infuse culture, history, music, art and literature with the ultimate goal of keeping us grounded in the humanities. Read more →


Vincent G Valentine, MD

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.