THIS MONTH'S FOCUS:

PATHOLOGY
PULMONARY TRANSPLANTATION

(PDF VERSION)

Many thanks to Brandon Larsen & Tereza Martinu for coordinating the content for this month's issue.




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VINCENT'S SPRING SENSE:

Now that spring is in the air, we are ever so closer to the new beginnings in Washington, DC and the blooming of nearly 1700 famous Cherry Blossom Trees. Unfortunately, by kick-off of the 36th Annual ISHLT meeting, these trees will have shed their blossoms with fresh green leaves bursting through for us as we try to identify these ever popular trees responsible for their evanescent blossoms. Nevertheless, a beautiful spring will greet us. Now, this issue greets us with a shining spotlight on the winners of this year's ISHLT Leach-Abramson-Imhoff Links Travel Awards. Next, Brandon Larsen from the Pathology Council gives us an update on the "Recent Progress in the Pathology of AMR and CAV", followed by June Kim from the Pulmonary Transplantation with "Life and Lung Transplantation in the Washington Area". Mandeep Mehra's "Deaton, the Mid-Life Crisis in America and Thoracic Transplantation, Pam Combs' "Where's the Rest of Me???" and Daniel Dilling's "Use of mTOR Inhibition among Candidates on Waiting List for Lung Transplantation: Is it Time for Consensus?" spark our interest with fresh ideas on what's to come from our continued efforts in the ISHLT. We wrap up with two articles from the Editor's Corner with "The Great Communicator: The Actor, The Gipper, The Quipster, Teflon and Alzheimer's" and "Taxes, International Affairs, Economy, Scandals, Terrorism, Natural Disasters, Healthcare". This completes our march across all 44 U.S. Presidents which began with George Washington in the June 2015 Volume 7, Issue 2, Onward Soldier to the ISHLT in Washington, DC. What lessons have we learned through this journey of some of America's greatest leaders spanning over 225 years? And how do these leaders compare with today's candidates for America's upcoming elections?

Vincent Valentine, MD
Links Editor-in-Chief



IN THE SPOTLIGHT:


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2016 Recipients of the ISHLT Leach-Abramson-Imhoff Links Travel Awards

Over the past year, the ISHLT again was very fortunate to have nearly 100 writers contributing to the ISHLT Links Newsletter. Attention to appropriate treatment strategies and drug monitoring for nontuberculous mycobacterial and fungal infections in our patients can contribute to better outcomes. Although expensive, innovative CFTR modulator therapies in cystic fibrosis continue to help patients suffering with cystic fibrosis and delay deterioration in their lung function. Read more →



PATHOLOGY:



Recent Progress in the Pathology of AMR and CAV

Brandon T. Larsen, MD, PhD

links imageAt times, the rapid pace of new developments can be overwhelming to the practicing physician, and this is certainly true in the field of heart and lung transplantation pathology! In the November 2015 issue of Links, our Council highlighted many of the key pathology publications from the last year, to help busy pathologists stay abreast of our rapidly evolving field. But time flies even faster, as we all know, necessitating another ISHLT Links update from the Pathology Council.
In the last 3 months since our last update, we've already seen several new studies published that advance our understanding of allograft pathology. As in recent years, antibody-mediated rejection (AMR) and cardiac allograft vasculopathy (CAV) remain a strong focus of our Council's discussions and research efforts. Read more →



PULMONARY TRANSPLANTATION:



Life and Lung Transplantation in the Washington Area

June Kim, MD

The Lung Transplantation community in the Maryland-Washington DC is exemplified by a spirit of collaboration among regional Transplant organizations and physicians on behalf of patients with Advanced Lung Disease. The University of Maryland Medical Center and Johns Hopkins Hospital recently joined forces as an approved Care Center Network (CCN) site for the Pulmonary Fibrosis Foundation. "The joint collaborative CCN site allows for an even more robust multi-disciplinary approach, taking advantage of each institution's unique areas of expertise to advance the care of individual patients, and to hopefully advance overall understanding of pulmonary fibrosis syndromes", explained Dr. Nevins Todd co-director of the program. Read more →



Lung Donation After Circulatory Death And The Potential Role Of Ex Vivo Lung Perfusion

Bryan A. Whitson, MD, PhD

links imageWorldwide, lung transplantation is growing and our collective outcomes are improving. These improvements are a culmination of our collective advances in patient selection, preoperative management, surgical experience, and meticulous postoperative and longitudinal care. Further increases in our ability to offer this life-giving therapy to patients in need is, and will be, limited by the availability of numbers of donors of sufficient quality. In order to meet the demand, non-traditional (i.e., brain-dead donors (DBD)), approaches need to be pursued. Lung donation after circulatory death (DCD) is one potential avenue. Read more →



OF SPECIAL INTEREST:



Deaton, the Mid-Life Crisis in America and Thoracic Transplantation

Mandeep Mehra, MD, MBBS, FACC, FACP

links imageAngus Deaton won the 2015 Nobel memorial prize in economic science for his work on the behavior of consumption and its effect on poverty and social ills. In an incisive analysis of recent data from the Centers for Disease Control, Deaton and his wife, Ann Case, concluded that the gains in life expectancy from advances in the treatment of heart disease, cancer and infectious diseases had somehow eluded a significant sector of the US population - the non-Hispanic middle aged white population (age groups of 25-45 years). As it turns out, this group is tracking a disturbing increase in death rates from drug overdose, substance abuse and suicides. Naturally, one must ask why this trend is occurring and how its unintended consequences might manifest in our world of transplantation. Read more →



"Where's the Rest of Me???"

Pam Combs, PhD, RN

links imageAs this author and Dr. Vincent Valentine confess and share a mutual passion regarding the movie classics, a relevant and most famous quote, "Where's the rest of me?" contained in President Ronald Reagan's best known film was discovered. The intellectual discussion around the quality of life (QOL) of Ventricular Assist Device (VAD) patients, and their quest for finding answers to "where's the rest of me?" has prompted providers to reassure VAD patients with a common mantra, "we are focused on providing you a life with quality." Certainly, this should serve as a reminder of "What's it all about?" in all endeavors for all patients in need of health care, and especially patients with failing hearts, failing lungs and recipients of replacement therapies including heart and lung transplantation. However, the focus of this brief primer is on the ever-important topic of QOL among VAD patients. Read more →



Use of mTOR Inhibition among Candidates on Waiting List for Lung Transplantation: Is it Time for Consensus?

Daniel Dilling, MD

links imageInhibitors of the mammalian target for rapamycin (mTOR) - the two agents being sirolimus and everolimus - are commonly used as immunosuppressants in solid organ transplant. These agents are used in lung transplantation for a variety of reasons: to augment standard immunosuppression; to allow for lower levels of calcineurin inhibitors (as in the case of renal dysfunction); to protect against malignancies (especially skin malignancies); or as a means of stabilizing chronic lung allograft dysfunction (CLAD). Read more →




EDITOR'S CORNER:

The Great Communicator: The Actor, The Gipper, The Quipster, Teflon and Alzheimer's

Vincent Valentine, MD

Ronald Wilson Reagan was born on February 6, 1911 in Tampico, Illinois. Son of a shoe salesman with a drinking problem and a deeply religious woman who loved the theater and encouraged him to act. His family was poor and lived as transients in different parts of Illinois before settling back in Tampico where they resided above the H.C. Pitney Variety Store before settling in Dixon, Illinois. This natural quintessential quipster would later quip that he was "living above the store again," after moving into the White House following his election. At Dixon High School he was a mediocre student but excelled in sports, acting, and in his work as a lifeguard and served as student body president. He attended Eureka College majoring in economics and sociology and continued to excel in sports, drama and again was elected student body president. Read more →



Taxes, International Affairs, Economy, Scandals, Terrorism, Natural Disasters, Healthcare

Vincent Valentine, MD

George Herbert Walker Bush was born in Milton, Massachusetts on June 12, 1924. He graduated from Phillips Academy in Andover, Massachusetts where he was secretary of the student council, president of his senior class and a member of the editorial board for the school newspaper. He joined the Navy on his 18th birthday and became the youngest naval aviator of the time during World War II. After an honorable discharge, he attended Yale University and graduated in 1948 with a BA in economics and member of Phi Beta Kappa and the secret Skull and Bones society. After moving to West Texas with his wife, Barbara Pierce Bush, and young family, he started a successful oil business in Texas. Twice elected to Congress, he became an Ambassador to the United Nations, then headed the Republican National Committee, the US Liaison Office in Peking, and the CIA. Read more →





Contact

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


Editorial Staff


""Recession is when your neighbor loses his job. Depression is when you lose yours. And recovery is when Jimmy Carter loses his."
— Ronald Reagan

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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.