Many thanks to Brandon Larsen, Jussi Tikkanen & Amresh Raina for coordinating the content for this month's issue.

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The Ides of March, the Luck of the Irish and the Vernal Equinox are fast approaching. In this issue, there are articles from the Pathology and Pulmonary Hypertension Councils. Included, we have messages from the International front and various announcements from our President, and congratulations to the winners of the Links Travel Awards. There are other important ideas contained within this special issue that might just give you pause to think and do what's right for humanity's sake. Read on.

Vincent Valentine, MD
Links Editor-in-Chief


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2017 Recipients of the ISHLT Leach-Abramson-Imhoff Links Travel Awards

Over the past year, the ISHLT again had a productive year from over 100 writers contributing to the ISHLT Links Newsletter. To deter us from analysis paralysis, we must decide, sometimes with "Big Decisions" but not always the right decision. From power dynamics and groupthink to group polarization, our decisions are subjected to biases resulting in decisions that could be hazardous to someone's life. A grid and a checklist will foster collaborative decision making to reduce hazards as we have decided on this year's Links' Writers of the Year. Congratulations from such big decisions and with what were you doing in 1996 to Pediatric Cardiac Prehab. Of course, the forever important and necessary discussions of difficult news with our pediatric transplant recipients shed light on our sensibilities about caring and compassion. In the end, simply showing up proves that it is all worthwhile. Here, our Writer of the Year Award goes to none other than Quincy Young. Our First Runner-Up is Monica Horn, and Honorable Mention awards go to Melissa Cousino Hood and Erin Wells. Read more →


Dear ISHLT Members,

In these uncertain times, it seems vitally important for the International Society for Heart and Lung Transplantation to reaffirm our commitment to inclusivity and engagement of the global community involved in the care of patients with advanced heart and lung disease. A foundational principle of our Society has been to support our membership through scientific exchange, advocacy, and education. This charge was underscored in the recently developed ISHLT strategic framework in which one of our strategic imperatives is to "Engage Our Community Worldwide". The ISHLT is a vibrant and healthy professional society enriched by our diversity. On behalf of the ISHLT Board of Directors, I strongly urge the entire membership to recommit to our global mission. Our patients and our disciplines deserve no less.


Maryl R. Johnson, MD


Update from the Pathology Council

Brandon T. Larsen, MD, PhD

links imageThe Pathology Council is an active and exciting group that continues to provide vital, clinical research and educational expertise to advance the Society's initiatives, strengthen the transplantation community, and most importantly, help the patients we serve! Antibody-mediated rejection (AMR) continues to be a strong focus of our Council's efforts as we seek to better understand the phenomenon of AMR in cardiac and pulmonary allografts, refine our diagnostic criteria and relevant biomarkers for such, and disseminate this information to pathologists. To this end, the Council put together several collaborative research groups over the last year to facilitate multi-center studies on these topics, and our members continue to expand available online resources for transplant pathology. Read more →


There's no RV in ReVerse...or is there?

Jeremy A. Mazurek, MD

links imageWhile there is an extensive literature dedicated to left ventricular (LV) reverse remodeling in heart failure (HF), with current staples of HF therapy proven to not only improve outcomes but also improve left heart structure and function, the same may not be true for the right ventricle (RV) in pulmonary arterial hypertension (PAH). A simple 'pubmed' search using the terms "LV reverse remodeling" produced 785 results, while a search of "RV reverse remodeling pulmonary hypertension" yielded only 52 items. So the question remains: In PAH, does the RV reverse remodel after the initiation of pulmonary hypertension (PH)-specific therapy? PAH is a rare condition characterized by significant elevations in pulmonary artery pressure and pulmonary vascular resistance that results in high RV afterload leading to exercise intolerance, RV failure and ultimately, death. It is the RV adaptation to this increased load, and not pulmonary artery pressure elevation per se, that dictates clinical symptoms and outcomes. Read more →

Hiding in Plain Sight: Harvest of Pulmonary Artery Endothelial Cells from Discarded Swan-Ganz Catheter Balloons May Illuminate PAH-Specific Biological Processes

Michael J. Passineau, PhD

The diagnosis of pulmonary hypertension (PH) requires right heart catheterization (RHC), thus this diagnostic procedure becomes the gateway through which patients enter into management of PH, regardless of the etiology. While the hemodynamic information obtained by RHC is crucial to the management of PH, hemodynamics alone provide relatively little insight into the biological processes underlying pulmonary pressure changes, and thus a constellation of additional clinical observations are needed in order to properly assign a patient to the appropriate WHO Group classification. In 2013, we reported in the Journal of Heart and Lung Transplantation that it was possible to recover Pulmonary Artery Endothelial Cells (PAECs) from the balloon tips of Swan-Ganz catheters after RHC. Read more →

Pathologic Lesions of Chronic Thromboembolic Pulmonary Hypertension

Belinda Rivera-Lebron
Michael G. Risbano

Acute venous thromboembolism resolves in most cases. However, an estimated 0.5%-3.8% of pulmonary embolism (PE) survivors develop chronic thromboembolic pulmonary hypertension (CTEPH) resulting from mechanical obstruction of the pulmonary arteries [1-3]. Most patients with CTEPH have experienced a PE in their lifetime; however, up to 25% of patients have never reported a thrombotic event [4]. Patients may present with exertional dyspnea, fatigue, palpitations, lightheadedness or syncope. CTEPH is diagnosed by precapillary pulmonary hypertension (mean pulmonary arterial pressure > 25 mm Hg and pulmonary arterial wedge pressure ≤ 15 mm Hg) on right heart catheterization and abnormal ventilation perfusion scintigraphy (VQ scan) including at least one mismatched perfusion defect with confirmatory imaging by either computed tomography (CT) angiography or pulmonary angiography [5]. CTEPH is primarily caused by the transformation of incomplete resolution of thrombi into fibrotic organized fibrotic scar tissue. Read more →


Pulmonary Arterial Hypertension, 25, and the Holy Grail

Timothy Baillie, BBiomedSC, BMBS, FRACP

links imageArbitrary: based on random choice or personal whim, rather than any reason or system. Undertaking a Fellowship should provide an opportunity to think and to ask questions. Moving to Toronto from Australia some months ago to continue training in my area of interest, pulmonary hypertension, I have been thinking: why is the sun so far away? Why aren't there more venomous creatures around? Why is Pulmonary Arterial Hypertension (PAH) only recognized as a 'problem' once hypertension arises, when it was noted that Primary Pulmonary Hypertension (now PAH) was best described as a "plexogenic pulmonary arteriopathy" back when gasoline (AKA Petrol) was 44c a gallon (AKA 3.785 litres) and you could pick up a new and improved version of the Ford Mustang (AKA Ford Mustang II) for $4105 (all USD of course) {Hatano S, 1975 #1273}? If PAH is a pulmonary arteriopathy, why is a mean pulmonary arterial pressure (mPAP) of 25mmHg a pre-requisite for diagnosis? Read more →

Antibody-Mediated Rejection in Lung Transplant: Pathologist's Perspective

Prodipto Pal, MD, PhD
Rex Michael Santiago, MD

Antibody-mediated rejection (AMR) is a complex process, well-recognized in kidney and cardiac allografts, but remains ill-defined in lung transplantation [1]. There are no agreed-upon histopathologic diagnostic criteria in pulmonary allografts. AMR as a cause of chronic lung allograft dysfunction (CLAD) is well-established in the literature; yet, the true incidence of pulmonary AMR remains unknown due to lack of comprehensive diagnostic criteria. The consequences of AMR mediated by donor HLA-specific antibodies (donor specific antibodies - DSA) range from persistent/ recurrent acute cellular rejection (ACR) to lymphocytic bronchiolitis, and chronic rejection manifesting as bronchiolitis obliterans syndrome (BOS) to the irreversible changes of chronic rejection and CLAD [2, 3]. Read More →



Click here to see a full list of the 2017 Grants & Awards Recipients


Click here to the times and locations of all Council Meetings and Networking Receptions taking place at the 2017 ISHLT Annual Meeting

Tweeting at #ISHLT2017

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Nobel Prizes, Transplantation and the Immune System

Javier Carbone, MD, PhD

links imageImmune response during transplantation is quite complex. Several components participate in distinct phases before and after transplantation and there's a huge amount of variability. Here, we briefly review more than a century of accomplishments in studying some of these components by Nobel Prizes in Physiology or Medicine. Each of these discoveries have provided us with a better understanding of how this system works. Emil von Behring (Nobel Prize in 1901) identified serum specific factors that neutralize the toxic products from tetanus and diphtheria bacteria. Specific hyper immune immunoglobulins can now be used for a better control of severe infectious complications after transplantation. Ilya Ilyich Mechnikov (1908) identified phagocyte cells and phagocytosis. However, the role of this important, innate immune function in heart and lung transplantation remains poorly explored. Paul Ehrlich's side-chain theory (1908) proposed how antibodies released in blood can control infection. Read more →

The Spanish Registry of Pulmonary Arterial Hypertension (REHAP)

Jose Cifrian, MD

Recently, large national observational registries in different countries have provided information on current PAH epidemiology, increasing awareness about the disease. Furthermore, these national registries have made possible the reassessment of patient survival under present conditions, leading to the formulation of new predictive survival equations. Epidemiological data from different countries, sometimes with different healthcare organizations, drug availability and financial outreach, may provide a more comprehensive view of current management of the disease worldwide. Different efforts have been done in United States (U.S Reveal), Scotland (Scottish-SMR), France (French Registry), China (New Chinese Registry), United Kingdom, but also in Spain to try to analyze prevalence, incidence and survival of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), and to assess the applicability of survival prediction equations. Read more →

Organ Procurement Surgeons: A Viable Surgical Specialty?

Roger Evans, PhD

links imageOver the past year, I have received numerous inquiries related to the recruitment of what are being called "organ procurement surgeons." I have come across 10 to 12 position postings on various electronic job boards. With one exception, the postings have only referred to cardiothoracic organs. Employer of Record: For the most part, the positions have been posted by hospitals and medical centers offering transplant services. In one instance, the position was posted by an organ procurement organization (OPO), in cooperation with a university medical center. Some of the other postings mention the local OPO, without elaboration. Responsibilities and Duties: The responsibilities of the organ procurement surgeon are variable. Some positions are clearly organ procurement only. In other words, there are no patient care/transplant responsibilities. Read more →


Cardiac Surgeon, Generic University Medical Center, Division of Cardiac Surgery, Any City, Any State, USA

Description: Generic University Medical Center, Division of Cardiac Surgery, is actively recruiting a cardiac surgeon with an academic appointment commensurate with experience. As everyone knows, we've been recruiting forever. Our position is moribund, and we've recently decided it's pretty much dead. Nonetheless, we're giving it the old college try. We know football fans will appreciate our commitment, although we're obviously losers. Without explanation, people have simply quit our A-team, as well as our practice squad. Thus, we now ask that you forgive us for past transgressions. We're on a bumpy road to recovery. With each additional setback, we're committed to digging a little deeper, until we reach six feet. The ideal candidate will have experience in minimally invasive cardiac surgery, including robotics, valve and coronary surgery, as well as TAVR. LVAD/MCS and transplant experience is preferred. Read more →


Dealing with Death as Witnesses

Vincent Valentine, MD

links imageOut of referrals, evaluations, listings and replacement procedures including transplantation and deploying mechanical devices, along with ongoing care and dutiful management comes experience with recovery and death. The thousands of lives we touch regardless will still result in the unavoidable topic of death. It is the pillar that underlies medicine, life, and art. We must turn to the literary arts to add a human dimension of our endeavors in medicine and life. If there is one book that will guide us among many others, it is Intoxicated by My Illness and Other Writings on Life and Death by Anatole Broyard. I believe it is the ultimate must read for all health care providers, especially for the ISHLT. We will benefit from the enlightenment that art can offer. Witnessing death has and will continue to occur, yet do we know what it means to witness death? To what extent is death a reality more for witnesses than it is for the dier? Faulkner's book As I Lay Dying sets the stage of death. 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.