This year’s fascinating basic science and translational research symposia are appealing to all ISHLT attendees. In Re-Focusing the Blurry Vision: Biomarkers of Thoracic Allograft Rejection, different biomarkers in diagnosing and monitoring thoracic graft rejection will be discussed, some of which are already in clinical use and others are investigational. The sunrise session Highways to Hell: Chronic Lung Allograft Dysfunction will bring exciting lectures about novel and interesting hypotheses involved in the pathophysiology of CLAD. In Seeing the Light: Antibodies in Thoracic Transplantation, the aim is to acquire a deeper understanding of antibody-mediated mechanisms, treatments and potential downstream consequences of antibodies in transplantation. These sessions are innovating for both clinicians and researchers and will undoubtedly lead to novel insights.

Interventional options for the treatment of CTEPH are expanding with BPA recently emerging as an option in addition to PTE surgery. Yet, how can we compare the two therapies when there are differences in patient populations, procedures performed, and variability in reporting of risks and outcomes? A Fork in the Road: How Can We Compare Interventional Therapies in CTEPH? will address these issues and facilitate discussion on how we can move toward more uniform reporting of outcomes. The success of PTE has improved over the years due to better understanding of the pathophysiological mechanisms leading to major complications. This knowledge has translated into better ability to prevent them, recognize them early on and manage them more appropriately. Resilience in the Face of Calamity: The Art of Preventing Pulmonary Thromboendarterectomy (PTE) Disasters will review specific complications related to PTE and discuss how to manage them to achieve a successful outcome.

ISHLT2019 offers an exciting line-up of eight symposia that are of great interest to the contemporary heart failure and transplant communities. Future Shock: Great Debates in Cardiogenic Shock will feature three lively debates between leading clinicians on approaches to manage patients with cardiogenic shock, ranging from hemodynamic management to temporary mechanical circulatory support.

Special heart failure populations require unique management approaches, and these will be highlighted in Heart Failure in Adult Congenital Heart Disease: Unique Problems Need Unique Solutions, which will discuss controversial topics such as the timing of transplantation in ACHD patients, strategies for combined heart-liver transplantation, and use of mechanical circulatory support.

The management of patients with restrictive cardiomyopathies will be highlighted in the cutting-edge symposium entitled In the Thick of It: Hypertrophic and Amyloid Cardiomyopathies.

Novel and sophisticated imaging techniques have been developed to better characterize and manage complex heart failure patients, and these will be explored in a joint symposium between the ISHLT and Society of Cardiac Magnetic Resonance: Joint ISHLT/SCMR Symposium: Cardiac MRI and the World of Heart Failure: When Two Disciplines Harmonize. Ultimately, many of these patients will require transplantation, but the donor organ shortage continues to restrict heart transplant activity worldwide. Innovative strategies to increase donor utilization, including use of marginal donors, hepatitis C positive donors, and donors from distant locations will be explored in All Talk, No Action? New Strategies and Best Practices to Maximize Donor Heart Utilization, which will culminate in an animated debate about the pros and cons of Opt Out vs Opt In policies for organ donation.

Clinicians actively involved in the care of heart transplant recipients will benefit from cutting-edge talks on strategies to personalize and minimize immunosuppression in One Size Does Not Fit All: Personalized Medicine in Heart Transplantation, while experts in coronary imaging and pharmacology will discuss the diagnosis, prevention, and treatment of cardiac allograft vasculopathy. This symposium, entitled Cardiac Allograft Vasculopathy: Have Hope, Ye Who Enter, will end with a captivating debate on the role of revascularization and defibrillators for CAV treatment.

Provocative approaches to replace heart transplantation will be presented by outstanding international leaders in the fields of cardiac 3D printing, xenotransplantation, and stem cell therapy in Print, Replace, or Innovate: Alternative Strategies to Cardiac Transplantation. Finally, numerous abstract presentations throughout the meeting will present the results of innovative, on-going research in the fields of advanced heart failure and transplantation.

Come join in the fun at ISHLT2019. In the Joint ISHLT/ABTO Symposium: Combining Experiences to Enhance Thoracic Organ Transplantation Worldwide, we are partnering with the Associação Brasileira de Transplante de Órgãos (ABTO) to highlight the similarities and differences in transplantation between South America and other areas across the globe. Talks on tuberculosis and Chagas’ disease will be delivered by highly experienced experts. This will be of interest for ID and transplant physicians alike, especially in this age of global travel. Infections in MCS device recipients will be looked at from a new angle, with an update on the consequences of MCS device infection and a very interesting talk on the role of biofilms in MCS device infections in MCS Infections: New Twists in an Old Saga.

In the Magic Kingdom of the Bronchoscopy, experts will discuss the evidence related to the interpretation and treatment (or not!) of positive culture results from surveillance bronchoscopies post-lung transplantation. To round out the fun on this ID rollercoaster, we will have an update on fungal infections in FUN and Games with FUNgal Infections in Lung Transplantation. We will hear cutting edge talks on diagnosis, drug-drug interactions, therapeutic drug monitoring, inhalational medications and in the increasing specter of antifungal resistance.

Six pulmonary-focused symposia will present scientific data and expert opinions of high clinical relevance to everyone who works in the field of lung failure and lung transplantation. The ongoing scarcity of organs available for transplant remains a challenge in lung transplantation. Making Them Count: Enhancing Donor Utilization aims to review strategies to optimize organ utilization by improving donor management and using organs from DCD donors, Hepatitis C donors and older donors.

Location, Location and Allocation: World Wide Application of Broader Sharing in Lung Transplant covers an overview the differences in international lung allocation practices, comparing the USA, European, Canadian and Australian experiences. Ex Vivo Lung Perfusion (EVLP) in 2019 – From Research to Implementation looks at current practices and different models used as well as the ongoing clinical trials with EVLP and the rationale for using portable EVLP.

Immunobiology of the Older Lung Transplant Recipient will address why there are significant differences in this cohort of patients who are more at risk of infection and malignancy but experience decreased rates of rejection. Lung Transplant Candidate Selection: Challenging Cases addresses previous contraindications which are now potentially possible leading to increased lung candidate access.

Finally, the greatest challenge of all, Chronic Lung Allograft Dysfunction (CLAD): The End of the Beginning? aims to review how we can make a more accurate diagnosis of the different phenotypes, i.e. obstructive versus restrictive terminology, and will cover the major risk factors for the development of CLAD using the most update information on this topic.

If you are looking for inspiration, cutting edge scientific content, or simply a great ride, you will get it all during ISHLT2019. Begin with leaving planet earth in the Joint ISHLT/ICCAC Symposium: Faster, Higher, Stronger: Monitoring Exercise in Cyberspace and you can learn how your LVAD patients can get the most out of their heart assist device.

The exciting interplay of pacing technologies and durable VAD will be further explored in a symposium They Tell Me I Am Irregular: Why Do They Care? Arrhythmias in LVAD Recipients. Exploring the ultimate goal of rebuilding the heart on LVAD, we provide the latest insights on recovery in the session Cardiac Reverse Remodeling in MCS: State of the Art. Surgical approaches to LVAD implantations have evolved dramatically and the symposium Limiting the Invasiveness of the VAD Therapy: Alternative to Limited Surgical Approaches will update you on how the edges are cut in 2019.

Two special symposia, From Isolated to Mainstream: Evolving ECMO Strategies That Are Reshaping Outcomes and Short Term Mechanical Support: Taking the Next Leap Forward will give a comprehensive primer and expert opinion on the many developments we have witnessed over the past two years in the exciting acute support arena. Hemodynamic tailoring, hemocompatibility assessments, device and patient selection, and ECMO management strategies are just a few of the topics covered here.

Lastly, before you leave, get a reality check in a symposium dedicated to serious adverse event currently (!) limiting our abilities to broaden MCS to earlier stages of heart failure in Medical Management of LVAD Patients: Once the Chest is Closed, the Trouble Begins. We hope to see you in Orlando for a great meeting!

This year’s Nursing and Allied Health sessions bring together ISHLT’s various disciplines – there is something for everyone in each session! Whether a mechanical circulatory support device or a continuous infusion pump, discharging home with a device can be fraught with challenges and fears. Preparing patients and families for a successful discharge home through self-management interventions and education will be covered in Part of (Their) World: Discharging Patients Home with a New Device. This session will also address issues important to patient quality of life, like bathing, drinking, sex and traveling.

Matters of Life and Death: Palliative and End of Life Care in Transplant Medicine, aims to advance the ways in which we care for patients during another important transition, end of life. Physical, emotional and pharmacological interventions will be discussed, while also bringing attention to the importance of collaboration and cultural/religious considerations. Under recognized for much too long, the need for addressing provider burn-out in organ failure/transplant medicine will also be highlighted at the podium.

Sunrise Symposium: Fragility: Not Necessarily Failure will underscore the holistic approach needed to care for a fragile community of patients with frailty, nutritional, cognitive and mental health concerns.

Lastly, the advancements in organ failure/transplant medicine that we have witnessed over the years would not be possible without research. To encourage research across all disciplines in our field, Sunrise Symposium: The Mission IS Possible If You Choose to Accept it: The Processes of Performing Research, will include accomplished researchers in the field who will provide guidance for both novice and expert investigators on the processes of research, from study design and funding to the dissemination of findings.

Clinical and pathologic definitions for chronic rejection in lung transplantation - antibody-mediated rejection (AMR) and chronic lung allograft dysfunction (CLAD) - have undergone rapid changes over the past decade. Nobody is CLAD to See AMR in Lung Transplantation will provide an update on these two major areas of discussion over the recent years and future development.

Bring Out Your Dead: The Postmortem Evaluation in the Thoracic Transplant Setting will highlight the postmortem examination ("autopsy") which is underutilized in modern medicine but provides critical information to the clinicians, families and loved ones of the decedent to help them understand the decedent's clinical course and how data obtained from autopsies may be used by hospital quality personnel, researchers, policy makers, registries and device manufacturers to improve the state of thoracic transplantation and mechanical circulatory support therapy.

The pediatric symposia are designed to provide a potpourri of topics in order to capture the interest of a wide range of disciplines and sub specialties. The content will bring together clinicians and researchers to share their work and to present on high impact topics that are changing how we care for our patients. The symposium Learning from the Children: Important Lessons from the Pediatric and Congenital Heart Disease Experience will focus on the pre-transplant support of children and how to improve waiting list survival. Hot topics in transplantation will be addressed in What Do We Do? Burning Platforms in Pediatric Thoracic Transplant. A sunrise symposium will be focused on lung transplant and is titled A Brand-New Day: The New Normal in Pediatric Thoracic Transplantation. And after they get an organ what do you do if they develop an infection? This question will be explored in the joint symposium with the International Pediatric Transplant Association: Joint ISHLT/IPTA Symposium: EBV and CMV are Not as Easy as 1-2-3 When Caring for Pediatric Thoracic Recipients.

Pharmacy and Pharmacology will appeal to all areas of the ISHLT membership with four symposia highlighting pharmacotherapy needs of our patients to ensure the best outcomes. We will be Making Co-Morbidities Great Again: with Practical Updates in Co-Morbidity Management. An expert panel will provide updates to the management of common co-morbidities pre- and post-transplant with a focus on the evidence base and novel medications. Diabetes, dyslipidemia, osteoporosis, psychiatric disorders, complimentary/alternative medicine, and immunizations/travel medicine will all be reviewed.

How do we avoid Making Deals with the Devil: Substances of Abuse from Pre- to Post-Transplant? Our multidisciplinary panel will review substance use and abuse in transplant recipients, with a focus on the evidence showing adverse effects of narcotics, anxiolytics, nicotine, marijuana, and alcohol before and after transplant. Novel approaches to assessment and cessation interventions will be discussed.

We won’t make A Bloody Mess: Management of Hematologic Complications in Transplantation and MCS; instead, we will offer insights into the management of neutropenia, thrombocytopenia, and hemoglobin optimization while also discussing direct acting oral anticoagulant use and pharmacologic management of bleeding reversal in both transplant and MCS patients. Lastly, So Your Patient is on ECMO... Now What? Considerations for Drug Dosing and Anticoagulation in ECMO will discuss the hot topics of optimal dosing of anti-infective medications and anticoagulation strategies in ECMO patients, especially as the boundaries of ECMO use are expanding.

Take These Broken Lungs and Learn to Fly: Great Debates for Patients with PAH Awaiting Transplant will explore the complex decision making in the care of patients with end stage pulmonary hypertension awaiting lung transplantation.

The Sunrise symposium, I Want to Ride My Bicycle: Cardiopulmonary Exercise Testing (CPET) for PAH and CTEPH, will review the various aspects of exercise testing from pathophysiology to outcome prediction. Breaking Bad: The Right Ventricle and Exercise Hemodynamics Rediscovered will provide an overview into the mechanisms, clinical diagnosis and management of chronic right heart failure in left heart disease, scleroderma, and pulmonary hypertension. In collaboration with the Pulmonary Vascular Research Institute (PVRI), Changes in the World of Pulmonary Hypertension: Nice or Not Nice will bring in experts to focus on controversies and new proposed developments under review since the recent World Symposium on Pulmonary Hypertension.