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The International Society for
Heart and Lung Transplantation

A Society that Includes Basic Science, the Failing Heart and Advanced Lung Disease.

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Thursday, April 4, 2019

In the Spotlight

Hepatitis C+ Cardiac Donors: Do They Get an A+?

HCV-positive cardiac donation has been traditionally avoided due to recipient’s increased mortality and coronary allograft vasculopathy (CAV). HCV viral load is detected via nucleic acid amplification test (NAT). Since 2015, direct acting antiviral drugs (DAA), curative of HCV infection, have heralded a new era in organ donation from HCV+ donors. In this symposium, we learn about the increased trend in HCV+ organ utilization, decreased wait time, and favorable short-term outcomes. Read more

Today's Highlights

Mechanical Lung Support for Isolated Organs and Patients

A Clinical Trial Evaluating the Effects of Ultra-violet C Treatment During Ex Vivo Lung Perfusion as a Method of Inactivating Hepatitis C Infection in Donor Lungs
Marcelo Cypel, MD
 
Is Ultra-violet C (UV-C) treatment the next paradigm shift in Hep C positive lung donor organ management? Researchers from Toronto have reported that UV-C treatment during ex-vivo lung perfusion (EVLP) lowers Hep C virus infectivity of transplanted Nat positive donor lungs. Read more

Total cf-DNA Ready for Primetime?

Increase in Total Cell-Free DNA Correlates with Death in Adult and Pediatric Heart Transplant Recipients: DNA Based Transplant Rejection Tests (DRTR) A Prospective Blinded Multicenter NIH/NHLBI Funded Clinical Study
Shriprasad Desphande, MD
 
Non-invasive methods that reliably predict clinical events following heart transplantation are needed to improve short and long term outcomes. Total cell-free DNA (TcfDNA) has been found to be at elevated levels in sepsis, oncology and maternal/fetal medicine. This biomarker may identify increased risk in several clinical scenarios including death, rejection, cardiac allograft vasculopathy (CAV) and infection.  Read more

Overcoming the Hurdle: Chronic Lung Allograft Dysfunction

Prognostic Significance of Mesenchymal Cell Colony Forming Units in Bronchoalveolar Lavage Fluid for Restrictive Chronic Lung Allograft Dysfunction
Michael Combs, MD
 
Biomarker for CLAD onset? A higher bronchoalveolar lavage (BAL) mesenchymal stem cell (MSC) colony forming units (CFU) is associated with restrictive chronic lung allograft dysfunction. Presentation by Combs and Colleagues from Michigan reported that BAL MSCs are increased at the onset of chronic lung allograft dysfunction (CLAD) Read more

Using Machine Learning to Tailor Precision Led Medicine: Use of Gene Expression Profiling in Heart Transplantation

Distinct Patterns of Gene Expression Profile Identified Longitudinally and within AlloMap Score Ranges are Associated with Clinical Outcomes
Jon Kobashigawa, MD
 
Gene expression profiling (GEP) include 11 genes associated with rejection predicated on the CARGO study. The GEP score ranges from 0-40 and is used for non-invasively monitoring for acute cellular rejection in low risk individuals. The Outcomes AlloMap Registry (OAR) is an ongoing multisite US prospective registry that includes over 1,900 adult heart transplant recipients. Read more

Directly to Apixaban in Patients with VADs?

Apixaban in HVAD Pateints Non-Compliant to Standard Vitamin-K-Antagonism
Sebastian Schulte-Eistrup, MD, PhD
 
Schulte-Eistrup et al. presented a provocative study on the use of apixaban in patients with HVAD. In light of the variable time in therapeutic range (TTR) of vitamin-K-antagonists, prevention of complications related to thrombosis can be challenging. Recent data has shown increased thromboembolic events with dabigatran in patients with VAD. The purpose of this study was to assess the safety and effectiveness of apixaban in patients non-compliant with VKA anticoagulation. Read more

Clot pre-LVAD Leads to Increased Stroke in Death

Presence of Left Atrial or Ventricular Thrombosis at the Time of CF-LVAD Implantation is Associated with Increased Post-operative Risk of Stroke or Death
Justin Fried, MD
 
Continuous flow LVADs offer a clear survival benefit over optimal medical therapy and first generation LVADs. Adverse events have limited the benefit of this technology. The highest risk of stroke is in the early perioperative period. Intracardiac thrombus formation (in left atrium and left ventricle) is a relatively common occurrence in patients with end stage heart failure. The aim of this study was to assess the impact of preoperative intracardiac thrombus on post-surgical outcomes. 

Read more

mTOR Inhibitors and Statins: Is There Anything New?

Late-Breaking Clinical Trial: 10-Year Follow-Up of the Everolimus Versus Azathioprine Multi-National Study
Jon Kobashigawa, MD
 
Effect of Donor Simvastatin Treatment on Gene Expression Profiels in Human Cardiac Allografts during Ischemia-Reperfusion Injury
Rainer Krebs, MSc, PhD
 
Higher Intensity Statin Therapy Reduces Clinical Endpoints after Heart Transplantation Independent of Lipid Levels
Jessica Golbus, MD
 
Many in the heart transplant community wonder how much more they can prolong a patient’s life and how to prevent or attenuate the progression of cardiac allograft vasculopathy (CAV).  A couple of drug options that are commonly used include the deployment of mTOR inhibitors (e.g. everolimus) and statins.  Read more

#ISHLT2019 Announcements

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Today's Press Releases

On the Horizon

Must-See Plenary Session

Be sure to attend the Plenary Session tomorrow morning from 8 to 10 AM in Grand Caribbean 1-7 for a riveting lineup of speakers and presentations.

  • Transplant from Every Angle. Susan Hou MD will talk about her experience being a living donor, an organ recipient and a transplant surgeon. 
  • Astronaut Col. Mike Mullane will inspire us on working with a team under stressful situations, drawing on his experience flying through space and in Vietnam.
If you can't make it, you can live stream it too! Just register here.
 

Asia Pacific Group to Meet

ISHLT’s International Engagement Committee is hosting its second regional meeting tomorrow, Friday, from 7:15 to 8:15 PM in Oceana 3-5. All are welcome so swing by and meet some of your peers. 

Have You Visited with Our Exhibitors Yet?

If not, get on over there and see what they’ve got in store. The Hall closes at 4:30 PM Friday so be sure to visit before they close. 
 

Daily Pulse Reporters:

Roy Lee, PharmD

Yasbanoo Moayedi, MD

Nirmal Sharma, MD

Van-Khue Ton, MD, PhD

Newsletter Coordinators:

Nancy Mays

Megan Barrett

Disclaimer: This content reflects the opinions and perspectives of the individual authors and does not reflect the opinions and perspectives of the ISHLT or the Editor.