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Abstract Session Highlights

Basic Science and Translational Research

New Frontiers in Cardiothoracic Organ Regeneration - From Cosmetic to Prosthetic will showcase the rapid developments in bioengineering which are already impacting on heart and lung transplantation, and which will transform our field into the future. Chaired by Sonja Schrepfer and Shaf Keshavjee, the session will cover the breadth of organ rejuvenation from the relatively cosmetic improvements which can be made during ex-vivo lung perfusion to the 'knock-down and rebuild' approach to organ replacement achieved using decellularised matrix.

The session combining the highest scoring abstracts on exploration and modification of the immune system, Exploring and Modifying the Immune Response - Cells, Antibodies, and Tolerance, will feature presentations on the impact of natural killer cells and T-cell deficiency on graft survival and BOS in lung transplantation. Innovative therapeutic approaches discussed in this session include pre-clinical evaluation of JAK 1/3 inhibitors and MHC-encoding chitosan-DNA microparticles in animal models.

During The Fundamental Difference- Innate Immunity and Xenotransplantation, new research on the challenges of platelet activation and aggregation in the setting of xenotransplantation and lung reperfusion will be presented. Further presentations evaluate Caspase 1 as a serum marker of myocardial remodeling and pre-clinical data on therapeutic use of VEGF-C/D for improved cardiac allograft survival.

Heart Failure and Transplantation

Heart Failure: What's New in Translational Science
CD34+ transplantation, post-transcriptional regulation, and miRNA modulation are center stage. For your pleasure, progenitor cells will circulate, free fatty acid will challenge glucose in the oxidation contest, and expression of cardiolipin biosynthesis will change your way of thinking about heart failure as a simple clinical phenomenon.

Heart Failure: Focus on the Right Heart
The delicate, innocent, yet vulnerable Right Ventricle brings together all corners of the ISHLT. Here are some of the most recent RV carols manufactured and interpreted for you by the Clinical Heart Failure Choir in six tasty chapters including prognosis, sildenafil, pulmonary wedge pressure and arrhytmogenic cardiomyopathy.

Heart Transplantation: Can We Improve Transplant Risk Assessment and Outcome Prediction?
Titanic dilemmas and naïve questions-in an effort to save as many lives as it is possible with our more and more limited donor heart resources -will be prepared and served to you in the form of six short stories about HIV-positive recipients, UNOS status modifying human fate, kidney-heart brotherhood in transplantation, and others.

Heart Transplantation: News from the Registries - What We Need To Learn To Achieve Long-Long Term
Very long term survival and guidance to support customized strategies: two holy grails that transplant clinicians cannot achieve with the limited everyday single center experience. In this concurrent session, evidence confirming or contradicting common experience-based concepts will be served, thanks to robust data regarding age and causes of death, racial differences and PRA, oversized hearts and recipients' pulmonary hypertension, and long term survival.

Coronary Artery Vasculopathy in 2013 - Diagnosis, Prognosis and Treatment
This concurrent session will provide a late breaking overview of a classical topic at the ISHLT meeting. Ranging from novel diagnostic views to detect prognostic relevant CAV, to the effects of mTOR inhibitors on coronary morphology and cardiovascular events, the audience will have a great opportunity to receive a full update on current and future perspectives on CAV diagnosis, prognosis and treatment.

Living with a Transplanted Heart - A Narrow Pathway in the Jungle
A successful heart transplant surgery is just the beginning of a hopefully long, but surely complex, journey in a minefield, which often distances recipients' life from the mirage of healthy normality. The dream of a successful pregnancy, the amplified negative effects of excessive food intake, the torture of receiving periodical invasive procedures, the nightmare of facing chronic and hazardous diseases of organs other than heart: the management these side-effects of our life-saving strategy-substituting one deadly disease with a bunch of dangerous others-will be discussed in this exciting session that will provide audiences with compass directions to recover the many patients wandering in the jungle.

Are All Antibodies Equal? Predicting, Managing and Treating the Risk for AMR
After being "easily" accustomed to pathologists' biopsy diagnoses-sometimes disconnected from patients clinical picture-transplant clinicians now must learn to deal with immunogenetists, a new species of lab-people providing reports containing obscure antibody names and typing, that may or may not be coherent with pathologists' readings, and may or may not trigger a treatment. In this session, the audience will have a unique opportunity to attend cutting edge presentations unraveling the complexities of different kinds of HLA antibodies, their time course, and how to manage organ allocation and post-transplant treatments. Returning back to clinic attendance, participants will have new tools to build a coherent view and management of the clinical and laboratory picture of sensitized patients.

Mechanisms and Markers of Acute Rejection: Within and Without Biopsy Sampling
Endomyocardial biopsy is still considered a gold standard for the diagnosis of rejection in clinical practice. However, established grading for T-cell mediated rejection, but also for antibody-mediated rejection, does not always include all the available information that could be gained from the myocardial specimens. On the other hand, non-invasive markers for rejection diagnosis haven't conquered clinical practice yet. In this visionary concurrent session, the audience will be excited by novel ways of looking at a biopsy to understand different mechanisms of rejection, insights on promising non-invasive methodologies for rejection diagnosis, and global clinical views on the interplay between histology, DSA and hemodynamics.

Infectious Diseases

Concurrent Session 18: From Fungus to Virus - The Microbiome Elicited
Come one, come all, from virus to fungal ball! As our knowledge grows of microbial colonization and growth in the lung allograft, share in these new findings and the implications they have for our lung transplant recipients.

Concurrent Session 25: MCS 6: Infectious Issues and Pump Failure
One of the biggest limitations in mechanical circulatory support today remains infectious complications and pump failure. Come pump up your own knowledge of these issues with a host of abstracts on these complications and their implications for patient management.

Junior Faculty and Trainees

The Junior Faculty Trainee Committee is again hosting the very popular session, "Clinical Case Dilemmas in Thoracic Transplantation." Test your own clinical skills as junior faculty present clinical conundrums to the fields' experts. Ask questions, share management strategies, and enjoy intellectual banter.

Mechanical Circulatory Support

A record 337 MCS abstracts were submitted to the 2013 ISHLT Annual meeting. This made the job of the planning committee-to prepare a terrific MCS program-quite easy! The top graded abstracts were selected for presentation in 11 oral and 2 mini-oral sessions. Two oral sessions will explore specifics of different devices as well as patient selection considerations. Another session will focus on physiological changes seen after VAD implant. Several sessions will focus on key complications seen with MCS support and discuss approaches to prevent and treat these. A review of clinical outcomes will be provided and approaches to maximize patient quality of life and survival after VAD placement discussed. A separate session will analyze the cost of achieving longevity and good quality of life in advanced heart failure patients through MCS support. A number of additional topics will be addressed during MCS poster sessions.

And, finally, do not forget to attend the 'Great Debates in MCS' symposium session. Several of the pressing topics explored by investigators in oral and poster submissions will be addressed by thought leaders from different parts of the globe in this engaging session: Should Stable LVAD Patients Receive Organ Allocation Advantage?; Should Sensitization Warrant Higher Priority on the Waiting List?; Does Mechanical Support Work for Those With Poor Social Support?; Are VAD Destination Therapy and Hemodialysis Compatible?

In summary, MCS has become a dynamic force in our Society, and the 2013 MCS program promises to be a platform to advance MCS science through scientific presentations, discussions and networking.

Nursing, Health Sciences & Allied Health

Implications and Innovations throughout the Lung Transplant Trajectory
This session sponsored by the NHSAH Council is sure to interest clinicians from a variety of disciplines who are involved in lung transplantation. Several of the presenters will discuss predictors of post-lung transplant outcomes, such as hospital readmission, medication adherence, health related quality of life, and survival. Other presenters will discuss the impact of novel interventions, including a consent process where recipients choose their donors and a stress reduction intervention for family caregivers. The research findings will be directly relevant to clinical practice and quality improvement in the setting of lung transplantation.

MCS and Heart Transplantation: Assessment, Outcomes and Interventions
This session sponsored by the NHSAH Council combines topics of interest to clinicians who are involved in the care of patients with heart failure facing MCS or heart transplantation. Several of the presenters will discuss the challenges of managing MCS devices such risk for hospital readmission and driveline site selection. Other presenters will discuss the impact of interventions on heart transplant candidates and early and long-term outcomes among heart recipients, including cardiac rehabilitation on cardiac vasculopathy, psychosocial assessment on medical outcomes, and the relationships between adherence, mental health and hygiene behaviors. The research findings will be directly relevant to clinical practice and quality improvement in the setting of heart failure and heart transplantation.

Pediatric Transplantation

There are few cities in the world that own Montréal's mixture of buzz and vitality, a taste of Europe in North America. We believe the Pediatric content of the Abstract Sessions at the 2013 ISHLT Annual Meeting reflect this great mixture, combining the best of Pediatric Heart and Lung Transplantation, Pediatric Infectious Diseases and Mechanical Circulatory Support in Children.

There are three Oral Sessions planned including "Pediatric Heart and Lung Transplantation", "Pediatric Heart Failure and Heart Transplantation" and "Mechanical Circulatory Support in Children". The Session on "Pediatric Heart and Lung Transplantation" focuses on aspects such as de novo donor specific HLA antibodies and rejection and graft loss in Pediatric heart transplant recipients, CMV specific immunity, the lung microbiome and the development of BOS in Pediatric lung transplantation, and Pediatric thoracic multi-organ transplantation.

In addition, there is a Mini Oral Poster Session on Pediatrics and Infectious Diseases.

Finally, more than 40 abstracts were selected for Poster Sessions, the largest number ever of Pediatric abstracts accepted for presentation at an ISHLT Annual Meeting. So you better make your travel arrangements and register for the 2013 ISHLT Annual Meeting in Montréal in April to be part of the ever growing Pediatric cardio-thoracic transplant community.

Pharmacy and Pharmacology

The Pharmacy and Pharmacology Council, now in its second year, continues to evolve in developing unique educational programming focused on pharmacologic therapy for the ISHLT Annual Meeting. For the 33rd Annual Meeting, the Program Committee has designed sessions and symposiums showcasing innovative science and real world clinical applications. Our programming which focuses on drug therapy lends applicability across all disciplines represented by the ISHLT membership.

There are two sessions sponsored by our council this year. The first is an Oral Scientific Session on Friday titled, Innovative Pharmacotherapeutic Approaches to Thoracic Transplant and Mechanically Assisted Patients. This session explores novel uses of drug therapy to improve outcomes in multiple therapeutic areas including treatment strategies for rejection and infection in heart and lung transplant patients as well as pharmacologic treatments for pulmonary hypertension in patients requiring mechanical circulatory support.

The second, on Saturday, is a symposium that continues our successful "Lifecycle Journey" series creating an enduring case to create a panel facilitated and audience supported best practice based discussion at predefined key "journey intervals." This year the session is titled, A Lifecycle Journey in Cystic Fibrosis and Lung Transplantation. In this session, members of the Pharmacy and Pharmacology and the Pulmonary Transplantation Councils will focus on four "journey points" which include: (1) listing considerations and pre-transplant infections, (2) peri-operative and immediate post-operative management issues, (3) metabolic and interaction considerations to drug dosing and (4) immunomodulation strategies for the management of bronchiolitis obliterans syndrome.

In addition, several posters selected by our council demonstrating the diversity and scope of pharmacotherapy as applied to multiple areas, including; Heart Transplantation, Lung Transplantation and Mechanical support will be presented.

Pulmonary Hypertension

The 2013 meeting promises to be another banner conference for pulmonary hypertension. A total of 53 abstracts will be presented covering a broad variety of clinical and translational research topics in the field. The Thursday oral session entitled "All About Outcomes" will lead off with the much anticipated initial results from the PROSPECT registry of 331 PAH patients treated with the room-temperature stable epoprostenol with arginine (Veletri®). The group from the University of Minnesota will present survival data using a simplified version of the REVEAL prediction model that does not require right heart cath or pulmonary function variables. Vizza et al will present their intriguing finding of a relatively high proportion of extra-cardiac causes of death in PAH. As the use of extra-corporeal support continues to expand worldwide, the Papworth group will present their experience with this modality following thrombo-endarterectomy for chronic thrombo-embolic pulmonary hypertension. Granton and co-workers will show the results of a microarray expression study in explanted PAH lungs demonstrating prominent upregulation of osteopontin, a potent vascular smooth muscle mitogen. The session will be rounded out with a paper from Rigshospitalet, Denmark on pulmonary hypertension in end-stage IPF.

Reflecting the increasingly recognized importance of right ventricular (RV) function in PH, two oral sessions will be devoted to this topic on Friday. The morning session, "Right Ventricular Matters" will include 2 presentations on the use of RV strain and other echocardiographic derived indices of RV function as predictors of outcome in PAH. Large animal models of RV failure were used in three studies to characterize RV function, assess RV angiogenesis and explore the feasibility of mechanical RV support. Wrapping up the session will be the team from Sapienza University in Rome presenting data on the impact of RV dysschrony in PAH. Later in the day, 6 more outstanding abstracts on "Right Ventricular Assessment and Function" will be presented. Investigators from Lyon, France will report on the prognostic value of RV ejection fraction in PAH. Researchers from Alberta, Canada will describe the role of HIF-1α signaling in RV myocardium. Saggar and colleagues will report their experience with parenteral treprostinil therapy on RV function in PH associated with pulmonary fibrosis. Finally, the group from Allegheny General Hospital in Pittsburgh will report on echocardiographic assessment of the RV as a predictor of RV fibrosis, as determined by late gadolinium enhancement by MRI and the prognostic value of the latter.

Pulmonary Transplantation

The Pulmonary Council is looking forward with great excitement to the ISHLT annual scientific program in Montreal April 2013. Council members and the Program Committee have worked diligently to create a program that includes several valuable sessions and symposiums that are vital to setting the tone for an outstanding educational forum for all ISHLT attendees.

The scientific program itself is filled with vital symposia and sessions presenting a forum for challenging debates and discussions on important issues regarding lung transplantation.

There are eight total symposia throughout the meeting, which cover a broad range of important topics. Some of these are collaborative efforts with other councils (including pathology, basic science, nursing, health science and allied health, and pharmacy).

Along with the scientific program, there are a large number of original scientific investigations focused on both basic and clinical science that were submitted for the meeting. These topics will be highlighted in six oral presentation sessions (thirty-six abstracts), eighteen mini-oral presentations and more than eighty posters for presentation.

Translational science will be highlighted in the "Bench to Bedside" session. Topics will range from BOS to infection.

There will be several sessions highlighting antibody mediated rejection (AMR) in lung transplantation. AMR has become increasingly more recognized over the last several years; however, there still is considerable controversy on its diagnosis, unique features and treatment. Two symposia in collaboration with the pathology and basic science councils will focus on discussions that will hopefully lead to better understanding of this issue. The interest in the current topic is also featured in the oral, mini-oral and poster sessions.

Bronchiolitis obliterans remains a major complication after lung transplant and is the major cause for late morbidity and mortality. We now understand that different processes can lead to allograft dysfunction. The term chronic lung allograft dysfunction (CLAD) has been incorporated to include these other processes. One symposium will provide state-of-the-art information on these issues and an abstract session will update us on its pathophysiology.

Another area of significant interest to our council members is how to best support patients with end-stage lung disease while bridging them to a successful lung transplant. A symposium will bring experts together to discuss techniques of bridging patients that are critically ill prior to transplant. A Sunrise symposium will discuss patient selection as part of this ongoing debate.

Immunosuppression is also featured prominently with an abstract session presenting interesting conundrums on the use of different therapeutic agents. This session will be nicely paired with a symposium on T cells and their roles post-transplant.

Other interesting sessions include outcomes after lung transplantation. Primary graft dysfunction is featured in an abstract session and a Sunrise symposium will discuss patient-reported outcomes. Two additional Sunrise symposia have been planned: one will assess anastomotic issues and the utility of bronchoscopy; the other will present different lung allocation systems around the world and discuss their merits and limitations.

Finally, common topics of interest that will also be discussed include a joint Saturday symposium with the Pharmacy council which assesses the journey of a cystic fibrosis patient through transplant. It discusses many unique pharmacologic, infectious challenges that this group of patients face, while undergoing lung transplantation.

We look forward to an exciting annual meeting that will stir discussion and add further momentum to the already energetic academic lung transplant community.