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links imageIN THE SPOTLIGHT:

ISHLT 2014 in Sunsational San Diego!



Plenary Lectures at ISHLT 2014

This article spotlights the invited lectures taking place during the Plenary Sessions at the Annual Meeting. You will hear about the cutting edge science related to personalizing approaches to patient care, the changing landscape of thoracic organ donors featuring a Nobel Laureate who will discuss the ethics and economics of organ allocation policy, caregiver burden, improving HLA compatibility, consensus statements, a spirited debate on therapies for secondary PH, and more. Plan to attend these outstanding sessions!



OPENING PLENARY SESSION
Friday, April 11
8:00 AM - 10:00 AM


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8:55 AM
   How Digitizing Humans Changes the Future of Medicine

ERIC TOPOL, MD
The Scripps Translational Science Institute, La Jolla, CA, USA

"The newfound capability of digitizing a human being—through sensors, imaging, and biologic omics—has the potential to reboot the future of medicine."

 

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9:30 AM
   Lifetime Achievement Award Recipient Lecture: "Follow Your Star"

SIR TERENCE ENGLISH, KBE, FRCS
Oxford, UNITED KINGDOM

"I have called my Talk "Follow Your Star" because I have always tried to follow whatever "star" was shining most brightly for me at any particular time of my life and have been prepared to stop and start again should a brighter one appear on the horizon. This led to several false starts and blind alleys but most added to a richer experience of life, even if they didn't contribute to my eventual career. There has also been that element of fortune along the way when my star beckoned me both in the right direction and at the right time."


PLENARY SESSION
Saturday, April 12
8:00 AM - 10:00 AM


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8:00 AM
   Trimming Heart Transplantation in the VAD Era

LYNNE W. STEVENSON, MD
Brigham & Women's Hospital, Boston, MA, USA

     "Cardiac transplantation remains the most effective therapy to enhance quality of life and prolong survival with end-stage heart failure, but there are only 2200 hearts available each year in the United States. In 2013, only 4% of hearts were given to patients waiting at home on standard medical therapies. The other 96% of hearts were implanted into patients in urgent status, 68% of whom were at the highest priority, defined as high risk for death in the next 7 days, although in fact almost half of patients currently in that status have been waiting over 1 year. Although there are considerable efforts to revise the status definitions, the fundamental problem is the mounting arithmetic that for each of the past 5 years, we have listed about 50% more patients than will undergo transplantation.
     "Responsible stewardship of the precious donor heart resource in the United States requires that we decrease the number of listed patients by only about 20%, a change which could within 5 years restore our ability to provide meaningful triage for listed patients, with a steady state list of about 1000. Other countries should also tailor their listing practice according to their own donor supply, which has been done well in some countries but not in others. The patients most likely to benefit from transplantation would then undergo transplantation at a time when they are most likely to do well. The responsibility to right-size the list is lightened by the increasing success of ventricular assist devices which can also increase quality and length of life. This technology was initially reinforced but is now being shackled by the use of these devices as bridges to transplant rather than as free-standing lifetime support.
     "Right-sizing the list is right not only for the success of transplantation and the progress of mechanical circulatory support, it is most importantly right for the patients. We are charged to do good and to do no harm, but promising transplant to those unlikely to receive it undermines the quality of life with alternative therapies, and can impose heavy financial and psychological costs on families. Furthermore, with less incentive for the affluent to move to favorable donor regions, the ethical mandate for distributive justice will be easier to meet. By establishing consensus to restore equilibrium between the patients joining the list and those moving on to transplantation, we will find it easier, both as a society and as individual physicians, to meet this classic lifeboat dilemma."

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8:40 AM
   Frontiers of DCD in Thoracic Transplantation

THOMAS M. EGAN, MD, MSC
University of North Carolina School of Medicine, Chapel Hill, NC, USA

"Lung transplantation is more limited by a shortage of suitable organs for transplant than most other organs. Unlike other solid organs that are transplanted, lungs live for hours after circulatory arrest and death of a potential donor. Thus, lungs might be suitable for transplant, even if recovered from victims of sudden death. Ex-vivo lung perfusion (EVLP) affords an opportunity to assess lungs recovered after death from uncontrolled Donation After Circulatory Determination of Death (uDCDDs). EVLP also offers an opportunity to treat lungs before implantation. Lung recovery from uDCDDs for transplant is an innovative disruptive technology poised to revolutionize therapy for end-stage lung disease."

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9:15 AM
   Organ Allocation Policy and the Decision to Donate

ALVIN E. ROTH, PhD
Professor of Economics, Stanford University, Stanford, CA, USA

Prof. Alvin (Al) E. Roth is the Craig and Susan McCaw Professor of Economics at Stanford University and the Gund Professor of Economics and Business Administration Emeritus at Harvard University. He works in the areas of game theory, experimental economics and market design. He shares the 2012 Nobel Prize Laureate in Economic Sciences with Lloyd S. Shapley "for the theory of stable allocations and the practice of market design".
     Roth is a pioneer in the field of game theory and experimental economics and in their application to the design of new economic institutions. As one of the first "microeconomic engineers," Roth has redesigned the market for kidney exchanges, the organization that matches medical residents with hospitals, public school choice systems and a variety of other institutions.
     Prof. Roth is a gifted lecturer with a wonderful and easy-going personality. The ISHLT looks forward to sharing his experience with the delegates during the Plenary Session the ISHLT 2014 Annual Meeting in San Diego.


PLENARY SESSION
Sunday, April 13
9:30 AM - 11:45 AM


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9:50 AM
   CONSENSUS REPORT: Invasive Fungal Infections Among Cardiothoracic Transplant Recipients: Consensus Guidelines and Recommendations from the ISHLT Fungal Expert Panel

SHAHID HUSAIN, MD, MS
Toronto General Hospital, Toronto, ON, CANADA

"Fungal infections (FIs) continue to be a major cause of morbidity and mortality in Cardio thoracic organ transplant recipients. In order to prevent the FIs the transplant centers have embarked upon diverse antifungal prophylactic strategies .The Infectious Diseases Council of International Society for Heart and Lung Transplantation (ISHLT) made a convened an international and multidisciplinary panel of experts in the field. The Panel members were recognized leaders in the field of heart/lung transplantation and Mechanical Circulatory Support Devices (MCSD), and were selected from established transplant centers worldwide by the Chairs. The Panel members identified and approved the most relevant questions to be addressed in the areas of epidemiology, diagnosis, prophylaxis, and treatment of FIs including therapeutic drug monitoring (TDM) of antifungal agents in adult and pediatric heart, lung and MCSD patients. The working groups within the panel reviewed existing literature to answer the identified questions based upon the published evidence or, in their absence, provided guidance based upon prevailing expert knowledge and experience. The Grading of Recommendations, Assessment, Development, and Evaluation 20 (GRADE) approach was used to appraise the evidence."

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10:00 AM
   CONSENSUS REPORT: Updated Guidelines for Lung Transplant Recipient Selection

DAVID WEILL, MD
Stanford University Medical Center, Stanford, CA, USA

     "The ISHLT has developed two previous editions of International Guidelines for the Selection of Lung Transplant Candidates. Published in 1998 and 2006, these Guidelines represented the best and most current information present at the time relevant to the appropriate selection of patients being evaluated for lung transplantation. Given the continued evolution of the field, the Pulmonary Transplantation Council presents a Third Edition of the Consensus Report for the Selection of Lung Transplant Candidates. The goal of this current Edition is to assist physicians, both those who refer candidates and those who work in the lung transplant field, in properly identifying patients who are the most likely to benefit from lung transplantation.
     "This report will discuss general indications and contraindications (relative and absolute) and disease specific selection criteria, some of which are unchanged from previous selection guidelines. As in previous Editions, the current report largely represents a consensus of expert opinion. However, an effort will be made to include a discussion of areas supported by robust scientific data. In light of the evolving nature of the field, important areas of emphasis of this Edition will include factors influencing recipient selection that were not present in previous selection guidelines Editions, such as lung allocation changes, pediatric lung transplantation, the use of mechanical ventilation and circulation support for both potential transplant recipients and for donor lungs, and the broadening of selection criteria (especially with regard to age, comorbidities, and retransplantation). The Writing Group's response to these challenging new areas exemplifies the natural tendency of clinicians working in this area to extend the envelope of care to patients once thought unsuitable for lung transplantation while collecting prospective data regarding those situations where known risk outweighs benefit."

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10:25 AM
   The Invisible Team Member: Family Caregivers of Thoracic Transplant and Mechanical Circulatory Support Patients

MICHAEL G. PETTY, PhD, RN
University of Minnesota Medical Center, Minneapolis, MN, USA

"Family caregivers are frequently cited as essential to the success of heart failure, lung failure, thoracic transplant and mechanical circulatory assist patients. Along with the patient they are integral members of the healthcare team. The value of their efforts has been estimated in the billions of dollars. Yet the physical, emotional and social impact of caregiving is underappreciated. The objective of this presentation will be to highlight the contributions of family caregivers (however they are defined), the literature on the effect of caregiving, and recommendations for ways in which we can offer care to them."

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10:45 AM
   Trading Risks of Sensitization in Thoracic Transplantation: ABO-Incompatibility to Achieve HLA-Compatibility

LORI J. WEST, MD, DPHIL
University of Alberta, Edmonton, AB, CANADA

Dr. West is Professor of Pediatrics, Surgery and Immunology and the Research Director at the Alberta Transplant Institute at the University of Alberta and a Tier 1 Canada Research Chair in Cardiac Transplantation. She is a world leader in pediatric cardiac transplantation and transplant immunobiology, including crucial translation of basic concepts and findings from murine models to clinical application in pediatric heart transplantation. Her clinical work resulted in a pioneering strategy for increasing donor availability for infants by crossing the ABO barrier, which has had a major global impact on infant heart transplantation. Her investigations of the immune development of infants after ABO-incompatible transplantation led to the first demonstration of neonatal transplantation tolerance in humans. She is now leading an international multi-site collaboration in the study of this unique patient population globally.

11:15 AM   PRESIDENT'S DEBATE: Stop Treating Secondary PH Right Now!

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PRO: Fernando Torres, MD
University of Texas Southwestern Medical Center, Dallas, TX, USA

Fernando Torres, M.D., is an Associate Professor of Medicine at UT Southwestern Medical Center and Director of the Lung Transplant and Pulmonary Hypertension Programs at St. Paul University Hospital. His clinical interests include pulmonary hypertension, lung transplantation, lung volume reduction surgery for emphysema, viral infections in immunosuppressed patients, and clinical outcomes research in lung transplantation and pulmonary hypertension. Since joining UT Southwestern in 2000, Dr. Torres developed the Pulmonary Hypertension Program, now the largest such program in the United States. In 2009 he assumed directorship of UT Southwestern's Lung Transplant Program, which is the eighth largest in the country.

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CON: Harrison W. Farber, MD
Boston University School of Medicine, Boston, MA, USA

"My opponent (Dr. Torres) will argue that patients with pulmonary hypertension associated with left heart disease should never be treated because of the risk of worsening left ventricular filling pressures. While this is often true, there may be some patients with left heart disease in whom treatment is not only possible but may be beneficial. While I certainly will not advocate that all patients with pulmonary hypertension associated with left heart disease be treated, I will discuss certain situations in which treatment may not be as crazy as it may appear."




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