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En Fuego: The Latin American Transplant Experience

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Scott Feitell, DO
Drexel College of Medicine
Philadelphia, PA, USA

In the first of its kind session, the ISHLT provided a great forum to voice growing concerns in heart and lung transplant in the developing world and allow members of the organization to highlight "the good, the bad, and the ugly" of transplants, in this growing region of the world, Latin America. The Concurrent Symposium 27: Heart Transplantation and Mechanical Circulatory Support (MCS) in Latin America session kicked off with an introduction by former ISHLT President Lori West explaining why this session was necessary and the potential for growth at future meetings of these types of sessions.

Dr. Juan Mejia opened the session highlighting the challenges facing Latin American countries as transplant and MCS continues to grow worldwide. It became painfully clear that these resources are greatly limited due to numerous reasons in these countries and that just a few centers in each country control the majority of transplants. That said Latin American countries have some of the lowest rates of transplantation per million population of any country in the world. Dr. Mejia was able to highlight several key areas that might improve these numbers including improved multidisciplinary teams and consulting centers that can help in expertise, as well as a need to better preserve/aid in harvesting donor grafts.

Dr. Fernando Bacal then focused a bit on the epidemiology of heart failure in Latin America, particularly highlighting the role Chagas' disease plays in heart failure, in these countries. It is important to make this distinction as he points out, because while these patients have much worse prognosis then other forms of heart failure such as ischemia, patients that do receive a transplant do much better post transplant with improved survival. One risk is reactivation of disease, which if monitored for closely can be aggressively treated, and perhaps requires a change in immunosuppression including the use of azathioprine instead of mycophenolate which is a different protocol than many Western countries use that don't contend with Chagas' disease.

Dr. Oscar Ortega Duran then shared his experience with a difficult patient with decompensated heart failure, and shared how limited access to transplant and MCS in his country led to a different approach to bridging support using a Vitacor paracorpeal pneumatic pump to support the patient until he was able to be transplanted. It was a very unique concept, and while the patient sadly died in the peri-transplant period, it shed light on a potential cheaper MCS device that can be used in the developing world.

Dr. Mauricio Villavicencio took this discussion one step further and shared his broader experience with managing cardiogenic shock in Latin America where limits to traditional LVADs and transplant make it difficult to manage these patients. He demonstrated his experience with the Centrimag device, which is much cheaper and more accessible, and through a tightly controlled protocol allows the patient to ambulate and perform ADLs while in the hospital waiting for a heart. He has outstanding results with the use of this device and offers that it may offer a tremendous advantage in countries with limited resources for cardiogenic shock patients.

The session closed with two great presentations by Dr. Roberto Favaloro and Dr. Alexandre Colafranceschi sharing long term results in Latin America from patients with transplant and MCS respectively. The overarching themes of these talks, were that while numbers are small, and the learning curve is steep, the trends are demonstrating that this is a growing field in Latin America and that continued support and lobbying will be necessary for these to be viable fields in Latin America in the future.

Following these presentations, there was a great deal of interest by the audience, and numerous statements of support were made by members from all over the world. There was a strong sense of urgency that the ISHLT should play an active role in lobbying national governments and provide education and data demonstrating the necessity of advanced cardiac support to countries and patients in need around the world. It was made abundantly clear that such international issues will play a prominent role at next years meeting in Nice.

Disclosure Statement: the author has no conflicts of interest to report.

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