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JHLT: The Year in Review

by Scott Feitell and Anders Andreasson

At this year's Concurrent Symposium 28: JHLT at ISHLT: The Year in a Capsule, a "who's who" of transplant medicine presented summaries of the most intriguing and novel publications put out this year in the Journal of Heart and Lung Transplantation.

The session started off with Dr. Martin Schweiger reviewing some of the biggest articles in MCS and Heart Transplants this year. He focused first on the interesting Heartware trial, HVAS Bridge to Transplant, which featured outstanding survival data and some promising hope for this new device that featured over 84% survival with use at one year. He then reviewed a retrospective review of the UNOS registry, which addressed organ allocation for those with congenital heart disease. Sadly as we are confronted with a greater number of these end stage patients, ventricular assist devices are often not feasible due to anatomical or physiologic factors that would otherwise provide a viable bridge to transplant. Unfortunately, our current procurement system does not make allowance for these patients to move higher on the list, and thus time waiting can seriously impede survival. On a similar topic, he reviewed findings of the European experience with the Cardiac Allocation Score to help address several deficits in transplant waiting lists. Using a combination of urgency, wait time and evaluating outcome/ survival odds after transplant, this system may better help predict who will benefit most from a transplant. Finally, further addressing donor shortages, he reviewed a fascinating review of the UNOS registry from 1994-2012 to evaluate whether there were any significant differences in outcomes using "marginal hearts" from post-CPR donors. Using a sample size of over 1300 patients, which represented nearly 5% of all donor hearts, there was no significant difference in outcome post transplant. While there were different features between CPR and non-CPR donors (regarding alcohol use, drug use, smoking, etc.), all recipients did quite well regardless. What should further allay fears to all of us in the transplant community, was that the amount of time CPR was administered had no bearing on outcomes either, with some donor hearts receiving upwards of 50 minutes of CPR, and a mean time of nearly 20 minutes for all CPR donors.

Dr. Heather Ross then took to the stage to congratulate Dr. Schweiger on his review of cutting edge literature, and echoed many of his sentiments from these articles, raising concerns from the Heartware trial that pump thrombosis remains a critical limiting step in the use of MCS. She also agreed with many of the limitations of the UNOS criteria for transplant waiting lists, and pointed out that many of these articles reviewed should further discussion on how better to improve the system.

Dr. Me-linh Luong reviewed three articles dealing with CMV, C diff and hepatitis E. While several of her topics pertained more to lung transplantation, her review of the emerging threat hepatitis E plays in all of our transplant patients was of significant concern. Emerging case series are demonstrating that hepatitis E, common in undercooked pork products and various other sources can activate in immunocompromised hosts. In a single center review six patients were found to have this virus. Fortunately if it is caught relatively early in its course it can be easily treated with medication and augmentation of immunosuppression. Dr. Shahid Husain then reviewed this topic further, and it is clear that appropriate screening in transplant patients with abnormal liver function tests and/or evidence of fibrosis and cirrhosis should trigger immediate testing.

Disclosure Statement: the authors have no conflicts of interest to report.

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