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Bugs, Drugs, and Beyond: Highlights of the 36th Annual Meeting and Scientific Sessions from the Transplant Infectious Diseases Vantage Point


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Stephanie Pouch, MD
The Ohio State University
Columbus, OH, USA
Stephanie.pouch@osumc.edu



In contrast to the DC weather that greeted us this year, the ISHLT Annual Meeting was anything but damp and dreary. We were met by a myriad of exciting sessions, which were not only highly relevant to the field of transplant ID, but showcased the incredible worldwide interdisciplinary work undertaken by the ISHLT. This made my current task of summarizing the Meeting's ID-related highlights an absolute pleasure, but a challenging one. While it is impossible to summarize all of the presentations in a few short paragraphs, there were several permeating themes worthy of recapitulation.

Mycobacterium abscessus continues to emerge as a major concern following lung transplantation. The global burden and challenges related to treatment of this pathogen were presented by Fernanda Silviera in the symposium, The Future is Here: Emerging Issues in Infectious Diseases, and Orla Morrissey presented a systematic review, including her center's experience with M. abscessus, in Cardiothoracic Transplantation and MCS Infections: Cracking the Code for Diagnosis, Monitoring, and Treatment. The management of M. abscessus remains extremely challenging at best, though there may be a flicker of light at the end of the proverbial tunnel. Ricardo La Hoz described the successful use of bedaquiline as salvage therapy for M. abscessus surgical site and allograft infection in a lung transplant recipient during the Junior Faculty Clinical Case Reports, and Audrey Perry and colleagues described the antimicrobial Activity of cysteamine against antibiotic resistant pathogens, including M. abscessus isolated from lung transplant recipients, with bactericidal activity noted in 11/12 M. abscessus isolates (abstract 1010). The importance of infection prevention and control measures in our transplant recipients was underscored at the Sunrise Symposium, The Fly in the Ointment: Nosocomial Infections, when Cameron Wolfe described an M. abscessus outbreak and pseudo-outbreak at his center and highlighted his institution's framework for approaching the issue. Finally, while M. abscessus remains a concern in our lung transplant recipients, Jedrek Wosik and colleagues presented a poster describing a fatal left ventricular device obstruction/thrombosis due to M. abscessus (abstract 1271).

CMV remains at the forefront of ID-related concerns in our heart and lung transplant recipients. It's All in Translation: CMV from Bedside to Bench and Back Again highlighted the impact of CMV on the heart and lung allografts, our current antiviral armamentarium, and potential new agents on the horizon. We also caught a glimpse of potential markers of CMV-specific immunity, including Laurie Snyder's exciting work with polyfunctional CMV-specific immunity in lung transplant recipients receiving valganciclovir prophylaxis. In Cardiothoracic Transplantation and MCS Infections: Cracking the Code for Diagnosis, Monitoring, and Treatment, Glen Westall presented an interim analysis of QuantiFERON-CMV-directed CMV prophylaxis versus standard of care, which showed that the QuantiFERON-CMV-directed approach reduces late CMV viremia in lung transplant recipients. Similarly, at the Junior Faculty Case Reports, Gregor Poglajen and colleagues presented data preliminarily demonstrating that the QuantiFERON-CMV assay may assist in guiding the management of resistant CMV in heart transplant recipients [abstract 1248]. There will certainly be much more to come on CMV and immune monitoring at future meetings, so stay tuned!

As indicated by the symposium title, infectious complications remain the Achilles Heel of MCS. Shashank Desai, Barbara Cagliostro, Stanley Martin, and Saima Aslam updated us on the scope of the issue, the role of driveline dressings and infectious risk, imaging modalities for diagnosing MCS infections, and the management of MCS recipients with bloodstream infections. The session closed with a colorful debate between Nader Moazami and Stephan Schueler regarding the link (or lack thereof) between device infection, thrombosis and CVA. In Cardiothoracic Transplantation and MCS Infections: Cracking the Code for Diagnosis, Monitoring, and Treatment, Erika Feller presented data suggesting that PET-CT may accurately assist with the diagnosis of ventricular assist device infection, and Sarah Taimur presented two posters (Successful Heart Transplantation in Patients with Total Artificial Heart infections [abstract 1012] and Successful Heart Transplantation in Patients with Active Staphylococcus Bloodstream Infection and Suspected Mechanical Circulatory Support Device Infection [abstract 1016]), suggesting that heart transplantation may be successfully performed in the context of device infection.

Finally, we received a fascinating update in donor-derived infections across the globe, as well as a framework for evaluating donors with possible encephalitis, and an approach to increased risk donors in Hanging in the Balance: Minimizing Risk and Maximizing Benefit with Donor Derived Infections. Joanna Schaenman also reviewed donor derived disease transmission events in thoracic organ transplantation (abstract 0846).

The presentations at this year's ISHLT Annual Meeting and Scientific Sessions highlighted the clinical dilemmas we face on a daily basis, served as a springboard for ongoing research, and led the groundwork for new and novel collaborations. I am truly grateful to have met with colleagues from around the world, all of whom contribute so greatly to patient care and outcomes and who teach me so much. I left the meeting even more excited about the future of heart and lung transplantation and with an increased sense of "this is why I do what I do." As an aside, I also learned a thing or two about the world of non-medicine, such as the fact that David Bowie and Elvis Presley had the same birthday (thanks to Allan Glanville). ■

Disclosure Statement: The author has no conflicts of interest to disclose.




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