Many thanks to Saima Aslam & Jussi Tikkanen for coordinating the content for this month's issue.

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In this issue of the Links, we reminisce over this Holiday's hallmarks in heart and lung transplantation, a 20th century marvel. 100 years ago, there were many technological advancements that simplified our lives but altered our perception of space and time. Marking the 75th anniversary of what some consider 20th century's greatest technological achievement from our greatest minds Einstein, Fermi, Compton, et al, was the CP-1 (Chicago Pile-1), a part of the Manhattan Project. These initial efforts and criticism brought to the world nuclear power plants and humanoid robots. Today, we decorate the 50th anniversary of heart transplantation with Jim Kirklin's spotlight on the history of heart and lung transplantation by reviewing the transition from animal to human candidacy. With tidings from Alyssa Perez and Steven Hays, we re-examine lung transplantation in patients with Mycobacterium Abscessus. Lindsay Caldarone explores the sprinkles of neutrophil extracellular traps (NETs) in lung transplantation, while Georgina Waldman unwraps the new shingles vaccine. Claire Aguilar gallops to a winter wonderland in her article, "When You Hear the Drumming of Hooves, Think Horses... (But Don't Forget Unicorn): Hyperammonemia Associated with Ureaplasma spp. Infection in Lung Transplant Recipients." Javier Carbone carols the season with his article, "European Day for the Prudent Use of Antibiotics. A European Health Initiative." To wrap it all up, Maryl Johnson caters an update from the ISHLT Governance Committee and our President Andy Fisher untangles the tinsels in his halftime report. In keeping with the December Yuletide of the ISHLT Links, yours truly provides a chorale and corrals the 20th Century's achievements reflected by the delightful Debussy.

Vincent Valentine, MD
Links Editor-in-Chief


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Introduction to the ISHLT e-monograph on the History of International Heart and Lung Transplantation

James K. Kirklin, MD

The developmental history of human heart transplantation is laced with innovation, prescient persuasion, intense competition and courageous convictions. When all is written and the controversies laid to rest, Norman Shumway will always rise above the rest as the true Father of Heart Transplantation. But he wasn't the first. That landmark event in the history of medicine is inexorably linked to Christian Barnard, the charismatic cardiac surgeon from Cape Town, South Africa, who on December 3, 1967 took the heart from Denise Darvall, the deceased victim of a hit-and-run motor vehicle tragedy. The recipient was Louis Washkansky, a 53-year-old former sports enthusiast in the terminal phase of heart failure. The simple recognition of this amazing and historic accomplishment belies the intensely competitive struggle involving four heart surgeons and their teams, each of whom would be acclaimed in the early history of heart transplantation. Read more →


An Update from Your ISHLT Governance Committee

Maryl Johnson, MD
Governance Committee Chair

links imageIn the ISHLT Strategic Plan for 2016 - 2020, under the Strategic Imperative: Ensure Organizational Vitality, one of the prioritized goals was to "Improve Governance." A starting point for this goal was the establishment of a formal Governance Committee, charged with tasks related to not only the Nominations and Elections processes of the Society, but also to the development of job descriptions for volunteer leaders in the Society, a process necessary prior to beginning an assessment of Society infrastructure and projects. As your past-president, I am the current chair of the Governance Committee, which also includes the president (Andy Fisher), president-elect (Jeff Teuteberg) and four at large members serving staggered three years terms (currently Duane Davis, Joe Rogers, Stuart Sweet and David Taylor). Read more →

Protecting Our Protected Characteristics: ISHLT President's Mid-Term Report

Andrew J. Fisher, FRCP, PhD
ISHLT President

links imageAs we enter December 2017 and those of us in the Northern hemisphere start to feel the cold chill of winter arrive and those of you in the Southern Hemisphere look forward to the warmth of the summer, we must take a few moments to remember the events that occurred 50 years ago in South Africa when the first human heart transplantation was performed. This momentous event in modern medical history is being celebrated in many ways this month and certainly, at the ISHLT we are making our own contribution. The December edition of JHLT is dedicated to this anniversary and contains a number of fascinating articles and is well worth a cover to cover read ( Read more →

ISHLT Call for 2018 Grants & Awards Applications

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ISHLT is currently accepting applications for all major 2018 awards. Application links and eligibility information for all awards can be found on the Grants and Scholarships page of the ISHLT website. Read more →


European Day for the Prudent Use of Antibiotics: A European Health Initiative

Javier Carbone, MD, PhD

links imageA recent high profile report estimates that by 2050, 10 million people will die every year due to antimicrobial resistance (AMR) unless a global response to the problem of AMR is mounted. On November 17, a meeting related with the European Antibiotic Awareness Day 2017 was held at the Spanish Ministry of Health in Madrid, Spain. Belen Crespo, Director of the Spanish Drug Agency (AEMPS), talked about recent advances of the Spanish National Plan against AMR (PRAN). Infection-related death rates due to AMR are increasing in Spain with antibiotic resistance causing 2,500 deaths each year. This situation generates an additional health spend of 150 million euro. Read more →

Re-Examining Lung Transplantation in Patients with Mycobacterium Abscessus

Alyssa A. Perez, MD, EdM
Steven R. Hays, MD

A 26F with a history of cystic fibrosis (FEV1 0.89) and Mycobacterium abscessus (diagnosed in 2006) presents for pre-lung transplant evaluation at your center after being turned away from multiple programs due to M abscessus infection.

The prevalence of nontuberculous mycobacterial (NTM) pulmonary infection is increasing worldwide among patients with structural lung disease and importantly, among our pre-lung transplant population [1]. Infection with NTM poses numerous challenges to lung transplantation as the organisms are difficult to eradicate, therapies are difficult to tolerate, and infection with NTM is associated with worse outcomes if present pre or acquired post lung-transplantation [2,3]. Read more →

New Shingles Vaccine

Georgina Waldman, PharmD

Vaccination is a core component of preventing infection. However, immunosuppressed patients have a reduced response to vaccination which is multifactorial, influenced by type of immunosuppression, time from transplantation and type of graft. Due to this blunted response, we optimize all vaccinations prior to transplant, particularly post-transplant contraindicated live vaccines. However, not all patients are able to be fully immunized prior to transplant or may not have developed full immunity, leading to risk of infection post-transplant. This has been an issue especially with herpes zoster (HZ), a reactivation of varicella-zoster virus (VZV) in the posterior dorsal root ganglion. Read more →


When You Hear the Drumming of Hooves, Think Horses... (But Don't Forget Unicorn): Hyperammonemia Associated with Ureaplasma spp. Infection in Lung Transplant Recipients

Claire Aguilar, MD

links imageWhen I started my fellowship in Transplant Infectious Diseases in Toronto two years ago, I was expecting to order numerous tests to find unusual infections in those very immunocompromised patients. As an example, the differential diagnosis for neurological symptoms in immunocompromised hosts includes various infectious etiologies. In fact, I quickly realized that after transplant, a lot of patients had delirium. My staff, Dr. Husain, asked me if I knew the proportion of cases due to infections. Less than 5% quite low. Think horses: medications, metabolic disorders, psychological stress post-transplant. Read more →

Exploring Neutrophil Extracellular Traps (NETs) in Lung Transplantation

Lindsay Caldarone

links imageA "suicide bomber" that undergoes "cellular kamikaze" to produce a "spider's web" - and these are just a few of the many colorful descriptions used to explain the process of neutrophils undergoing NETosis [1,2,3]. NETosis was first described in 2004 by Brinkmann et al. as an innate immune response to bacterial invasion [4]. Since that time, research into the mechanisms and consequences of NETosis has exploded. NETs have been described as beneficial agents that fend off viruses and fungi, in addition to bacteria. They have also been implicated in a wide variety of inflammatory disease states, from autoimmune disease to acute lung injury. Read more →


Paintings, Words and Wines: Blurred Reflections of France and Debussy

Vincent Valentine, MD

links imageThe 20th century marks an epoch of phenomenal progress in virtually every aspect of Western society, including the genesis of heart transplantation and birth of the ISHLT. With music as a mirror, musical style has also gone through a period of accelerated change during the 20th century. Many turn to concert music as a refuge from the complexities, ironies and difficulties of modern life with much that might appear to be ugly, confusing and incomprehensible. To those who feel this way, would they prefer vanilla over chocolate; coke over a 100 year old single malt; scrambled eggs over caviar or a Ford over a Ferrari? Most of the best things in life, including the music of the 20th century, are acquired tastes. Read more →


Vincent G Valentine, MD

Editorial Staff

"Music is the silence between notes."
— Claude Debussy

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Disclaimer: Any opinion, conclusion or recommendation published by the Links is the sole expression of the writer(s) and does not necessarily reflect the views of the ISHLT.