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The Evolution of Heart Transplantation in Latin America: The ISHLT Knows No Boundaries

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Juan Alberto Cosquillo Mejía, MD
Messejan Hospital
Fortaleza, CE Brazil

Five years ago under the Florida sun in the city of Tampa, physicians and the most diverse health professionals across Latin America met for the first time to talk specifically about heart transplantation and mechanical circulatory assistance. It was the first Pan American Workshop for Mechanical Circulatory Support and Heart Transplant. The event was the beginning of a fruitful relationship between Latin America and the International Society for Heart and Lung Transplantation (ISHLT). The meetings of this group were held at the ISHLT annual congresses: San Diego (2014), Nice (2015), Washington (2016), and finally in April 2017 again in San Diego.

This last meeting in San Diego was very rich. In addition, relevant facts have shown the progress in the different Latin American countries. From Colombia and Chile, we have received the good news of the recently won changes in the organ and tissue donation laws, which have become mandatory. The move will surely bring more organ donations to transplants and help reduce the long waiting list.

The novelties of Mexico showed the beginning of the use of mechanical circulatory assistance as a bridge for transplantation in paediatric patients. From Mexico came the good news that temporary devices manufactured by the local industry began to be used in patients with acute heart failure.

In Peru, the cardiac transplant program of the Heart Institute of Lima was consolidated, and the use of temporary devices as a bridge for transplants was started.

links imageArgentines deserve a special mention: they have been able to gather all data from intra-thoracic transplants performed in their country through the National Transplant Center (INCUCAI) and are until now, the only ones in the region that have been able to send this data in a systematic way to the ISHLT Registry.

The Uruguayans are also to be congratulated for having just completed the 100th heart transplant and, like the Argentines, are excited to send this information to the ISHLT Registry.

In Brazil, despite the economic and political crisis, we can still present positive results in the number of cardiac transplant procedures. We highlight the creation of a national program for the multidisciplinary training of health centers in various regions of the country in the area of heart transplants: The Tutorial Transplantation Project of Messejana Hospital, in Fortaleza, Ceará. At the end of a theoretical and practical training, lasting 18 months, these centers will already be able to transplant.

The available data about heart failure is very scarce in Latin American countries, and several studies suggest inequity of access to evidence-based HF care among them, specifically reduced access to treatments like transplantation and MCS.

Among the goals that emerged in San Diego are: to create partnerships between regional societies and ISHLT, to facilitate training actions that improve the level of cardiac and pulmonary transplantation services in Latin America. Additionally, the need to create a specific registry for patients transplanted with Chagas disease, which in Brazil, for example, represent about 20% of the total number of transplanted patients. The need for the creation of a Latin American registry on the use of mechanical circulatory assistance devices, since the data available so far are only those from the manufacturers' records. One of the possibilities would be the adhesion to IMACS.

An important statement made by ISHLT registry director Josef Stehlik, was that in view of the resumption of the increase in the number of transplants globally, even with the stabilization of numbers of these procedures in Europe and the US, Real growth corresponds to regions outside this axis, among them Latin America. However, despite this growth, it is estimated that of the total number of transplants performed in Latin America, only 30% are reported; therefore, creative and practical actions to stimulate the sending of such data are equally urgent. For this reason, news that was received with enthusiasm by all of us was that the official documents generated by the ISHLT would be translated into Spanish and Portuguese.

links imageFinally, according to a poll conducted by an ISHLT cardiologist and ambassador to Colombia, Adriana Torres, listening to Latin American participants at the Washington congress in 2016, there would be a strong demand for a greater opening of the ISHLT to our region. This could translate into practical and political actions to facilitate access to event programming. The Latin American session was organized by I2C2, under the direction of Howard J. Eisen, with the collaboration of Andreas Zuckermann. The speakers were Paulo Pego-Fernandes and Juan Mejía (Brazil), Alejandro Bertolotti (Argentina), Adriana Torres and Leonardo Salazar (Colombia) and Douglas Greig (Chile).

links imageOur expectation now, is for the first the ISHLT / Latino-America Joint Meeting to be held on October 20th, 2017 in the city of Foz do Iguaçú, state of Paraná, southern Brazil, during the XV Congress of ABTO (Brazilian Association of Transplants of Organs). See you in Foz! ■

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

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