ISHLT: The International Society for Heart & Lung Transplantation

The Newsletter of the International Society for Heart and Lung Transplantation
Summer, 2002
Volume 5, Issue 1

4TH FALL EDUCATION MEETING: TOWARD OPTIMIZING DONOR HEART QUALITY
September 15-17, 2002
St. John's College, Cambridge, United Kingdom

Meeting Venue

We are pleased to be able to conduct this meeting in the College of St. John the Evangelist, on the banks of the river Cam in one of the most beautiful sites in the Cambridge. The College was founded in 1511 by Lady Margaret Beaufort, mother of Henry VII, on the original medieval site of the hospital of St. John. The meeting will take place in the Palmerston Room of St. John's College. Cambridge is considered one of the most beautiful cities in Britain, particularly in the fall. You can walk along the Backs, the famous grass-covered banks of the River Cam, enjoy the architectural glories of the riverside colleges, and browse among the multitude of bookshops. Cambridge has a wealth of museums and is famous for its bookshops. Peterhouse, the first college in Cambridge, was founded in 1284. There are now 31 colleges which contain Cambridge's great architectural treasures that reflect perfectly 700 years of British architectural heritage.

Meeting Overview

So why do we need a measure of donor heart quality? Currently, there is a severe shortage of donor hearts available for transplantation, a substantial waiting period for a heart transplant, and a high mortality rate for those on the waiting list. Improved utilization of donor hearts is one target area that has been identified for addressing these problems. It has been reported that donor yield in some regions is as low as 19%. Aggressive donor management combined with carefully expanded criteria for donor heart suitability are critical issues that need to be addressed. A great deal of work has been going on in order to better understand the human donor heart. As a result it is clear that what we have assumed to be a "normal" or "low risk" donor heart is far from "normal". The time is well overdue for us to focus on this pool of knowledge and the seek answers from it to the following five questions:

1. Are we being too conservative in our guidelines for use of the human heart for transplantation?
2. Can we propose a minimum standard or "quality" below which hearts should not be used?
3. With such a standard can we move to objective descriptors of the donor hearts and so towards the confident use of distant teams to procure hearts for cardiac transplantation in our own hospitals?
4. Can we optimize a "sub-optimal heart" through resuscitation and avoid the disposal of an increasingly vital resource?
5. Can we look forward to an era when we can make certain and sensible use of donor hearts that we are currently rejecting?

This Fall Meeting of the ISHLT offers a wonderful opportunity for us to wrestle with these five challenging questions. It is hoped that following this meeting, we will be able to produce a paper describing how close we are to finding answers and as a result directing future work. In this way we may be more likely to ensure that heart transplantation does not become a rarity, failing to provide relief to those patients who have in all other ways reached the end of the road with heart failure.

Registration and housing forms for this meeting were mailed in June and are available form the ISHLT office and on our web site (www.ishlt.org). Because of space limitations, attendance will be limited to the first 300 registrants.

2003 ANNUAL MEETING CALL FOR ABSTRACTS

Mark your calendar now for the 2003 Annual Meeting, April 9-12, 2003, which will be held in Vienna, Austria. The scientific sessions will be conducted in the Hofburg, a former palace of the Habsburgs which now contains several museums, the Winter Riding School (where the Lipizzaner Stallions perform every April), and the President of Austria's offices. The meeting rooms are works of art themselves, with soaring frescoed ceilings, huge crystal chandeliers, and gilt encrusted plasterwork.

Hotel rooms have been booked at a number of hotels of varying price ranges (some as low as $100) and most within easy walking distance of the Hofburg and the nearby art galleries, shops, and coffee houses.

Preliminary program information as well as registration and housing forms will be mailed to all ISHLT members and interested individuals in December. The Call for Abstracts will be mailed to all members in July. The deadline for electronic abstract submission is September 20. Paper abstract submissions will not be accepted. To access the electronic submission site, visit the ISHLT web site (www.ishlt.org). The link for abstract submission will be live in early July.

This year, the Society is implementing a new system for coding abstracts that more accurately reflects the specific areas of science to which the abstracts belong. Submitting authors will be asked to code their abstracts as follows:

First, according to the appropriate organ:
Heart, Lung, Heart/Lung, or Not Thoracic-Organ Specific

Second, according to the appropriate category of science:
Clinical (involving patients or in vitro assays using patient samples) or Basic Science (involving animal models or in vitro systems other than those using patient samples)

Third, according to the appropriate subcategory:

Clinical Subcategories:

1. Prospective Clinical Trials
2. Therapeutics: (e.g. Immunosuppression/Immunomodulation/Others)
3. Diagnostics: (e.g. Immune Monitoring/IVUS/Endomyocardial Biopsy/Others)
4. Pathology
5. Post-Transplant Complications (e.g. Infectious Disease/Malignancy/Renal
Failure/Osteoporosis/Others)
6. Mechanical Assist/Artificial Organs
7. Advanced Heart Failure/Lung Failure Therapies (non-transplant)
8. Tissue Engineering/Stem Cells
9. Genomics/Proteomics
10. Pediatrics
11. Nursing/Social Science Issues
12. Donor Issues (e.g. Preservation/Ischemia Reperfusion/Others)
13. Organizational/Governmental Issues
14. Pulmonary Hypertension
15. Other

Basic Science Subcategories
1. Acute Rejection/Allorecognition
2. Chronic Rejection
3. Tolerance
4. Histocompatibility/Antibodies
5. Tissue Engineering/Stem Cells
6. Immunosuppression
7. Immune Monitoring
8. Mechanical Assist/Artificial Organs
9. Donor Issues (e.g. Preservation/Ischemia Reperfusion/Others)
10. Xenotransplantation
11. Other

ISHLT CONGRATULATES 2002 AWARD WINNERS

Applications for the 2003 awards will be mailed in October to all members and interested individuals. The application deadline is February 15, 2003. ISHLT will award up to three one-year $40,000 Fellowship Awards in 2003.

Congratulations to the recipients of the 2002 ISHLT Awards:

$40,000 ISHLT/Roche Transplant Research Fellowship Awards:

* Ruediger Hoerbelt, MD, Massachusetts General Hospital, Boston, MA, "Studies to Elucidate the Role of Activation-Induced Cell Death in the Induction of Tolerance in Miniature Swine Using Rapamycine, Donor-Specific Transfusions and Costimulation Blockade."

* Markus Riha, MD, University of Pennsylvania, Philadelphia, PA , "Ventricular Tissue Engineering: The Role of Acellular Matrix in Guided Cardiac Regeneration."

$80,000 ISHLT Transplant Career Development Award:

* Anthony Azakie, MD, University of California at San Francisco, San Francisco, CA, "Bioengineering Cardiac Myoblasts."

$12,000 ISHLT Nursing and Social Sciences Research Award:

* Annette J. De Vito Dabbs, RN, MN, PhD, University of Pittsburgh School of Nursing, Pittsburgh, PA, "The Nature of the Transition After Lung Transplantation."

Caves Award, a $1,000 prize for the best presentation at the meeting by a resident/fellow and first autho

* Peter Blaha, MD, Vienna General Hospital, Vienna, Austria, "The Effects of Rapamycin and Cyclosporin A on Tolerance Induction Through Bone Marrow Transplantation with Costimulation Blockade.

MEMBERS ELECT NEW BOARD MEMBERS AND OFFICERS

At the ISHLT Annual Business Meeting, the Society members elected the following individuals into office as new members of the Board of Directors:

President-Elect
Jon Kobashigawa, MD
University of California at Los Angeles
Los Angeles, CA

Directors
Soon J. Park, MD
University of Minnesota
Minneapolis, MN

Hermann Reichenspurner, MD, PhD
University Hospital Eppendorf
Hamburg, Germany

Heather J. Ross, MD
Toronto General Hospital
Toronto, Ontario, Canada

Also at the Annual Business Meeting, Stephen Schueler, MD, succeeded to the office of President of the Society

The members of the Board of Directors and the Society extend their heartfelt thanks to the outgoing members of the Board of Directors who have volunteered their time and energy over the past three years on behalf of the Society: Robert Bourge, MD, Axel Haverich, MD, Anne Keogh, MD, and Mehmet Oz, MD.

ANNUAL BUSINESS MEETING MINUTES

Call to Order - President James B. Young, MD called the meeting to order at 12:05 pm on Saturday, April 13, 2002. Secretary-Treasurer Patterson recognized a quorum.

President's Report - Dr. Young noted that he had given his President's Report has been given the prior day during the plenary session.

Treasurer's Report - Secretary-Treasurer Alec Patterson, MD reported that the Society is in good shape financially, and operated slightly in the red in 2001 due to the decision to invest in the MCSD Database and to provide higher quality audio-visual at the Annual meeting (a substantial expense). He reported that the Society's net income for 2001 was a loss of approximately $130,000. He also reported that, if investment losses were excluded, since they are essentially paper losses, the Society's net income for 2001 was approximately $52,000.

JHLT Editor's Report - James Kirklin reported that the JHLT's manuscript submission rate is remaining constant at approximately 300 per year, but that the quality of those manuscripts is improving. The current acceptance rate is 50%. He reported that electronic manuscript submission is being considered seriously, and that email submissions have been the interim substitute for a full-fledged electronic submission process. President Young thanked Dr. Kirklin for shepherding the JHLT and for continuing to improve its quality.

Election - President Young presented the Nominating Committee's slate of officers and directors:

President-Elect: Jon Kobashigawa, MD
Director: Soon Park, MD
Director: Hermann Reichenspurner, MD, PhD
Director: Heather Ross, MD

He then asked the members to cast their vote on the slate using the ballots provided. The ballots were counted and President Young announced that the slate was approved unanimously.

Presentation of Awards - Mark Barr, MD, Co-Chair of the Grants and Awards Committee, thanked the Board of Directors for the opportunity to serve in this capacity for such an important program. He thanked Co-Chair John Dark and the 39 committee members and Caves Award reviewers who had helped judge the high quality grant applications and Caves Presentations. He reported that the prior grant recipients were making excellent progress and that we should be hearing the results of their work at the Vienna meeting. He then thanked Roche for their generosity in helping to fund the awards. Dr. Barr concluded with the presentation of the 2002 Award Winners. President Young then introduced Sandra Cupples, DNSc, Co-Chair of the Research Committee of the Nursing and Social Sciences Council, who presented the Nursing and Social Sciences Research Award. (See award recipient article elsewhere in this issue for listing of award winners.) President Young thanked Dr. Barr and Roche for their support of the Society's Grants and Awards Program.

Recognition of Outgoing Board Members - President Young remarked that the outgoing Board members had worked hard over the past three years to bring the Society to its current level, and he extended to them his personal thanks for their dedicated efforts: Robert Bourge, Axel Haverich, Anne Keogh, and Mehmet Oz.

Recognition of Incoming President - President Young thanked everyone for their support and direction during his year as President. He then welcomed Dr. Schueler as President of the Society and passed the Presidential Gavel to him.

Recognition of Outgoing President - President Schueler thanked Dr. Young for his excellent service to the Society and expressed hope that he would follow well in his footsteps. He then presented him with the Commemorative Presidential Gavel. President Schueler extended congratulations to Dr. Robbins for organizing an excellent meeting and promised all an equally enjoyable meeting in Vienna in 2003. He announced that the Fall Education meeting would take place in Cambridge, UK in September, and he encouraged everyone to attend. President Schueler then called for any new business.

Adjournment - There being no other business, the meeting was adjourned at 12:25 pm.

SUMMARY OF BOARD OF DIRECTORS MEETING DECISIONS

The Board of Directors met April 10 and 13, 2002, in Washington, DC and made the following decisions:

1) to pursue the development and publication of an Advanced Heart Failure Manual/Handbook of Heart Failure, with regular updates, as a companion to the Journal of Heart and Lung Transplantation

2) to approve Retired Membership Status for Dr. Raj Lal.

3) to consider Miami, New York City, Boston, Philadelphia, Baltimore, and Las Vegas for the 2005 Annual Meeting

4) to consider Barcelona, Zurich, Prague, London, and Paris for the 2006 Annual Meeting

5) to negotiate a renewal of the contact with Elsevier Science to publish the Journal of Heart and Lung Transplantation and to include in the contract a system for online electronic manuscript submission, tracking, and review

6) to appoint Bruce Rosengard and Doris Taylor as the new co-chairs of the Scientific Council on Cell Transplantation

7) to appoint a sub-group to develop proposed criteria for identifying designated VAD centers for reimbursement purposes

8) to discontinue providing complimentary meals with the Sunrise Symposia and the Mid-Day Workshops at the Annual Meeting

9) to require that the Annual Meetings beginning in 2004 be operated on a break-even basis at a minimum

10) to provide funding for the Nursing and Social Science Council to produce a white paper on psychosocial outcomes in adult transplant recipients and interventions that can be taken to improve these outcomes

11) to approve Jon Kobashigawa's appointment of Mandeep Mehra as Program Chair for the 2004 Annual Meeting in San Francisco

ISHLT REGISTRY DATA AVAILABLE AS A POWER POINT FILE

We are pleased to announce that the Registry data graphs and charts of data through December 2001 will be available from the ISHLT web site at no charge as a Power Point file.

The 2001 data, presented at the 2002 Annual Meeting in April, will be available for online download on August 1, 2002. ISHLT members who need the data for presentation/manuscript purposes prior to this date may arrange with the ISHLT office to have them emailed. Please contact Phyllis Glenn at the ISHLT Headquarters Office (972-490-9495) or phyllis.glenn@ishlt.org to obtain a copy of the Registry Side Order form.

To download the Registry Data Power Point Slides, go to the ISHLT web site at www.ishlt.org and then click on "Registries" and then click on "Heart/Lung Registry". There, you will find instructions for downloading the Power Point Slides.

SCIENTIFIC PROGRAM COMMITTEE SELECTED FOR WASHINGTON, DC MEETING

The below individuals have agreed to serve on the Scientific Program Committee for the ISHLT 23rd Annual Meeting and Scientific Sessions, April 9-12, 2003, in Vienna, Austria. You may communicate your thoughts and ideas for the program directly to the individual category chairs or to the Program Committee Chair. The Committee will meet in mid-October to finalize the scientific program for the Annual Meeting. We anticipate that by December 1, the Final Program and the selected abstracts will be available for viewing online via the ISHLT web site. You will be able to search the accepted abstracts by topic and author and will be able to generate a personal itinerary for the meeting. Check the Society web site in December for instructions on how to do this.

Chair
Bruce R. Rosengard, MD, Philadelphia, PA

Basic Science and Immunobiology
Thomas Wekerle, Vienna, Austria
Thomas Dengler, Heidelberg Germany
Michael S. Mulligan, Seattle, WA

New Alternative Therapies to Transplantation
Cell Transplantation & Tissue Engineering
Guenther Laufer, Innsbruck, Austria
Doris Taylor, Durham, NC

Clinical Lung/Heart-Lung Transplantation
Medical Management of Lung Failure and Candidate Selection
Pulmonary Hypertension
Walter Klepetko, Vienna, Austria
Selim M. Arcasoy, New York, NY
Paul Corris, Newcastle, United Kingdom

Clinical Heart Transplantation
Carmelo A. Milano, Durham, NC
Asghar Khagani, Amersham Bucks, UK
George Tellides, New Haven, CT
Mariell Jessup, Philadelphia, PA

Immunosuppression-Clinical and Animal Studies
Joren Madsen, Boston, MA
Bruno M. Meiser, Munich, Germany

Donor Management, Organ Preservation, Organ Distribution
Robert B. Love, Madison, WI
Stephen R. Large, Cambridge, United Kingdom
James K. Kirklin, Birmingham, AL

Mechanical Circulatory Support
Michael A. Acker, Philadelphia, PA
Robert L. Kormos, Pittsburgh, PA
Robert C. Robbins, Stanford, CA

Medical Management of Heart Failure and Candidate Selection
Barry K. Rayburn, Birmingham, AL
Mandeep Mehra, New Orleans, LA
Susan Brozena, Philadelphia, PA

Pediatrics
Steven A. Webber, Pittsburgh, PA
Lori J. West, Toronto, Canada

Pathology
Loukas Kaklamanis, Athens, Greece

Nursing/Social Services/Health Economics
Carol Twomey, Warrington, PA

SCIENTIFIC COUNCIL REPORTS

The ISHLT Scientific Councils were created to decentralize the mechanism by which the Society pursues its educational, scientific, and social missions. The Councils provide advice and feedback to the Scientific Program Committee and Board of Directors; address the need for scientific consensus conferences, documents, and position statements; define research priorities and opportunities for collaborative research with other entities; and foster the development and maintenance of formal and informal social networks for Society members.

The Society now has 9 Scientific Councils: Cell Transplantation/Tissue Engineering, Heart Failure and Transplant Medicine, Mechanical Circulatory Support, Nursing and Social Sciences, Pathology and Basic Science, Pediatric Transplantation, Pulmonary Arterial Hypertension, Pulmonary Transplantation, Xenotransplantation

A form will be mailed to all members in July for use in signing up to participate in the Councils. If you do not receive this form and would like to receive one, please contact Phyllis Glenn at the ISHLT Headquarters Office. There is no fee to join a Council, and you may join as many as you wish.

The Councils met in April at the ISHLT Annual Meeting and several of them have submitted the minutes from their meetings for publication in the Newsletter:

Cell Transplantation/Tissue Engineering
by Doris Taylor, PhD

The first meeting of the Cell Transplantation/Tissue Engineering Scientific Council was held on April 10, 2002, 6:15 - 7 pm.

Approximately 30 individuals were present. Doris Taylor, PhD, facilitated the meeting. Those present discussed several issues relating to the future of cell-based approaches for cardiovascular repair and the role of ISHLT in this field.

Motion: To form a Cell Tissue/Tissue Engineering Scientific Council of the ISHLT.

Discussion: The field of cell transplantation is exploding. ISHLT is an organization that attracts a variety of clinical providers and pre-clinical investigators and thus is in a good position to provide education and guidelines in this rapidly changing field. Cell transplantation is one future for patients currently on mechanical support or bridge devices. Clinicians in the field need advice regarding the promise of various technologies to avoid the kind of morass that has arisen in the past with other treatments such as transplant. ISHLT is in an excellent position to develop a system of investigators that can cohesively apply these new technologies with rigor in multi-center studies.

A Cell Transplantation Council could use available ISHLT resources and previous Council models to begin to:

Compile data from on-going clinical trials
Provide a future think tank to advise the ISHLT Board of Directors on the promise of new technology
Develop a yearly white paper on cell transplantation and tissue engineering for publication in the Journal of Heart and Lung Transplantation.
Issue a joint statement with the ISHLT Board of Recommendations and Guidelines for Cell- Based Clinical Trials

Motion passes unanimously.

Motion: The ISHLT Cell Transplantation/Tissue Engineering Scientific Council should compile or create "Recommendations and Guidelines for Cell-Based Clinical Trials" that will be issued jointly with the ISHLT Board.

Discussion: A draft of these guidelines should be sent to the principal Cardiology and Cardiac Surgery organizations (AHA [Transplantation group, vascular biology group], ACC, ACS, STS, HFS) for comment, suggestion and participation.

Motion passes unanimously.

Motion: The ISHLT Cell Transplantation/Tissue Engineering Scientific Council should compile or create "Recommendations and Guidelines for Translating Pre-clinical Studies into Cell-based Clinical Trials."

Discussion: One mechanism to do this is to establish as a Council a program that brings together leaders in the field to educate the Council on the latest science and on clinical needs. We could then use the information to formulate guidelines about how to translate research from bench to bedside. Bringing together clinicians and scientists at the same forum to begin a dialog is critical to designing appropriate pre-clinical studies. Our recommendations will have more weight if we agree to work with and or serve as an advisory group to regulatory bodies such as the FDA as they develop biologic approaches to cardiac repair. Cell therapy/tissue engineering is an excellent translational field. We need to attract more basic scientists to this meeting or to any meeting we hold. Advertising at AHA would help.

Motion passes unanimously.

Motion: The ISHLT Cell Transplantation/Tissue Engineering Scientific Council should recommend to the Board of Directors that either at AHA in November or at next year's ISHLT meeting or both, ISHLT sponsor a Featured Research Session designed to attract both clinicians and basic scientists. The meeting should have as a tentative format: A pre-clinical overview. The latest science (short talks). A clinical overview. The latest clinical data (short talks). This should be followed by a Council meeting that includes a panel discussion and a significant period of dialog to begin to formulate clinical and pre-clinical guidelines (or to discuss any drafts that already exist).

Discussion: Cell therapy/tissue engineering is an excellent translational field. We need to attract more basic scientists to this meeting or to any meeting we hold. Holding the meeting at AHA would have the advantage of already having many clinicians and basic scientists in one place for a meeting.

Motion passes unanimously.

Motion: The ISHLT Cell Transplantation/Tissue Engineering Scientific Council should generate a yearly white paper for publication in the Journal of Heart Lung Transplantation.

Motion passes unanimously.

Motion: The ISHLT Cell Transplantation/Tissue Engineering Scientific Council should compile data from on-going clinical trials with the goal of establishing a worldwide database of cell-based approaches for cardiac repair.

Motion passes unanimously.

Initial Discussion of Recommendations and Guidelines for Clinical Trials
Several initial general questions were raised and comments made that should be included in any draft document. They include:

* What are appropriate clinical outcomes measurements in cell-based trials?
* DSE, morbidity, mortality
* What safety measures should be put in place during trials (Holters, AICDs)?
* What is the minimum number of patients for any investigator (statistical power).
* Time dependent endpoints 30days, 6 months should be included.
* Endpoints should be simple and readily available at all centers
* Some appropriate endpoints include: re-admission, morbidity, mortality, NYHA functional class, DSE, neurohumoral markers, BNP levels. Expensive technology with limited availability (MRI, PET) should be avoided in trials.
* Multiple patient populations should be included (e.g., angina, HF)

A cohesive multi-center clinical trial should be considered. ISHLT should evaluate its possible role in this. A liaison with NIH/NHLBI should be considered for funding.

A mix of centers should be involved in any clinical trials - not just the high-powered academic centers. This will increase investigator confidence in the reproducibility of the technology.

The question was raised as to whether ISHLT should poll its membership as to who might be interested and able to participate in such a trial. It was decided that prior to doing that a working-group needs to be established to generate criteria for deciding what to do with any information gathered.

Next steps:

* Report to the Board of Directors
* Disseminate notes to the members of the Council who left their email addresses (~30 people)
* Ask the e-mail group whether their interest is primarily clinical or pre-clinical.
* Establish working groups to begin to plan the kind of meeting discussed.
* Begin a draft of guidelines for clinical and pre-clinical studies to be evaluated and crafted by the electronic group.
* Ask ISHLT for buy-in to having a meeting either at AHA or next year at ISHLT.

Meeting was adjourned at ~ 7 pm.

Pulmonary Arterial Hypertension
by Anne Keogh, MD

Fourteen people attended the inaugural meeting of the Pulmonary Arterial Hypertension Council of the ISHLT, held Friday 12 April 2002, 5.30pm - 6.30pm. A meeting of the Council's Co-Chairs was held Saturday 13 April 2002, 10.00am - 10.45am.

Background Discussion

At the behest of ISHLT Board of Directors in 2001, it was decided to that a PAH Council should be organized. A letter was emailed to members of the ISHLT to ask if they wished to join this Council and to non-members of ISHLT who were known active researchers in PAH to determine if they felt the ISHLT could potentially become the umbrella for this rapidly growing field. Responses were adequately broad, enthusiastic and positive for the adhoc Chairs Dr's Paul Corris and Anne Keogh, to feel encouraged that this initiative would indeed be supported. The goal is to set the ISHLT as the

home for clinicians, Cardiologists and Respiratory Physicians, basic Scientists, Pathologists, Surgeons and Allied Health with an interest in PAH. These multi disciplinary roles could collaborate for optimal impact on PAH. The attendees of this inaugural meeting were extremely positive, action-orientated and importantly were representative each in their county or state of centres of excellence and tertiary referral.

Structure

It was agreed to elect co-representatives for Cardiac Surgery (Dr Chris McGregor, 2 year term), Pulmonology (Dr Keith McNeil, 3 year term), Cardiology (Dr Jean-Luc Vachiery, 3 year term), Board of Directors Liaison (Dr Paul Corris).

It was recognised that registration of bosentan, being an oral and easily administered, would likely define expertise in PAH, before the time when comprehensive care plans had been devised in all local situations. Education therefore is urgently required.

Action Plan rapid agreement was reached to:

* request a PAH satellite on Wednesday prior to Vienna meeting (2.5 hours) and request pharmaceutical companies to support the satellite financially, to consider supporting a key name speaker (to largely be of European derivation given the mid Europe meeting venue) and to consider sponsoring trainees in field to the meeting (partial travel support). Dr. Bruce Rosengard (Program Chair 2003) was supportive of this request. (Special request was made by a member that Dr Stuart Jamieson be invited to speak).
* plan a 1 - 1.5 day ISHLT additional workshop (fall 2003/2004) to address a wide variety of issues, spanning "how to" and basic PAH for trainees and nurses through to high level specific item talks, how to read pulmonary angiograms, how to do PTE, what is in development. This initiative will require the approval of the Board of Directors.

Both of these initiatives are to be independently sponsored in an unrestricted manner from multiple sources via the ISHLT Development Committee on behalf of the Society (action: Anne Keogh to approach UT, Actelion Board, North Carolina and Pfizer, New York; Paul Corris to approach BOC, Glaxo Welcome).

* submit to Dr Bruce Rosengard (program chair Vienna 2003) a request for a session including 1 - 2 short plenary PAH talks with abstracts to follow. These abstracts to be sourced via usual membership but also by a personal invitation to non-members to submit. The letters to be devised by the chairs to go to members and non members informing them of the new PAH Council, and notifying them a month ahead of time of the September 2002 deadline for submission of abstracts to the ISHLT.

Other Discussion

Databases: P.A.H databases are known to be held by many individuals, NIH, NHIBI and institutions worldwide. Since the ISHLT has recently committed to support the Mechanical Assist Database, it was not considered an appropriate time to make this initiative.

Guidelines

Similarly guidelines have recently been published (British) and others are in the process. Due to the rapid changes in the field of PAH, printed guidelines are rapidly outdated. This issue is to be reconsidered in the future.

Vicarious databasing may be able to be achieved by limiting data from existing registration, to be presented at the satellite or session contained within the ISHLT internal program.

Recognised Complimentary Societies

It was recognised that the ATS provided a pulmonary vascular stream. The PAH CURE foundation meeting (next June 2002 Irvine California) and multiple independent meetings did provide access to the discipline. However the ISHLT with its existing cooperative and established relationships

between physicians, surgeons, basic scientists, surgeons and allied health remains most naturally suited to become an active forum in this multi disciplinary field.

Administration of PA Council Activities

All correspondence is to be sent via Mrs Amanda Rowe at ISHLT for forwarding and collection. Current email lists exist for key player non-members and PAH Council members. Action: all attendees to identify key local rheumatologists and dermatologists to be added to non-member email invitation list. Action: all attendees to now invite respected colleagues and trainees to submit abstracts for Vienna 2003.

Clinical Projects

It was agreed that to create a short term, double sided collaborative project may establish the PAH Council in the near term as a clinically applicable entity (with possible prospective collaboration in future) and establish a momentum.

A timely project would involve key centralised people providing data, to Chairs, regarding miscellaneous combination and switch therapies with which they have experience. No single centre has broad experience but it is likely that together, the attendees of the inaugural meeting have between them a plethora of experiences. Efficacy data would likely be too diffused but combined safety data reports of great interest. Action: chairs to devise a limited email questionnaire (to be distributed via ISHLT list) questioning minimal safety with all permutations of combination therapies.

Possible Future Areas for Collaborative Research

* Subgroups - identifying subgroup response, tailoring therapy (e.g. Eisenmenger's).
* Transition therapy.

The Council Meeting adjourned at 6.30pm.

Pulmonary Transplantation
by Greg Snell, FRACP, MBBS and Jonathan Orens, MD

40 people were in attendance at the meeting on April 12 chaired by Associate Professor Greg Snell, Alfred Hospital, Melbourne, Australia.

1. Following a suggestion at the previous meeting, a decision was confirmed to appoint a co-chair of the Pulmonary Council. It was felt that this had the advantage of providing a smooth transition between leaders and allowed for any gaps in attendance. The voting on such a position would alternate with the existing position. In essence this meant that one of the two co-chairs would be elected each year. Following approval of this position by the membership, Bert Trulock nominated Jonathan Orens, Johns Hopkins Hospital, Baltimore, USA. There being no other nominations, Jonathan was elected as co-chair.

2. Attention was drawn to the re-classification of BOS, which had just come out in print in the Journal of Heart and Lung Transplantation. All members were encouraged to use this new system in subsequent analyses.

3. The current project of the Pulmonary Council was the review of donor acceptability and it was noted that five successful presentations have been given at a satellite symposium at the start of a meeting on this subject. It was planned to publish the sections in the Journal of Heart and Lung Transplantation. It was still possible for any interested members to contribute and this contribution to be recognised as there was still a bit of work in getting the manuscripts ready for final publication.

From this Donor Review, came a plan to prospectively record variables in relationship to potential and actual lung donors. A number of members offered their views. On the one hand, it is possible to perform a relatively simple study of a few variables that could be collected clinically. This would enable comparison between centres of the sort of donors that are being used in the timeframe of 1-2 years. Alternatively, it was suggested that the variables that actually determine what is a good donor are unknown, and that collecting a wider set of variables would provide the best chance of putting some science behind the whole issue. It was eventually concluded that centres could choose to go either way. The smaller clinical variables project would be included in the longer list of potential variables and centres could be in one or both projects. Tom Waddell agreed to produce a list of variables that centres should collect on donors starting as soon as possible. This will need to be communicated back to the membership. Although a more sophisticated global analysis would require involvement of organ procuring agencies, in the first instance the plan was for the centres to collect these variables themselves. Marshal Hertz noted that the ISHLT registry database could potentially help out with analysis. It was suggested that analysis of pilot data might lead to a Project Grant in a year or two's time.

4. A question came up about the number of abstracts submitted vs. accepted for the meeting. Mark Barr (a former meeting chair) responded by explaining that it was equal representation by Pulmonary and Cardiac Groups, with acceptance being related to the number of actually submitted abstracts in a given section. There was support from the audience that the scoring system was fair and it was noted the number of posters or presentations is often limited by space and time at a given meeting site.

5. As future projects for the Pulmonary Council, there was a suggestion that the classification of acute rejection could potentially be reconsidered, noting that in an abstract from this meeting patients with A1 acute lung rejection were at increased risk of problems. No firm plans were made regarding this.

6. It was suggested that if centres or groups of centres were interested in creating or participating in studies with a large pharmaceutical companies, then using the "strength" of the Pulmonary Council may provide a mechanism to start discussions or coordinate centre involvement.

7. Suggestions for symposia at the front end of next year's or the year after's meeting are welcome. The symposiums take some time to plan and the competing interests of the different sub-groups of the Society also might determine whether a given subject gets up or not. Any suggestions for upcoming meetings should be forwarded to one of the Pulmonary Council Co-chairs over the summer.

If anyone has any suggestions to put forward for discussion by the Pulmonary Council, either in the near future or even for next year's meeting, we'd be happy to discuss them or put them on the agenda. Thank you for your ongoing support.

CALL FOR NOMINATIONS

After their meeting in September, the Board will be forwarding to the Nominating Committee a list of recommended individuals for consideration as incoming members of the Board of Directors. Vacancies to be filled at the 2003 Annual Business Meeting include the President-Elect and 5 Directors. Please send your recommended nominees to Amanda Rowe at the ISHLT Headquarters Office no later than October 15, 2002.

TOP TEN REASONS TO ATTEND ISHLT 2003 IN VIENNA

1. You simply cannot turn down an invitation to meet in a former Emperor's imperial apartment
2. You asked for it, you got it - expanded Plenary Sessions chock full of "can't miss" lectures
3. Viennese coffee houses
4. Presentation of the latest and greatest science in thoracic transplantation/end-stage organ failure
5. Strudel and Sacher torte
6. A night at the Vienna Opera House
7. The new ISHLT dress code just might include Lederhosen
8. An opportunity to see the Vienna Boys Choir and the Lipizzaner Stallions
9. We hope to accept more abstracts than ever, so your chances of getting on the Scientific Program are better than ever
10. You can spend Euros!

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