Many thanks to Brandon Larsen & Jorge Silva Enciso for coordinating the content for this month's issue.

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The ISHLT exceeds disciplinary borders with involvement from more than one specialty including cardiothoracic surgery, cardiology, pulmonary, pediatrics, pathology, immunology, basic science, basic science, infectious diseases, nursing, social work, psychology, other allied health areas, pharmacy, and the many personnel maintaining the ISHLT. The extended borders are across space, countries, regions, cultures and time. With such immense diversity, the Society has exposed and educated its members on vast skills and new patient technology such as heart transplantation, lung transplantation, ventricular-assist devices, extracorporeal membrane oxygenation, other forms of mechanical circulatory and respiratory support including advances in donor management. It is important to celebrate the success caused from new research, as it is communicable to the curiosities of other's. Keeping mindful of accomplishments of the past continues to remind us that it is not history that repeats itself but the behaviors of men and women who repeat history so we dare not make the same mistakes. The new mistakes are enough.

In this issue, we have congealed as a society and continue to take the impact factor of the Journal of Heart and Lung Transplantation to new heights. David Baran of Sentara Hospital in Norfolk, VA extols are impact factor of 7.11. We have lost a great pioneer of heart and lung transplantation from France, Christian Cabrol. This issue pays homage to him as one of our giants and his illustrative career. Dr Brandon Larsen from the Mayo Clinic in Scottsdale, AZ and Dr Diyar Saeed of Hinrich-Heine University in Dusseldorf, Germany, Dr Palak Shah of Inova Fairfax Hospital in Virginia and Dr Jennifer Cook of University of Arizona in Tucson, Arizona provide updates from the Pathology Council and MCS Academy 2018, respectively. Dr Jorge Silva Enciso of UCSD in San Diego representing the Junior Faculty Council delivers an insightful update on heart-lung transplantation for congenital heart disease and challenges our math with the sum of one and one. Javier Carbone, our Ambassador of the International Correspondents Board from Complutense University in Madrid reminds us of the growing problem of secondary immunodeficiencies of our patients we manage. It is Sara Schlette, MCSD Coordinator from the Mayo Clinic in Rochester, MN, who links us with Words, Books and Patients to help us manage complex and challenging problems in our patients as we balance to do the right thing and maintain their trust and confidence. Finally, yours truly from the Editor's Corner evokes the ancients to start a wisp of a journey through the evolution of natural philosophy to science over hundreds of years and what it means to us today as we look ahead to the 38th Annual Meeting in Nice, France.

Vincent Valentine, MD
Links Editor-in-Chief


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JHLT Impact Factor: Take it to the Top

David A. Baran, MD, FACC, FSCAI

Discoveries and advances in medicine occur with increasing speed; therefore, textbooks serve to provide a foundation for knowledge. We rely on journals to inform on the latest and greatest developments, many of which are able to be translated into clinical practice. Health care providers must read journals to adhere to the rapidly evolving fields of medicine including Heart failure, thoracic transplantation and mechanical circulatory support. There are numerous competing journals all vying for the reader's eye. A logical place to acquire the latest information in these areas is the Journal of Heart and Lung Transplantation, which is the official Journal of the ISHLT. This has always been a key journal to read about the annual ISHLT Registry Report as well as immunosuppression for both heart and lung transplantation. Read more →


Update from the Pathology Council - Recap of 2017 Annual Meeting

Brandon T. Larsen, MD PhD

links imageAlthough we are only a small subset of the broader ISHLT membership, the Pathology Council is an active and exciting group that continues to provide vital clinical, research, and educational expertise to advance the Society's initiatives, strengthen the transplantation community, and most importantly to help the patients we serve! This past April, we enjoyed a highly productive Annual Meeting, where we were enriched not only by great scientific content, but also by the close comradery of our excellent colleagues. At this meeting, we saw a renewed emphasis on several Council initiatives and heard several new proposals aiming to expand our research and educational efforts as we seek to improve the care of our patients and enhance the skills of our pathology colleagues who are not (yet) members of the Society. We also witnessed a change in leadership in our Council, with Dr. Robert F. Padera assuming the role of Council Chair for the next two years, and Dr. Martin J. Goddard stepping down and assuming the role of Council Past Chair. We are grateful to Dr. Goddard for his leadership and service, and look forward to having Dr. Padera at the helm! Read more →


When One Plus One Does Not Equal Two

Jorge Silva Enciso, MD

links imageCombined heart and lung transplantation has been sought as the therapeutic option for patients with advanced pulmonary vascular disease including congenital heart disease, fixed pulmonary hypertension with elevated pulmonary vascular resistance (PVR) or idiopathic pulmonary arterial hypertension. The recent ISHTL registry data contains more than 3800 combined heart-lung transplants (HLT) worldwide but the number of HLT performed has decreased in recent years probably due to advances in technology and pharmacological treatments for such patients. Many patients with fixed or irreversible pulmonary hypertension from left heart disease for example are candidates to receive a ventricular assist device as a bridge to transplant with the goal of reducing PVR. Patients with IPAH are improving quality of life, functional class and survival with targeted medical therapy. For CHD patients, however therapeutic options are limited once advanced heart failure occurs. Read more →


Christian Cabrol 1925-2017

links imageChristian Cabrol, renowned pioneer of cardiac and pulmonary transplantation, and ISHLT President 1991-92, died on May 16th 2017. He had been ill for a number of months and spent his last days in his own hospital, Pitié-Salpêtrière. Cabrol was born in 1925, and educated in Paris. He trained in thoracic and then cardiac surgery, spending a year with Lillehei in the USA. He came to prominence when, in 1968, he performed the first cardiac transplant in Europe. His patient lived only 53 hours, but he persisted when others hesitated, seeing clearly the potential for great impact. In the late 1960's and early 1970's, Shumway's team at Stanford and Cabrol's group in Paris were almost alone in keeping heart transplantation alive. Always in the vanguard, Cabrol went on to perform the first heart and lung transplant in Europe in 1982, and then in 1986 the first implant of the Jarvik 7 total artificial heart. Read more →


Secondary Immunodeficiencies: A Growing Problem?

Javier Carbone, MD, PhD

links imageWidespread use of biologic therapies and procedures such as ventricular assist devices and ECMO is associated with an increase in the number of patients who can develop secondary immunodeficiency. Indeed, severe and recurrent infections are a common adverse effect of these interventions. Biologic therapies do not cause the same degree of immunosuppression as that observed with more conventional immunosuppressive drugs, such as corticosteroids, cyclosporine, tacrolimus, mycophenolate, methotrexate, cyclophosphamide, and azathioprine. However, they may have unintended effects on immune function that can compromise innate and acquired immunocompetence and lead to severe infections. Some biologics can also induce other adverse effects of immunosuppression, such as autoimmune diseases and malignancy. The many new biologics targeting the immune system are subject to various infectious complications. Read more →

Update from MCS Academy 2018

Diyar Saeed, MD, PhD
Palak Shah, MD, MS
Jennifer Cook, MD

The Core Competencies in mechanical Circulatory Support (MCS) began in 2012 under the leadership of David Feldman, Andreas Zuckermann and Jeffrey Teuteberg. Since then and due to continuous positive feedback from conference participants, the academy has been an extraordinary source for education. Traditionally, the academy takes place one day prior to the ISHLT meeting. This course provides a concise review of clinical knowledge and outlines the essential professional skills for candidate assessment and longitudinal support for mechanical circulatory support patients. The course is primarily designed to be of benefit for clinicians and allied professionals who are in the early stages of their careers. The course also provides an update on the current state of the field for more established providers. Read more →

Words, Books and Patients

Sarah Schettle, PA-C

links imageA quick shameless Wikipedia search suggests that 45% of English words derive from French origins. French hails primarily from Latin roots, and Latin is the foundation of medical terminology, linking medical providers together in the end with words being our primary sources of communication. When pondering the concept of words, I immediately recalled several interesting concepts I have read in few recent books, one which ironically was bought to tide me over in an airport delay after ISHLT. Some Links readers may be familiar with "the jam studies," an interesting assessment of the impact of choices in decision making. Sheena Iyengar in her 2011 book The Art of Choosing, describes the study. Large jam assortment stands with 24 flavors and small jam assortments of 6 flavors were set up on different days at the same grocery store. 60% of shoppers were drawn to the large assortment and 40% to the small assortment. Customers could sample as many jams as they wished, and on average 2 jams were sampled regardless of whether the assortment was small or large. Read more →


Geocentric, Heliocentric, Eccentric and Egocentric Revolution of Science

Vincent Valentine

links imageScience is a systematized knowledge that has been accumulated through observation, experimentation and reasoning. It reveals itself as a dynamic, evolving entity, intimately connected to the needs and commitment for those who pursue science. Familiar scientific developments frequently emerge and return suggesting different means of present-day thinking and science to develop. Speaking of, the word "science" roots from the Latin word scientia, and simply means "knowledge." First conceived in the 19th century, "science" and "scientist" are understood today. "Natural philosophy" was the term for study of the natural world and held a broader scope than modern science. For the sake of time-honored time and my own lack of knowledge, I will not bore the reader with the details of the evolution of natural philosophy and the science involving the interpretation of the natural world and human culture. Instead, over the next several issues of Links, the focus will include 1) the origins of the scientific revolution coinciding with the age of enlightenment, 2) the emergence of rationalization and 3) the role of France in the contributions to science and the relationship to the ISHLT. Read more →


Vincent G Valentine, MD

Editorial Staff

"The farther back you can look, the farther forward you are likely to see."
— Winston Churchill

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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.