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• W2055368434 abstract "At the Thirty-third Annual Meeting and Scientific Sessions of the International Society of Heart and Lung Transplantation (Montréal, Quebec, Canada), a joint session between the Junior Faculty Council members and the editorial consultants of the Journal of Heart and Lung Transplantation took place to summarize recently published impacting publications in the Journal. The topics reviewed were mechanical circulatory support, heart transplantation, lung transplantation, pulmonary hypertension and pediatrics. The cooperative presentations has been formulated into the present report. At the Thirty-third Annual Meeting and Scientific Sessions of the International Society of Heart and Lung Transplantation (Montréal, Quebec, Canada), a joint session between the Junior Faculty Council members and the editorial consultants of the Journal of Heart and Lung Transplantation took place to summarize recently published impacting publications in the Journal. The topics reviewed were mechanical circulatory support, heart transplantation, lung transplantation, pulmonary hypertension and pediatrics. The cooperative presentations has been formulated into the present report. At the Thirty-third Annual Meeting and Scientific Sessions of the International Society of Heart and Lung Transplantation (Montréal, Quebec, Canada), a joint session between the Junior Faculty Council members and the editorial consultants of the Journal of Heart and Lung Transplantation took place to summarize recently published impacting publications in the Journal. The cooperative presentations by budding faculty and experienced senior editorial consultants has been formulated into the present report.Mechanical circulatory supportThe fourth iteration of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) report highlighted the increasing rate of continuous-flow (CF) left ventricular assist devices (LVADs), with a trend toward more implantations with the intention of destination therapy and earlier device implantation in less sick patients.1Kirklin J.K. Naftel D.C. Kormos R.L. et al.The Fourth INTERMACS annual report: 4,000 implants and counting.J Heart Lung Transplant. 2012; 31: 117-126Abstract Full Text Full Text PDF PubMed Scopus (325) Google Scholar Most important, the data showed sustained improvements in outcomes after device implantation. The findings are testament to the commitment of the surgeons, clinicians, and engineers to continually improve device design, patient selection, and post-implant care.With rising LVAD volumes, studies focused on characterizing patients, specific risk, and complications after device implantation. Goldstein et al2Goldstein D.J. Naftel D. Holman W. et al.Continuous-flow devices and percutaneous site infections: clinical outcomes.J Heart Lung Transplant. 2012; 31: 1151-1157Abstract Full Text Full Text PDF PubMed Scopus (162) Google Scholar studied patients in the INTERMACS database to better understand risk factors for and outcomes of percutaneous site infections (PSI) in CF-LVAD patients. They found 10% of patients developed a PSI, with rates of 19% and 25% of patients surviving to 1 and 2 years, respectively. Notably, previously identified risk factors, including body mass index (BMI), history of diabetes mellitus, higher severity of illness, and history of prior infection, did not predict occurrence of a PSI in contemporary device patients. The only predictor in a multivariate analysis was younger age, insinuating that increased mobility or decreased compliance with driveline care may play a role in the occurrence of driveline infections. Nonetheless, overall survival was decreased in patients who developed a driveline infection, underscoring the need for continued device design advancements and the development of preventative strategies.In the pre-clinical realm, Wohlschlaeger et al3Wohlschlaeger J. Levkau B. Takeda A. et al.Increase of ABCG2/BCRP+ side population stem cells in myocardium after ventricular unloading.J Heart Lung Transplant. 2012; 31: 318-324Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar studied tissue samples before and after LVAD implantation and found that the presence of regenerative progenitor cells and differentiated stem cells were increased after myocardial unloading. By staining tissue samples for the ABCG2 channel and c-kit/myocyte enhancer factor-2, they were able to present the first data to show an increase of potential cardiomyocyte and endothelial precursors localized in the myocardium. Further studies will have to define a mechanistic length between the presence of these cells and myocardial recovery along with identifying the origin of the progenitor cells.Senior faculty commentsOutcomes for mechanical circulatory support for advanced heart failure continue to improve. The most recent data evaluating the use of CF-LVADs for bridge to transplantation demonstrate approximately 90% survival at 1 year,4Starling R.C. Naka Y. Boyle A.J. et al.Results of the post-U.S. Food and Drug Administration-approval study with a continuous flow left ventricular assist device as a bridge to heart transplantation: a prospective study using the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support).J Am Coll Cardiol. 2011; 57: 1890-1898Abstract Full Text Full Text PDF PubMed Scopus (369) Google Scholar, 5Aaronson K.D. Slaughter M.S. Miller L.W. et al.Use of an intrapericardial, continuous-flow, centrifugal pump in patients awaiting heart transplantation.Circulation. 2012; 125: 3191-3200Crossref PubMed Scopus (501) Google Scholar and that outcomes for destination therapy at 2 years are similar to heart transplantation in selected patients.6Kirklin J.K. Naftel D.C. Pagani F.D. et al.Long-term mechanical circulatory support (destination therapy): on track to compete with heart transplantation?.J Thorac Cardiovasc Surg. 2012; 144: 584-603Abstract Full Text Full Text PDF PubMed Scopus (218) Google Scholar Thus, with improved survival comes a longer duration of support and possible exposure to adverse events. This makes a database like INTERMACS even more important moving forward. Having access to a national database that prospectively collects long-term data on patients with mechanical circulatory support will not only allow ongoing evaluation of survival but can now also be used for identifying and potentially reducing adverse events that will lead to better outcomes and improved quality of life.As noted by Goldstein et al,2Goldstein D.J. Naftel D. Holman W. et al.Continuous-flow devices and percutaneous site infections: clinical outcomes.J Heart Lung Transplant. 2012; 31: 1151-1157Abstract Full Text Full Text PDF PubMed Scopus (162) Google Scholar one of these complications is driveline infections. Although significantly improved, they continue to be a problem that impairs quality of life and effects overall survival. New innovative techniques for implanting and immobilization of the driveline will be helpful, but ultimately, there is a need for a fully implantable system to potentially eliminate the adverse events associated with a percutaneous driveline.7Slaughter M.S. Myers T.J. Transcutaneous energy transmission for mechanical circulatory support systems: history, current status, and future prospects.J Card Surg. 2010; 25: 484-489Crossref PubMed Scopus (75) Google ScholarA future hope for LVAD support is that it will result in clinically significant myocardial recovery allowing for device removal and avoiding the need for heart transplantation or lifelong support on a LVAD. One approach is the concept of using the LVAD as a platform for support while adding additional medical therapy to promote recovery. Wohlschlaeger et al3Wohlschlaeger J. Levkau B. Takeda A. et al.Increase of ABCG2/BCRP+ side population stem cells in myocardium after ventricular unloading.J Heart Lung Transplant. 2012; 31: 318-324Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar have provided data to suggest a more direct role of LVAD support in recovery by increasing the stem cell population in the myocardium.Adult heart transplantationIn 2012, the International Society for Heart and Lung Transplantation (ISHLT) Registry was transferred to the stewardship of Dr Josef Stehlik. In the Twenty-ninth Annual Adult Heart Transplant Report, Stehlik noted the continuing trend of decreasing post-transplant complications from infections and malignancies.8Stehlik J. Edwards L.B. Kucheryavaya A.Y. et al.The Registry of the International Society for Heart and Lung Transplantation: 29th official adult heart transplant report—2012.J Heart Lung Transplant. 2012; 31: 1052-1064Abstract Full Text Full Text PDF PubMed Scopus (441) Google Scholar The report also acknowledges the rapidly growing dependence of patients on mechanical circulatory support before heart transplantation.Several publications evaluated outcomes after transplantations in high-risk populations of patients. Oliveira et al9Oliveira G.H. Hardaway B.W. Kucheryavaya A.Y. Stehlik J. Edwards L.B. Taylor D.O. Characteristics and survival of patients with chemotherapy-induced cardiomyopathy undergoing heart transplantation.J Heart Lung Transplant. 2012; 31: 805-810Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar studied the ISHLT transplant registry to publish the largest evaluation of outcomes for patients with chemotherapy-induced cardiomyopathy (CCMP) as an indication for heart transplantation. They found that patients with CCMP had increased use of right ventricular assist devices as a bridge to transplant and longer ischemic times at the time of transplantation. The complexity of the surgery is likely related to the biventricular nature of this cardiomyopathy in addition to the complicating effects of concomitant radiation therapy on the heart and mediastinal tissue. Patients with CCMP had less allograft rejection but more frequent infectious complications, possibly related to an immunoquiescent state from the treatment of the cancer. In contrast to previous publications, the post-transplant survival for CCMP patients was similar to those with non-ischemic cardiomyopathies. Although, the frequency of malignancy in the CCMP group was higher (5% vs 2% at 1 year), most of these were easily managed skin cancers. There was only 1 recurrence of a primary cancer in 1 patient. These favorable findings suggested that heart transplantation could be performed safely in selected patients with a history of cancer in CCMP; however, the data analysis was limited because the confounding effects of radiation therapy or time from cancer diagnosis were not reported.Several studies explored the United Network for Organ Sharing (UNOS) transplant data and defined outcomes in other populations with higher risks. DePasquale et al10DePasquale E.C. Nasir K. Jacoby D.L. Outcomes of adults with restrictive cardiomyopathy after heart transplantation.J Heart Lung Transplant. 2012; 31: 1269-1275Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar found that patients with restrictive cardiomyopathy and those with non-ischemic cardiomyopathy had comparable outcomes after heart transplantation, except for patients with cardiac amyloidosis or previous radiation exposure. Rasmusson et al11Rasmusson K. Brunisholz K. Budge D. et al.Peripartum cardiomyopathy: post-transplant outcomes from the United Network for Organ Sharing Database.J Heart Lung Transplant. 2012; 31: 180-186Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar performed the largest published evaluation of post-transplant outcomes in peri-partum cardiomyopathy. In contrast to previous reports, the investigators reported an increased incidence of allograft failure and decreased survival after transplantation in this population.11Rasmusson K. Brunisholz K. Budge D. et al.Peripartum cardiomyopathy: post-transplant outcomes from the United Network for Organ Sharing Database.J Heart Lung Transplant. 2012; 31: 180-186Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar They proposed that younger age and higher levels of sensitization led to poorer outcomes.Floerchinger et al12Floerchinger B. Ge X. Lee Y.L. et al.Graft-specific immune cells communicate inflammatory immune responses after brain death.J Heart Lung Transplant. 2012; 31: 1293-1300Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar studied the effects of donor brain death on allograft function in a syngeneic mouse model. They found that mice that received allografts from brain-dead donors had increased lymphocyte activation and circulating inflammatory mediators, including tumor necrosis factor-α and interferon-γ. Pre-treatment of the donor mice with anti-thymocyte globulin before transplantation mitigated activation of CD4 and CD8 cells, expression of inflammatory cytokines, and myocyte necrosis. These data confirmed the pro-inflammatory and immune-activating effects of brain death, and more important, identified a potential therapeutic opportunity with treatment of donors with lymphocyte-depleting therapies.Senior faculty commentsHeart transplantation, with its well-established long-term outcomes, still remains the gold standard for treating patients with advanced heart failure. In addition to the overall increased knowledge and experience with managing patients with a heart transplant is the improvement in outcomes in select high-risk sub-sets of patients. Recent data suggest improved outcomes for patients with CCMP and some restrictive cardiomyopathies. However, patients with amyloidosis or peri-partum cardiomyopathy remain very challenging for the heart transplant team. Expanding the donor pool, improving donor organ preservation, and eliminating peri-operative organ dysfunction will allow more patients access to heart transplantation as a treatment for end-stage heart failure while incrementally continuing to improve outcomes for this treatment modality.Lung transplantationFrom the pulmonary perspective, 2012 provided many highlights. More than 200 articles involving the field of lung transplantation were published in the Journal. Hence, this review must perforce be limited to a select few articles with a perspective from the rest of the international literature.The lung allocation score (LAS), implemented in 2005, prioritizes patients in the most urgent need for transplantation and those with the best outcome expectation.13Egan T.M. Murray S. Bustami R.T. et al.Development of the new lung allocation system in the United States.Am J Transplant. 2006; 6: 1212-1227Crossref PubMed Scopus (565) Google Scholar In a retrospective cohort study using the UNOS database and including more than 9,000 patients, Georges et al14George T.J. Beaty C.A. Kilic A. Shah P.D. Merlo C.A. Shah A.S. Outcomes and temporal trends among high-risk patients after lung transplantation in the United States.J Heart Lung Transplant. 2012; 31: 1182-1191Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar reported 20% of lung transplant recipients were in the highest LAS quartile (LAS ≥ 48.4) but had no ventilator or extracorporeal membrane oxygenator (ECMO) support, whereas 6% underwent transplantation from the ventilator, and just over 1% were bridged to transplant with ECMO support. Patients with ventilator or ECMO support were significantly younger than other high LAS patients (51 and 48 years vs 55 years; p < 0.001). Survival was worse in patients with ventilator (67.7%) and ECMO (57.6%) support than in the other patients in the highest LAS quartile (81%; p < 0.001). This effect was mainly due to increased short-term mortality, although adjustment for 90-day survival still revealed a worse 2-year survival for patients receiving ventilator or ECMO support. Nevertheless, 1-year survival improved over time in high LAS patients, from 76.1% in 2005 to 83.5% in 2010 (p = 0.006) and for patients on ECMO from 29.3% in 2005 to 74.7% in 2010 (p = 0.061). In this rapidly changing era of evolving technologic advances, it would be prudent to recommend the continued application of such support for patients with single-organ failure in experienced centers.Boussaud et al15Boussaud V. Mal H. Trinquart L. et al.One-year experience with high-emergency lung transplantation in France.Transplantation. 2012; 93: 1058-1063Crossref PubMed Scopus (34) Google Scholar evaluated the survival outcome of the High-Emergency Lung Transplantation program in France, implemented in 2007. Patients with cystic fibrosis, pulmonary fibrosis, and pulmonary vascular diseases can be placed on the high emergency list for 7 to 14 days. In agreement with the study of Georges et al,14George T.J. Beaty C.A. Kilic A. Shah P.D. Merlo C.A. Shah A.S. Outcomes and temporal trends among high-risk patients after lung transplantation in the United States.J Heart Lung Transplant. 2012; 31: 1182-1191Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar transplantation of patients with an imminent risk of death was feasible, but survival rates were inferior, with 2-year survival of 51.5% for High-Emergency transplants vs 71% for non-urgent transplants (p = 0.03).Renal function may deteriorate progressively after lung transplantation.16Ishani A. Erturk S. Hertz M.I. Matas A.J. Savik K. Rosenberg M.E. Predictors of renal function following lung or heart-lung transplantation.Kidney Int. 2002; 61: 2228-2234Crossref PubMed Scopus (89) Google Scholar, 17Esposito C. De Mauri A. Vitulo P. et al.Risk factors for chronic renal dysfunction in lung transplant recipients.Transplantation. 2007; 84: 1701-1703Crossref PubMed Scopus (25) Google Scholar Hellemons et al18Hellemons M.E. Bakker S.J.L. Postmus D. et al.Incidence of impaired renal function after lung transplantation.J Heart Lung Transplant. 2012; 31: 238-243Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar demonstrated in their observational single-center study that the incidence of doubling the baseline serum creatinine was 37% at 2 years and 47% at 4 years after lung transplantation. Despite accepting more patients at risk for renal function decline (age, BMI, heavy smoking history, or prevalence of hypertension before transplantation), the incidence of doubling of the baseline serum creatinine was found to be decreasing. The possible explanations include a switch in immunosuppression from cyclosporine to tacrolimus, lower target levels, and improved post-operative management. A significant decline in the glomerular filtration rate was still observed in the first year after transplantation, emphasizing the need for progress in this important area.In this regard, a sub-analysis of the Nordic Everolimus (Certican) Trial in Heart and Lung Transplantation (NOCTET) open-label, multicenter, randomized controlled study in Scandinavia may provide some insights. Arora et al19Arora S. Gude E. Sigurdardottir V. et al.Improvement in renal function after everolimus introduction and calcineurin inhibitor reduction in maintenance thoracic transplant recipients: the significance of baseline glomerular filtration rate.J Heart Lung Transplant. 2012; 31: 259-265Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar studied the introduction of everolimus combined with a reduction in calcineurin inhibitor (CNI) dose in 282 thoracic transplant recipients (190 heart, 92 lung) with advanced renal failure. Owing to adverse events, the study was discontinued in 13% of the patients in the everolimus group compared with 1.5% in the control group (p < 0.001).19Arora S. Gude E. Sigurdardottir V. et al.Improvement in renal function after everolimus introduction and calcineurin inhibitor reduction in maintenance thoracic transplant recipients: the significance of baseline glomerular filtration rate.J Heart Lung Transplant. 2012; 31: 259-265Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar Everolimus combined with CNI reduction improved renal function in thoracic transplant recipients with advanced and moderate renal function impairment. However, improvement in renal function was only detected when the medication adjustment was made within 5 years after transplantation, reflecting the risk of permanent CNI nephrotoxicity.Bhorade et al20Bhorade S.M. Husain A.N. Liao C. et al.Interobserver variability in grading transbronchial lung biopsy specimens after lung transplantation.Chest. 2013; 143: 1717-1724Crossref PubMed Scopus (46) Google Scholar analyzed differences in the grading of 481 transbronchial biopsy specimens by the local center and a central pathologist. The overall concordance rate was 74% for Grade A specimens and 89% for Grade B specimens. When specimens from biopsies performed at different times after transplantation were assessed, the level of agreement was higher within 6 weeks of transplant compared with later times. However, there was still only moderate agreement for both Grade A (κ = 0.479; 95% confidence interval, 0.29–0.67) and Grade B (κ = 0.465; 95% confidence interval, 0.08–0.85) rejection.Diamond et al21Diamond J.M. Lee J.C. Kawut S.M. et al.Clinical risk factors for primary graft dysfunction after lung transplantation.Am J Respir Crit Care Med. 2013; 187: 527-534Crossref PubMed Scopus (394) Google Scholar reported the results of an analysis of risk factors for primary graft dysfunction (PGD) from the Lung Transplant Outcomes Group (LTOG). The study enrolled 1,255 from 10 centers; of these, 211 (16.8%) developed Grade 3 PGD. Multivariable models showed independent risk factors for PGD were any history of donor smoking, fraction of inspired oxygen during allograft reperfusion, single-lung transplant, use of cardiopulmonary bypass, overweight and obese recipient body mass index, pre-operative sarcoidosis, or pulmonary arterial hypertension. PGD was significantly associated with death at 90 days (relative risk, 4.8; absolute risk increase, 18%; p < 0.001) and 1 year (relative risk, 3; absolute risk increase, 23%; p < 0.001). Whether any of these factors can be ameliorated remains conjectural.Senior faculty commentsThe field of lung transplantation continues to grow exponentially, with major improvements in device technology driving bridge to transplant and support of PGD thereby altering the allocation algorithm. How the community continues to accommodate these changes will determine the ongoing face of lung transplantation, but an important precedent has been set. Similarly, improving standards of uniformity in the assessment and management of acute rejection and lymphocytic bronchiolitis remains a worthy goal for which a global perspective is needed.Pulmonary hypertensionIn the past year the Journal published excellent manuscripts in the field of pulmonary hypertension (PH). They included a comprehensive review of Group 2 PH, further exploration of the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL) data set, as well as a look into treatment and new markers in the evaluation of the severity of PH.The review of World Health Organization (WHO) Group 2 by the Pulmonary Hypertension Council gave us a comprehensive review, including pathophysiology, diagnosis, treatment, and future directions in respect to nomenclature.22Fang J.C. DeMarco T. Givertz M.M. et al.World Health Organization pulmonary hypertension group2: pulmonary hypertension due to left heart disease in the adult—a summary statement from the Pulmonary Hypertension Council of the International Society for Heart and Lung Transplantation.J Heart Lung Transplant. 2012; 31: 913-933Abstract Full Text Full Text PDF PubMed Scopus (174) Google Scholar An important critical primary step to the future study of this important clinical problem will be to standardize definitions across disciplines to facilitate an evidence base that is interpretable and applicable to clinical practice. A suggested nomenclature sub-divided Group 2 into passive and mixed PH. The defining factor between the two would be elevated pulmonary vascular resistance (PVR) and transpulmonary gradient (TPG) found in the mixed group compared with normal values found in passive PH. Mixed PH could be further sub-divided to include reactive and non-reactive groups as they respond to pharmacologic therapy (including diuretic) and mechanical circulatory support devices.A future use of the REVEAL data was considered by Cogswell et al.23Cogswell R. McGlothlin D. Kobashigawa E. Shaw R. De Marco T Performance of the REVEAL model in WHO group2 to 5 pulmonary hypertension: application beyond pulmonary arterial hypertension.J Heart Lung Transplant. 2013; 32: 293-298Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar They used the REVEAL model, which has previously been studied in Group 1 PAH, and applied it to WHO Groups 2 through 5. The cohort of 200 patients, 37% of whom were in WHO Groups 2 to 5, was compared with PAH patients in respect to survival or freedom from lung transplantation. The group concluded that the REVEAL survival prediction model for PAH shows comparable performance when applied to a broad population of PH patients. These data provide preliminary support that the model can be used in all PH patients.Pons et al,24Pons J. Leblanc M.-H. Bernier M. et al.Effects of chronic sildenafil use on pulmonary hemodynamics and clinical outcomes in heart transplantation.J Heart Lung Transplant. 2012; 31: 1281-1287Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar from Quebec, studied the effect of long-term sildenafil use on hemodynamics and outcomes in heart transplantation. They reviewed 119 patients who received a transplant between 2004 and 2011 and divided them into two groups: Group A had severe PH, assessed as mean pulmonary artery pressure (mPAP) > 25 mm Hg, PVR > 2.5 Woods units (WU) and/or TPG > 12 mm Hg, and Group B was without severe PH. Group A received treatment with sildenafil. The mPAP, PVR, and TPG all decreased (p < 0.5), whereas survival was similar in both groups These data suggest that sildenafil therapy before and after heart transplant in patients with severe PH is associated with improved hemodynamics, without an increase in mortality.The final study we reviewed looked at a marker being used as a prognostic indicator in PH. Belly et al25Belly M.J. Tiede H. Morty R.E. et al.HbA1c in pulmonary arterial hypertension: a marker of prognostic relevance?.J Heart Lung Transplant. 2012; 31: 1109-1114Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar from Germany studied glycosylated hemoglobin (HbA1c) as a prognostic marker in PAH. They reviewed 115 therapy-naïve patients and assessed whether HbA1c was correlated with long-term survival. The study was based on the theory that PAH may affect downstream targets of bone morphogenetic protein receptor type II signaling, such as peroxisome proliferators-activated receptor-γ and apolipoprotein E, both of which are involved in glucose metabolism. Baseline characteristics, including hemodynamics and HbA1c levels, were reviewed. Compared with patients with higher HbA1c levels, survival was better in patients with an HgA1c level < 5.7% at 1, 3, and 5 years (97.8%, 97.8% and 85.1% vs 92.3%, 68.2% and 55.8%, respectively). The investigators concluded that the HgA1c level for patients with PAH at the time of diagnosis is an independent predictor of long-term prognosis.Senior faculty commentsThe field of PH is now a major part of the ISHLT’s activity and is now well reflected in the composition of our Journal. During the last year, a number of helpful manuscripts have been published, as identified above. The ISHLT has recognized the need to improve our understanding of PH associated with left-sided heart disease, and the review article described above sets out a useful guide for future direction. The role of sildenafil in cardiac transplant recipients was well established in the study by Pons et al.24Pons J. Leblanc M.-H. Bernier M. et al.Effects of chronic sildenafil use on pulmonary hemodynamics and clinical outcomes in heart transplantation.J Heart Lung Transplant. 2012; 31: 1281-1287Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar The large REVEAL registry is consistently producing useful data, particularly in risk analysis, although it must be recognized that this registry does not comprise incident case patients exclusively. Finally, the expanding recognition of metabolic disturbance in PAH, in particular, glucose metabolism was emphasized and the positive role of monitoring HbA1c as a prognostic marker identified. This supports the need to continue exploration of systemic abnormalities associated with PAH.Pediatric transplantation and mechanical supportIn the past year, there was a strong focus on aspects of pediatric heart transplantation, including optimization of the donor organ pool, categorization and management of pre-transplant risk factors, transplant outcomes for patients with congenital heart disease, and characterization of post-transplant rejection. We will summarize the key aspects of articles covering each of these topics.High waiting list mortality for pediatric heart transplant candidates continues to necessitate strategies such as ABO-incompatible (ABOi) transplantation to maximize the organ donor pool. The Pediatric Heart Transplant Study (PHTS) group analyzed outcomes in infants undergoing ABOi heart transplantation in North America. Survival and freedom from rejection in the first 12 months after ABOi transplantation were equivalent to patients receiving ABO-compatible hearts.26Henderson H.T. Canter C.E. Mahle W.T. et al.ABO-incompatible heart transplantation: analysis of the Pediatric Heart Transplant Study (PHTS) database.J Heart Lung Transplant. 2012; 31: 173-179Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar Moreover, infection in the first year after transplant was reported to be significantly less c" @default.
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