Trailblazing Transplant Research Expanding Organ Options

Ingrid Hein

April 04, 2018

NICE, France — Heart donation after circulatory death, transplantation from patients with hepatitis C, and transplant rejection diagnostics at the molecular level — which could all change the game in transplantation — will be discussed at the upcoming International Society for Heart and Lung Transplantation (ISHLT) 2018 Scientific Sessions.

"A lot of unpublished cutting-edge research" will be presented at the meeting, said ISHLT President Andrew Fisher, PhD, from the Institute of Transplantation at Freeman Hospital in Newcastle Upon Tyne, United Kingdom.

The issue of donation after circulatory death will be addressed in what will likely be a lively discussion and debate. And during a special symposium on the topic, researchers will discuss early results from the first transplants performed with hearts taken from donors whose hearts had stopped.

"Normally we take hearts from people whose hearts continue to beat but are brain-dead," Fisher explained.

"Now, the heart can be taken after it has stopped, removed from the body, restarted, assessed with ex vivo heart perfusion, and then implanted," he told Medscape Medical News.

Where we go next as we roll out this technology could completely change the face of donation.

Researchers will describe the successful performance of this procedure in several centers around the world. "Where we go next as we roll out this technology could completely change the face of donation," said Fisher.

Even the president's debate — which will be moderated by Lara Danziger-Isakov, MD, from Cincinnati Children's Hospital Medical Center, who is scientific chair for the 2019 meeting — will focus on donation after circulatory death, as Gregory Snell, MBBS, from Alfred Hospital in Melbourne, Australia, and Howard Eisen, MD, from Drexel University in Philadelphia, take different sides of the issue.

"I'll be glad to be up close and up front for that," Danziger-Isakov said. "It's one of my favorite parts of the meeting."

Infection and Molecular Diagnostics

Danziger-Isakov said she is also looking forward to sessions addressing infection.

"The opioid epidemic has had an impact on the donation and donor pool," she said. Because donors who die of opioid overdose have often participated in risky behaviors, hepatitis C is common in this group.

"There's a lot of interest in the success of transplants from donors who have it, and it is under significant investigation," she said. Abdominal organs have been accepted from donors with hepatitis C for some time, but findings for hearts and lungs are new.

"We need to expand our donor pool, and this is another avenue," Danziger-Isakov explained.

Cutting-edge molecular diagnostics for rejection will also be presented, Fisher reported.

Traditionally, organ rejection has been diagnosed by a pathologist who studies a biopsy sample through a microscope. But the molecular signature could be a more accurate way to diagnose it. Presentations on the INTERHEART study (NCT02670408), which is looking at nearly a thousand biopsies at the molecular level, will be highly anticipated.

Chronic thromboembolic pulmonary hypertension will also be in the spotlight, with presentations that address surgical and nonsurgical techniques to remove blood clots and scar tissue.

"We have a major session looking at the whole range of treatments, such as balloon pulmonary angioplasty, already used in coronary but now being used in pulmonary vessels to open the lungs," Fisher explained.

Celebrating Heart Transplantation

In a "tribute to the pioneers of heart transplantation," a symposium will look at the history of the procedure, first performed in 1967. "We'll look at how it's progressed," Fisher said.

Included will be a brief talk by Brent Evje, from Fairdale, North Dakota, who underwent transplantation 38 years ago.

"We are the largest gathering of professionals who work with patients with advanced heart and lung disease, where transplantation is supported as part of the treatment," Fisher pointed out.

"We want people to come and share their experiences and ideas and listen to some excellent cutting-edge science so we can all do better moving advanced lung disease and heart failure forward," he said. "We're all looking forward to it."

Fisher and Danziger-Isakov have disclosed no relevant financial relationships.

Follow Medscape on Twitter @Medscape and Ingrid Hein @ingridhein

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