ISHLT celebrates 20th anniversary of infant cardiac transplantation

Research supports pioneering hypothesis that 'babies are different' in transplantation

Renowned pediatric cardiothoracic surgeon, Leonard L. Bailey, MD, Loma Linda University Medical Center, Loma Linda, CA, addresses the International Society for Heart and Lung Transplantation (ISHLT) 26th Annual Meeting and Scientific Sessions in Madrid today. Dr. Bailey will present a "Pioneers in Transplantation Lecture" highlighting 20 years of historic advances in neonatal cardiac transplantation.

Today, nearly 100 infants per year receive heart transplants. Dr. Bailey's hypothesis that infants' immature immune systems would make them more likely to accept transplanted organs than older patients is supported by years of research and studies in pediatric transplantation. The ISHLT Pediatric Registry shows that patients transplanted in early infancy have a significant advantage in long-term survival compared to pediatric patients transplanted at any later age.

Researchers speculate improved infant survival is likely related to the immune advantage suggested by Dr. Bailey and that infants' immunologic immaturity at the time of transplantation allows them to be able to receive donor organs from mismatched blood groups. In contrast to older children and adults, published studies have shown that infants under one year of age can tolerate heart transplants from donors of different blood groups 1, improving the chances of survival for infant candidates and substantially altering the potential donor pool for each individual.

"By expanding the boundaries of therapy for congenital heart disease and stimulating research in cardiac transplantation, Dr. Bailey has become a world leader in pediatric cardiac transplantation," said ISHLT president Mark Barr, M.D. "The ISHLT is honored to host Dr. Bailey as a Pioneer Lecturer this year."

The ISHLT Pioneer Lecture series honors enduring contributions to the field of heart and lung transplantation. Past Pioneer Lecturers include Norman Shumway, M.D. Christian Barnard, M.D. and Joel Cooper M.D.

Pediatric Research Focus
Also at the ISHLT Meeting this week, a satellite symposium and two other meeting sessions are devoted to research in pediatric heart and lung transplantation. Highlights include an important study that found cytomegalovirus (CMV) infection in pediatric heart transplant recipients prior to transplant was the only independent predictor of death from coronary artery disease. Because patients infected with CMV prior to transplant are typically considered to be at lower risk for complications from CMV, this study should stimulate further research into the role of CMV in coronary artery disease.

Another significant study showed that routine bronchoscopy a visual examination of the lungs through a lighted, flexible tube in pediatric lung transplant recipients during the first year after transplant frequently identified silent rejection episodes. Because episodes of rejection are correlated with long-term complications, this study suggests that combining routine surveillance bronchoscopy with early treatment of rejection may improve pediatric lung transplant outcomes.

"I am thrilled that the ISHLT meeting this year will provide attendees interested in pediatric heart and lung transplant a mixture of historical perspective, tantalizing research and practical information" said Stuart C. Sweet, MD, PhD, Washington University, St. Louis MO, pediatric representative to the program committee.

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About ISHLT
The International Society for Heart and Lung Transplantation (ISHLT) is a not-for-profit organization dedicated to the advancement of the science and treatment of end-stage heart and lung diseases. Created in 1981, the Society now includes more than 2,200 members from 45-plus countries, representing a variety of disciplines involved in the management and treatment of end-stage heart and lung disease.

ISHLT maintains two vital databases. The International Heart and Lung Transplant Registry is a one-of-a-kind registry that has been collecting data since 1983 from 223 hospitals from 18 countries. The ISHLT Mechanical Circulatory Device (MCSD) database has been collecting data since 2002 with the aim of identifying patient populations who may benefit from MCSD implantation; generating predictive models for outcomes; and assessing the mechanical and biological reliability of current and future devices. For more information, visit www.ishlt.org.

1 N Engl J Med 2001344:793-800 and Nature Medicine 2004 10: 1227-33


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