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HIV, West Nile virus, SARS – infections and thoracic transplantation


Two largest organ transplant societies join forces to tackle problem of traditional and exotic infections in thoracic transplantation

Complications from infectious diseases, such as HIV and West Nile virus in heart and lung transplant patients, is the focus of a joint symposium at the International Society for Heart and Lung Transplantation (ISHLT) 24th Annual Meeting held in San Francisco.

When demand for organs continually outstrips supply, offering transplants to patients with infectious diseases, such as HIV, remains controversial. For those needing heart and lung transplants, it’s not only controversial but somewhat uncharted territory. Only in the last few years have organ transplants even been offered to HIV-positive patients, much less performed; and most of the procedures have been liver and kidney transplants.

"While there are no prospective data in heart and lung transplantation, this is an area that merits careful investigation," said Jay A. Fishman, M.D., Infectious Disease Division, Massachusetts General Hospital and Harvard Medical School. "Recent data suggest that transplantation can be safely performed in selected individuals infected with HIV if viral infection can be controlled by highly-active anti-retroviral therapy."

Managing anti-rejection drugs and anti-retroviral therapies presents quite a challenge. Transplant teams must achieve just the right balance between the two types of drugs because of interactions and toxicity. Suppressing the immune system too much with high doses of the anti-rejection drug may allow a viral infection to worsen; too low a dose and the organ may be rejected.

In an effort to advance the science and treatment of heart and lung transplantation in patients affected by infectious disease, the ISHLT together with the American Society of Transplantation (AST), is sponsoring a joint symposium for the first time. Research and commentary is being presented and discussed by experts from around the globe on:
  • HIV in transplantation
  • Experiences with SARS and West Nile virus
  • Infections of left ventricular assist devices (LVADs) and other devices
  • Hepatitis viruses in transplantation
  • Fungal infections in thoracic transplantation

In addition to traditional viral infections, such as herpes, hepatitis C and influenza, "exotic" infections like SARS and West Nile virus are becoming a major problem for transplant recipients. These infections may have direct effects contributing to morbidity and mortality, as well as indirect effects resulting in organ dysfunction and loss.

Atul Humar, M.D. from the University of Toronto, Canada, is presenting SARS and West Nile virus as emerging infectious diseases in transplantation. Although most infections in the general population are asymptomatic, little is known about the consequences of infection in transplant recipients.

"Efforts aimed at improving our understanding of the diagnosis, natural history, prevention and treatment of these infections will lead to improved transplant organ and patient survival," said Dr. Humar.

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 at a gathering of about 15 cardiologists and cardiac surgeons, 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 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.

Kelly Goff | EurekAlert!
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