A Quarter Century of Achievements in Heart and Lung Transplantation
A Quarter Century of Achievements in Heart and Lung Transplantation
Commemoration of the 25th Anniversary of the International Society for Heart and Lung Transplantation (ISHLT)
The annual scientific sessions of the ISHLT are significant because this year marks the celebration of the 25th anniversary of its inception. The growth of the ISHLT in the last 25 years parallels the growth of heart and lung transplantation as a therapeutic tool for patients with end-stage heart and lung disease. What follows is a brief historical overview of the foundation and achievements of the ISHLT, a vibrant organization that embraces the clinical, scientific, and pathological facets of transplant medicine and continues to address the myriad technological and humanitarian issues surrounding transplantation medicine. To mark the 25th anniversary, the ISHLT invited the former presidents to the annual meeting. A visual program, reflecting society leaders and accomplishments, including landmarks in thoracic transplantation, was shown between sessions.
Foundation of the Society
(Canada: Notre Dame hospital of Montreal and Norway: National Hospital of Norway)
In 1980, a core group of cardiologists and cardiac surgeons in the United States took the lead in founding a society that would defend their interest in cardiac transplantation. This idea was discussed at a meeting in November 1980 in Miami, Florida, during the annual meeting of the American Heart Association, spearheaded by Michael Hess, a cardiologist from Virginia. In this meeting, 9 centers from around the world (United States: Michael Reese Hospital, The Medical College of Virginia, Stanford University, Mayo Clinic, University of Minnesota, University of Arizona, University of Pittsburgh; Canada: Notre Dame Hospital; Norway: National Hospital of Norway) involved in cardiac transplantation were in attendance. The first major topic of discussion was the United States government's policy towards cardiac transplantation and the agreement that this group would work very closely with the National Institute of Health Subcommittee on Cardiac Transplantation to report data regarding the status of heart transplantation to the Cardiology Advisory Board of the National Heart, Lung, and Blood Institute. Second, the group discussed and agreed to create of a central heart transplantation registry. In January 1981 at Michael Reese Hospital, the plans for an official Society were settled.
Dr. Michael Hess (Figure 1), the first ISHLT president, in his first official letter in that capacity, clearly established the need for the creation of a new Society and the principles by which the new Society would abide:
Cardiac transplantation has re-entered another and rapidly accelerating growth phase ...Three month survival rates are now expected in the range of 70-80 percent, with an anticipated 40-50 percent five-year survival rate. This progress is particularly impressive when one considers that the three-month survival rates of potential transplant candidates (Class IV NYHA end-stage heart disease are reported in the range of 0-20 percent ...We who are active in the field are enthusiastic about the future of cardiac transplantation. Our enthusiasm is not shared by others in the health care financing agencies...The International Society for Heart Transplantation has two principal aims: (1) To serve as a forum for the exchange of scientific information among those physicians and scientists active in the field, and (2) to serve as an interface between the cardiac transplantation community and the health care financing agencies and other governmental and scientific interest groups and the public. To accomplish these aims, we need accurate and up-to-date information on the current state of cardiac transplantation. Our registry is aimed at producing such data ...
Figure 1. Initial steps...why?
Together with Dr. Hess, other founding members were well-recognized figures in transplantation, including Jack Copeland, Andrea Hastillo, Jacques Losman, Terence English, Stuart Jamieson, Michael Kaye, Edward Stinson, and Mark Thompson. The first official meeting of the newly formed ISHLT took place in San Francisco, California, on March 14, 1981. During this meeting an important decision was made; Dr. Norman Shumway, a pioneer and key figure in the development of cardiac transplantation, became the honorary president of the Society for life. In addition, the Society developed from inception an international flavor with European cardiac surgeons who were key figures in heart transplantation, such as, Magdi Yacoub, Christian Cabrol, and Bruno Reichart. Thereafter, not only cardiologists and cardiovascular surgeons, but also other specialists, became interested and represented the society in the international field of scientists.
Lung transplantation was pioneered by Dr. Vladimir Demikhov and Dr. James Hardy, and in the late 1980s and early 1990s Dr. Joel Cooper positioned lung transplantation as a therapeutic tool for severe lung disease. Many members of the Society were involved not only in cardiac transplantation but also in lung transplantation. Therefore, in 1991, the Board of Directors, with agreement of the membership, changed the name of the Society to the ISHLT to reflect the commitment of the Society to embracing the advancement of the science and treatment of end-stage heart and lung disease. Today, the Society has more than 2200 members from 45 countries, representing all disciplines in thoracic organ transplantation. Since its inception, the Society has had 21 presidents, all key figures in thoracic organ transplantation from around the world.
The Journal of the International Society for Heart and Lung Transplantation
The official scientific journal of the Society was established in 1981. The journal was initially called Heart Transplantation and the first issue included a foreword by the first editor, Dr. Jacques Losman. He explained clearly why there was a need for a publication of this sort and the importance in collecting clinical and basic research data in transplantation. He wrote:
...and it is legitimate to question the objective need for launching an additional publication in the crowded medical literature. The need may not appear as obvious today as it hopefully may be in a few years. However, two good reasons justify our initiative. The first is that the field of heart transplantation is expanding rapidly ... on that account, heart transplantation has reached the status of a pertinent branch of medicine, and a journal devoted to the special interest of the subject is justified ... a second reason... is to give our society a say in the debate on the social usefulness and cost-benefit aspects of the procedure ... and if Heart Transplantation becomes a central and international source for information in the field, it will only be kept alive and thrive through the contributions of those involved in heart transplantation.
After those humble beginnings under Dr. Losman's leadership, the Journal has certainly thrived and has become a very important publication in the field. With the distinguished guidance of editors Dr. Michael Kaye, Dr. Maria Rosa Costanzo, and more recently Dr. James Kirklin, supported by a multidisciplinary and multinational editorial board, the Journal has matured, submissions have steadily increased, and the scientific content is excellent. In 1990, The Board of Directors changed the name of the journal to The International Journal for Heart and Lung Transplantation to reflect the commitment of the Society to embrace clinical and basic research science research in lung transplantation.
ISHLT Registries
From its foundation, the Society was committed to the creation of a central world database on heart and lung transplantation. The Heart and Lung Transplant Registry began collecting data in 1983 and through the efforts of registry directors Michael Kaye, Jeffrey Hosenpud, and Marshall Hertz and centers submitting their data, the Registry database has become the largest collection of data in the field of heart and lung transplantation, including more than 65,000 patients from 223 hospitals from 18 countries worldwide (Figure 2). The Heart and Lung Transplant Registry is the international quality reference in thoracic transplantation and it sets high standards for every transplant program in the world.
Figure 2. The ISHLT Thoracic Organ Transplant Registry.
In recent years, mechanical circulatory-assist devices have been used more frequently for the treatment of end-stage heart disease, and in response to their widespread use in 2002, the Society created in the MCSD database. This endeavor, under the guidance of Dr. Mario Deng and Dr Robert Kormos, aims to identify patient populations who may benefit from implantation of mechanical circulatory-assist devices. In addition, the data allow for the generation of predictive models to analyze patient outcomes and study of the mechanical and biological reliability of current and future assist devices.
ISHLT Awards
The commitment of the Society to the funding of research is evidenced by the availability of annually awarded grants, including the Research Fellowship award, the Transplant Career Development award, the Nursing and Social Science Research award, and the Philip Caves award. The latter is the award with the longest history, established in 1982 and named in memory of Philip Caves, who pioneered the technique of transvenous endomyocardial biopsy, which has been the gold standard for identification of cardiac rejection. Philip Caves was a young Scottish surgeon who died at a young age. In his memory this award was established to encourage and reward original research performed by trainees and graduate students who will represent the Society in the future. Many of the recipients of the award have become established physicians and scientists in the field of thoracic transplantation.
Standardization of a Grading System for Heart and Lung Transplant Rejection
Another important milestone in the history of the Society was the work by a group of members in creating a standard grading system for the diagnosis of heart and lung transplant rejection. Dr. Margaret Billingham, former president of the ISHLT and an internationally recognized pathologist in the field of transplantation, chaired the Heart Rejection Study Group, who published their results supporting a standardization of nomenclature in the diagnosis of heart and lung rejection. Dr. Billingham explained the need for a standardized grading system for the diagnosis of rejection in cardiac transplantation: "With the emergency of many different grading systems for heart and lung biopsy interpretation, the ISHLT realized the necessity to establish a standardized grading system for the purpose of multicenter trials and for publication so that results from different centers could be compared effectively...Basic grading systems are presented in the following articles that will now be required for all manuscripts accepted for the Journal of Heart and Lung Transplantation. In making this step...the Society has taken a leadership role and has made a significant contribution to more meaningful scientific results in the field of thoracic organ transplantation." Dr. Gerald Berry chaired the Lung Rejection Study Group, who likewise formulated a standardized grading system for the diagnosis of lung rejection.
In 1993, the results of another ISHLT ad hoc working group, chaired by Dr. Joel Cooper, were published. This group took the lead in creating a grading system for the clinical staging of chronic dysfunction in lung allografts. Dr. Cooper and colleagues created this system as a clinically applicable, standardized method for assessing functional results after lung transplantation to evaluate factors that may affect long-term outcome, to permit comparison of results from different centers, and to evaluate results of clinical trials.
The History and Archives Council of the ISHLT
In 2004, the Board of Directors endorsed the creation of the History and Archives Council, parallel in concept to other basic science and clinical councils of the Society. The founding members of this council (Dr. Mandeep Mehra and Dr. Hector Ventura [Chairs], Dr. Terence English, Dr. Sharon Hunt, Dr. John Kirklin, Dr. Jon Kobashigawa, Dr. Alec Patterson, Dr. Stephan Schueler) met for the first time at the ISHLT 2005 meeting and agreed that the principal functions of this group will be creation of official Society archives, development of brief reports celebrating landmarks in the history of thoracic transplantation, and development of historical reports marking Society landmarks, such as:
The historical development of thoracic transplantation is based on experimental studies that started in the beginning of the last century. Several phases in the evolution of this procedure were related to the advances in other branches of medicine. The ISHLT has been a leader in shaping a bright future for thoracic transplantation. The initial vision of a small group of physicians of a forum for facilitating a better understanding of the immunologic processes that led to the development of immunosuppressive agents and advances in thoracic surgery assured that heart and lung transplantation was not a "fantastic speculation for the future", but the present reality.
Supported by an independent educational grant from Astellas.
References
The annual scientific sessions of the ISHLT are significant because this year marks the celebration of the 25th anniversary of its inception. The growth of the ISHLT in the last 25 years parallels the growth of heart and lung transplantation as a therapeutic tool for patients with end-stage heart and lung disease. What follows is a brief historical overview of the foundation and achievements of the ISHLT, a vibrant organization that embraces the clinical, scientific, and pathological facets of transplant medicine and continues to address the myriad technological and humanitarian issues surrounding transplantation medicine. To mark the 25th anniversary, the ISHLT invited the former presidents to the annual meeting. A visual program, reflecting society leaders and accomplishments, including landmarks in thoracic transplantation, was shown between sessions.
Foundation of the Society
(Canada: Notre Dame hospital of Montreal and Norway: National Hospital of Norway)
In 1980, a core group of cardiologists and cardiac surgeons in the United States took the lead in founding a society that would defend their interest in cardiac transplantation. This idea was discussed at a meeting in November 1980 in Miami, Florida, during the annual meeting of the American Heart Association, spearheaded by Michael Hess, a cardiologist from Virginia. In this meeting, 9 centers from around the world (United States: Michael Reese Hospital, The Medical College of Virginia, Stanford University, Mayo Clinic, University of Minnesota, University of Arizona, University of Pittsburgh; Canada: Notre Dame Hospital; Norway: National Hospital of Norway) involved in cardiac transplantation were in attendance. The first major topic of discussion was the United States government's policy towards cardiac transplantation and the agreement that this group would work very closely with the National Institute of Health Subcommittee on Cardiac Transplantation to report data regarding the status of heart transplantation to the Cardiology Advisory Board of the National Heart, Lung, and Blood Institute. Second, the group discussed and agreed to create of a central heart transplantation registry. In January 1981 at Michael Reese Hospital, the plans for an official Society were settled.
Dr. Michael Hess (Figure 1), the first ISHLT president, in his first official letter in that capacity, clearly established the need for the creation of a new Society and the principles by which the new Society would abide:
Cardiac transplantation has re-entered another and rapidly accelerating growth phase ...Three month survival rates are now expected in the range of 70-80 percent, with an anticipated 40-50 percent five-year survival rate. This progress is particularly impressive when one considers that the three-month survival rates of potential transplant candidates (Class IV NYHA end-stage heart disease are reported in the range of 0-20 percent ...We who are active in the field are enthusiastic about the future of cardiac transplantation. Our enthusiasm is not shared by others in the health care financing agencies...The International Society for Heart Transplantation has two principal aims: (1) To serve as a forum for the exchange of scientific information among those physicians and scientists active in the field, and (2) to serve as an interface between the cardiac transplantation community and the health care financing agencies and other governmental and scientific interest groups and the public. To accomplish these aims, we need accurate and up-to-date information on the current state of cardiac transplantation. Our registry is aimed at producing such data ...
Together with Dr. Hess, other founding members were well-recognized figures in transplantation, including Jack Copeland, Andrea Hastillo, Jacques Losman, Terence English, Stuart Jamieson, Michael Kaye, Edward Stinson, and Mark Thompson. The first official meeting of the newly formed ISHLT took place in San Francisco, California, on March 14, 1981. During this meeting an important decision was made; Dr. Norman Shumway, a pioneer and key figure in the development of cardiac transplantation, became the honorary president of the Society for life. In addition, the Society developed from inception an international flavor with European cardiac surgeons who were key figures in heart transplantation, such as, Magdi Yacoub, Christian Cabrol, and Bruno Reichart. Thereafter, not only cardiologists and cardiovascular surgeons, but also other specialists, became interested and represented the society in the international field of scientists.
Lung transplantation was pioneered by Dr. Vladimir Demikhov and Dr. James Hardy, and in the late 1980s and early 1990s Dr. Joel Cooper positioned lung transplantation as a therapeutic tool for severe lung disease. Many members of the Society were involved not only in cardiac transplantation but also in lung transplantation. Therefore, in 1991, the Board of Directors, with agreement of the membership, changed the name of the Society to the ISHLT to reflect the commitment of the Society to embracing the advancement of the science and treatment of end-stage heart and lung disease. Today, the Society has more than 2200 members from 45 countries, representing all disciplines in thoracic organ transplantation. Since its inception, the Society has had 21 presidents, all key figures in thoracic organ transplantation from around the world.
The Journal of the International Society for Heart and Lung Transplantation
The official scientific journal of the Society was established in 1981. The journal was initially called Heart Transplantation and the first issue included a foreword by the first editor, Dr. Jacques Losman. He explained clearly why there was a need for a publication of this sort and the importance in collecting clinical and basic research data in transplantation. He wrote:
...and it is legitimate to question the objective need for launching an additional publication in the crowded medical literature. The need may not appear as obvious today as it hopefully may be in a few years. However, two good reasons justify our initiative. The first is that the field of heart transplantation is expanding rapidly ... on that account, heart transplantation has reached the status of a pertinent branch of medicine, and a journal devoted to the special interest of the subject is justified ... a second reason... is to give our society a say in the debate on the social usefulness and cost-benefit aspects of the procedure ... and if Heart Transplantation becomes a central and international source for information in the field, it will only be kept alive and thrive through the contributions of those involved in heart transplantation.
After those humble beginnings under Dr. Losman's leadership, the Journal has certainly thrived and has become a very important publication in the field. With the distinguished guidance of editors Dr. Michael Kaye, Dr. Maria Rosa Costanzo, and more recently Dr. James Kirklin, supported by a multidisciplinary and multinational editorial board, the Journal has matured, submissions have steadily increased, and the scientific content is excellent. In 1990, The Board of Directors changed the name of the journal to The International Journal for Heart and Lung Transplantation to reflect the commitment of the Society to embrace clinical and basic research science research in lung transplantation.
ISHLT Registries
From its foundation, the Society was committed to the creation of a central world database on heart and lung transplantation. The Heart and Lung Transplant Registry began collecting data in 1983 and through the efforts of registry directors Michael Kaye, Jeffrey Hosenpud, and Marshall Hertz and centers submitting their data, the Registry database has become the largest collection of data in the field of heart and lung transplantation, including more than 65,000 patients from 223 hospitals from 18 countries worldwide (Figure 2). The Heart and Lung Transplant Registry is the international quality reference in thoracic transplantation and it sets high standards for every transplant program in the world.
In recent years, mechanical circulatory-assist devices have been used more frequently for the treatment of end-stage heart disease, and in response to their widespread use in 2002, the Society created in the MCSD database. This endeavor, under the guidance of Dr. Mario Deng and Dr Robert Kormos, aims to identify patient populations who may benefit from implantation of mechanical circulatory-assist devices. In addition, the data allow for the generation of predictive models to analyze patient outcomes and study of the mechanical and biological reliability of current and future assist devices.
ISHLT Awards
The commitment of the Society to the funding of research is evidenced by the availability of annually awarded grants, including the Research Fellowship award, the Transplant Career Development award, the Nursing and Social Science Research award, and the Philip Caves award. The latter is the award with the longest history, established in 1982 and named in memory of Philip Caves, who pioneered the technique of transvenous endomyocardial biopsy, which has been the gold standard for identification of cardiac rejection. Philip Caves was a young Scottish surgeon who died at a young age. In his memory this award was established to encourage and reward original research performed by trainees and graduate students who will represent the Society in the future. Many of the recipients of the award have become established physicians and scientists in the field of thoracic transplantation.
Standardization of a Grading System for Heart and Lung Transplant Rejection
Another important milestone in the history of the Society was the work by a group of members in creating a standard grading system for the diagnosis of heart and lung transplant rejection. Dr. Margaret Billingham, former president of the ISHLT and an internationally recognized pathologist in the field of transplantation, chaired the Heart Rejection Study Group, who published their results supporting a standardization of nomenclature in the diagnosis of heart and lung rejection. Dr. Billingham explained the need for a standardized grading system for the diagnosis of rejection in cardiac transplantation: "With the emergency of many different grading systems for heart and lung biopsy interpretation, the ISHLT realized the necessity to establish a standardized grading system for the purpose of multicenter trials and for publication so that results from different centers could be compared effectively...Basic grading systems are presented in the following articles that will now be required for all manuscripts accepted for the Journal of Heart and Lung Transplantation. In making this step...the Society has taken a leadership role and has made a significant contribution to more meaningful scientific results in the field of thoracic organ transplantation." Dr. Gerald Berry chaired the Lung Rejection Study Group, who likewise formulated a standardized grading system for the diagnosis of lung rejection.
In 1993, the results of another ISHLT ad hoc working group, chaired by Dr. Joel Cooper, were published. This group took the lead in creating a grading system for the clinical staging of chronic dysfunction in lung allografts. Dr. Cooper and colleagues created this system as a clinically applicable, standardized method for assessing functional results after lung transplantation to evaluate factors that may affect long-term outcome, to permit comparison of results from different centers, and to evaluate results of clinical trials.
The History and Archives Council of the ISHLT
In 2004, the Board of Directors endorsed the creation of the History and Archives Council, parallel in concept to other basic science and clinical councils of the Society. The founding members of this council (Dr. Mandeep Mehra and Dr. Hector Ventura [Chairs], Dr. Terence English, Dr. Sharon Hunt, Dr. John Kirklin, Dr. Jon Kobashigawa, Dr. Alec Patterson, Dr. Stephan Schueler) met for the first time at the ISHLT 2005 meeting and agreed that the principal functions of this group will be creation of official Society archives, development of brief reports celebrating landmarks in the history of thoracic transplantation, and development of historical reports marking Society landmarks, such as:
Creation of the Society;
Development of the Heart and Lung Transplant Registry and its global impact on transplantation;
Development, growth, and direction of Journal of Heart and Lung Transplantation;
Profiles of Society presidents and other leaders marking their achievements; and
Oral interviews of Society leaders (ie, presidents, journal editors, council chairs) to be submitted in consideration publication in the Journal of Heart and Lung Transplantation.
The historical development of thoracic transplantation is based on experimental studies that started in the beginning of the last century. Several phases in the evolution of this procedure were related to the advances in other branches of medicine. The ISHLT has been a leader in shaping a bright future for thoracic transplantation. The initial vision of a small group of physicians of a forum for facilitating a better understanding of the immunologic processes that led to the development of immunosuppressive agents and advances in thoracic surgery assured that heart and lung transplantation was not a "fantastic speculation for the future", but the present reality.
Supported by an independent educational grant from Astellas.
References
Ventura HO, Muhammed K. Historical perspectives on cardiac transplantation: the past as prologue to challenges for the 21st century. Curr Opin Cardiol. 2001;16:118-123.
Schueler S. The changing face of heart and lung transplantation: Presidential address, 2003 annual meeting of the International Society for Heart and Lung Tansplantation. J Heart Lung Transplant. 2004;23:816-822.
Hess M. Letter of the President. The International Registry for Cardiac Transplantation. Archived by the International Society for Heart and Lung Transplantation.
Losman JG. Foreword. Heart Transplant. 1981;1:1.
Billingham ME, Cary NR, Hammond ME, et al. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Heart Rejection Study Group. J Heart Transplant. 1990;9:587-593.
Berry GJ, Brunt EM, Chamberlain D, et al. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Lung Rejection Study Group. J Heart Transplant. 1990;9:593-601.
Cooper JD, Billingham M, Egan T, et al. A working formulation for the standardization of nomenclature and for clinical staging of chronic dysfunction in lung allografts. International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 1993;12:713-716.
Marcus E, Wong SNT, Luisada AA. Homologous heart grafts: transplantation of the heart in dogs. Surg Forum. 1951;2:212-217.
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