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Spring 2004, Vol. 3, No. 1

Editor’s Memo   Redefining the Window of Opportunity in Lung Transplantation Our articles in this issue span the spectrum of treatment for severe pulmonary hypertension (PH), not only from a historical perspective through our profiling of the work of Joel Cooper, MD, a true pioneer in the surgical suite, but also in terms of the therapeutic options available, from medical therapy to lung transplantation. The discussion is particularly timely and relevant because the allocation system for donated lungs may soon be changed by the United Network of Organ Sharing. Although the options for managing patients with right ventricular failure have expanded significantly through the use of prostanoids and with atrial septostomy, the paramount issue remains in those patients whose disease is no longer adequately responding to these measures: When is it the right time to proceed with transplantation or listing? Our experts on the Pulmonary Hypertension Roundtable addressed a multitude of issues surrounding this question. Although outcomes have improved in the 20 years that lung transplantation has been available for PH, the observation of Dr Cooper—that this surgery remains among the most demanding and difficult largely because of postoperative considerations—remains true. Outcomes in general for lung transplantation for PH have been inferior to those for many other diseases, such as chronic obstructive pulmonary disease. Because of strides made in medical management, however, we have been able to extend the window prior to lung transplantation in many patients. Ironically, this sometimes has proved to be a mixed blessing. The advent of continuous intravenous epoprostenol, a medication that has revolutionized the treatment of pulmonary arterial hypertension, thereby offering the potential to delay transplantation, may have resulted in a higher proportion of extremely sick, higher-risk patients presenting for transplantation. The articles in this issue offer a comprehensive resource to address these questions as they delineate the practices and policies prevailing at centers of excellence throughout the country. Once again, I wish to congratulate my colleagues who contributed to this issue on a job well done. Victor F. Tapson, MD Editor-in-Chief   Take it With You   Download this issue in PDF (655 KB)   Issue Sponsors   Actelion(PDF) Accredo Therapeutics(PDF)	Articles   Advances in Pulmonary Hypertension, Spring 2004, Vol. 3, No. 1 cover close-up Click titles to read stories... Profiles in Pulmonary Hypertension: Joel D. Cooper, MD, the Physician Who Launched Lung Transplantation on Its Path to Successful Outcomes You might say that every patient with pulmonary hypertension whose life has been extended by a lung transplant continues to live and thrive in the long shadow cast by Joel D. Cooper, MD, the physician who performed the first successful lung transplant surgery in 1983.... Listing the Patient: Deciding When Transplantation Is the Only Viable Life-Sustaining Option ...despite major strides in the field of lung transplantation, numerous shortcomings are still associated with this procedure, including lack of available donor lungs, need for lifelong immunosuppression, acute and chronic allograft rejection, infection, and extremely high costs of the procedure and posttransplantation care.... Lung Transplantation: Timing, Perioperative Considerations and Postoperative Outcome ...While transplantation offers the prospect of improved survival and functional status, the potential consequences of lifelong immunosuppression and infection as well as chronic, refractory allograft rejection mandate careful patient selection and close follow-up prior to proceeding to transplantation.... Pulmonary Hypertension Roundtable Protocols in Heart and Lung Transplantation: An Essential Guide to Preoperative Assessment and Timing to Improve Outcomes Featuring: Robert Frantz, MD, Assistant Professor of Medicine, Cardiovascular Division, Mayo Clinic, Rochester, Minnesota John Conte, MD, Associate Professor of Surgery and Director of Heart and Lung Transplantation, Johns Hopkins University, Baltimore, MD. Pull-Out Section Lung Transplant Evaluation: Requirements Prior to Listing (PDF)     PHA Announcements   From Puzzle to Picture: 6th International Pulmonary Hypertension Conference and Scientific Session (PDF) K08 & K23 2004 Program Announcement (PDF)
Notes   Editorial Advisory Board Editor-in-Chief Ronald J. Oudiz, MD Associate Professor of Medicine UCLA School of Medicine Director, Liu Center for Pulmonary Hypertension Division of Cardiology Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center Torrance, California Immediate Past Editor Vallerie V. McLaughlin, MD Associate Professor of Medicine Director, Pulmonary Hypertension Program University of Michigan Health System Ann Arbor, Michigan Editor-in-Chief Elect Richard Channick, MD Professor of Clinical Medicine Pulmonary and Critical Care Division University of California, San Diego Medical Center San Diego, California Associate Editors Erika Berman Rosenzweig, MD Assistant Professor of Pediatrics Department of Pediatrics Columbia College of Physicians and Surgeons New York, New York Robert Frantz, MD Consultant in Cardiovascular Diseases and Internal Medicine Assistant Professor of Medicine Mayo Clinic College of Medicine Rochester, Minnesota Srinivas Murali, MD, FACC Professor of Medicine Drexel University College of Medicine Director, Division of Cardiovascular Medicine Medical Director, Gerald McGinnis Cardiovascular Institute Allegheny General Hospital Pittsburgh, Pennsylvania Publisher Pulmonary Hypertension Association Jack Stibbs, Board Chair Rino Aldrighetti, President Donica Merhazion, Medical Services Associate Director Publishing Staff Stu Chapman, Executive Editor Susan Chapman, Managing Editor Heidi Green, Associate Editor Gloria Catalano, Production Director Michael McClain, Design Director PHA Office Pulmonary Hypertension Association 801 Roeder Road., St.e 400 Silver Spring, MD 20910 301-565-3004, 301-565-3994 (fax) www.PHAssociation.org Provided with an unrestricted educational grant from Actelion Pharmaceuticals, U.S., Inc. and Accredo Therapeuticss. © 2006 by Pulmonary Hypertension Association and DataMedica. All rights reserved. None of the contents may be reproduced in any form whatsoever without the written permission of PHA. Editorial Offices Advances in Pulmonary Hypertension DataMedica 424 Dune Road Westhampton Beach, NY 11978 Tel: 631-288-7733 Fax: 631- 288-7744 Advances in Pulmonary Hypertension is circulated to cardiologists, pulmonologists, rheumatologists and other selected physicians by the Pulmonary Hypertension Association . The contents of the articles are independently determined ly the Editor and the Editorial Advisory Board. PHA's Scientific Leadership Council Editorial Mission Advances in Pulmonary Hypertension is committed to help physicians in their clinical decision making by informing them of important trends affecting their practice. Analyzing the impact of new findings and covering current information in the peer-reviewed literature, Advances in Pulmonary Hypertension is published four times a year. Advances in Pulmonary Hypertension is the official journal of the Pulmonary Hypertension Association. Each article in this journal has been reviewed and approved by members of the Editorial Advisory Board.   Editorial Board Todd Bull, MD Division of Pulmonary Sciences and Critical Care Medicine University of Colorado Health Sciences Center Denver, Colorado Murali Chakinala, MD Director, Pulmonary Hypertension Clinic Washington University School of Medicine St. Louis, Missouri Kristin Highland, MD Assistant Professor Division of Pulmonary and Critical Care Director, Pulmonary Hypertension Clinic Medical University of South Carolina Charleston, South Carolina Jim Maloney, MD Associate Professor of Pulmonary and Critical Care Medicine University of Colorado Health Sciences Center Denver, Colorado Ioana Preston, MD Assistant Professor of Medicine Tufts - New England Medical Center Boston, Massachusetts Zeenat Safdar, MD Assistant Professor of Medicine Department of Medicine, Pulmonary & Critical Care Section Pulmonary Hypertension Center Baylor College of Medicine Houston, Texas Rajan Saggar, MD Assistant Professor Division of Pulmonary and Critical Care Medicine and Hospitalists David Geffen School of Medicine UCLA Los Angeles, California Robert Schilz, DO, PhD Medical Director of Lung Transplantation and Pulmonary Vascular Disease University Hospital of Cleveland Case Western Reserve University Cleveland, Ohio Francisco Soto, MD, MS Assistant Professor Director, Pulmonary Hypertension Program Medical College of Wisconsin Milwaukee, Wisconsin Roxana Sulica, MD Assistant Professor of Medicine Albert Einstein College of Medicine Director, Beth Israel Pulmonary Hypertension Program Beth Israel Medical Center New York, New York

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