President's Message
Vijay Gorantla
President, ISVCA
Associate Professor of Surgery
Director, Vascularized Composite
Allotransplantation Program
Wake Forest Baptist Health System and Wake Forest School of Medicine
Winston Salem, NC, USA
TRAILBLAZING INNOVATION AND INSPIRING CHANGE: FOUNDATIONS FOR THE FUTURE OF ISVCA
Founded in 1998, the ISVCA remains the first and longest-serving, global society that represents the field of VCA. As the President of the ISVCA, it is my honor to uphold the mandate, values and vision of the society whose mission is to provide an inclusive, responsive, equitable forum for educational excellence, patient-focused research, and global advocacy for VCA.
Clinical experience in VCA over the past two decades has shed light on their impressive benefits and inherent risks. Most of these insights have emanated from individual programs across the world that have borne the responsibility of ensuring technical, immunological and functional outcomes after these transformative procedures. Pioneering research progress has also been made in detection, monitoring and therapies for rejection in VCA, advanced imaging for surgical planning and novel approaches to facilitate tissue preservation, nerve regeneration or drug delivery to improve the safety, efficacy and survival of VCA grafts.
Despite such advances and tremendous promise of VCA, the morbidity and mortality risks associated with immunosuppression or chronic rejection remain sobering barriers to the future of our field. We must realize that the clinical impact of trailblazing innovation in VCA in overcoming these challenges can only be realized by open and collaborative sharing of clinical outcomes between programs across the world. This is especially important given the small numbers/cohorts of patients undergoing these procedures.
The ISVCA is thus encouraging and educating teams on the collaborative imperative for agreement on study standards, uniform assessments and protocols, or data points and pooling of data or comparison of results among centers to validate safety, efficacy and feasibility of VCA across participants from different demographic, ethnic and etiopathologic groups. As a first step, over the past three years, working groups led by multidisciplinary VCA experts have come together to recommend guidelines for the definitions of success and failure in VCA such as hand or face transplants and diagnostic qualifiers for chronic rejection. Together with the help of peer societies, the ISVCA is making steady headway towards this goal through meaningful debate.
Beyond leading international efforts to increase generalizability of outcomes after hand, face, uterus, penis, abdominal wall (or other transplants), the ISVCA maintains an unflinching focus on the bioethical and psychosocial challenges that hamper clinical advancement of the field. The ISVCA was closely involved in the First International Workshop on Bioethical Challenges in Reconstructive Transplantation organized by the Brocher Foundation in Hermance, Switzerland in 2017. The ISVCA remains closely engaged with peer professionals representing teams from across the world examining the overarching bioethical dilemmas and debates in VCA. These relate to justice and vulnerability of subjects, and their experiences with risks, benefits and outcomes, privacy, confidentiality, and equitability, public awareness and attitudes toward transplantation, and policy and regulatory issues shaping progress of the field.
We are learning from VCA programs across the world that patient-centered aspects are critical to overall outcomes of these procedures. These include understanding risks and benefits, informed decision-making, matching motivation with expectations, commitment/compliance with study regimens, and satisfaction with functional outcomes or adaptation with transplants. The Chauvet Working Group at the ISVCA is committed to improving methods, tools and guidelines for psychosocial screening to understand how VCA patients assimilate information about the lifelong burdens of transplant, commitments to physician recommendations, and financial and caregiver stresses. VCA outcomes documented over the past two decades lack patient reported elements in defining success or failure and measuring outcomes after these complex surgeries. The ISVCA strongly encourages programs to focus on the spiritual, emotional, and sociocultural factors affecting recipients and implement qualitative and data-driven research methods in informing clinical practice and policy to overcome barriers and improve health outcomes in VCA.
The value of intellectual investments in innovation require us to first standardize outcome measures for VCA. This is a key prerequisite to validate new therapeutic approaches, increase quality of evidence for clinical decision making, provide objective cost-value analysis for reimbursement, and inform health policy for approval and adoption of a given VCA as a standard of care, safe, effective, and ethical therapeutic option. Twenty years into the evolution of this remarkable specialty, we are at an exciting watershed moment in the history of VCA. Please join me in leading the charge to inspire the change that is the keystone for innovation and advancement of VCA.
The 14th Congress of the International Society for Vascularized Composite Allotransplantation (ISVCA) held in New Delhi, India (September 30 - October 1, 2019) was a fantastic success. The theme of the meeting was “Learning from the Past, Preparing for the Future." More than 100 participants from 18 countries participated in the meeting. The meeting was preceded by a 2-day hands on workshop that demonstrated donor and recipient VCA procedures on soft embalmed specimens. Over 40 presentations included world updates in VCA as well as progress in experimental research and innovative advances with clinical impact (including topics such as psychosocial aspects in VCA, prosthetics versus VCA and bioethical dilemmas in VCA). A Satellite Symposium was held in the southern Indian city of Kochi on October 4th to discuss advances in emerging fields such as regenerative medicine, tissue engineering and nanomedicine as relevant to VCA.
However, the unprecedented impact of the pandemic of 2020 has had far reaching consequences on the planning and organization of the next ISVCA congress. Taking into consideration the global trends of COVID-19 and predictive estimates for persistent restrictions to global travel which extend into late 2021, the ISVCA Council has made the difficult but consensus decision to postpone the 15th ISVCA Congress to 2022. We believe that the ISVCA is not the only meeting being postponed, with numerous congresses being rescheduled or canceled for 2021. The Council exercised a high degree of caution in its decision to postpone the meeting, as the health, safety and convenience of our members, trainees, attendees, sponsors, staff and exhibitors are the paramount priority of the Society.
The meeting Chairman of the 15th ISVCA Congress, Dr. Martin Iglesias is working closely with the President of the World Society of Reconstructive Microsurgery (WSRM), Dr. Eric Santamaria, to organize the next ISVCA Congress in conjunction with the 11th Congress of the WSRM, which is also planned for Cancun, Mexico in 2022. The ISCVA remains grateful to its membership for their understanding and looks forward to maximal participation of young trainees, clinicians and scientists from across the world at the upcoming meeting in beautiful, breathtaking Cancun, Mexico in the summer of 2022! Please pledge your membership today to support the society to provide you with the highest quality scientific programming and showcase cutting-edge advances in VCA.Your continued commitment as a member goes a long way in advancing the mission of the ISVCA as a global society representing our game-changing field.
Obituary: Jean-Michel “Max” Dubernard (1941-2021)
Jean Michel Dubernard (Max to his friends) passed away on July 11, 2021. He was on vacation with his wife Camille and some of his grandchildren. His death was sudden and unexpected.
His exemplary life leaves us to reflect on life in general, and what a surgeon can do for a suffering patient He was a pioneer with an innate sense of innovation. Transgression of dogmatic ideas was one on his leading lines of thought. He wanted to push the limits… and to extend the world of the possible.
As a child, he was fascinated by the concept of transplantation, from the first kidney graft on Marius Renard in 1952 in Paris. Dream became reality a few years later with the simultaneous start of transplantation programs in Paris and in Boston. He moved to Boston as a research fellow where he spent 3 years with Dr. Joseph Murray, the transplantation pioneer who was later awarded a Nobel Prize. There, he worked on an islet transplantation project in rodents and familiarized himself with the very first immunosuppression induction treatments. His masters and peers became the pioneers who spread transplantation techniques throughout the world.
Back in Lyon, he joined the burgeoning transplantation program mentored by Jules Traeger, a nephrologist who was at that time conducting research with Charles Mérieux on anti-lymphocyte globulin. Very early he started an experimental research program on heterografts in primates. A few years later, as diabetic patients with renal insufficiency were increasing in number, he started one of the first pancreas transplant programs in Europe. Considering the initial failure of whole organ transplantation in Minneapolis in 1972, he imagined to tackle the problem with a simple segmental graft, with intraductal injection of Neoprene, that would block exocrine secretions, thus transforming a dual-function organ into a single endocrine gland. He set up a surgical and research team with a young surgeon named Xavier Martin who was 12 years his junior, establishing a collaboration and friendship that would last for more than 43 years. The rather simple preparation technique of the graft was a booster for pancreatic transplantation programs to start again all over the world, in Minneapolis, Munich, Milan, Birmingham and several other institutions. The advent of new powerful immunosuppressive drugs such as Ciclosporin A allowed them to revisit new pancreas transplantation techniques . He organized in Lyon the very first international meeting on pancreas transplantation in 1979, where the the International Pancreas Transplant Registry (IPTR) was created with his good friend David Sutherland. This laid the foundation for founding of the International Pancreas and Islet Transplant Association (IPITA) and the organization of the 3rd Congress of IPITA in Lyon in 1991. The last IPITA meeting was organized in Lyon in 2019 by Xavier Martin, Lionel Badet, Emmanuel Morelon and Thierry Berney under his honorary presidency. He was on the founding board of many otherscientific societies, including ESOT and the International Microsurgical Society. He was President of many of them.
In parallel, he organized a urologic department that became a leading international group in new technologies, such as shock wave lithotripsy, endoscopy and of prostate cancer treatment with high intensity focused ultrasound (HIFU). At the University of Lyon, he introduced microsurgery techniques brought from Sydney by Earl Owen, with whom he would later organize the hand transplantation program.
It may seem that Max Dubernard has led several parallel lives: in the late eighties, he got involved in politics and became Deputy Mayor of Lyon. He was elected for almost 20 years to the Assemblée Nationale (French Congress). This new area of activity didn’t stop him from thinking about an ambitious project : transplantation of composite tissues. His friendship with Earl Owen, a specialist of limb replantation and microsurgery in Sydney, lead him to develop the hand transplantation project. The first case was a patient from New Zealand. Surgery was performed with the help of an international team including Marco Lanzetta and Nadey Hakim. Although unsuccessful due to non-adherence to immunosuppressive treatment, this first experience became the basis for a new program of bilateral hand transplantation. It led to success in 2000 with the first graft on Denis Chatelier, with more than 20 years of success in recovery of function. The multidisciplinary team set up for this project continued as a new means of cooperation between surgeons and neuroscientists, leading to breakthrough discoveries in the field of neuroscience, such as the plasticity of brain connections.
This success of composite tissue transplantation also opened the path to other transplants in the world, such as joints, abdominal wall and larynx among others. He created the International Composite Tissue Transplantation Society with the help of Palmina Petruzzo. Later, in 2005, he had a leading role in the first face transplant that was performed in Amiens by Bernard Devauchelle and Sylvie Testelin. The Lyon group had indeed shown pioneering skills and expertise in the management of composite tissue transplant patients, with a team including nephro-immunologists, pathologists, rehabilitation care, psychiatry and nursing care, and Bernard Devauchelle was therefore happy to leverage this experience and initiate this exemplary collaboration.
During his entire career Max was a team builder, finding the right people, putting them in charge, mentoring them with his extraordinary sense of confidence and endless enthusiasm. He always referred to the “rugby team spirit”, a sport he had practiced in his youth and where he allegedly received his “Max” nickname. He was a mentor and a teacher and was the founder, together with Henri Kreis, of the Hesperis Course, a fantastic lectures cycle, in which new generations of transplant surgeons and physicians were taught by the European leaders in the field.
Max was a visionary and was always looking for some new application in the field of surgery and technology. He was a prolific scientist, and the author of more than 400 scientific papers. He received numerous awards for his monumental achievements, such as the Honorary ESOT Membership Award in 2019, the Lillehei Lecture Award from IPITA in 2103, and the prestigious Medawar Prize of The Transplant Society in 2008.
Perhaps most importantly, Max had a very deep sense of humanity and loyalty in his relationships and with his friends. He was always keen to maintain his numerous friendships almost everywhere in the world.
- Xavier Martin, Lionel Badet, Emmanuel Morelon, Thierry Berney
Click here to visit Jean-Michel Dubernard page with videos, his 2008 Medawar speech and more.
The Transplant Infectious Disease Section (TID) has prepared an update and guidance on the 2019 Novel Coronavirus (2019-nCov) for transplant ID clinicians.
Contact
Address
International Society of Vascularized Composite Allotransplantation
International Headquarters
505 Boulevard René-Lévesque Ouest
Suite 1401
Montréal, QC, H2Z 1Y7
Canada