There was a real buzz after the pharmacy symposium at the International Society of Heart and Lung Transplant (ISHLT) annual conference this year in Montreal, with the audience and speakers breaking into groups to discuss aspects of the challenging real life case that had been presented as part of the Pharmacy and Pharmacology council's ‘Lifecycle Journey’ series. This series uses a developing case to create a panel-facilitated and audience-supported best practice-based discussion at predefined key ‘journey intervals.’ This year the session was titled: A Lifecycle Journey in Cystic Fibrosis and Lung Transplantation. In this session, members of the Pharmacy and Pharmacology and the Pulmonary Transplantation Councils focused on four ‘journey points,’ which include: (1) listing considerations and pretransplant infections, (2) perioperative and immediate postoperative management issues, (3) metabolic and interaction considerations to drug dosing and (4) immunomodulation strategies for the management of bronchiolitis obliterans syndrome. The first journey point proved thought-provoking, hearing the expert panel of pharmacists and physicians discuss their practice in managing a complex patient with resistant infections in order to ensure that the patient was in optimal condition at transplant. Unfortunately, need for suppression of Burkholderia cepacia complex and Mycobacterium abscessus prior to transplant is becoming all …