Cardiac transplantation is frequently associated with accelerated coronary atherosclerosis and immune-mediated microvascular injury. To determine if orthotopic cardiac transplantation impairs the capacity of the coronary vasculature to vasodilate and conduct hyperemic blood flow, maximal coronary vasodilator reserve was measured in 25 cardiac allograft recipients with no evidence of rejection 6-57 months after transplantation and in 20 normal subjects. Left ventricular wall thickness was assessed echocardiographically, and epicardial coronary anatomy was evaluated by quantitative coronary angiography. Coronary vasodilator reserve (CVDR) was measured in all patients with a coronary Doppler catheter and a maximally vasodilating dose of intracoronary papaverine. CVDR measured in the transplant recipients with normal coronary arteries, left ventricular function, and wall thickness (5.0 +/- 0.3 [mean +/- SEM] peak/resting velocity; range, 3.8-7.3; n = 16) was not different from that of normal ...
Improving recovery time following heart transplantation: the role of the multidisciplinary health care team Maureen G Roussel,1 Noreen Gorham,2 Lynn Wilson,2 Abeel A Mangi2 1Heart and Vascular Center, Yale-New Haven Hospital, New Haven, CT, USA; 2Center for Advanced Heart Failure, Mechanical Circulatory Support and Cardiac Transplantation, Yale New Haven Heart and Vascular Institute, Yale-New Haven Hospital, New Haven, CT, USA Background: The care of cardiac transplant patients is complex requiring a finely orchestrated endeavor to save a patient’s life. Given the chronic and complex nature of these patients, multiple disciplines are involved in their care. Recognizing difficulties with communication among team members and striving for improved efficiencies in our pretransplant listing process and in our inpatient care, our team was prompted to change the existing approach to patient care related to heart transplantation. Methods: Daily multidisciplinary rounds were instituted and the format of
History:. Now called the Pediatric Heart Transplant Society (PHTS), the Pediatric Heart Transplant Study Registry was established in 1993 by a group of physicians who wanted to improve the lives of children who needed a heart transplant. The primary purposes of the organization was to establish and maintain a prospective, event driven database for heart transplantation, to encourage and stimulate basic and clinical research in the field of pediatric heart transplantation, and to promote new therapeutic strategies. The ultimate goal was to improve the lives of pediatric heart transplant recipients.. With more than 25 years of data collection, PHTS has produced over 120 abstract presentations and over 80 peer-reviewed manuscripts analyzing the continuum from pre-transplant risk factors to post-transplant morbidities which impact long-term survival after heart transplant in childhood. Information gained has significantly increased our understanding of pediatric heart transplantation and has allowed ...
TY - JOUR. T1 - Sinus tachycardia is associated with impaired exercise tolerance following heart transplantation. AU - Peled, Yael. AU - Varnado, Sara. AU - Lowes, Brian D. AU - Zolty, Ronald. AU - Lyden, Elizabeth R.. AU - Moulton, Michael J. AU - Um, John Y. AU - Raichlin, Eugenia. PY - 2017/5. Y1 - 2017/5. N2 - Background: Sinus tachycardia often presents in heart transplantation (HTx) recipients, but data on its effect on exercise performance are limited. Methods: Based on mean heart rate (HR) value 3 months after HTx, 181 patients transplanted from 2006 to 2015 at University of Nebraska Medical Center were divided into two groups: (i) HR,95 beats/min (bpm, n=93); and (ii) HR≥95 bpm (n=88). Cardiopulmonary exercise testing (CPET) was performed 1 year after HTx. Results: Mean HR at 3 months post-HTx was 94±11 bpm and did not change significantly at 1 year post-HTx (96±11 bpm, P=.13). HR≥95 bpm at 3 months was associated with younger donor age (OR 1.1; CI 1.0-1.1, P=.02), female donors ...
TY - JOUR. T1 - The yield of surveillance endomyocardial biopsies as a screen for cellular rejection in pediatric heart transplant patients. AU - Levi, Daniel S.. AU - DeConde, Adam S.. AU - Fishbein, Michael C.. AU - Burch, Caron. AU - Alejos, Juan C.. AU - Wetzel, Glenn T.. PY - 2004/2. Y1 - 2004/2. N2 - Endomyocardial biopsy is commonly used to screen for cellular rejection in pediatric heart transplant patients. The yield of EMBs when combined with newly developed immunohistochemical techniques and modern immunosuppression in pediatric heart transplant patients is unknown. After OHT, surveillance biopsies were performed on a routine basis on all pediatric patients. EMBs were also performed on symptomatic OHT patients suspected to have rejection. All positive results (greater than ISHLT grade 1B) were confirmed with immunohistochemical staining. A retrospective review of consecutive EMBs performed in this institution from January 1995 to January 2003 was performed. The echocardiographic ...
Diabetes mellitus (DM) is a major cause of morbidity and mortality following heart transplantation (HT), with 21% and 35% of survivors being affected within 1 and 5 years following HT, respectively. Magnesium deficiency is common among HT patients treated with calcineurin inhibitors and is a known risk factor for DM in non-HT patients. We therefore investigated the association between serum Mg (s-Mg) levels and new-onset diabetes after transplantation (NODAT). Between 2002 and 2017, 102 non-DM HT patients were assessed. In accordance with the mean value of all s-Mg levels recorded during the first year post-HT, patients were divided into high s-Mg (≥ 1.8 mg/dL) and low s-Mg (| 1.8 mg/dL) groups. The endpoint was NODAT, defined according to the diagnostic criteria of the American Diabetes Association. Baseline clinical and demographic characteristics for the high (n = 45) and low s-Mg (n = 57) groups were similar. Kaplan-Meier survival analysis showed that 15-year freedom from NODAT was significantly
TY - JOUR. T1 - Reduction of infectious complications following heart transplantation with triple-drug immunotherapy. AU - Andreone, P. A.. AU - Olivari, M. T.. AU - Elick, B.. AU - Arentzen, C. E.. AU - Sibley, R. K.. AU - Bolman, R. M.. AU - Simmons, R. L.. AU - Ring, W. S.. PY - 1986. Y1 - 1986. UR - http://www.scopus.com/inward/record.url?scp=0022892559&partnerID=8YFLogxK. UR - http://www.scopus.com/inward/citedby.url?scp=0022892559&partnerID=8YFLogxK. M3 - Article. VL - 5. SP - 13. EP - 19. JO - Journal of Heart and Lung Transplantation. JF - Journal of Heart and Lung Transplantation. SN - 1053-2498. IS - 3. ER - ...
Background- Sudden cardiac death among orthotopic heart transplant recipients is an important mechanism of death after cardiac transplantation. The role for implantable cardioverter-defibrillators (ICDs) in this population is not well established. This study sought to determine whether ICDs are effective in preventing Sudden cardiac death in high-risk heart transplant recipients.. Methods and Results- We retrospectively analyzed the records of all orthotopic heart transplant patients who had ICD implantation between January 1995 and December 2005 at 5 heart transplant centers. Thirty-six patients were considered high risk for sudden cardiac death. The mean age at orthotopic heart transplant was 44±14 years, the majority being male (n=29). The mean age at ICD implantation was 52±14 years, whereas the average time from orthotopic heart transplant to ICD implant was 8 years ±6 years. The main indications for ICD implantation were severe allograft vasculopathy (n=12), unexplained syncope (n=9), ...
TY - JOUR. T1 - ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation. AU - Kirk, Richard. AU - Dipchand, Anne I.. AU - Davies, Ryan R.. AU - Miera, Oliver. AU - Chapman, Gretchen. AU - Conway, Jennifer. AU - Denfield, Susan. AU - Gossett, Jeffrey G.. AU - Johnson, Jonathan. AU - McCulloch, Michael. AU - Schweiger, Martin. AU - Zimpfer, Daniel. AU - Ablonczy, László. AU - Adachi, Iki. AU - Albert, Dimpna. AU - Alexander, Peta. AU - Amdani, Shahnawaz. AU - Amodeo, Antonio. AU - Azeka, Estela. AU - Ballweg, Jean. AU - Beasley, Gary. AU - Böhmer, Jens. AU - Butler, Alison. AU - Camino, Manuela. AU - Castro, Javier. AU - Chen, Sharon. AU - Chrisant, Maryanne. AU - Christen, Urs. AU - Danziger-Isakov, Lara. AU - Das, Bibhuti. AU - Everitt, Melanie. AU - Feingold, Brian. AU - Fenton, Matthew. AU - Garcia-Guereta, Luis. AU - Godown, Justin. AU - Gupta, Dipankar. AU - Irving, Claire. AU - Joong, Anna. AU - Kemna, Mariska. AU - Khulbey, Sanjeev ...
Median survival after pediatric heart transplantation (HT) is 15 years in the current era. This means that a substantial fraction of patients transplanted during childhood fail to survive to adulthood, or require heart re-transplantation, because of complications related to heart transplant. These complications include heart transplant rejection, infection, coronary artery disease, post-transplant lymphoproliferative disorder (PTLD; a form of lymphoma seen in transplant recipients), and kidney failure. Most complications stem not from the heart transplant itself, but from the drugs commonly used to suppress the immune system in order to prevent rejection. In the US, tacrolimus (TAC) and mycophenolate mofetil (MMF), have emerged over the past decade as the standard of care for pediatric heart transplant immunosuppression. While pediatric survival has improved significantly in the era of TAC and MMF, post-HT complications remain a major problem that limits median survival to 15 years. Recently, ...
TY - JOUR. T1 - A critical analysis of morbidity and mortality as it relates to recipient age following cardiac transplantation. AU - Hosenpud, J. D.. AU - Pantely, G. A.. AU - Norman, D. J.. AU - Cobanoglu, A. M.. AU - Hovaguimian, H.. AU - Starr, A.. PY - 1990/1/1. Y1 - 1990/1/1. N2 - Older patients (age greater than 55) are now being accepted as candidates for cardiac transplantation. The outcome following cardiac transplantation in this older age group has been largely limited to an analysis of mortality and rejection and infection incidence. In addition to these factors, this report investigates whether morbidity related to other organ system disease is greater than in older patients. Seventy-eight cardiac transplant operations in patients aged 15 through 64 have been performed using the identical immunosuppression protocol from December 1985 to May 1989. Of these, 58 patients were under the age of 55 (younger), and 20 were 55 years of age or older (older). One- and 2-yr survival tended to ...
TY - JOUR. T1 - Multiparametric Cardiac Magnetic Resonance Imaging Can Detect Acute Cardiac Allograft Rejection After Heart Transplantation. AU - Dolan, Ryan S.. AU - Rahsepar, Amir A.. AU - Blaisdell, J.. AU - Suwa, Kenichiro. AU - Ghafourian, Kambiz. AU - Wilcox, Jane E. AU - Khan, Sadiya Sana. AU - Vorovich, Esther Elizabeth. AU - Rich, Jonathan D. AU - Anderson, Allen Sawyer. AU - Yancy, Clyde W. AU - Collins, Jeremy D.. AU - Carr, James. AU - Markl, Michael. PY - 2019/8/1. Y1 - 2019/8/1. N2 - Objectives: The purpose of this study was to evaluate the sensitivity of multiparametric cardiac magnetic resonance imaging (CMR) for the detection of acute cardiac allograft rejection (ACAR). Background: ACAR is currently diagnosed by endomyocardial biopsy, but CMR may be a noninvasive alternative because of its capacity for regional myocardial structure and function characterization. Methods: Fifty-eight transplant recipients (mean age 47.0 ± 14.7 years) and 14 control subjects (mean age 47.7 ± ...
Objective: The aim of this study was to compare the requirement for temporary and permanent pacemaker insertion and the incidence of the problems regarding the rhythm following heart transplantation with the bicaval or biatrial technique in the early postoperative period.Methods: Sixty-one patients underwent orthotopic heart transplantation between the dates of September 1989 and December 2008 in our clinics were included to the study. The study was designed as retrospective analysis, and all data were collected from hospital records. The transplantation was performed by using standard biatrial method in 28 of the patients, by using bicaval anastomosis method in 33 of the patients. Statistical analyses were performed using Chi-square, Fischers exact and Mann-Whitney U tests. Predictors of temporary and permanent pacemaker insertion were analyzed using logistic regression analysis.Results: In the biatrial group, the temporary pacemaker requirement (p|0.05), left bundle branch block (LBBB) (p|0.01) and
Kidney disease is a common problem after heart transplantation. It may be caused by anti-rejection medications such as cyclosporine or tacrolimus. However, the reason why some people develop kidney problems after a heart transplant, but other people do not, is not fully known. This study plans to learn more about the relationship between a persons genetic make-up (DNA; deoxyribonucleic acid) and the risk of kidney problems after a heart transplant. The long-term goal of this research is to identify genetic variations that may help predict the development of kidney problems after heart transplantation ...
TY - JOUR. T1 - Inferior Outcomes on the Waiting List in Low-Volume Pediatric Heart Transplant Centers. AU - Rana, A.. AU - Fraser, C. D.. AU - Scully, B. B.. AU - Heinle, J. S.. AU - McKenzie, E. D.. AU - Dreyer, W. J.. AU - Kueht, Michael. AU - Liu, H.. AU - Brewer, E. D.. AU - Rosengart, T. K.. AU - OMahony, C. A.. AU - Goss, J. A.. PY - 2017/6/1. Y1 - 2017/6/1. N2 - Low case volume has been associated with poor outcomes in a wide spectrum of procedures. Our objective was to study the association of low case volume and worse outcomes in pediatric heart transplant centers, taking the novel approach of including waitlist outcomes in the analysis. We studied a cohort of 6482 candidates listed in the Organ Procurement and Transplantation Network for pediatric heart transplantation between 2002 and 2014; 4665 (72%) of the candidates underwent transplantation. Candidates were divided into groups according to the average annual transplantation volume of the listing center during the study period: ...
TY - JOUR. T1 - The effect of donor specific transfusions and dietary fatty acids on rat cardiac allograft survival. AU - Perez, Richard V. AU - Waymack, J. Paul. AU - Munda, Rino. AU - Alexander, J. Wesley. PY - 1987. Y1 - 1987. N2 - A rat heterotopic cardiac transplant model was used to study the effect of dietary lipids on the immune response. Animals receiving linoleic acid (LA), oleic acid (OA), and fish oil (FO) enriched diets showed significant prolongation of allograft survival when compared to the control diet fed animals. When LA was given to animals who had received a single donor specific transfusion (DST) augmentation of the beneficial DST effect was observed, while the OA and FO fed groups showed no differences from control DST animals. Dietary regulation of the immune response, possibly through manipulation of arachidonic acid metabolism, is implied.. AB - A rat heterotopic cardiac transplant model was used to study the effect of dietary lipids on the immune response. Animals ...
Alternative wait list strategies for heart transplant recipients have not yet been popularized in Canada. This article from Columbia University explores the concept of matching ñhigh riskî recipients with marginal donor organs. Survival analysis revealed lower post-HTx survival in high risk recipients (82.2 versus 87.4 % at 1-yr; 59.8 versus 76.3 % at 5-yrs post-HTx; p=0.0005). In addition, a prognostic risk score (CARRS) derived from clinical factors stratified survival post-HTx into high risk (3+ points) versus low risk (0-2 points) patients. ...
Background: Coronary vasculopathy (CAV) is the leading cause of late morbidity and mortality in both adult and pediatric heart transplant (HTx) recipients. Virtual histology intravascular ultrasound (VH-IVUS) may add important information in the evaluation of CAV progression. Indeed, the presence of VH-IVUS derived "inflammatory plaques" has been found to be associated with higher progression of CAV in adult patient recipients. The aim of this prospective study was to investigate tissue characterization of CAV by VH-IVUS in a pediatric cohort.. Methods: 40 patients (mean age: 17,1 ± 6,7 yrs, male= 23) underwent VH-IVUS analysis of the left anterior descending coronary artery 8.1± 4.6 years after HTx. Based on age, patients were divided in two groups (group A , 18 yrs; group B: ≥ 18 yrs; time from HTx: group A: 6.6 ± 2.9 yrs vs group B: 10.3±4.9 yrs, p=.01). According to VH-IVUS analysis, coronary allograft lesions were divided into "inflammatory" (VHD-IP) (necrotic core and dense calcium ...
The purpose of this study is to see if the use of real time ultrasound of heart muscle perfusion is a usable and effective non-invasive way to detect Coronary Allograft Vasculopathy (heart transplant caused blood vessel disease) in child and adult heart transplant patients.. ...
This hospital was formerly the Willis F. Pierce Memorial Hospital. It has 2,200 beds and more than 400 staff members with senior (chief and deputy chief) professional titles. Over 65% of the staff holds masters or doctoral degrees. Its number of allogeneic heart transplants performed leads the nation. Its pediatric heart transplantation and heart re-transplantation fill a gap in this field in China. Its technology in liver transplantation heart re-transplantation and bilateral lung transplantation lead the nation.188. Since its Heart Surgery Department conducted the first orthotopic heart transplant in Fujian Province in 1995, it has successfully performed heart transplants for patients with advanced heart disease from more than 30 cities and regions of China. Its specialty ranks among the best in allogeneic heart transplantation, holds 16 "first in the country" titles, and serves as the base for heart transplantation in China.. It helped more than 40 large hospitals in large cities such as ...
TY - JOUR. T1 - Replacement of infected aortic prosthetic graft with aortic homograft after heart transplantation. T2 - 13-year follow-up. AU - Macedo, Francisco Igor B. AU - Salerno, Tomas. AU - Pham, Si M.. PY - 2013/5/1. Y1 - 2013/5/1. N2 - Acute ascending aortic dissection (AAAD) is a rare complication after orthotopic heart transplantation. We report a patient with AAAD after heart transplantation in whom repair was complicated by infection of the ascending aortic prosthetic graft. This was successfully managed by re-do replacement with two cryopreserved aortic homografts. Despite extensive calcification in the wall, the homografts show no aneurysm or dilation after 10 years.. AB - Acute ascending aortic dissection (AAAD) is a rare complication after orthotopic heart transplantation. We report a patient with AAAD after heart transplantation in whom repair was complicated by infection of the ascending aortic prosthetic graft. This was successfully managed by re-do replacement with two ...
TY - JOUR. T1 - Early primary graft failure after a pediatric heart transplant and successful rescue with plasmapheresis, immunoglobulins, and alemtuzumab. AU - Raj, Shashi. AU - Ruiz, Phillip. AU - Rusconi, Paolo. PY - 2017/1/1. Y1 - 2017/1/1. N2 - Early primary graft failure after pediatric orthotopic heart transplantation (OHT) has a high mortality rate and can occur due to several causes including but not limited to prolonged graft ischemia time, suboptimal preimplant myocardial preservation, hyperacute rejection, and maladaptation of the graft to the hosts hemodynamic status. Mechanical circulatory support with either extracorporeal membrane oxygenation (ECMO) or ventricular assist device has been used for the rescue of primary graft failure in pediatric patients after heart transplant. Cardiac arrest before ECMO initiation in these patients is associated with adverse neurologic outcome although those surviving to hospital discharge generally have excellent long-term outcome. We report a ...
Background-The effect of donor-recipient human leukocyte antigen (HLA) matching on outcomes remains relatively unexplored in pediatric patients. The objective of this study was to investigate the effects of donor-recipient HLA matching on graft survival in pediatric heart transplantation. Methods and Results-The UNOS database was queried for heart transplants occurring between October 31, 1987 to December 31, 2012 in a recipient aged ≤ 17 with at least one postoperative follow-up visit. Retransplants were excluded. Transplants were divided into 3 donor-recipient matching groups: no HLA matches (HLA-no), 1 or 2 HLA matches (HLA-low), and 3-6 HLA matches (HLA-high). Primary outcome was graft loss. 4471 heart transplants met study inclusion criteria. High degree of donor-recipient HLA matching occurred infrequently; (HLA-high n=269 (6 %) v. HLA-low n=2683 (60%) v. HLA-no n=1495 (34%). There were no differences between HLA matching groups in frequency of coronary vasculopathy (p=0.19) or rejection ...
TY - JOUR. T1 - Sirolimus Therapy Is Associated with Elevation in Circulating PCSK9 Levels in Cardiac Transplant Patients. AU - Simha, Vinaya. AU - Qin, Sisi. AU - Shah, Pankaj. AU - Smith, Byron H.. AU - Kremers, Walter K. AU - Kushwaha, Sudhir. AU - Wang, Liewei M. AU - Pereira, Naveen Luke. PY - 2016/12/27. Y1 - 2016/12/27. N2 - Sirolimus used in transplantation is often associated with hypercholesterolemia. We measured serum lipid and PCSK9 levels in 51 heart transplant recipients who had their immunosuppressive therapy switched from calcineurin inhibitors to sirolimus. The switch resulted in a 23% increase in LDL cholesterol, and 46% increase in triglycerides and PCSK9 levels increased from 316 ± 105 ng/mL to 343 ± 107 ng/mL (p = 0.04), however the change in PCSK9 levels did not correlate with an increase in lipid levels (p = 0.2). To investigate the mechanism for the variability in the change in PCSK9 levels, lymphoblastoid cell lines were incubated with both sirolimus and everolimus, ...
TY - JOUR. T1 - Increased immunoreactive endothelin-1 in human transplant coronary artery disease. AU - Ravalli, Stefano. AU - Szabolcs, Matthias. AU - Albala, Arline. AU - Michler, Robert E.. AU - Cannon, Paul J.. PY - 1996/1/1. Y1 - 1996/1/1. N2 - Background: The pathogenesis of transplant coronary artery disease (TCAD) is unknown, but it is thought to derive from an interaction between immune and nonimmune factors, leading to smooth muscle cell proliferation and accumulation in the expanded neointima. Endothelin-1 (ET-1), a potent vasoconstrictor with mitogenic properties for vascular smooth muscle cells, has recently been demonstrated in native vessel atherosclerosis. The present study used immunohistochemistry to investigate the role of ET-1 in TCAD. Methods and Results: ET-1 immunoreactivity and cellular localization were assessed in human coronary arteries with TCAD (n=13) and in normal coronary arteries (n=10) with single- and double-label immunohistochemistry. The intensity of ...
Background Hypercholesterolemia is common after heart transplantation and is seen in 60-80% of all patients. HMGCo-A Reductase Inhibitor (Statin) therapy is effective in cholesterol lowering and has been associated with a significant survival benefit and reduction in transplant coronary artery disease (TCAD) following heart transplantation. TCAD is seen in approximately half of heart transplant patients within 5 years and is the major limiting factor in long-term survival. In the general population hypercholesterolemia is associated with increase incident of cardiovascular mortality. It is not known if hypercholesterolemia refractory to statin therapy also has poor outcome in heart transplant recipients. ...
Pediatric Heart Transplants Stephanie Wood ITT Technical Institute Breckinridge School of Nursing Professor M. Siddique GS1145 Pediatric Heart Transplants
Heart transplantation offers a means to improve longevity and quality of life in patients with end stage heart failure. Although survival following cardiac transplantation improved significantly following the advent of calcineurin inhibitors, the development of vascular disease within the arterial system of the grafted heart, known as cardiac allograft vasculopathy, is a major cause of morbidity and mortality (1,2). Graft vasculopathy, defined by an angiographically determined stenosis ,50% in an epicardial coronary artery, is present in 40% to 50% of patients by 5 years post-transplant and is the leading cause of death in recipients who survive past the first year (3,4). Unfortunately, ischemic symptoms in cardiac transplant patients are often nonspecific, and a common presentation of cardiac allograft vasculopathy is that of sudden cardiac death. Indeed, far too often, transplant cardiologists receive the most dreaded of phone calls from a bereaved spouse, child, or parent reporting the sudden ...
Raj govt hospital makes history by successful heart transplant: SMS Hospital in Jaipur became the first government hospital of the state to undertake a successful heart transplantation. . Get all latest entertainment & viral stories on english.lokmat.com
BACKGROUND--Failure of the donor (graft) heart is the main cause of mortality in the first month after orthotopic cardiac transplantation. In a preliminary study marked downregulation of cardiac beta adrenoceptor density was found in apparently normal donor hearts of recipients who developed severe cardiac failure soon after implantation. Cardiac beta adrenoceptors are an important factor in the development of cardiac failure in the human heart. The aim of this study therefore was to determine whether fatal graft failure in the first month after transplantation is associated with downregulation of beta adrenoceptor density in the donor heart. PATIENTS AND METHODS--Right ventricular endomyocardial biopsy specimens were taken from consecutive adult donor patients immediately before implantation. A previously described radioligand binding method was used to determine beta adrenoceptor density in consecutive patients who developed fatal graft failure and died within 1 month of transplantation and in ...
Enzyme immunoassay is used to probe serum and plasma levels of tumor-necrosis factor-alpha (TNFα) in human heart transplant patients during the first few months post-transplantation. Detectability of TNFα was increased by heat-pretreatment of serum (56°C for 30 minutes), in order to inactivate inhibitors of the immunoassay present in the sera. In EDTA-treated plasma samples such treatment was not necessary, thus suggesting the possible involvement of complement in such inhibition. Compared with samples from control (healthy) volunteers, transplant patients frequently displayed elevated levels of TNFα, especially in the first few weeks post-transplantation. However, increased cytokine levels did not correlate with histologically (biopsy)-determined rejection episodes. We were unable to detect interleukin-6 (IL-6) in plasma samples of heart transplant patients.
Outcomes of cardiac transplantation have been improved with immunosuppressive therapies that effectively reduce the risk of rejection and with prophylaxis against opportunistic infections. With the current management leading to decreased likelihood of hyperacute and acute rejections, efforts have been focused on improving long-term survival by targeting post-transplant complications associated with chronic rejection. Cardiac allograft vasculopathy (CAV) has been 1 of the main causes of mortality for heart transplant recipients (1). The CAV progression has been traditionally managed with mechanistic target of rapamycin inhibitors, such as sirolimus and everolimus. Though mechanistic target of rapamycin inhibitors have been successful in ameliorating or preventing CAV, they frequently cause many significant side effects, like pancytopenia, wound healing issues, renal dysfunction and hyperlipidemia (2). This has limited their widespread use. Statins have been demonstrated to reduce the incidence of ...
Introduction: Long-term survival after heart transplantation (HTx) is hampered by cardiac allograft vasculopathy (CAV). Better understanding of the pathophysiological mechanisms of CAV might have considerable consequences for therapeutic approaches in the future. The aim of the present study was to investigate the histological phenotypes of CAV in relation with clinical ... read more patient characteristics. Methods and results: Coronary cross-sections from 51 HTx patients were obtained at autopsy. CAV was observed in 42 patients (82%). Three histological CAV phenotypes were identified (H-CAV 1-3). No CAV (H-CAV 0) is as seen in normal coronary arteries; intimal thickening consisting of a layer of longitudinal oriented smooth muscle cells. In H-CAV 1 to 3 a second intimal layer is formed, on top of the longitudinal oriented smooth muscle cell layer, with predominantly mononuclear inflammatory infiltrate in loose connective tissue (H-CAV 1), smooth muscle cells in different orientation (H-CAV 2), ...
Although cardiac denervation occurs immediately after HTx, cardiac reinnervation is a variable phenomenon and is still considered as a controversial issue in the field of cardiac transplantation. Yet, there is ample evidence in literature supporting the idea of cardiac reinnervation, which has been shown to occur in 40% to 70% of recipients late after HTx.40, 41, 42, 43, 44 Sensory reinnervation may occur following HTx as well.45 Sympathetic reinnervation requires the presence of functional nerve terminals occurring outside the heart that are connected to nerve terminals in the transplanted heart.3, 8, 9 Restored presynaptic nerve terminals in HTx recipients were correlated with the reestablishment of interactions between pre‐ and postsynaptic adrenergic components of the synapse.4 Studies using microscopy show sympathetic nerves growing along the coronary blood vessels and the anastomoses between the donor heart and the recipient portions of the myocardium.2 Cardiac reinnervation after HTx ...
TY - JOUR. T1 - Cilostazol is useful for the treatment of sinus bradycardia and associated hemodynamic deterioration following heart transplantation. AU - Uchikawa, Tomoki. AU - Fujino, Takeo. AU - Higo, Taiki. AU - Ohtani, Kisho. AU - Shiose, Akira. AU - Tsutsui, Hiroyuki. PY - 2019/1/1. Y1 - 2019/1/1. N2 - Bradycardia is a common complication at the early postoperative period after heart transplantation (HT). The heart rate (HR) usually recovers within a few weeks; however, several patients need a temporary pacemaker or chronotropic agents to stabilize their hemodynamics. Here, we report the first case of transient bradycardia associated with hemodynamic deterioration following HT, which was successfully treated with cilostazol, a phosphodiesterase-3-inhibiting agent. A 59-year-old man received HT for advanced heart failure due to ischemic cardiomyopathy. General fatigue persisted even after the HT. His HR was around 60 beats per minute (bpm) with sinus rhythm. Echocardiography showed no ...
TY - JOUR. T1 - The Influence of Gender on Survival After Heart Transplantation. AU - Tsao, C. I.. AU - Chen, R. J.. AU - Chou, N. K.. AU - Ko, W. J.. AU - Chi, N. H.. AU - Yu, H. Y.. AU - Chen, Y. S.. AU - Chen, S. C.. AU - Wang, S. S.. PY - 2008/10/1. Y1 - 2008/10/1. N2 - Because of a shortage of deceased donors, more than one-third of patients die during the waiting period for transplantation. This study was conducted to analyze the influence of gender on survival after heart transplantation. We retrospectively reviewed the recipients after primary orthotopic heart transplantation. According to gender, patients were divided into four groups: male donor to male recipient, male donor to female recipient, female donor to male recipient, and female donor to female recipient. Kaplan-Meier survival curves were plotted with log-rank tests. Cox regression analysis with dummy variables were used to examine the effects of donor gender, recipient gender, and donor-recipient gender combinations on ...
Transthoracic echocardiography is a primary non-invasive modality for investigation of heart transplant recipients. It is a versatile tool which provides comprehensive information about cardiac structure and function. Echocardiographic examinations can be easily performed at the bedside and serially repeated without any patients discomfort. This review highlights the usefulness of Doppler echocardiography in the assessment of left ventricular and right ventricular systolic and diastolic function, of left ventricular mass, valvular heart disease, pulmonary arterial hypertension and pericardial effusion in heart transplant recipients. The main experiences performed by either standard Doppler echocardiography and new high-tech ultrasound technologies are summarised, pointing out advantages and limitations of the described techniques in diagnosing acute allograft rejection and cardiac graft vasculopathy. Despite the sustained efforts of echocardiographic technique in predicting the biopsy state,
Kevin is a pediatric cardiologist at Boston Children s Hospital specializing in Pediatric Heart Failure & Transplantation. He is an Assistant Professor of Pediatrics at Harvard Medical School. Kevin is the co-chair of the AST Trainee & Young Faculty Community of Practice and a member of the UNOS Region 1 Heart Review Board. Kevin is currently a Trial Co-Chair for the recently funded TEAMMATE trial which will be the first randomized controlled trial of maintenance immunosuppression in pediatric heart transplantation. The trial will use a validated a composite clinical endpoint to study the effects of a regimen including everolimus/low-dose tacrolimus with tacrolimus/mycophenolate mofetil. In addition to clinical trials, Kevin s research has focused on the development of biomarkers for cardiac allograft vasculopathy (CAV). He has demonstrated that VEGF-A can be used to stratify risk for development CAV in children after heart transplantation. Kevin has been highly involved in the development of ...
OSLO, NORWAY. Most heart transplant patients (60-100%) develop hypertension within six months following their surgery. It is believed that the increase in blood pressure is caused by the anti-rejection drug cyclosporine. Medical doctors at the University of Oslo now report that supplementation with fish oils will prevent the development of hypertension. Their clinical trial involved 28 heart transplant patients who, 4 days after surgery, were randomized to receive either 4 grams of fish oil (providing 1.9 g of eicosapentaenoic acid [EPA] and 1.5 g of docosahexaenoic acid [DHA] as well as 14.8 mg of vitamin E) or 4 grams of corn oil with vitamin E once a day for 6 months. The patients blood pressure (24-hour readings) were measured 12 days, 1 month, 2 months, 3 months, and 6 months after surgery. Blood samples were also taken for analysis of EPA and DHA content.. The researchers found that the average (mean) systolic blood pressure in the placebo group had increased by 17 mm Hg at the end of the ...
TY - JOUR. T1 - Ischemia-induced interleukin-8 release after human heart transplantation. T2 - A potential role for endothelial cells. AU - Oz, M. C.. AU - Liao, H.. AU - Naka, Y.. AU - Seldomridge, A.. AU - Becker, D. N.. AU - Michler, Robert E.. AU - Smith, C. R.. AU - Rose, E. A.. AU - Stern, D. M.. AU - Pinsky, D. J.. PY - 1995. Y1 - 1995. N2 - Background: Interleukin-8 (IL-8) secreted from endothelial cells is a powerful neutrophil chemoattractant and activator. We hypothesized that human endothelial cells deprived of oxygen would secrete IL-8, which might translate into elevated IL-8 production after cardiac ischemia. Furthermore, we hypothesized that coronary sinus (CS) IL-8 levels would be particularly high after cardiac preservation for transplantation, due to extended ischemic times. Methods and Results: Human saphenous vein endothelial cells exposed to a hypoxic environment (PO2 ,20 mm Hg) demonstrated a time-dependent release of IL-8 (measured by ELISA) into the culture supernatant ...
1. To determine whether activation of the left ventricular C-fibre mechanoreceptors initiates the vasodepressor reflex that often causes syncope, we exposed six orthotopic cardiac transplant patients and six matched, healthy control subjects to progressively increasing lower body negative pressure until the onset of vasodepressor responses.. 2. There was no significant difference (P = 0.78) between the central hypovolemia tolerances of the cardiac transplant and the control groups.. 3. The decrease in systolic blood pressure before the onset of vasodepressor reflexes was greater in the cardiac transplant group. The cardiac transplant group did not maintain diastolic blood pressure during central hypovolaemia. From baseline to the onset of vasodepression, there were no differences in leg circumference, forearm blood flow and forearm vascular resistance responses between the two groups.. 4. We conclude that the left ventricular mechanoreceptors may not be the primary afferent trigger for ...
The pediatric heart transplantation Chap. 17 deals with indications, preparations, and preoperative management of recipient and donor while addressing the medical treatment of children undergoing...
Purpose: Plasmapheresis in combination with immunoglobulin and rituximab is often used to induce accommodation in ABO-incompatible (ABOi) living-donor transplantation; however, this regimen cannot be applied to cases of ABOi deceased-donor transplantation. Here, we investigated whether an anti-complement component 5 (C5) antibody-based regimen can induce accommodation in ABOi heart transplantation.. *Methods: Sensitization using human blood type A antigen, induced both IgM and IgG anti-A antibodies in wild-type mice. Heterotrophic ABOi heart transplantation was performed from human blood type A-transgenic C57BL/6J mice to sensitized syngeneic wild-type C57BL/6J or allogeneic DBA/2 mice.. *Results: Both anti-C5 antibody and triple immunosuppressants (corticosteroid, tacrolimus, mycophenolate mofetil) suppressed antibody-mediated rejection, immune cell infiltration, and deposition of IgG and C4d in ABOi heart syngrafts. Allogeneic ABOi heart transplantation induced ABMR to greater degree than ...
Heart transplantation is the final treatment option in heart failure, and transplant patients have substantially increased survival rates and quality of life.27 The first human-to-human heart transplantation was performed in South Africa in 1967, and by the end of 1968 102 patients had received transplants at 52 institutions.1 However, the results were disappointing, with a 60% early death rate and a mean survival of only 29 days.28 In a large study in 2000, when the duration of cold ischaemia was 6 h, graft survival at 3 years after surgery was nearly 25% less than that when the cold ischaemia period was ,2 h.29. Use of organs from marginal donors has resulted in decreased graft function and survival compared with the use of organs from younger donors.30 It is currently difficult to obtain donor hearts. In addition, long-term outcomes for transplanted hearts are limited by the development of cardiac allograft vasculopathy resulting from immunological and non-immunological risk factors ...
Allograft rejection and infection are the major sources of morbidity and mortality after heart transplant. Early differential diagnosis is clinically crucial but difficult. The aim of the study was to examine serum cytokine profiles associated with each entity and whether such profiles could help to differentiate between them. Heart allografts from Wistar rats were transplanted to Lewis rats as described by Yokoyama. Cardiac rejection and pulmonary bacterial infection were induced by Cyclosporine cessation and bacteria bronchus injection, and pathologically confirmed. Ninety serological cytokines profiles of the study objects were then simultaneously measured using a biotin label-based cytokine array. The fold change (FC) was used for relative cytokine concentration comparison analysis. Four cytokines in cardiac rejection group were significantly dysregulated as compared to health controls (β -Catenin, 0.51 FC; E-Selectin, 0.62 FC; IFN-gamma, 1.87 FC; and IL-13, 0.60 FC, respectively). In pulmonary
BACKGROUND: In heart transplantation, acute renal failure is not uncommon immediately after heart transplantation. It may be due to pre-existing disease or due to the bypass pump run and/or to the initiation of calcineurin inhibitor therapy. Many patients have temporary hemodialysis and gradually recover normal kidney function. Yet others have chronic kidney failure and require hemodialysis indefinitely. It has not been well established as to the outcomes of these patients after heart transplant.. METHODS: Between 1994 and 2011, we evaluated 52 heart transplant patients who were in need of kidney dialysis in the first 30 days after transplant and after 1 year post-transplant. Patients were divided into those who needed temporary kidney dialysis (resolved prior to 6 months post-transplant) and those with persistent hemodialysis (greater than 6 months post transplant) and those who never required kidney hemodialysis (control group). Outcomes included 5 year survival, development of CAV.. RESULTS: ...
Data from 64 children were evaluated; the mean age was 7 years (SD: 6). Cardiomyopathy was the most common cause of heart failure (n = 55; 86%). There was (as yet) no indication for heart transplantation in 19 children (30%); there was an indication for heart transplantation in 45 children. Mechanical support by extracorporeal membrane oxygenation or a ventricular assist device was used in 7 patients. 26 children of the 45 children with an indication for transplantation were put on the waiting list and 13 of these underwent a successful heart transplant at a mean age of 9 years (SD: 5) after a mean waiting time of 9 weeks (SD: 8), 12 within the Rotterdam centre and 1 abroad. 1 patient died within 1 year due to rejection and infections, the other 12 were in good physical condition at the last check-up, on average 4 years (SD: 2) after the transplant. Among the children on the waiting list, 8 died after an average of 22 weeks (SD: 23), 1 was removed from the list because of clinical improvement, ...
Posttransplant diabetes mellitus (PTDM) is a well-recognized complication of heart transplantation and is associated with increased morbidity and mortality. Previous studies have yielded wide ranging estimates in the incidence of PTDM due in part to variable definitions applied. In addition, there is a limited published data on the management of PTDM after heart transplantation and a paucity of studies examining the effects of newer classes of hypoglycaemic drug therapies. In this review, we discuss the role of established glucose-lowering therapies and the rationale and emerging clinical evidence that supports the role of incretin-based therapies (glucagon like peptide- (GLP-) 1 agonists and dipeptidyl peptidase- (DPP-) 4 inhibitors) and sodium-glucose cotransporter 2 (SGLT2) inhibitors in the management of PTDM after heart transplantation. Recently published Consensus Guidelines for the diagnosis of PTDM will hopefully lead to more consistent approaches to the diagnosis of PTDM and provide a ...
Background: although symptoms of heart failure abate after heart transplantation, other new symptoms caused by the surgery, immunosuppressant drugs, and complications can be new sources of symptom distress for patients after operation. Methods: This two-site national Institutes of Health study compared symptom distress in 173 adult heart transplant recipients from before operation to 3 months after operation. The Heart Transplant symptom scale was used to measure 92 symptoms related to heart disease and heart failure, transplantation, medication side effects, and complications commonly found in this population. Analysis was via paired t tests with Bonferroni correction. Most patients (93%) were receiving a triple immunosuppressant regimen of cyclosporine, azathioprine, and prednisone. Results: Total symptom distress decreased significantly (p = 0.013) from before operation to 3 months after heart transplantation. The 23 symptoms that decreased the most (p = 0.000) after operation accounted for a ...
The evaluation of right and left ventricular morphology by CMR with comparison to recipient heart after heart transplant: a surgical perspective. Farber, Nicholas; Doyle, Mark; Williams, Ronald B.; Murali, Srinivas; Olson, Peter; Yamrozik, June A.; Biederman, Robert W. W. // Journal of Cardiovascular Magnetic Resonance (BioMed Central);2011 Supplement 1, Vol. 13 Issue Suppl 1, p1 An abstract of the paper "The Evaluation of Right and Left Ventricular Morphology by CMR With Comparison to Recipient Heart After Heart Transplant: A Surgical Perspective," by Nicholas Farber and colleagues is presented. ...