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Kampaktsis PN, Doulamis IP, Asleh R, Makri E, Kalamaras I, Papastergiopoulos C, Emfietzoglou M, Drosou A, Alnsasra H, Duque ER, Briasoulis A. Characteristics, Predictors, and Outcomes of Early mTOR Inhibitor Use After Heart Transplantation: Insights From the UNOS Database. J Am Heart Assoc 2022; 11:e025507. [PMID: 36000418 PMCID: PMC9496402 DOI: 10.1161/jaha.122.025507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background The clinical characteristics of mTOR (mammalian target of rapamycin) inhibitors use in heart transplant recipients and their outcomes have not been well described. Methods and Results We compared patients who received mTOR inhibitors within the first 2 years after heart transplantation to patients who did not by inquiring the United Network for Organ Sharing (UNOS) database between 2010 and 2018. The primary end point was all‐cause mortality with retransplantation as a competing event. Rejection, malignancy, hospitalization for infection, and renal transplantation were secondary end points. There were 1619 (9%) and 15 686 (81%) mTOR inhibitors+ and mTOR inhibitors− patients, respectively. Body mass index, induction, cardiac allograft vasculopathy, calculated panel reactive antibody, and fewer days in 1A status were independently associated with mTOR inhibitors+ status. Over a follow‐up of 10.4 years, there was no difference in all‐cause mortality after adjusting for donor and recipient characteristics (adjusted subdistribution hazard ratio, 1.03 [0.90–1.19]; P=0.66). mTOR inhibitors+ were independently associated with increased risk for rejection (odds ratio [OR], 1.43 [1.11–1.83]; P=0.005) and basal skin cancer (OR, 1.35 [1.19–1.51]; P=0.012) but not for infection or renal transplantation. Conclusions mTOR inhibitors are used in <10% patients in the first 2 years after heart transplantation and are noninferior to contemporary immunosuppression regimens in terms of all‐cause mortality, infection, malignancy, or renal transplantation. They are associated with risk for rejection.
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Affiliation(s)
| | - Ilias P Doulamis
- Department of Surgery The Johns Hopkins Hospital and School of Medicine Baltimore MD
| | | | - Elpiniki Makri
- Centre for Research & Technology Hellas Information Technologies Institute (CERTH-ITI) Thessaloniki Greece
| | - Ilias Kalamaras
- Centre for Research & Technology Hellas Information Technologies Institute (CERTH-ITI) Thessaloniki Greece
| | | | - Maria Emfietzoglou
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine University of Oxford Oxford UK
| | - Anastasis Drosou
- Centre for Research & Technology Hellas Information Technologies Institute (CERTH-ITI) Thessaloniki Greece
| | - Hilmi Alnsasra
- Cardiovascular Medicine Department Mayo Clinic Rochester Rochester MN USA
| | - Ernesto Ruiz Duque
- Division of Cardiovascular Diseases University of Iowa Hospitals and Clinics Iowa City IA USA
| | - Alexandros Briasoulis
- Division of Cardiovascular Diseases University of Iowa Hospitals and Clinics Iowa City IA USA
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Du Y, Duan C, Yang Y, Yuan G, Zhou Y, Zhu X, Wei N, Hu Y. Heart Transplantation: A Bibliometric Review From 1990-2021. Curr Probl Cardiol 2022; 47:101176. [PMID: 35341797 DOI: 10.1016/j.cpcardiol.2022.101176] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND As the rapidly aging population and the rising incidence of end-stage heart failure (HF), extensive research has been conducted on heart transplantation (HTx). Bibliometrics harbors the function for describing the relationships of knowledge structures in different research fields and predicting the growth trend . METHODS The publications were searched and filtered based on the WOS core database. The target literature was visualized and analyzed by CiteSpace or VOSviewer . RESULTS In total, 19,998 published papers were obtained. There is a wave-like growth in HTx development. Most advanced research results are concentrated in a few developed countries, while the interactions with developing countries are still in infancy. The United States occupies a strong dominant position among active countries on HTx. Early research hotpots mostly focused on primary disease, survival risk factors, and complications. In recent years, the research frontiers have shifted steadily to clinical evaluation of immunosuppressants and diagnosis of acute rejection, cardiac re-injury with COVID-19, innovations in ventricular assist devices(VAD), and donation allocation strategies. The research directions of HTx are gradually shifting from observational studies to intervention research.
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Affiliation(s)
- Yihang Du
- Cardiovascular department, Guang'anmen Hospital, China Academy of Traditional Chinese Medicine Sciences, Beijing, China
| | - Chenglin Duan
- Cardiovascular department, Guang'anmen Hospital, China Academy of Traditional Chinese Medicine Sciences, Beijing, China; Beijing University of Chinese Medicine, Beijing, China
| | - Yihan Yang
- Cardiovascular department, Guang'anmen Hospital, China Academy of Traditional Chinese Medicine Sciences, Beijing, China; Beijing University of Chinese Medicine, Beijing, China
| | - Guozhen Yuan
- Cardiovascular department, Guang'anmen Hospital, China Academy of Traditional Chinese Medicine Sciences, Beijing, China
| | - Yan Zhou
- Cardiovascular department, Guang'anmen Hospital, China Academy of Traditional Chinese Medicine Sciences, Beijing, China; Beijing University of Chinese Medicine, Beijing, China
| | - Xueping Zhu
- Cardiovascular department, Guang'anmen Hospital, China Academy of Traditional Chinese Medicine Sciences, Beijing, China
| | - Namin Wei
- Beijing University of Chinese Medicine, Beijing, China
| | - Yuanhui Hu
- Cardiovascular department, Guang'anmen Hospital, China Academy of Traditional Chinese Medicine Sciences, Beijing, China.
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Abstract
Mechanistic target of rapamycin (mTOR) inhibitors are macrocyclic lactone antibiotics derived from Streptomyces hygroscopicus that prevent T lymphocyte activation and B cell differentiation. Unlike calcineurin inhibitors (CNIs) that inhibit cytokine production, mTOR inhibitors block the cytokine signal transduction to arrest cells in the G1 to S phase. This class of drugs is commonly used for post-transplantation and cancer management because of its immunosuppressive and antiproliferative properties, respectively. The potential uses of mTOR inhibitors are heavily explored because of their impact on cell growth and proliferation. However, mTOR inhibitors have a broad range of effects that can result in adverse reactions, but side effects can occur with other immunosuppressive agents as well. Thus, the performance of mTOR inhibitors is compared to the outcomes and adverse effects of other immunosuppressive drugs or the combination of other immunosuppressants and mTOR inhibitors. Because mTOR regulates many downstream pathways, mTOR inhibitors can affect these pathways to manage various diseases. Sirolimus (rapamycin) is approved by the Food and Drug Administration (FDA) to treat post-renal transplantation and lymphangioleiomyomatosis (LAM). Everolimus is approved by the FDA to treat postmenopausal advanced hormone receptor-positive, HER2-negative breast cancer in women, progressive neuroendocrine tumors of pancreatic origin (PNET), advanced renal cell carcinoma (RCC), renal angiomyolipoma (AML) and tuberous sclerosis complex (TSC), and subependymal giant cell astrocytoma (SEGA) associated with TSC as well as renal and liver transplantation. Temsirolimus is approved by the FDA to treat advanced RCC. Opportunities to use mTOR inhibitors as therapy for other transplantation, metabolic disease, and cancer management are being researched. mTOR inhibitors are often called proliferation signal inhibitors (PSIs) because of their effects on proliferation pathways.
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Affiliation(s)
- Denise Wang
- Mount Sinai Icahn School of Medicine, New York, NY, USA.
| | - Howard J Eisen
- Pennsylvania State University College of Medicine/Milton S. Hershey Medical Center, Hershey, PA, USA
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Klaeske K, Lehmann S, Palitzsch R, Büttner P, Barten MJ, Jawad K, Eifert S, Saeed D, Borger MA, Dieterlen MT. Everolimus-Induced Immune Effects after Heart Transplantation: A Possible Tool for Clinicians to Monitor Patients at Risk for Transplant Rejection. Life (Basel) 2021; 11:life11121373. [PMID: 34947904 PMCID: PMC8703808 DOI: 10.3390/life11121373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Patients treated with an inhibitor of the mechanistic target of rapamycin (mTORI) in a calcineurin inhibitor (CNI)-free immunosuppressive regimen after heart transplantation (HTx) show a higher risk for transplant rejection. We developed an immunological monitoring tool that may improve the identification of mTORI-treated patients at risk for rejection. Methods: Circulating dendritic cells (DCs) and regulatory T cells (Tregs) were analysed in 19 mTORI- and 20 CNI-treated HTx patients by flow cytometry. Principal component and cluster analysis were used to identify patients at risk for transplant rejection. Results: The percentages of total Tregs (p = 0.02) and CD39+ Tregs (p = 0.05) were higher in mTORI-treated patients than in CNI-treated patients. The principal component analysis revealed that BDCA1+, BDCA2+ and BDCA4+ DCs as well as total Tregs could distinguish between non-rejecting and rejecting mTORI-treated patients. Most mTORI-treated rejectors showed higher levels of BDCA2+ and BDCA4+ plasmacytoid DCs and lower levels of BDCA1+ myeloid DCs and Tregs than mTORI non-rejectors. Conclusion: An mTORI-based immunosuppressive regimen induced a sufficient, tolerance-promoting reaction in Tregs, but an insufficient, adverse effect in DCs. On the basis of patient-specific immunological profiles, we established a flow cytometry-based monitoring tool that may be helpful in identifying patients at risk for rejection.
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Affiliation(s)
- Kristin Klaeske
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (K.K.); (S.L.); (R.P.); (K.J.); (S.E.); (D.S.); (M.A.B.)
| | - Sven Lehmann
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (K.K.); (S.L.); (R.P.); (K.J.); (S.E.); (D.S.); (M.A.B.)
| | - Robert Palitzsch
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (K.K.); (S.L.); (R.P.); (K.J.); (S.E.); (D.S.); (M.A.B.)
| | - Petra Büttner
- Heart Center Leipzig, Department of Internal Medicine and Cardiology, University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany;
| | - Markus J. Barten
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany;
| | - Khalil Jawad
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (K.K.); (S.L.); (R.P.); (K.J.); (S.E.); (D.S.); (M.A.B.)
| | - Sandra Eifert
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (K.K.); (S.L.); (R.P.); (K.J.); (S.E.); (D.S.); (M.A.B.)
| | - Diyar Saeed
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (K.K.); (S.L.); (R.P.); (K.J.); (S.E.); (D.S.); (M.A.B.)
| | - Michael A. Borger
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (K.K.); (S.L.); (R.P.); (K.J.); (S.E.); (D.S.); (M.A.B.)
| | - Maja-Theresa Dieterlen
- Heart Center, Department of Cardiac Surgery, HELIOS Clinic, University Hospital Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany; (K.K.); (S.L.); (R.P.); (K.J.); (S.E.); (D.S.); (M.A.B.)
- Correspondence: ; Tel.: +49-341-865-256144
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Legaz I, Bernardo MV, Alfaro R, Martínez-Banaclocha H, Galián JA, Jimenez-Coll V, Boix F, Mrowiec A, Salmeron D, Botella C, Parrado A, Moya-Quiles MR, Minguela A, Llorente S, de la Peña-Moral J, Muro M. PCR Array Technology in Biopsy Samples Identifies Up-Regulated mTOR Pathway Genes as Potential Rejection Biomarkers After Kidney Transplantation. Front Med (Lausanne) 2021; 8:547849. [PMID: 33681239 PMCID: PMC7927668 DOI: 10.3389/fmed.2021.547849] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 01/27/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Antibody-mediated rejection (AMR) is the major cause of kidney transplant rejection. The donor-specific human leukocyte antigen (HLA) antibody (DSA) response to a renal allograft is not fully understood yet. mTOR complex has been described in the accommodation or rejection of transplants and integrates responses from a wide variety of signals. The aim of this study was to analyze the expression of the mTOR pathway genes in a large cohort of kidney transplant patients to determine its possible influence on the transplant outcome. Methods: A total of 269 kidney transplant patients monitored for DSA were studied. The patients were divided into two groups, one with recipients that had transplant rejection (+DSA/+AMR) and a second group of recipients without rejection (+DSA/-AMR and -DSA/-AMR, controls). Total RNA was extracted from kidney biopsies and reverse transcribed to cDNA. Human mTOR-PCR array technology was used to determine the expression of 84 mTOR pathway genes. STRING and REVIGO software were used to simulate gene to gene interaction and to assign a molecular function. Results: The studied groups showed a different expression of the mTOR pathway related genes. Recipients that had transplant rejection showed an over-expressed transcript (≥5-fold) of AKT1S1, DDIT4, EIF4E, HRAS, IGF1, INS, IRS1, PIK3CD, PIK3CG, PRKAG3, PRKCB (>12-fold), PRKCG, RPS6KA2, TELO2, ULK1, and VEGFC, compared with patients that did not have rejection. AKT1S1 transcripts were more expressed in +DSA/-AMR biopsies compared with +DSA/+AMR. The main molecular functions of up-regulated gene products were phosphotransferase activity, insulin-like grown factor receptor and ribonucleoside phosphate binding. The group of patients with transplant rejection also showed an under-expressed transcript (≥5-fold) of VEGFA (>15-fold), RPS6, and RHOA compared with the group without rejection. The molecular function of down-regulated gene products such as protein kinase activity and carbohydrate derivative binding proteins was also analyzed. Conclusions: We have found a higher number of over-expressed mTOR pathway genes than under-expressed ones in biopsies from rejected kidney transplants (+DSA/+AMR) with respect to controls. In addition to this, the molecular function of both types of transcripts (over/under expressed) is different. Therefore, further studies are needed to determine if variations in gene expression profiles can act as predictors of graft loss, and a better understanding of the mechanisms of action of the involved proteins would be necessary.
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Affiliation(s)
- Isabel Legaz
- Department of Legal and Forensic Medicine, Faculty of Medicine, Biomedical Research Institute (IMIB), University of Murcia, Murcia, Spain
| | - María Victoria Bernardo
- Department of Immunology, University Clinical Hospital Virgen de la Arrixaca-Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Rafael Alfaro
- Department of Immunology, University Clinical Hospital Virgen de la Arrixaca-Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Helios Martínez-Banaclocha
- Department of Immunology, University Clinical Hospital Virgen de la Arrixaca-Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Jose Antonio Galián
- Department of Immunology, University Clinical Hospital Virgen de la Arrixaca-Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Victor Jimenez-Coll
- Department of Immunology, University Clinical Hospital Virgen de la Arrixaca-Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Francisco Boix
- Department of Immunology, University Clinical Hospital Virgen de la Arrixaca-Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Anna Mrowiec
- Department of Immunology, University Clinical Hospital Virgen de la Arrixaca-Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Diego Salmeron
- Departamento de Ciencias Sociosanitarias, Universidad de Murcia, Murcia, Spain
- Centro de Investigación Biomédica en Red (CIBER) Epidemiología y Salud Pública (CIBERESP), Murcia, Spain
- Instituto Murciano de Investigacion Biomédica-Arrixaca, Murcia, Spain
| | - Carmen Botella
- Department of Immunology, University Clinical Hospital Virgen de la Arrixaca-Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Antonio Parrado
- Department of Immunology, University Clinical Hospital Virgen de la Arrixaca-Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - María Rosa Moya-Quiles
- Department of Immunology, University Clinical Hospital Virgen de la Arrixaca-Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Alfredo Minguela
- Department of Immunology, University Clinical Hospital Virgen de la Arrixaca-Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Santiago Llorente
- Department of Nephrology, University Clinical Hospital Virgen de la Arrixaca-Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Jesús de la Peña-Moral
- Department of Pathology Services, University Clinical Hospital Virgen de la Arrixaca-Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Manuel Muro
- Department of Immunology, University Clinical Hospital Virgen de la Arrixaca-Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
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Eisen HJ. CAVEAT mTOR: You've heard about the benefits of using mTOR inhibitors, here are some of the risks. Am J Transplant 2021; 21:449-450. [PMID: 32715588 DOI: 10.1111/ajt.16225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 06/28/2020] [Accepted: 07/19/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Howard J Eisen
- Department of Medicine, Division of Cardiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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7
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Ye S, Liu H, Chen Y, Qiu F, Liang CL, Zhang Q, Huang H, Wang S, Zhang ZD, Lu W, Dai Z. A Novel Immunosuppressant, Luteolin, Modulates Alloimmunity and Suppresses Murine Allograft Rejection. THE JOURNAL OF IMMUNOLOGY 2019; 203:3436-3446. [PMID: 31732527 DOI: 10.4049/jimmunol.1900612] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023]
Abstract
An allograft is rejected in the absence of any immunosuppressive treatment because of vigorous alloimmunity and thus requires extensive immunosuppression for its survival. Although there are many conventional immunosuppressants for clinical use, it is necessary to seek alternatives to existing drugs, especially in case of transplant patients with complicated conditions. Luteolin, a natural ingredient, exists in many plants. It exhibits multiple biological and pharmacological effects, including anti-inflammatory properties. In particular, luteolin has been shown to upregulate CD4+CD25+ regulatory T cells (Tregs) in the context of airway inflammation. However, it remains unknown whether luteolin regulates alloimmune responses. In this study, we demonstrated that luteolin significantly prolonged murine skin allograft survival, ameliorated cellular infiltration, and downregulated proinflammatory cytokine gene expression in skin allografts. Furthermore, luteolin increased the percentage of CD4+Foxp3+ Tregs while reducing frequency of mature dendritic cells and CD44highCD62Llow effector CD4+/CD8+ T cells posttransplantation. It also suppressed the proliferation of T cells and their production of cytokines IFN-γ and IL-17A in vitro while increasing IL-10 level in the supernatant. Moreover, luteolin promoted CD4+Foxp3+ Treg generation from CD4+CD25- T cells in vitro. Depleting Tregs largely, although not totally, reversed luteolin-mediated extension of allograft survival. More importantly, luteolin inhibited AKT/mTOR signaling in T cells. Thus, for the first time, to our knowledge, we found that luteolin is an emerging immunosuppressant as an mTOR inhibitor in allotransplantation. This finding could be important for the suppression of human allograft rejection, although it remains to be determined whether luteolin has an advantage over other conventional immunosuppressants in suppression of allograft rejection.
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Affiliation(s)
- Shulin Ye
- Section of Immunology and Joint Immunology Program, Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong 510006, China
| | - Huazhen Liu
- Section of Immunology and Joint Immunology Program, Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong 510006, China
| | - Yuchao Chen
- Section of Immunology and Joint Immunology Program, Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong 510006, China
| | - Feifei Qiu
- Section of Immunology and Joint Immunology Program, Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong 510006, China
| | - Chun-Ling Liang
- Section of Immunology and Joint Immunology Program, Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong 510006, China
| | - Qunfang Zhang
- Section of Immunology and Joint Immunology Program, Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong 510006, China
| | - Haiding Huang
- Section of Immunology and Joint Immunology Program, Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong 510006, China
| | - Sumei Wang
- Section of Immunology and Joint Immunology Program, Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong 510006, China
| | - Zhong-De Zhang
- Section of Immunology and Joint Immunology Program, Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong 510006, China
| | - Weihui Lu
- Section of Immunology and Joint Immunology Program, Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong 510006, China
| | - Zhenhua Dai
- Section of Immunology and Joint Immunology Program, Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong 510006, China
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Eisen HJ. Left Ventricular Assist Devices (LVADS): History, Clinical Application and Complications. Korean Circ J 2019; 49:568-585. [PMID: 31243930 PMCID: PMC6597447 DOI: 10.4070/kcj.2019.0161] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/17/2022] Open
Abstract
Congestive heart failure is a major cause of morbidity and mortality as well as a major health care cost in the developed world. Despite the introduction of highly effective heart failure medical therapies and simple devices such as cardiac resynchronization therapy that reduce mortality, improve cardiac function and quality of life, there remains a large number of patients who do not respond to these therapies or whose heart failure progresses despite optimal therapy. For these patients, cardiac transplantation is an option but is limited by donor availability as well as co-morbidities which may limit survival post-transplant. For these patients, left ventricular assist devices (LVADs) offer an alternative that can improve survival as well as exercise tolerance and quality of life. These devices have continued to improve as technology has improved with substantially improved durability of the devices and fewer post-implant complications. Pump thrombosis, stroke, gastrointestinal bleeding and arrhythmias post-implant have become less common with the newest devices, making destination therapy where ventricular assist device are implanted permanently in patients with advanced heart failure, a reality and an appropriate option for many patients. This may offer an opportunity for long term survival in many patients. As the first of the totally implantable devices are introduced and go to clinical trials, LVADs may be introduced that may truly be alternatives to cardiac transplantation in selected patients. Post-implant right ventricular failure remains a significant complication and better ways to identify patients at risk as well as to manage this complication must be developed.
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Affiliation(s)
- Howard J Eisen
- Heart and Vascular Institute, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA.
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9
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Zieliński T. Mammalian target of rapamycin inhibitors in heart transplantation what we know and do not know? Int J Cardiol 2018; 265:79-80. [PMID: 29885703 DOI: 10.1016/j.ijcard.2018.04.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 04/30/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Tomasz Zieliński
- Department of Heart Failure and Transplantation, Institute of Cardiology, 04-628 Warszawa, Ul.Alpejska 42, Poland.
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