Impact of Traumatically Brain-Injured Donors on Outcomes After Heart Transplantation

Rehabilitation effect of rTMS combined with cognitive training on cognitive impairment after traumatic brain injury

OBJECTIVE

To innvestigate the rehabilitation effects of repetitive transcranial magnetic stimulation (rTMS) combined with cognitive training on cognitive impairment in patients with traumatic brain injury (TBI) by using multimodal magnetic resonance imaging.

METHODS

Clinical data of 166 patients with cognitive impairment after TBI were retrospectively analyzed. The patients were assigned into an observation group and a control group according to different treatment methods, with 83 cases in each group. The observation group was given rTMS + cognitive training, and the control group was given cognitive training only. The changes in GCS score, the Cho/Cr, Cho/NAA and NAA/Cr ratios examined by MRSI, the score of cognitive impairment, the grading of cognitive impairment, and the changes in modified Barthel index were observed and compared between the two groups.

RESULTS

The GCS score, and the ratios of Cho/Cr, Cho/NAA and NAA/Cr after treatment were better than those before treatment in both groups and were lower in the observation group compared with the control group (all P<0.05). The score and grading of cognitive impairment as well as modified Barthel index after treatment were all significantly better in the observation group than in the control group (all P<0.05).

CONCLUSION

rTMS can improve the rehabilitation effect on cognitive impairment in patients after TBI and is recommended for clinical use.

Twenty-year survival following orthotopic heart transplantation in the United States

BACKGROUND

This study evaluated 20-year survival after adult orthotopic heart transplantation (OHT).

METHODS

The United Network of Organ Sharing Registry database was queried to study adult OHT recipients between 1987 and 1998 with over 20-year posttransplant follow-up. The primary and secondary outcomes were 20-year survival and cause of death after OHT, respectively. Multivariable logistic regression was used to identify significant independent predictors of long-term survival, and long-term survival was compared among cohorts stratified by number of predictors using Kaplan Meier survival analysis.

RESULTS

20,658 patients undergoing OHT were included, with a median follow-up of 9.0 (IQR, 3.2-15.4) years. Kaplan-Meier estimates of 10-, 15-, and 20-year survival were 50.2%, 30.1%, and 17.2%, respectively. Median survival was 10.1 (IQR, 3.9-16.9) years. Increasing recipient age (>65 years), increasing donor age (>40 years), increasing recipient body mass index (>30), black race, ischemic cardiomyopathy, and longer cold ischemic time (>4 h) were adversely associated with a 20-year survival. Of these 6 negative predictors, presence of 0 risk factors had the greatest 10-year (59.7%) and 20-year survival (26.2%), with decreasing survival with additional negative predictors. The most common cause of death in 20-year survivors was renal, liver, and/or multisystem organ failure whereas graft failure more greatly impacted earlier mortality.

CONCLUSIONS

This study identifies six negative preoperative predictors of 20-year survival with 20-year survival rates exceeding 25% in the absence of these factors. These data highlight the potential for very long-term survival after OHT in patients with end-stage heart failure and may be useful for patient selection and prognostication.

Predictors and outcomes of heart transplantation utilizing donors with different brain death mode: A propensity-score matching study from China

BACKGROUND

Heart transplantation (HTx) of brain-dead donors in China has not been reported, not to mention analysis of donors with different brain death mechanisms. The present study aimed to compare clinical outcomes between HTx of traumatically brain-injured (TBI) and non-TBI donors, as well as to establish a risk-prediction model of mortality.

METHODS

All patients undergoing HTx at our institute between January 1st, 2015 and December 31st, 2018 were dichotomized according to cause of donor death, and outcomes between the two groups were compared based on propensity score matching (PSM). The primary endpoint was all-cause mortality. Secondary endpoints included cardiac allograft vasculopathy and other postoperative complications.

RESULTS

342 eligible HTx recipients were included. TBI grafts accounted for 62.87% (215/342). 121 pairs of candidates were generated from PSM. Actuarial and risk-adjusted survival were similar between TBI and non-TBI groups. Risk factors associated with all-cause mortality included recipient age > 60y (HR = 2.781, p = .002), history of cardiac surgery (HR = 2.186, p = .032), chronic kidney disease (HR = 2.948, p = .033) and smoking (HR = 0.465, p = .041), as well as donor age > 45y (HR = 2.701, p = .003) and BMI > 25 kg/m² (HR = 2.025, p = .045). The risk-prediction model was established successfully based on specific preoperative variables and high-risk group with a score>10 had nearly fourfold increase in mortality (HR = 3.726, p < 0.001) compared to the low-risk group.

CONCLUSIONS

In this largest single-center cohort from China, we found similar survival and rates of complications between HTx recipients with TBI and non-TBI donors. The risk-prediction model may help to identify high-risked recipients and donors and optimize organ-sharing.