Review of the current state of thoracic transplantation: a national prospective cohort study. UK Cardiothoracic Transplant Audit Steering Group

Human neutrophil peptide in lung chronic allograft dysfunction

CONTEXT

Our previous case-control study identified human neutrophil peptide (HNP) as a potential biomarker for bronchiolitis obliterans syndrome (BOS) in lung transplant recipients.

OBJECTIVE

To prospectively validate HNP as a biomarker for BOS.

MATERIALS AND METHODS

HNP was measured by ELISA in bronchoalveolar lavage (BAL) fluid in lung transplant recipients.

RESULTS

The first HNP measurement after reaching baseline pulmonary function was predictive of developing BOS ≥2 (p = 0.0419). HNP remained elevated in those that developed BOS. The effect of potential confounders did not significantly impact BOS-free survival time.

CONCLUSION

HNP levels are elevated early and persistently in those that develop BOS.

Effect of receiving a heart transplant: analysis of a national cohort entered on to a waiting list, stratified by heart failure severity. Comparative Outcome and Clinical Profiles in Transplantation (COCPIT) Study Group

OBJECTIVE

To determine whether there is a survival benefit associated with cardiac transplantation in Germany.

DESIGN

Prospective observational cohort study.

SETTING

All 889 adult patients listed for a first heart transplant in Germany in 1997.

MAIN OUTCOME MEASURE

Mortality, stratified by heart failure severity.

RESULTS

Within 1 year after listing, patients with a predicted high risk had the highest global death rate (51% v 32% and 29% for medium and low risk patients respectively; P<0.0001), had the highest risk of dying on the waiting list (32% v 20% and 20%; P=0.0003), and were more likely to receive a transplant (48% v 45% and 41%; P=0.01). Differences between the risk groups in outcome after transplantation did not reach significance (P=0.2). Transplantation was not associated with a reduction in mortality risk for the total cohort, but it did provide a survival benefit for the high risk group.

CONCLUSION

Cardiac transplantation in Germany is currently associated with a survival benefit only in patients with a predicted high risk of dying on the waiting list. Patients with a predicted low or medium risk have no reduction in mortality risk associated with transplantation; they should be managed with organ saving approaches rather than transplantation.

Orthotopic heart transplantation with concurrent aortic valve replacement and coronary artery bypass grafting

We report a case of successful orthotopic heart transplantation of a donor heart with normal ventricular function, 2-vessel coronary artery disease, and a bicuspid aortic valve, which required concurrent aortic valve replacement and coronary artery bypass grafting. In confronting the disparities in demand and supply, we must consider the so-called marginally acceptable heart for either critically ill recipients or those who may be disadvantaged on the waiting list.