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Lynn J, Malik T, Montgomery A, Lang A, Shamapant N, Miggins J, Kamepalli S, Goss J, Rana A. Risk Index Predicts Pediatric Heart Allograft Non-Utilization. Pediatr Transplant 2024; 28:e14629. [PMID: 38317338 DOI: 10.1111/petr.14629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/27/2023] [Accepted: 10/10/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Children listed for heart transplantation face the highest waitlist mortality among all solid organ transplant patients (14%). Attempts at decreasing donor allograft non-utilization (41.5%) could potentially decrease waitlist mortality for pediatric heart transplant patients. Our aim was to quantify the non-utilization risk of pediatric donor heart allografts at the time of initial offering. METHODS Using the United Network of Organ Sharing (UNOS) database, we retrospectively analyzed 8823 deceased donors (≤18 years old) data through univariable and multivariable analysis and logistic regression models. These factors were divided into a training (n = 5882) and validation set (n = 2941). Donor clinical characteristics and laboratory values were used to predict non-utilization of donor hearts. The multivariable analysis used factors that were significant from the univariable analysis (p-value < .05), and the pediatric non-utilization risk index (pDRSI) included significant factors from the multivariable analysis, producing an overall risk score for non-utilization. With these data, we created a non-utilization risk index to predict likelihood of donor allograft non-utilization. RESULTS From the 24 potential factors that were identified from univariable analysis, 17 were significant predictors (p < .05) of pediatric heart non-utilization in the multivariable analysis. Low left ventricular ejection fraction (odds ratio (OR)-35.3), hepatitis C positive donor (OR-23.3), high left ventricular ejection fraction (OR-3.29), and hepatitis B positive donor (OR-3.27) were the most significant risk factors. The phDSRI has a C-statistic of 0.80 for the training set and 0.80 for the validation set. CONCLUSION Using over 8000 donors, the phDSRI uses 17 significant risk factors to predict risk of pediatric heart donor allograft non-utilization.
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Affiliation(s)
- Jake Lynn
- Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
| | - Tahir Malik
- Department of Internal Medicine, New York University, New York City, New York, USA
| | - Ashley Montgomery
- Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
| | - Anna Lang
- Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
| | - Nikhil Shamapant
- Department of Internal Medicine, University of Colorado, Denver, Colorado, USA
| | - John Miggins
- Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
| | - Spoorthi Kamepalli
- Department of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
| | - John Goss
- Division of Abdominal Transplant, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Abbas Rana
- Division of Abdominal Transplant, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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Olkowicz M, Ribeiro RVP, Yu F, Alvarez JS, Xin L, Yu M, Rosales R, Adamson MB, Bissoondath V, Smolenski RT, Billia F, Badiwala MV, Pawliszyn J. Dynamic Metabolic Changes During Prolonged Ex Situ Heart Perfusion Are Associated With Myocardial Functional Decline. Front Immunol 2022; 13:859506. [PMID: 35812438 PMCID: PMC9267769 DOI: 10.3389/fimmu.2022.859506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Ex situ heart perfusion (ESHP) was developed to preserve and evaluate donated hearts in a perfused beating state. However, myocardial function declines during ESHP, which limits the duration of perfusion and the potential to expand the donor pool. In this research, we combine a novel, minimally-invasive sampling approach with comparative global metabolite profiling to evaluate changes in the metabolomic patterns associated with declines in myocardial function during ESHP. Biocompatible solid-phase microextraction (SPME) microprobes serving as chemical biopsy were used to sample heart tissue and perfusate in a translational porcine ESHP model and a small cohort of clinical cases. In addition, six core-needle biopsies of the left ventricular wall were collected to compare the performance of our SPME sampling method against that of traditional tissue-collection. Our state-of-the-art metabolomics platform allowed us to identify a large number of significantly altered metabolites and lipid species that presented comparable profile of alterations to conventional biopsies. However, significant discrepancies in the pool of identified analytes using two sampling methods (SPME vs. biopsy) were also identified concerning mainly compounds susceptible to dynamic biotransformation and most likely being a result of low-invasive nature of SPME. Overall, our results revealed striking metabolic alterations during prolonged 8h-ESHP associated with uncontrolled inflammation not counterbalanced by resolution, endothelial injury, accelerated mitochondrial oxidative stress, the disruption of mitochondrial bioenergetics, and the accumulation of harmful lipid species. In conclusion, the combination of perfusion parameters and metabolomics can uncover various mechanisms of organ injury and recovery, which can help differentiate between donor hearts that are transplantable from those that should be discarded.
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Affiliation(s)
- Mariola Olkowicz
- Department of Chemistry, University of Waterloo, Waterloo, ON, Canada
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Krakow, Poland
| | - Roberto Vanin Pinto Ribeiro
- Division of Cardiovascular Surgery, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Frank Yu
- Division of Cardiovascular Surgery, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Juglans Souto Alvarez
- Division of Cardiovascular Surgery, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Liming Xin
- Division of Cardiovascular Surgery, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Miao Yu
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Roizar Rosales
- Division of Cardiovascular Surgery, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Mitchell Brady Adamson
- Division of Cardiovascular Surgery, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Ved Bissoondath
- Division of Cardiovascular Surgery, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | | | - Filio Billia
- Toronto General Hospital Research Institute (TGHRI), University Health Network, Toronto, ON, Canada
- Ted Roger’s Center for Heart Research, University Health Network, Toronto, ON, Canada
| | - Mitesh Vallabh Badiwala
- Division of Cardiovascular Surgery, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Ted Roger’s Center for Heart Research, University Health Network, Toronto, ON, Canada
| | - Janusz Pawliszyn
- Department of Chemistry, University of Waterloo, Waterloo, ON, Canada
- *Correspondence: Janusz Pawliszyn,
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Reul RM, Saleem AA, Keller CN, Malik TH, Rosengart TK, Goss JA, Rana AA. Allograft discard risk index for heart transplantation. Clin Transplant 2021; 35:e14442. [PMID: 34319617 DOI: 10.1111/ctr.14442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The numberof patients awaiting heart transplantation (HTx) substantially exceeds the number of donor hearts transplanted each year, yet nearly 65% of eligible donor hearts are discarded rather than transplanted. METHODS Deceased organ donors listed within the UNOS Deceased Donor Database between 2010 and 2020 were reviewed. Those greater than 10 years old and consented for heart donation were included and randomly separated into training (n = 48 435) and validation (n = 24 217) cohorts. A discard risk index (DSRI) was created using the results of univariable and multivariable analyses. Discard data were assessed at DSRI value deciles, and stratum-specific likelihood ratio (SSLR) analysis and Kaplan-Meier survival function were used for mortality data. RESULTS Factors associated with higher DSRI values included donor age > 45, LVEF, HBV-core antibodies, hypertension, and diabetes. The DSRI C-statistic was .906 in the training cohort and .904 in the validation cohort. The DSRI did not reliably predict 30-day or 1-year mortality after transplantation (C-statistic .539 and .532, respectively). CONCLUSIONS The factors leading to heart allograft discard are not correlated to the same degree with post-transplant outcomes. This suggests that optimizing utilization of certain allografts with slightly higher risk of discard could increase the heart donor pool with limited impact on posttransplant mortality.
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Affiliation(s)
- Ross M Reul
- Office of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
| | - Asad A Saleem
- Office of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
| | - Christian N Keller
- Office of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
| | - Tahir H Malik
- Office of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
| | - Todd K Rosengart
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - John A Goss
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Abbas A Rana
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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Pradegan N, Toscano G, Gerosa G. Mending hearts: A further strategy to improve cardiac donors availability. J Card Surg 2021; 36:2989-2991. [PMID: 33982341 DOI: 10.1111/jocs.15628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/07/2021] [Accepted: 05/03/2021] [Indexed: 12/01/2022]
Abstract
Patients listed for heart transplantation are increasing annually worldwide, but the limited number of available donor hearts restricts this treatment to a small fraction of potential recipients. Attempts have, therefore, been made to expand the donor pool by recruiting donors who may not satisfy the standard criteria for organ donation. We reviewed our early experience by using three donor hearts which were successfully transplanted either after correction or not of pre-existing defects (Case #1: Coronary fistula; Case #2: Takayasu syndrome; Case #3: Percutaneously repaired atrial septal defect), demonstrating that structural cardiac abnormalities might not always be an absolute contraindication to donation candidacy.
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Affiliation(s)
- Nicola Pradegan
- Heart Transplantation Unit, Cardio-Thoraco-Vascular Sciences and Public Health Department, University Padova Hospital, Padova, Italy
| | - Giuseppe Toscano
- Heart Transplantation Unit, Cardio-Thoraco-Vascular Sciences and Public Health Department, University Padova Hospital, Padova, Italy
| | - Gino Gerosa
- Heart Transplantation Unit, Cardio-Thoraco-Vascular Sciences and Public Health Department, University Padova Hospital, Padova, Italy
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Atik FA, Oliveira FBM, Peres PHM, Moraes CS, Ulhoa MB, Biondi R, Barzilai VS, Chaves RB, Cunha CR. Is shortage of heart donors a real problem? Insights from a Brazilian Mid‐West heart transplant program. J Card Surg 2020; 35:1802-1810. [DOI: 10.1111/jocs.14781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Fernando A. Atik
- Department of Cardiovascular Surgery Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
| | - Felipe B. M. Oliveira
- Department of Cardiology Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
| | - Pedro H. M. Peres
- Department of Cardiovascular Surgery Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
| | - Camila S. Moraes
- Department of Cardiovascular Surgery Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
| | - Marcelo B. Ulhoa
- Department of Cardiology Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
| | - Rodrigo Biondi
- Department of Cardiology Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
| | - Vitor S. Barzilai
- Department of Cardiology Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
| | - Renato B. Chaves
- Department of Cardiology Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
| | - Claudio R. Cunha
- Department of Cardiovascular Surgery Instituto de Cardiologia do Distrito Federal Brasilia Distrito Federal Brazil
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New Strategies to Expand and Optimize Heart Donor Pool: Ex Vivo Heart Perfusion and Donation After Circulatory Death: A Review of Current Research and Future Trends. Anesth Analg 2019; 128:406-413. [PMID: 30531220 DOI: 10.1213/ane.0000000000003919] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Heart transplantation remains the definitive management for end-stage heart failure refractory to medical therapy. While heart transplantation cases are increasing annually worldwide, there remains a deficiency in organ availability with significant patient mortality while on the waiting list. Attempts have therefore been made to expand the donor pool and improve access to available organs by recruiting donors who may not satisfy the standard criteria for organ donation because of donor pathology, anticipated organ ischemic time, or donation after circulatory death. "Ex vivo" heart perfusion (EVHP) is an emerging technique for the procurement of heart allografts. This technique provides mechanically supported warm circulation to a beating heart once removed from the donor and before implantation into the recipient. EVHP can be sustained for several hours, facilitate extended travel time, and enable administration of pharmacological agents to optimize cardiac recovery and function, as well as allow assessment of allograft function before implantation. In this article, we review recent advances in expanding the donor pool for cardiac transplantation. Current limitations of conventional donor criteria are outlined, including the determinants of organ suitability and assessment, involving transplantation of donation after circulatory death hearts, extended criteria donors, and EVHP-associated assessment, optimization, and transportation. Finally, ongoing research relating to organ optimization and functional ex vivo allograft assessment are reviewed.
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Vorlat A, De Hous N, Vervaecke AJ, Vermeulen T, Van Craenenbroeck E, Heidbuchel H, Rodrigus I, Van Donink W, Ancion A, Van Cleemput J, Van Hoof VO, Claeys MJ. Biomarkers and Donor Selection in Heart Transplantation. Transplant Proc 2019; 51:1673-1678. [PMID: 31307770 DOI: 10.1016/j.transproceed.2019.04.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/19/2019] [Accepted: 04/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previously, we showed that B-type natriuretic peptide (BNP) measured in the donor was related to cardiac performance after cardiac transplantation. The present study assesses the value of 3 biomarkers in the selection of donor hearts in a larger cohort. METHODS Blood samples were prospectively obtained in 105 brain-dead patients scheduled for heart donation. BNP, soluble suppressor of tumorigenicity 2 (ST2), and troponin of heart donors were correlated with hemodynamic parameters early after transplantation as well as with the mortality of the recipients. RESULTS A significant inverse relationship was found between donor BNP measured at the time of donation and recipient cardiac index and cardiac output at day 13 post-transplantation (r = -0.31, P = .005, and r = -0.34, P = .0016, respectively). Logistic regression analysis-including BNP, ST2, and troponin-showed that donor BNP was a predictor of a poor cardiac index (< 2.2 L/min/m2) in the recipient (P = .04). A donor BNP > 132 pg/mL has a sensitivity of 56% (95% confidence interval 21-86) and a specificity of 86% (95% confidence interval 77-93) to predict poor cardiac performance in the recipient. When the donor BNP is ≤ 132 pg/mL, the risk of a poor cardiac function in the recipient is very low (negative predictive value 94%). Mortality at 30 days was also correlated to donor BNP (r = 0.29, P = .0029). Long-term survival of the recipient was not correlated to the biomarkers measured in the donor. CONCLUSION Donor BNP, but not donor ST2 or high-sensitivity troponin, provides information on the donor heart and early post-transplant performance, including 1-month mortality.
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Affiliation(s)
- Anne Vorlat
- Department of Cardiology, University Hospital of Antwerp, Edegem, Belgium.
| | - Nicolas De Hous
- Department of Cardiology, University Hospital of Antwerp, Edegem, Belgium
| | | | - Tom Vermeulen
- Department of Cardiology, University Hospital of Antwerp, Edegem, Belgium
| | | | - Hein Heidbuchel
- Department of Cardiology, University Hospital of Antwerp, Edegem, Belgium
| | - Inez Rodrigus
- Department of Cardiac Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - Walter Van Donink
- Department of Cardiac Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - Arnaud Ancion
- Department of Cardiology, University Hospital Sart Tilman, Liege, Belgium
| | - Johan Van Cleemput
- Department of Cardiology, University Hospital of Leuven, Leuven, Belgium
| | - Viviane O Van Hoof
- Department of Clinical Chemistry, Antwerp University Hospital, Edegem, Belgium; Translational Pathophysiological Research Group, University of Antwerp, Edegem, Belgium
| | - Marc J Claeys
- Department of Cardiology, University Hospital of Antwerp, Edegem, Belgium
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See VY. Organized atrial arrhythmias after cardiac transplantation: The overlooked value of the 12-lead electrocardiogram and cavotricuspid atrial flutter isthmus. J Heart Lung Transplant 2017; 37:S1053-2498(17)32084-3. [PMID: 29129369 DOI: 10.1016/j.healun.2017.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/18/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Vincent Y See
- Cardiovascular Medicine Division, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
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Lazzeri C, Guetti C, Migliaccio ML, Ciapetti M, Peris A. The utility of serial echocardiograms for organ procurement in brain death. Clin Transplant 2017; 31. [PMID: 28836706 DOI: 10.1111/ctr.13094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Chiara Lazzeri
- Intensive Care Unit and Regional ECMO Referral Centre; Emergency Department; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - Cristiana Guetti
- Intensive Care Unit and Regional ECMO Referral Centre; Emergency Department; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - Maria L. Migliaccio
- Intensive Care Unit and Regional ECMO Referral Centre; Emergency Department; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - Marco Ciapetti
- Intensive Care Unit and Regional ECMO Referral Centre; Emergency Department; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral Centre; Emergency Department; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
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Advances in cardiac transplantation. Curr Opin Cardiol 2017; 32:283-285. [DOI: 10.1097/hco.0000000000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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