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Moniz I, Soares M, Sousa AP, Ramalho-Santos J, Branco A. The Low Survivability of Transplanted Gonadal Grafts: The Impact of Cryopreservation and Transplantation Conditions on Mitochondrial Function. BIOLOGY 2024; 13:542. [PMID: 39056734 PMCID: PMC11274302 DOI: 10.3390/biology13070542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/10/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024]
Abstract
Advances in tissue preservation techniques have allowed reproductive medicine and assisted reproductive technologies (ARTs) to flourish in recent years. Because radio- and chemotherapy procedures are often gonadotoxic, irreversible damage can preclude future gamete production and endocrine support. Accordingly, in recent years, the freezing and storage of gonadal tissue fragments prior to the first oncological treatment appointment and autologous transplantation post-recovery have been considered improved solutions for fertility recovery in cancer survivors. Nevertheless, the cryopreservation and transplantation of thawed tissues is still very limited, and positive outcomes are relatively low. This review aims to discuss the limitations of oncofertility protocols with a focus on the impacts of mitochondrial dysfunction, oxidative stress, and the loss of antioxidant defense in graft integrity.
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Affiliation(s)
- Inês Moniz
- Doctoral Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research, University of Coimbra, 3030-789 Coimbra, Portugal; (I.M.)
- CNC—Centre for Neuroscience and Cell Biology, CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Azinhaga de Santa Comba, Polo 3, 3000-548 Coimbra, Portugal
| | - Maria Soares
- Doctoral Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research, University of Coimbra, 3030-789 Coimbra, Portugal; (I.M.)
- CNC—Centre for Neuroscience and Cell Biology, CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Azinhaga de Santa Comba, Polo 3, 3000-548 Coimbra, Portugal
| | - Ana Paula Sousa
- CNC—Centre for Neuroscience and Cell Biology, CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Azinhaga de Santa Comba, Polo 3, 3000-548 Coimbra, Portugal
- Reproductive Medicine Unit, Unidade Local de Saúde de Coimbra, Praceta Prof. Mota Pinto, 3000-075 Coimbra, Portugal
- Eugin Coimbra, Rua Filipe Hodart, 3000-185 Coimbra, Portugal
| | - João Ramalho-Santos
- CNC—Centre for Neuroscience and Cell Biology, CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Azinhaga de Santa Comba, Polo 3, 3000-548 Coimbra, Portugal
- Department of Live Sciences, University of Coimbra, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal
| | - Ana Branco
- CNC—Centre for Neuroscience and Cell Biology, CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Azinhaga de Santa Comba, Polo 3, 3000-548 Coimbra, Portugal
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Frandsen EL, Banker KA, Mazor RL, McMullan DM, Law YM, Kemna MS, Albers EL, Hong BJ, Friedland-Little JM. Waitlist and posttransplant outcomes of critically ill infants awaiting heart transplantation managed without ventricular assist device support. Pediatr Transplant 2022; 26:e14308. [PMID: 35587026 DOI: 10.1111/petr.14308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/14/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Infants listed for heart transplant are at high risk for waitlist mortality. While waitlist mortality for children has decreased in the current era of increased ventricular assist device use, outcomes for small infants supported by ventricular assist device remain suboptimal. We evaluated morbidity and survival in critically ill infants listed for heart transplant and managed without ventricular assist device support. METHODS Critically ill infants (requiring ≥1 inotrope and mechanical ventilation or ≥2 inotropes without mechanical ventilation) listed between 2008 and 2019 were included. During the study period, infants were managed primarily medically. Mechanical circulatory support, specifically extracorporeal membrane oxygenation, was utilized as "rescue therapy" for decompensating patients. RESULTS Thirty-two infants were listed 1A, 66% with congenital heart disease. Median age and weight at listing were 2.2 months and 4.4 kg, with 69% weighing <5 kg. At listing, 97% were mechanically ventilated, 41% on ≥2 inotropes, and 25% under neuromuscular blockade. Five patients were supported by ECMO after listing. A favorable outcome (transplant or recovery) was observed in 84%. One-year posttransplant survival was 92%. Infection was the most common waitlist complication occurring in 75%. Stroke was rare, occurring in one patient who was supported on ECMO. Renal function improved from listing to transplant, death, or recovery (eGFR 70 vs 87 ml/min/1.73m2 , p = .001). CONCLUSION A strategy incorporating a high threshold for mechanical circulatory support and acceptance of prolonged mechanical ventilation and neuromuscular blockade can achieve good survival and morbidity outcomes for critically ill infants listed for heart transplant.
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Affiliation(s)
- Erik L Frandsen
- Pediatric Cardiology, Loma Linda University Children's Hospital, Loma Linda, California, United States
| | - Katherine A Banker
- Division of Critical Care, Seattle Children's Hospital, Seattle, Washington, USA
| | - Robert L Mazor
- Division of Critical Care, Seattle Children's Hospital, Seattle, Washington, USA
| | - D Michael McMullan
- Division of Pediatric Cardiac Surgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Yuk M Law
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Mariska S Kemna
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Erin L Albers
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Borah J Hong
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
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Wang M, Yan L, Li Q, Yang Y, Turrentine M, March K, Wang IW. Mesenchymal stem cell secretions improve donor heart function following ex vivo cold storage. J Thorac Cardiovasc Surg 2022; 163:e277-e292. [PMID: 32981709 PMCID: PMC7921217 DOI: 10.1016/j.jtcvs.2020.08.095] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/15/2020] [Accepted: 08/24/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Heart transplantation is the gold standard of treatments for end-stage heart failure, but its use is limited by extreme shortage of donor organs. The time "window" between procurement and transplantation sets the stage for myocardial ischemia/reperfusion injury, which constrains the maximal storage time and lowers use of donor organs. Given mesenchymal stem cell (MSC)-derived paracrine protection, we aimed to evaluate the efficacy of MSC-conditioned medium (CM) and extracellular vesicles (EVs) when added to ex vivo preservation solution on ameliorating ischemia/reperfusion-induced myocardial damage in donor hearts. METHODS Mouse donor hearts were stored at 0°C-4°C of <1-hour cold ischemia (<1hr-I), 6hr-I + vehicle, 6hr-I + MSC-CM, 6hr-I + MSC-EVs, and 6hr-I + MSC-CM from MSCs treated with exosome release inhibitor. The hearts were then heterotopically implanted into recipient mice. At 24 hours postsurgery, myocardial function was evaluated. Heart tissue was collected for analysis of histology, apoptotic cell death, microRNA (miR)-199a-3p expression, and myocardial cytokine production. RESULTS Six-hour cold ischemia significantly impaired myocardial function, increased cell death, and reduced miR-199a-3p in implanted hearts versus <1hr-I. MSC-CM or MSC-EVs in preservation solution reversed the detrimental effects of prolong cold ischemia on donor hearts. Exosome-depleted MSC-CM partially abolished MSC secretome-mediated cardioprotection in implanted hearts. MiR-199a-3p was highly enriched in MSC-EVs. MSC-CM and MSC-EVs increased cold ischemia-downregulated miR-199a-3p in donor hearts, whereas exosome-depletion neutralized this effect. CONCLUSIONS MSC-CM and MSC-EVs confer improved myocardial preservation in donor hearts during prolonged cold static storage and MSC-EVs can be used for intercellular transport of miRNAs in heart transplantation.
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Affiliation(s)
- Meijing Wang
- Division of Cardiothoracic Surgery, Department of Surgery, IU School of Medicine, Indianapolis, Ind.
| | - Liangliang Yan
- Division of Cardiothoracic Surgery, Department of Surgery, IU School of Medicine, Indianapolis, Ind; Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fujian, China
| | - Qianzhen Li
- Division of Cardiothoracic Surgery, Department of Surgery, IU School of Medicine, Indianapolis, Ind; Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fujian, China; Division of Cardiovascular Medicine, Department of Medicine, IU School of Medicine, Indianapolis, Ind
| | - Yang Yang
- Division of Cardiothoracic Surgery, Department of Surgery, IU School of Medicine, Indianapolis, Ind
| | - Mark Turrentine
- Division of Cardiothoracic Surgery, Department of Surgery, IU School of Medicine, Indianapolis, Ind
| | - Keith March
- Division of Cardiovascular Medicine, Department of Medicine, IU School of Medicine, Indianapolis, Ind; Division of Cardiovascular Medicine, Center for Regenerative Medicine, University of Florida, Gainesville, Fla
| | - I-Wen Wang
- Division of Cardiothoracic Surgery, Department of Surgery, IU School of Medicine, Indianapolis, Ind; Methodist Hospital, IU Health, IU School of Medicine, Indianapolis, Ind.
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Scott SR, March KL, Wang IW, Singh K, Liu J, Turrentine M, Sen CK, Wang M. Bone marrow- or adipose-mesenchymal stromal cell secretome preserves myocardial transcriptome profile and ameliorates cardiac damage following ex vivo cold storage. J Mol Cell Cardiol 2022; 164:1-12. [PMID: 34774548 PMCID: PMC8860861 DOI: 10.1016/j.yjmcc.2021.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 10/24/2021] [Accepted: 11/03/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Heart transplantation, a life-saving approach for patients with end-stage heart disease, is limited by shortage of donor organs. While prolonged storage provides more organs, it increases the extent of ischemia. Therefore, we seek to understand molecular mechanisms underlying pathophysiological changes of donor hearts during prolonged storage. Additionally, considering mesenchymal stromal cell (MSC)-derived paracrine protection, we aim to test if MSC secretome preserves myocardial transcriptome profile and whether MSC secretome from a certain source provides the optimal protection in donor hearts during cold storage. METHODS AND RESULTS Isolated mouse hearts were divided into: no cold storage (control), 6 h cold storage (6 h-I), 6 h-I + conditioned media from bone marrow MSCs (BM-MSC CM), and 6 h-I + adipose-MSC CM (Ad-MSC CM). Deep RNA sequencing analysis revealed that compared to control, 6 h-I led to 266 differentially expressed genes, many of which were implicated in modulating mitochondrial performance, oxidative stress response, myocardial function, and apoptosis. BM-MSC CM and Ad-MSC CM restored these gene expression towards control. They also improved 6 h-I-induced myocardial functional depression, reduced inflammatory cytokine production, decreased apoptosis, and reduced myocardial H2O2. However, neither MSC-exosomes nor exosome-depleted CM recapitulated MSC CM-ameliorated apoptosis and CM-improved mitochondrial preservation during cold ischemia. Knockdown of Per2 by specific siRNA abolished MSC CM-mediated these protective effects in cardiomyocytes following 6 h cold storage. CONCLUSIONS Our results demonstrated that using MSC secretome (BM-MSCs and Ad-MSCs) during prolonged cold storage confers preservation of the normal transcriptional "fingerprint", and reduces donor heart damage. MSC-released soluble factors and exosomes may synergistically act for donor heart protection.
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Affiliation(s)
- Susan R Scott
- Department of Surgery, IU School of Medicine, Indianapolis, IN, U.S.A
| | - Keith L March
- Division of Cardiovascular Medicine, Department of Medicine, IU School of Medicine, Indianapolis, IN, U.S.A,Division of Cardiovascular Medicine, Center for Regenerative Medicine, University of Florida, Gainesville, FL, U.S.A
| | - I-wen Wang
- Department of Surgery, IU School of Medicine, Indianapolis, IN, U.S.A,Methodist Hospital, IU Health, IU School of Medicine, Indianapolis, IN, U.S.A
| | - Kanhaiya Singh
- Department of Surgery, IU School of Medicine, Indianapolis, IN, U.S.A,Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Jianyun Liu
- Department of Surgery, IU School of Medicine, Indianapolis, IN, U.S.A
| | - Mark Turrentine
- Department of Surgery, IU School of Medicine, Indianapolis, IN, U.S.A
| | - Chandan K Sen
- Department of Surgery, IU School of Medicine, Indianapolis, IN, U.S.A,Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Meijing Wang
- Department of Surgery, IU School of Medicine, Indianapolis, IN, USA.
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Li J, Richmond B, Hong T. Cardiac T-Tubule cBIN1-Microdomain, a Diagnostic Marker and Therapeutic Target of Heart Failure. Int J Mol Sci 2021; 22:ijms22052299. [PMID: 33669042 PMCID: PMC7956774 DOI: 10.3390/ijms22052299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 12/23/2022] Open
Abstract
Since its first identification as a cardiac transverse tubule (t-tubule) protein, followed by the cloning of the cardiac isoform responsible for t-tubule membrane microdomain formation, cardiac bridging integrator 1 (cBIN1) and its organized microdomains have emerged as a key mechanism in maintaining normal beat-to-beat heart contraction and relaxation. The abnormal remodeling of cBIN1-microdomains occurs in stressed and diseased cardiomyocytes, contributing to the pathophysiology of heart failure. Due to the homeostatic turnover of t-tubule cBIN1-microdomains via microvesicle release into the peripheral circulation, plasma cBIN1 can be assayed as a liquid biopsy of cardiomyocyte health. A new blood test cBIN1 score (CS) has been developed as a dimensionless inverse index derived from plasma cBIN1 concentration with a diagnostic and prognostic power for clinical outcomes in stable ambulatory patients with heart failure with reduced or preserved ejection fraction (HFrEF or HFpEF). Recent evidence further indicates that exogenous cBIN1 introduced by adeno-associated virus 9-based gene therapy can rescue cardiac contraction and relaxation in failing hearts. The therapeutic potential of cBIN1 gene therapy is enormous given its ability to rescue cardiac inotropy and provide lusitropic protection in the meantime. These unprecedented capabilities of cBIN1 gene therapy are shifting the current paradigm of therapy development for heart failure, particularly HFpEF.
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Affiliation(s)
- Jing Li
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA; (J.L.); (B.R.)
| | - Bradley Richmond
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA; (J.L.); (B.R.)
| | - TingTing Hong
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA; (J.L.); (B.R.)
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84112, USA
- Diabetes and Metabolism Research Center, University of Utah, Salt Lake City, UT 84112, USA
- Correspondence: ; Tel.: +1-801-581-3090
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Ellis BW, Traktuev DO, Merfeld-Clauss S, Can UI, Wang M, Bergeron R, Zorlutuna P, March KL. Adipose stem cell secretome markedly improves rodent heart and human induced pluripotent stem cell-derived cardiomyocyte recovery from cardioplegic transport solution exposure. STEM CELLS (DAYTON, OHIO) 2020; 39:170-182. [PMID: 33159685 DOI: 10.1002/stem.3296] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/18/2020] [Indexed: 12/21/2022]
Abstract
Heart transplantation is a life-saving therapy for end-stage organ failure. Organ deterioration during transportation limits storage to 4 hours, limiting hearts available. Approaches ameliorating organ damage could increase the number of hearts acceptable for transplantation. Prior studies show that adipose-derived stem/stromal cell secretome (ASC-S) rescues tissues from postischemic damage in vivo. This study tested whether ASC-S preserved the function of mouse hearts and human induced pluripotent stem cell-derived cardiomyocytes (iCM) exposed to organ transportation and transplantation conditions. Hearts were subjected to cold University of Wisconsin (UW) cardioplegic solution ± ASC-S for 6 hours followed by analysis using the Langendorff technique. In parallel, the effects of ASC-S on the recovery of iCM from UW solution were examined when provided either during or after cold cardioplegia. Exposure of hearts and iCM to UW deteriorated contractile activity and caused cell apoptosis, worsening in iCM as a function of exposure time; these were ameliorated by augmenting with ASC-S. Silencing of superoxide dismutase 3 and catalase expression prior to secretome generation compromised the ASC-S cardiomyocyte-protective effects. In this study, a novel in vitro iCM model was developed to complement a rodent heart model in assessing efficacy of approaches to improve cardiac preservation. ASC-S displays strong cardioprotective activity on iCM either with or following cold cardioplegia. This effect is associated with ASC-S-mediated cellular clearance of reactive oxygen species. The effect of ASC-S on the temporal recovery of iCM function supports the possibility of lengthening heart storage by augmenting cardioplegic transport solution with ASC-S, expanding the pool of hearts for transplantation.
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Affiliation(s)
- Bradley W Ellis
- Bioengineering Graduate Program, University of Notre Dame, Notre Dame, Indiana, USA
| | - Dmitry O Traktuev
- Division of Cardiovascular Medicine and Center for Regenerative Medicine, University of Florida, Gainesville, Florida, USA.,Malcom Randall Veterans' Affairs Medical Center, Gainesville, Florida, USA
| | - Stephanie Merfeld-Clauss
- Division of Cardiovascular Medicine and Center for Regenerative Medicine, University of Florida, Gainesville, Florida, USA.,Malcom Randall Veterans' Affairs Medical Center, Gainesville, Florida, USA
| | - Uryan Isik Can
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, Indiana, USA
| | - Meijing Wang
- The Division of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ray Bergeron
- Division of Cardiovascular Medicine and Center for Regenerative Medicine, University of Florida, Gainesville, Florida, USA
| | - Pinar Zorlutuna
- Bioengineering Graduate Program, University of Notre Dame, Notre Dame, Indiana, USA.,Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, Indiana, USA
| | - Keith L March
- Division of Cardiovascular Medicine and Center for Regenerative Medicine, University of Florida, Gainesville, Florida, USA.,Malcom Randall Veterans' Affairs Medical Center, Gainesville, Florida, USA
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Taylor LJ, Fiedler AG. Balancing supply and demand: Review of the 2018 donor heart allocation policy. J Card Surg 2020; 35:1583-1588. [DOI: 10.1111/jocs.14609] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Lauren J. Taylor
- Division of Cardiothoracic Surgery, Department of Surgery University of Wisconsin Madison Wisconsin
| | - Amy G. Fiedler
- Division of Cardiothoracic Surgery, Department of Surgery University of Wisconsin Madison Wisconsin
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Yin MY, Wever-Pinzon O, Mehra MR, Selzman CH, Toll AE, Cherikh WS, Nativi-Nicolau J, Fang JC, Kfoury AG, Gilbert EM, Kemeyou L, McKellar SH, Koliopoulou A, Vaduganathan M, Drakos SG, Stehlik J. Post-transplant outcome in patients bridged to transplant with temporary mechanical circulatory support devices. J Heart Lung Transplant 2019; 38:858-869. [DOI: 10.1016/j.healun.2019.04.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/20/2019] [Accepted: 04/14/2019] [Indexed: 01/06/2023] Open
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de Miguel-Yanes JM, Jiménez-García R, de Miguel-Díez J, Hernández-Barrera V, Méndez-Bailón M, Muñoz-Rivas N, López-de-Andrés A. In-hospital outcomes for solid organ transplants according to type 2 diabetes status: An observational, 15-year study in Spain. Int J Clin Pract 2018; 73:e13283. [PMID: 30317700 DOI: 10.1111/ijcp.13283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/02/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023] Open
Abstract
AIMS To describe trends and outcomes during admission for solid organ transplant in people with or without type 2 diabetes in Spain, 2001-2015. METHODS We used national hospital discharge data to select all hospital admissions for kidney, lung, heart, and liver transplant. We estimated admission rates stratified by type 2 diabetes status. We built Poisson regression models to compare the adjusted time trends in admission rates. We tested in-hospital mortality (IHM) in logistic regression analyses. RESULTS We identified 50 964 transplants (16.7% in people with type 2 diabetes): kidney, 30 919; lung, 2810; heart, 3649; liver, 13 586. The overall adjusted incidence rate ratios (95% confidence intervals) of admission in people with type 2 diabetes vs no diabetes were 2.4 (2.32-2.48) for kidney, 1.51 (1.33-1.70) for lung, 2.87 (2.63-3.13) for heart, and 4.16 (3.99-4.33) for liver transplant. In the multivariate analysis, IHM decreased significantly over time for all types of transplant. Type 2 diabetes independently predicted lower IHM during admission only for heart (Odds ratio, OR [95% CI] = 0.62 [0.47-0.81]) and liver transplant (OR [95% CI] = 0.69 [0.58-0.82]). CONCLUSIONS Admission rates for solid organ transplant were higher in people with type 2 diabetes than in people without diabetes. Type 2 diabetes was associated with lower in-hospital mortality during admission for heart and liver transplant.
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Affiliation(s)
- José M de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Javier de Miguel-Díez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Manuel Méndez-Bailón
- Internal Medicine Department, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Nuria Muñoz-Rivas
- Internal Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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Hua F, Chen Y, Yang Z, Teng X, Huang H, Shen Z. Protective action of bone marrow mesenchymal stem cells in immune tolerance of allogeneic heart transplantation by regulating CD45RB + dendritic cells. Clin Transplant 2018; 32:e13231. [PMID: 29488658 DOI: 10.1111/ctr.13231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Bone marrow-derived mesenchymal stem cells (BMSCs) could exert a potent immunosuppressive effect and therefore may have a therapeutic potential in T-cell-dependent pathologies. We aimed to examine the effects of BMSCs on immune tolerance of allogeneic heart transplantation and the involvement of CD45RB+ dendritic cells (DCs). METHODS Bone marrow-derived DCs and BMSCs were co-cultured, with CD45RB expression on the surface of DCs measured by flow cytometry. qRT-PCR and Western blotting were used to detect mRNA and protein levels. Cytometric bead array was performed to determine the serum level of IL-10. Survival time of transplanted heart and expression of CD4+ , CD8+ , IL-2, IL-4, IL-10, IFN-γ were determined. Immunofluorescence assay was employed to determine intensity of C3d and C4d. RESULTS DCs co-cultured with BMSCs showed increased CD45RB and Foxp3 levels. CD45RB+ DCs co-cultured with T-cells CD4+ displayed increased T-cell CD4+ Foxp3 ratio and IL-10 than DCs. Both of them extended survival time of transplanted heart, decreased histopathological classification and score, intensity of C3d, C4d, proportion of CD4+ , expression levels of IL-2 and IFN-γ, and increased the CD4+ Foxp3 ratio and levels of IL-4 and IL-10. CD45RB+ DCs achieved better protective effects than DCs. CONCLUSION BMSCs increased the expression of CD45RB in the bone marrow-derived DCs, thereby strengthening immunosuppression capacity of T cells and immune tolerance of allogeneic heart transplantation.
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Affiliation(s)
- Fei Hua
- Department of Cardiac Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow University, Suzhou, China
| | - Yueqiu Chen
- Department of Cardiac Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow University, Suzhou, China
| | - Ziying Yang
- Department of Cardiac Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow University, Suzhou, China
| | - Xiaomei Teng
- Department of Cardiac Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow University, Suzhou, China
| | - Haoyue Huang
- Department of Cardiac Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow University, Suzhou, China
| | - Zhenya Shen
- Department of Cardiac Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow University, Suzhou, China
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11
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Parker WF, Garrity ER, Fedson S, Churpek MM. Trends in the Use of Inotropes to List Adult Heart Transplant Candidates at Status 1A. Circ Heart Fail 2017; 10:e004483. [PMID: 29246896 PMCID: PMC5739062 DOI: 10.1161/circheartfailure.117.004483] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/13/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The number of adult heart transplant candidates waiting at the most urgent status 1A has increased over time despite the expansion of geographic sharing of hearts in 2006. We aimed to determine whether candidates listed with inotropes contribute to the excess status 1A candidates. METHODS AND RESULTS The initial registrations of all adult heart-only candidates listed from 2000 to 2015 were analyzed using the Scientific Registry of Transplant Recipients data set. Trends in listing status, justifications, and candidate factors were measured. Adjusted trends in listing status pre- and post-geographic sharing were estimated using multilevel logistic regression. Competing risks models provided trends in transplant-free waitlist survival. There were 46 853 adult heart-alone listings during 2000 to 2015. Pre-sharing, status 1A listing was unchanged over time (adjusted odds ratio, 0.98; 95% confidence interval, 0.78-1.23). Post-sharing, the adjusted odds of status 1A listing increased 117% over 9 years (adjusted odds ratio 2.17, 95% confidence interval, 1.82-2.58). The number of candidates listed as status 1A with inotropes increased by 193 a year, whereas the dobutamine, dopamine, and milrinone doses used decreased 49%, 55%, and 29% (P<0.001). The risk of waitlist death or deterioration of status 1A inotrope candidates relative to status 2 candidates decreased 62% for 2006 to 2010 and 70% for 2011 to 2015 compared with that for 2003 to 2006. CONCLUSIONS After the wider geographic sharing of hearts in 2006, transplant programs used multiple inotropes to list candidates at status 1A more frequently with progressively lower doses. Concurrently, the status 1A inotrope candidate waitlist outcomes improved substantially. These trends suggest that overtreatment with multiple inotropes contributes to the current critical excess of status 1A candidates.
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Affiliation(s)
- William F Parker
- From the Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago Medicine, IL (W.F.P., E.R.G., M.M.C.); MacLean Center for Clinical Medical Ethics, University of Chicago, IL (W.F.P., E.R.G.); and Michael E. DeBakey VA Medical Center (S.F.) and Center for Medical Ethics and Health Policy (S.F.), Baylor College of Medicine, Houston, TX.
| | - Edward R Garrity
- From the Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago Medicine, IL (W.F.P., E.R.G., M.M.C.); MacLean Center for Clinical Medical Ethics, University of Chicago, IL (W.F.P., E.R.G.); and Michael E. DeBakey VA Medical Center (S.F.) and Center for Medical Ethics and Health Policy (S.F.), Baylor College of Medicine, Houston, TX
| | - Savitri Fedson
- From the Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago Medicine, IL (W.F.P., E.R.G., M.M.C.); MacLean Center for Clinical Medical Ethics, University of Chicago, IL (W.F.P., E.R.G.); and Michael E. DeBakey VA Medical Center (S.F.) and Center for Medical Ethics and Health Policy (S.F.), Baylor College of Medicine, Houston, TX
| | - Matthew M Churpek
- From the Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago Medicine, IL (W.F.P., E.R.G., M.M.C.); MacLean Center for Clinical Medical Ethics, University of Chicago, IL (W.F.P., E.R.G.); and Michael E. DeBakey VA Medical Center (S.F.) and Center for Medical Ethics and Health Policy (S.F.), Baylor College of Medicine, Houston, TX
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12
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Assessing Consequences of Intraaortic Balloon Counterpulsation Versus Left Ventricular Assist Devices at the Time of Heart Transplantation. ASAIO J 2017; 62:232-9. [PMID: 26735554 DOI: 10.1097/mat.0000000000000329] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The proportion of heart transplant recipients bridged with durable, intracorporeal left ventricular assist devices (dLVADs) has dramatically increased; however, concern exists regarding obligate repeat sternotomy, increased bleeding risk because of anticoagulation and acquired von Willebrand disease, and increased rates of allosensitization. Whether dLVAD patients have impaired posttransplant outcomes compared with equivalent patients with less invasive intraaortic balloon pump counterpulsation (IABP) at the time of transplant is unknown. Therefore, we analyzed adult, first time, heart-only transplant procedures with dLVAD (n = 2,636) compared with IABP (n = 571) at the time of transplant based on data from the United Network for Organ Sharing (UNOS) July 2004 to December 2011. There was clear geographic variation in IABP and dLVAD at transplant. Multivariable analysis demonstrated equivalent cumulative risk of death (adjusted Cox proportional hazard ratio, 1.08; 95% confidence interval, 0.87-1.33; p = 0.51). There was no significant difference in adjusted comparison of perioperative morality, length of stay, postoperative renal failure requiring dialysis, or early acute rejection (p ≥ 0.14 for all). Therefore, data from UNOS suggest that the presence of dLVAD at the time of heart transplantation does not have a detrimental effect on postoperative outcomes compared with IABP, which must be considered in the context of pretransplant mortality and locoregional organ availability.
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13
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Vilchinsky N, Ginzburg K, Fait K, Foa EB. Cardiac-disease-induced PTSD (CDI-PTSD): A systematic review. Clin Psychol Rev 2017; 55:92-106. [DOI: 10.1016/j.cpr.2017.04.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 04/18/2017] [Accepted: 04/23/2017] [Indexed: 11/25/2022]
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14
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Abstract
Unique to striated muscle cells, transverse tubules (t-tubules) are membrane organelles that consist of sarcolemma penetrating into the myocyte interior, forming a highly branched and interconnected network. Mature t-tubule networks are found in mammalian ventricular cardiomyocytes, with the transverse components of t-tubules occurring near sarcomeric z-discs. Cardiac t-tubules contain membrane microdomains enriched with ion channels and signaling molecules. The microdomains serve as key signaling hubs in regulation of cardiomyocyte function. Dyad microdomains formed at the junctional contact between t-tubule membrane and neighboring sarcoplasmic reticulum are critical in calcium signaling and excitation-contraction coupling necessary for beat-to-beat heart contraction. In this review, we provide an overview of the current knowledge in gross morphology and structure, membrane and protein composition, and function of the cardiac t-tubule network. We also review in detail current knowledge on the formation of functional membrane subdomains within t-tubules, with a particular focus on the cardiac dyad microdomain. Lastly, we discuss the dynamic nature of t-tubules including membrane turnover, trafficking of transmembrane proteins, and the life cycles of membrane subdomains such as the cardiac BIN1-microdomain, as well as t-tubule remodeling and alteration in diseased hearts. Understanding cardiac t-tubule biology in normal and failing hearts is providing novel diagnostic and therapeutic opportunities to better treat patients with failing hearts.
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Affiliation(s)
- TingTing Hong
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; and Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Robin M Shaw
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; and Department of Medicine, University of California Los Angeles, Los Angeles, California
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15
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Rise of the Machines: In an Era of Ventricular Assist Devices, Prolonging Life or Death? J Dr Nurs Pract 2017; 10:96-107. [PMID: 32751024 DOI: 10.1891/2380-9418.10.2.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The past few decades witnessed the unprecedented "rise of the machines"; life-prolonging devices to support failing organs or as a form of organ replacement. Sophisticated machines provide us clinical milieu to intervene on sicker, dying patients, support the failing organ, prevent downward trajectory to multi-organ failure, and avert death. Hemodialysis has been in existence for several decades and has become the standard therapy for acute renal failure. Extracorporeal liver assist device replaces the detoxification function of the failing liver. Extracorporeal membrane oxygenator in cases of profound respiratory failure can replace the native lung function in the oxygenation of the venous blood and removal of carbon dioxide. The technology can also be used as a short-term heart-lung machine to keep the patient alive in the event of profound refractory cardiopulmonary collapse until the native heart and lung function returns. Ventricular assist devices (VADs) can completely replace the cardiac function in patients with end-stage heart failure and provide systemic flow. These innovative machines were developed under the assumption that they will improve survival, functional capacity, and quality of life in this cohort of patients. This case study focuses on the appropriate use of VADs as an alternative therapy for end-stage heart failure. This will explicate the ethical dilemma that concomitantly may arise with the use of these sophisticated organ replacement strategies when the goals of their placement are not met and just merely prolonging the dying process.
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16
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Zakaria D, Frazier E, Imamura M, Garcia X, Pye S, Knecht KR, Prodhan P, Gossett JR, Swearingen CJ, Morrow WR. Improved Survival While Waiting and Risk Factors for Death in Pediatric Patients Listed for Cardiac Transplantation. Pediatr Cardiol 2017; 38:77-85. [PMID: 27803956 DOI: 10.1007/s00246-016-1486-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/18/2016] [Indexed: 11/29/2022]
Abstract
Our aim is to determine (a) the effect of changes in pre-transplant management and era of listing on survival of children listed for HTx and (b) risk factors for death while waiting. This retrospective study included all children listed between 1/1993 and 12/2009 at our center. Survival was determined using survival analysis and competing outcomes modeling. There were 254 listed patients of whom 144 (57%) had congenital heart disease, 208 (82%) were status 1, 52 used ECMO (20%), and 28 used ventricular assist device support (VAD) (11%) beginning in 2005. Overall mortality while waiting was 17% at 6 months, and 69% underwent transplant. Seven of 95 patients (7%) died waiting after 2004 compared to 36 of 159 (23%) before. ECMO and earlier year of listing were significant risk factors (p < 0.001) for wait-list mortality, whereas mortality was significantly lower (p = 0.002) after availability of VADs. Race, gender, blood type, and congenital diagnosis were not significant risk factors for death. Survival in pediatric patients listed for HTx has improved significantly in the current era at our institution. The availability of pediatric VADs has had a significant impact on survival while waiting in children listed for transplantation.
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Affiliation(s)
- Dala Zakaria
- Division of Pediatric Cardiology, College of Medicine, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 512-3, Little Rock, AR, USA.
| | - Elizabeth Frazier
- Division of Pediatric Cardiology, College of Medicine, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 512-3, Little Rock, AR, USA
| | - Michiaki Imamura
- Division of Pediatric Cardiothoracic Surgery, Arkansas Children's Hospital, University of Arkansas for the Medical Science, Little Rock, AR, USA
| | - Xiomara Garcia
- Division of Pediatric Cardiology, College of Medicine, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 512-3, Little Rock, AR, USA
| | - Sherry Pye
- Division of Pediatric Cardiology, College of Medicine, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 512-3, Little Rock, AR, USA
| | - Kenneth R Knecht
- Division of Pediatric Cardiology, College of Medicine, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 512-3, Little Rock, AR, USA
| | - Parthak Prodhan
- Division of Pediatric Cardiology, College of Medicine, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 512-3, Little Rock, AR, USA
| | - Jeffrey R Gossett
- Division of Pediatric Cardiology, College of Medicine, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 512-3, Little Rock, AR, USA
| | - Christopher J Swearingen
- Biostatistics Program, Arkansas Children's Hospital, University of Arkansas for the Medical Science, Little Rock, AR, USA
| | - W Robert Morrow
- Division of Pediatric Cardiology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
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17
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Abstract
Heart transplantation is the most effective therapy for patients with Stage D heart failure with a median life expectancy of ≈10 to 15 years. Unfortunately, many patients die on the waiting list hoping for a chance of survival. The life boat cannot rescue everyone. Over a decade, the donor pool has remained relatively stable, whereas the number of heart transplant candidates has risen. Potential recipients often have many comorbidities and are older because the criteria for heart transplantation has few absolute contraindications. Women, Hispanics, and patients with restrictive heart disease and congenital heart disease are more likely to die while awaiting heart transplantation than men, white patients, and those with either ischemic or dilated cardiomyopathy. To better match the market, we need to (1) increase the donor pool, (2) reduce the waitlist, and (3) improve the allocation system. This review article addresses all 3 options and compares strategies in the United States to those in other countries.
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Affiliation(s)
- Eileen M Hsich
- From the Heart and Vascular Institute at the Cleveland Clinic, OH; and Case Western Reserve University School of Medicine, Cleveland, OH.
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18
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Continuous Flow Device Support in Children Using the HeartWare HVAD: 1,000 Days of Lessons Learned From a Single Center Experience. ASAIO J 2016; 61:569-73. [PMID: 25967955 DOI: 10.1097/mat.0000000000000253] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study is to provide a single center experience with a continuous flow device in adolescents with end-stage heart failure. A retrospective single center analysis of patients aged 18 years or younger implanted with HVAD (HeartWare Inc, Framingham, MA) between October 2012 and March 2014 was performed. Demographics, preimplant and postimplant clinical data, survival, and adverse events (AEs) were recorded. A matched group of adults based on diagnosis, body surface area (BSA), and time period were used for outcome comparisons. Six adolescents with dilated cardiomyopathy were implanted with the HVAD. Median age and BSA were 13.4 years and 1.45 m2, respectively. All were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile-1 or profile-2. Median days on device were 108 with total patient-days on device of 1,017. Four adolescents were discharged home on device all in New York Heart Association 1. Five underwent transplantation with 100% survival. There were 18 AEs with one AE per 170 days on device. Compared with the adult cohort (n = 5), there was no difference in 1 year survival (p = 0.32). HVAD support in adolescents is highly successful as a bridge to transplantation. It provides early rehabilitation and improvement in quality of life. Morbidity is not negligible but appears comparable with that seen in adults.
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19
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Hsich EM, Rogers JG, McNamara DM, Taylor DO, Starling RC, Blackstone EH, Schold JD. Does Survival on the Heart Transplant Waiting List Depend on the Underlying Heart Disease? JACC-HEART FAILURE 2016; 4:689-97. [PMID: 27179836 DOI: 10.1016/j.jchf.2016.03.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 02/22/2016] [Accepted: 03/14/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The aim of this study was to identify differences in survival on the basis of type of heart disease while awaiting orthotopic heart transplantation (OHT). BACKGROUND Patients with restrictive cardiomyopathy (RCM), congenital heart disease (CHD), or hypertrophic cardiomyopathy (HCM) may be at a disadvantage while awaiting OHT because they often are poor candidates for mechanical circulatory support and/or inotropes. METHODS The study included all adults in the Scientific Registry of Transplant Recipients database awaiting OHT from 2004 to 2014, and outcomes were evaluated on the basis of type of heart disease. The primary endpoint was time to all-cause mortality, censored at last patient follow-up and time of transplantation. Multivariate Cox proportional hazards modeling was performed to evaluate survival by type of cardiomyopathy. RESULTS There were 14,447 patients with DCM, 823 with RCM, 11,799 with ischemic cardiomyopathy (ICM), 602 with HCM, 964 with CHD, 584 with valvular disease, and 1,528 in the "other" category (including 1,216 for retransplantation). During median follow-up of 3.7 months, 4,943 patients died (1,253 women, 3,690 men). After adjusting for possible confounding variables including age, renal function, inotropes, mechanical ventilation, and mechanical circulatory support, the adjusted hazard ratios by diagnoses relative to DCM were 1.70 for RCM (95% confidence interval [CI]: 1.43 to 2.02), 1.10 for ICM (95% CI: 1.03 to 1.18), 1.23 for HCM (95% CI: 0.98 to 1.54), 1.30 for valvular disease (95% CI: 1.07 to 1.57), 1.37 for CHD (95% CI: 1.17 to 1.61), and 1.51 for "other" diagnoses (95% CI: 1.34 to 1.69). Sex was a significant modifier of mortality for ICM, RCM, and "other" diagnoses (p < 0.05 for interaction). CONCLUSIONS In the United States, patients with RCM, CHD, or prior heart transplantation had a higher risk for death while awaiting OHT than patients with DCM, ICM, HCM, or valvular heart disease.
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Affiliation(s)
- Eileen M Hsich
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Joseph G Rogers
- Division of Cardiology, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | | | - David O Taylor
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Randall C Starling
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Eugene H Blackstone
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
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20
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Brant S, Holmes C, Cobert M, Powell L, Shelton J, Jessen M, Peltz M. Successful transplantation in canines after long-term coronary sinus machine perfusion preservation of donor hearts. J Heart Lung Transplant 2016; 35:1031-6. [PMID: 27160493 DOI: 10.1016/j.healun.2016.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/01/2016] [Accepted: 03/11/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Machine perfusion is a promising strategy for donor heart preservation, but delivery of perfusate through the aorta may be limited by aortic valve incompetence. We hypothesized that retrograde machine perfusion preservation through the coronary sinus avoided this issue and allowed for recovery of donor hearts after long-term storage. METHODS Canine hearts were procured after arrest with 1 liter University of Wisconsin Machine Perfusion Solution (UWMPS) and preserved for 14 hours by static hypothermic storage (Static group, n = 5) or retrograde machine perfusion through the coronary sinus (RP group, n = 5). Myocardial oxygen consumption (MVo2) and lactate were monitored in perfused hearts. Hearts were implanted and reperfused for 6 hours. The pre-load recruitable stroke work was determined as a measure of myocardial function. Cardiac enzyme release was quantified. Cell death was evaluated by TUNEL (terminal deoxynucleotidyltransferase-mediated deoxy uridine triphosphate nick-end label). RESULTS MVo2 decreased initially then stabilized. Lactate accumulation was low in RP hearts. All RP hearts separated from cardiopulmonary bypass. All Static hearts required a return to bypass (p < .05). Pre-load recruitable stroke work in RP hearts was increased (55 ± 7 mm Hg) compared with Static (20 ± 11 mm Hg, p < .05) and did not differ from baseline values. Creatine kinase release was greater in Static group hearts (102 ± 16 IU/liter/g) than in RP hearts (51 ± 8 IU/liter/g, p < .05). The fraction of TUNEL-positive cells was higher in the Static group, but this difference was not significant. CONCLUSIONS Retrograde machine perfusion can preserve donor hearts for long intervals. Cardiac function after implantation suggested excellent myocardial protection. Retrograde machine perfusion appears promising for extending the donor ischemic interval and improving results of heart transplantation.
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Affiliation(s)
| | | | | | | | - John Shelton
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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21
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Gkouziouta A, Farmakis D, Manginas A, Sfyrakis P, Saroglou G, Adamopoulos S, Iliodromitis EK. Double organ transplantation in cardiac amyloidosis. J Cardiovasc Med (Hagerstown) 2016; 17:126-9. [DOI: 10.2459/jcm.0000000000000216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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BIN1 regulates dynamic t-tubule membrane. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2015; 1863:1839-47. [PMID: 26578114 DOI: 10.1016/j.bbamcr.2015.11.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/31/2015] [Accepted: 11/09/2015] [Indexed: 11/23/2022]
Abstract
Cardiac transverse tubules (t-tubules) are specific membrane organelles critical in calcium signaling and excitation-contraction coupling required for beat-to-beat heart contraction. T-tubules are highly branched and form an interconnected network that penetrates the myocyte interior to form junctions with the sarcoplasmic reticulum. T-tubules are selectively enriched with specific ion channels and proteins crucial in calcium transient development necessary in excitation-contraction coupling, thus t-tubules are a key component of cardiac myocyte function. In this review, we focus primarily on two proteins concentrated within the t-tubular network, the L-type calcium channel (LTCC) and associated membrane anchor protein, bridging integrator 1 (BIN1). Here, we provide an overview of current knowledge in t-tubule morphology, composition, microdomains, as well as the dynamics of the t-tubule network. Secondly, we highlight multiple aspects of BIN1-dependent t-tubule function, which includes forward trafficking of LTCCs to t-tubules, LTCC clustering at t-tubule surface, microdomain organization and regulation at t-tubule membrane, and the formation of a slow diffusion barrier within t-tubules. Lastly, we describe progress in characterizing how acquired human heart failure can be attributed to abnormal BIN1 transcription and associated t-tubule remodeling. Understanding BIN1-regulated cardiac t-tubule biology in human heart failure management has the dual benefit of promoting progress in both biomarker development and therapeutic target identification. This article is part of a Special Issue entitled: Cardiomyocyte Biology: Integration of Developmental and Environmental Cues in the Heart edited by Marcus Schaub and Hughes Abriel.
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23
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Mannon RB. Organ-specific features in clinical transplantation. Transpl Immunol 2015. [DOI: 10.1002/9781119072997.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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24
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Baumann Kreuziger LM, Kim B, Wieselthaler GM. Antithrombotic therapy for left ventricular assist devices in adults: a systematic review. J Thromb Haemost 2015; 13:946-55. [PMID: 25845489 DOI: 10.1111/jth.12948] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) have dramatically increased the survival of adults with end-stage systolic heart failure. However, rates of bleeding and thromboembolism remain high. OBJECTIVES We completed a systematic review to evaluate outcomes of adults with LVADs treated with various anticoagulant and antiplatelet strategies. METHODS Databases were searched using the terms 'assist device', 'thrombosis', and 'anticoagulant' or 'platelet aggregation inhibitor' with appropriate synonyms, device names and manufacturers. RESULTS AND CONCLUSIONS Of 977 manuscripts, 24 articles met the inclusion criteria of adults with implanted LVADs where clinical outcomes were defined based on anticoagulant and/or antiplatelet regimen. Most studies reported treatment with unfractionated heparin post-operatively which was transitioned to a vitamin K antagonist (VKA). Goal INR varied between 1.5-3.5. Antiplatelet regimens ranged from no treatment to dual therapy. Definition of major bleeding differed between trials and incidence varied between 0% and 58%. The available evidence could not demonstrate a clear benefit of aspirin compared with VKA therapy alone [stroke RR 1.02 (95% CI 0.49-2.1)]. There was a suggestion that treatment with aspirin and dipyridamole decreased the risk of thromboembolism compared to aspirin [RR 0.50 (0.36-0.68)], but the comparison is limited by differences in demographics, devices, and INR goals among studies. Additionally, most studies did not blind investigators to outcomes thus contributing to an increased risk for bias. Clinical equipoise exists as to the most appropriate antithrombotic therapy in LVAD patients. Randomization between regimens within a prospective trial is needed to define the treatment regimen that minimizes both bleeding and thrombotic complications.
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Affiliation(s)
- L M Baumann Kreuziger
- Department of Medicine/Hematology and Oncology, Blood Center of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - B Kim
- University of California San Francisco, San Francisco, CA, USA
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25
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Sánchez PL, Fernández-Santos ME, Costanza S, Climent AM, Moscoso I, Gonzalez-Nicolas MA, Sanz-Ruiz R, Rodríguez H, Kren SM, Garrido G, Escalante JL, Bermejo J, Elizaga J, Menarguez J, Yotti R, Pérez del Villar C, Espinosa MA, Guillem MS, Willerson JT, Bernad A, Matesanz R, Taylor DA, Fernández-Avilés F. Acellular human heart matrix: A critical step toward whole heart grafts. Biomaterials 2015; 61:279-89. [PMID: 26005766 DOI: 10.1016/j.biomaterials.2015.04.056] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/22/2015] [Accepted: 04/30/2015] [Indexed: 12/20/2022]
Abstract
The best definitive treatment option for end-stage heart failure currently is transplantation, which is limited by donor availability and immunorejection. Generating an autologous bioartificial heart could overcome these limitations. Here, we have decellularized a human heart, preserving its 3-dimensional architecture and vascularity, and recellularized the decellularized extracellular matrix (dECM). We decellularized 39 human hearts with sodium-dodecyl-sulfate for 4-8 days. Cell removal and architectural integrity were determined anatomically, functionally, and histologically. To assess cytocompatibility, we cultured human cardiac-progenitor cells (hCPC), bone-marrow mesenchymal cells (hMSCs), human endothelial cells (HUVECs), and H9c1 and HL-1 cardiomyocytes in vitro on dECM ventricles up to 21 days. Cell survival, gene expression, organization and/or electrical coupling were analyzed and compared to conventional 2-dimensional cultures. Decellularization removed cells but preserved the 3-dimensional cardiac macro and microstructure and the native vascular network in a perfusable state. Cell survival was observed on dECM for 21 days. hCPCs and hMSCs expressed cardiocyte genes but did not adopt cardiocyte morphology or organization; HUVECs formed a lining of endocardium and vasculature; differentiated cardiomyocytes organized into nascent muscle bundles and displayed mature calcium dynamics and electrical coupling in recellularized dECM. In summary, decellularization of human hearts provides a biocompatible scaffold that retains 3-dimensional architecture and vascularity and that can be recellularized with parenchymal and vascular cells. dECM promotes cardiocyte gene expression in stem cells and organizes existing cardiomyocytes into nascent muscle showing electrical coupling. These findings represent a first step toward manufacturing human heart grafts or matrix components for treating cardiovascular disease.
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Affiliation(s)
- Pedro L Sánchez
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain; Bioartifical Organs Laboratory, Department of Cardiology, Instituto de Investigación Sanitaria Hospital Gregorio Marañon (IiSGM), Madrid, Spain; Hospital Universitario de Salamanca, IBSAL, Salamanca, Spain
| | - M Eugenia Fernández-Santos
- Bioartifical Organs Laboratory, Department of Cardiology, Instituto de Investigación Sanitaria Hospital Gregorio Marañon (IiSGM), Madrid, Spain; Cell Production Unit, Department of Cardiology, Instituto de Investigación Sanitaria Hospital Gregorio Marañon (IiSGM), Madrid, Spain
| | - Salvatore Costanza
- Bioartifical Organs Laboratory, Department of Cardiology, Instituto de Investigación Sanitaria Hospital Gregorio Marañon (IiSGM), Madrid, Spain; Department of Cardiac Surgery, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - Andreu M Climent
- Bioartifical Organs Laboratory, Department of Cardiology, Instituto de Investigación Sanitaria Hospital Gregorio Marañon (IiSGM), Madrid, Spain
| | - Isabel Moscoso
- Department of Cardiovascular Development and Repair, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Instituto de Salud Carlos III, Spain
| | - M Angeles Gonzalez-Nicolas
- Bioartifical Organs Laboratory, Department of Cardiology, Instituto de Investigación Sanitaria Hospital Gregorio Marañon (IiSGM), Madrid, Spain
| | - Ricardo Sanz-Ruiz
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain; Bioartifical Organs Laboratory, Department of Cardiology, Instituto de Investigación Sanitaria Hospital Gregorio Marañon (IiSGM), Madrid, Spain
| | - Hugo Rodríguez
- Cell Production Unit, Department of Cardiology, Instituto de Investigación Sanitaria Hospital Gregorio Marañon (IiSGM), Madrid, Spain
| | - Stefan M Kren
- Center for Cardiovascular Repair, University of Minnesota, Minneapolis, USA
| | - Gregorio Garrido
- National Transplant Organization (ONT), Spanish Ministry of Health and Consumption, Spain
| | - Jose L Escalante
- Solid Organ Transplantation Program, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - Jaime Elizaga
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - Javier Menarguez
- Department of Pathology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Gregorio Marañon (IiSGM), Madrid, Spain
| | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - Candelas Pérez del Villar
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain
| | - M Angeles Espinosa
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain; Bioartifical Organs Laboratory, Department of Cardiology, Instituto de Investigación Sanitaria Hospital Gregorio Marañon (IiSGM), Madrid, Spain
| | - María S Guillem
- Bioartifical Organs Laboratory, Department of Cardiology, Instituto de Investigación Sanitaria Hospital Gregorio Marañon (IiSGM), Madrid, Spain
| | | | - Antonio Bernad
- Department of Cardiovascular Development and Repair, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Instituto de Salud Carlos III, Spain
| | - Rafael Matesanz
- National Transplant Organization (ONT), Spanish Ministry of Health and Consumption, Spain
| | - Doris A Taylor
- Bioartifical Organs Laboratory, Department of Cardiology, Instituto de Investigación Sanitaria Hospital Gregorio Marañon (IiSGM), Madrid, Spain; Regenerative Medicine Research, Texas Heart Institute, Houston, USA.
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Madrid, Spain; Bioartifical Organs Laboratory, Department of Cardiology, Instituto de Investigación Sanitaria Hospital Gregorio Marañon (IiSGM), Madrid, Spain.
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26
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Abstract
Background—
This study evaluated whether minority orthotopic heart transplant (OHT) recipients tend to be transplanted at worse performing centers.
Methods and Results—
OHT recipients between 2000 and 2010 were identified in the United Network for Organ Sharing database and stratified by race. Center performance was evaluated using observed-to-expected mortality ratios that were calculated using validated indexes for recipient and donor risk in OHT. The primary outcome was 1-year post-OHT mortality. A total of 102 centers performed OHT in 18 085 patients. Blacks had higher unadjusted 1-year mortality, which was confirmed after risk adjustment. Blacks had increased risk-adjusted mortality at poor performing centers (observed-to-expected mortality ratio, >1.2; odds ratio, 1.37 [95% confidence interval, 1.12–1.69];
P
=0.002) and a strong trend toward increased mortality at excellent performing centers (observed-to-expected mortality ratio, <0.8; odds ratio, 1.42 [95% confidence interval, 0.99–2.02];
P
=0.06). A higher proportion of blacks were treated at centers with higher-than-expected mortality (56.4% versus 47.1% whites versus 48.1% Hispanics;
P
<0.001), a finding that persisted after adjusting for insurance type and highest education level. In addition, there was a positive correlation between the percentage of blacks and observed-to-expected mortality ratios at the center level (
r
=0.32;
P
=0.001). In multivariable analysis incorporating immunologic and socioeconomic variables, there was no clear dominant source for the disparities in outcomes of OHT between races.
Conclusions—
Blacks have a propensity to be transplanted at worse performing centers; however, center effect alone does not explain the mortality difference between ethnicities. Although referral of minorities to better performing centers would improve absolute survival, it would not likely eliminate the racial disparities that exist in OHT outcomes.
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Affiliation(s)
- Arman Kilic
- From Department of Surgery, Johns Hopkins Hospital, Baltimore, MD (Arman Kilic); and Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH (R.S.D.H., B.A.W., Ahmet Kilic)
| | - Robert S. D. Higgins
- From Department of Surgery, Johns Hopkins Hospital, Baltimore, MD (Arman Kilic); and Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH (R.S.D.H., B.A.W., Ahmet Kilic)
| | - Bryan A. Whitson
- From Department of Surgery, Johns Hopkins Hospital, Baltimore, MD (Arman Kilic); and Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH (R.S.D.H., B.A.W., Ahmet Kilic)
| | - Ahmet Kilic
- From Department of Surgery, Johns Hopkins Hospital, Baltimore, MD (Arman Kilic); and Division of Cardiac Surgery, Department of Surgery, Ohio State University Wexner Medical Center, Columbus, OH (R.S.D.H., B.A.W., Ahmet Kilic)
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27
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Mujib M, Khanna N, Mazumder NK, Aronow WS, Kolte D, Khera S, Palaniswamy C, Jain D, Lanier GM, Sule S, Ahmed A, Levy WC, Prabhu SD, Cooper HA, Panza JA, Gass AL, Fonarow GC. Pretransplant coagulopathy and in-hospital outcomes among heart transplant recipients: a propensity-matched nationwide inpatient sample study. Clin Cardiol 2015; 38:300-8. [PMID: 25684174 DOI: 10.1002/clc.22391] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/05/2015] [Accepted: 01/07/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The prevalence and contemporary trends of pre-heart transplantation (HT) coagulopathy and associated clinical outcomes have not been studied from a national database. HYPOTHESIS Pre-HT coagulopathy is associated with increased in-hospital mortality. METHODS Among 2454 adult HT recipients from the 2003 to 2010 Nationwide Inpatient Sample databases, 707 (29%) had pre-HT coagulopathy (defined as a comorbidity variable, based on International Classification of Diseases, Ninthe Revision, Clinical Modification and Diagnosis Related Group codes). We used propensity scores for coagulopathy to assemble a matched cohort of 664 pairs of patients with and without coagulopathy balanced in 54 baseline characteristics. RESULTS The prevalence of pre-HT coagulopathy increased from 17% in 2003 to 44% in 2010 (P for trend <0.001). In-hospital mortality occurred in 8.6% and 4.7% of matched HT recipients with and without coagulopathy, respectively (hazard ratio: 1.81; 95% confidence interval [CI]: 1.17-2.80; P = 0.008). Coagulopathy was not significantly associated with post-HT graft complications (odds ratio [OR]: 1.20; 95% CI: 0.95-1.52; P = 0.131) but was associated with increased blood transfusions (OR: 1.92; 95% CI, 1.54-2.41; P < 0.001). Coagulopathy and no-coagulopathy groups had no difference in median length of stay (22 days in each group, P = 0.746), but median total hospital charges were higher among patients with coagulopathy compared to those without (US$425 643 vs US$389 656; P = 0.008). CONCLUSIONS In this national study of HT recipients, pretransplant coagulopathy was common, increased over time, and was not significantly associated with post-HT graft complications or increased hospital stay. However, it was associated with increased bleeding risk, in-hospital mortality, and total hospital charges. These findings may have implications for the selection of patients for HT.
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Affiliation(s)
- Marjan Mujib
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Neel Khanna
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Nabila K Mazumder
- Department of Medicine, Flushing Hospital Medical Center, Flushing, New York
| | - Wilbert S Aronow
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Dhaval Kolte
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Sahil Khera
- Division of Cardiology, New York Medical College, Valhalla, New York
| | | | - Diwakar Jain
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Gregg M Lanier
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Sachin Sule
- Department of Medicine, New York Medical College, Valhalla, New York
| | - Ali Ahmed
- Department of Medicine, Washington DC VA Medical Center, Washington, DC
| | - Wayne C Levy
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Sumanth D Prabhu
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Howard A Cooper
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Julio A Panza
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Alan L Gass
- Division of Cardiology, New York Medical College, Valhalla, New York
| | - Gregg C Fonarow
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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28
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Ansari D, Bućin D, Nilsson J. Human leukocyte antigen matching in heart transplantation: systematic review and meta-analysis. Transpl Int 2014; 27:793-804. [PMID: 24725030 DOI: 10.1111/tri.12335] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/16/2014] [Accepted: 04/07/2014] [Indexed: 11/29/2022]
Abstract
Allocation of donors with regard to human leukocyte antigen (HLA) is controversial in heart transplantation. This paper is a systematic review and meta-analysis of the available evidence. PubMed, Embase, and the Cochrane Library were searched systematically for studies that addressed the effects of HLA matching on outcome after heart transplantation. Fifty-seven studies met the eligibility criteria. 34 studies had graft rejection as outcome, with 26 of the studies reporting a significant reduction in graft rejection with increasing degree of HLA matching. Thirteen of 18 articles that reported on graft failure found that it decreased significantly with increasing HLA match. Two multicenter studies and nine single-center studies provided sufficient data to provide summary estimates at 12 months. Pooled comparisons showed that graft survival increased with fewer HLA-DR mismatches [0-1 vs. 2 mismatches: risk ratio (RR) = 1.09 (95% confidence interval (CI): 1.01-1.19; P = 0.04)]. Having fewer HLA-DR mismatches (0-1 vs. 2) reduced the incidence of acute rejection [(RR = 0.81 (0.66-0.99; P = 0.04)]. Despite the considerable heterogeneity between studies, the short observation time, and older data, HLA matching improves graft survival in heart transplantation. Prospective HLA-DR matching is clinically feasible and should be considered as a major selection criterion.
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Affiliation(s)
- David Ansari
- Division of Cardiothoracic Surgery, Department of Clinical Sciences Lund, Lund University and Skane University Hospital, Lund, Sweden
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29
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Lee KF, Lin CY, Tsai YT, Lee CY, Hsu PS, Lin YC, Yang HY, Kao CH, Song J, Sung SY, Lin FY, Lee WH, Tsai CS. The Status of Heart Transplantation in Taiwan, 2005–2010. Transplant Proc 2014; 46:934-6. [DOI: 10.1016/j.transproceed.2013.11.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 11/22/2013] [Indexed: 11/28/2022]
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30
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Cobert ML, Merritt ME, West LM, Ayers C, Jessen ME, Peltz M. Metabolic characteristics of human hearts preserved for 12 hours by static storage, antegrade perfusion, or retrograde coronary sinus perfusion. J Thorac Cardiovasc Surg 2014; 148:2310-2315.e1. [PMID: 24642559 DOI: 10.1016/j.jtcvs.2014.02.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/17/2014] [Accepted: 02/03/2014] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Machine perfusion of donor hearts is a promising strategy to increase the donor pool. Antegrade perfusion is effective but can lead to aortic valve incompetence and nonnutrient flow. Experience with retrograde coronary sinus perfusion of donor hearts has been limited. We tested the hypothesis that retrograde perfusion could support myocardial metabolism over an extended donor ischemic interval. METHODS Human hearts from donors that were rejected or not offered for transplantation were preserved for 12 hours in University of Wisconsin Machine Perfusion Solution by: (1) static hypothermic storage; (2) hypothermic antegrade machine perfusion; or (3) hypothermic retrograde machine perfusion. Myocardial oxygen consumption (MVO2), and lactate accumulation were measured. Ventricular tissue was collected for proton and phosphorus 31 magnetic resonance spectroscopy (MRS) to evaluate the metabolic state of the myocardium. Myocardial water content was determined at the end of the experiment. RESULTS Stable perfusion parameters were maintained throughout the perfusion period with both perfusion techniques. Lactate/alanine ratios were lower in perfused hearts compared with static hearts (P<.001). Lactate accumulation (antegrade 2.0±0.7 mM, retrograde 1.7±0.1 mM) and MVO2 (antegrade 0.25±0.2 mL, retrograde 0.26±0.3 mL O2/min/100 g) were similar in machine-perfused groups. High-energy phosphates were better preserved in both perfused groups (P<.05). Left ventricular myocardial water content was increased in retrograde perfused hearts (80.2±0.8%) compared with both antegrade perfused hearts (76.6±0.8%, P=.02) and static storage hearts (76.7±1%, P=.02). CONCLUSIONS Machine perfusion by either the antegrade or the retrograde technique can support myocardial metabolism over long intervals. Machine perfusion seems promising for long-term preservation of human donor hearts.
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Affiliation(s)
- Michael L Cobert
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Matthew E Merritt
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Tex
| | - LaShondra M West
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Colby Ayers
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Michael E Jessen
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
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31
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da Silva BU, Jatene AD, Leme J, Fonseca JWG, Silva C, Uebelhart B, Suzuki CK, Andrade AJP. In vitro assessment of the Apico Aortic Blood Pump: anatomical positioning, hydrodynamic performance, hemolysis studies, and analysis in a hybrid cardiovascular simulator. Artif Organs 2013; 37:950-3. [PMID: 24251772 DOI: 10.1111/aor.12229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Apico Aortic Blood Pump (AABP) is a centrifugal continuous flow left ventricular assist device (LVAD) with ceramic bearings. The device is in the initial development phase and is being designed to be attached directly to the left ventricular apex by introducing an inlet cannula. This paper reports results from in vitro experiments. In order to evaluate implantation procedures and device dimensioning, in vitro experiments included an anatomic positioning study for the analysis of surgical implantation procedure and device dimensions and positioning that was performed using the body of a pig. The results revealed no damage caused by the device, and the surgical implantation procedure was considered feasible. Hydrodynamic performance curves were obtained to verify the applicability of the device as an LVAD, showing adequate performance. Mechanical blood trauma was analyzed through 6-h hemolysis tests, with total pressure head of 100 mm Hg and flow of 5 L/min. Mean normalized index of hemolysis was 0.009 g/100 L (±0.002 g/100 L). Studies using a hybrid cardiovascular simulator were conducted for three types of circulatory conditions: normal healthy conditions, concentric hypertrophic heart failure (CHHF), and CHHF with AABP assistance. Analysis of cardiovascular parameters under those three conditions demonstrated that when the AABP was assisting the system, parameters under CHHF conditions went back to normal healthy values, indicating the AABP's effectiveness as CHHF therapy. Our preliminary results indicate that it is feasible to use the AABP as a LVAD. The next steps include long-term in vivo experiments.
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Affiliation(s)
- Bruno Utiyama da Silva
- Department of Bioengineering, Engineering Center for Cardiac Assistance, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil; Faculty of Mechanical Engineering, Department of Materials, State University of Campinas, Campinas, São Paulo, Brazil
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32
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Risk factors for mortality or delisting of patients from the pediatric heart transplant waiting list. J Thorac Cardiovasc Surg 2013; 147:462-8. [PMID: 24183905 DOI: 10.1016/j.jtcvs.2013.09.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 08/12/2013] [Accepted: 09/08/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Current literature assessing factors associated with outcomes of patients waiting for pediatric heart transplants has focused on survival to transplant and mortality. Our aim was to determine risk factors associated with the outcomes of delisting, transplant, or death while waiting. METHODS In this single-center, retrospective study of patients listed for heart transplants, competing risk analysis was used to model survival from listing to 4 competing outcomes (transplant, death, delisting for clinical deterioration, delisting for clinical improvement or surgical intervention). RESULTS There were 308 listing episodes in 280 patients. In competing risk analysis, 11% remained listed at 6 months (transplant 62%, dead 13%, delisted worse 6%, delisted improved 8%). Extracorporeal membrane oxygenation and ventricular assist devices were associated both with higher probability of transplant (hazard ratio [HR], 2.8; P < .001) and delisting for clinical deterioration (HR, 2.7; P = .06). Younger age at listing and complex congenital heart disease were shared risk factors for mortality (HR, 1.07; P = .05; HR, 2.9; P = .003) and delisting because of clinical deterioration (HR, 1.17; P = .01; HR, 2.8; P = .02). Younger age at listing and fetal listing were associated with delisting for clinical improvement or surgical intervention (HR, 1.13; P = .01; HR, 2.9; P = .02). CONCLUSIONS Overall survival to transplant depends on risk factors including age at listing, cardiac diagnosis, and mechanical circulatory support. Knowledge of risk factors for death and delisting for clinical deterioration or improvement can assist patient selection and timing of transplant listing.
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33
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Baranyi A, Krauseneck T, Rothenhäusler HB. Posttraumatic stress symptoms after solid-organ transplantation: preoperative risk factors and the impact on health-related quality of life and life satisfaction. Health Qual Life Outcomes 2013; 11:111. [PMID: 23822659 PMCID: PMC3717120 DOI: 10.1186/1477-7525-11-111] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 07/01/2013] [Indexed: 01/18/2023] Open
Abstract
Background Solid-organ transplantations (SOT) are usually life-saving high-tech medical procedures. The transplantation itself and the intensive care unit stay could be traumatic stressors triggering posttraumatic stress symptoms (PTSS). Our retrospective follow-up study aimed to explore preoperative risk factors of PTSS in a cohort of SOT recipients, and we investigated how PTSS are associated with health-related quality of life (HRQOL) and life satisfaction. Methods 126 SOT recipients were enrolled in this investigation. Psychiatric examination of all SOT candidates based on the Transplant Evaluation Rating Scale was carried out before SOT, and after SOT, recipients completed the PTSS-10, the SF-36 and the FLZ. Results After the surgical intervention 19 (15.1%) SOT recipients had clinical significant PTSS. Preoperative risk factors for developing postoperative PTSS were: 1.) preexisting psychiatric morbidity, 2.) history of retransplantation, 3.) chronic benzodiazepine consumption, 4.) age, and 5.) type of transplantation. SOT-related PTSS were associated with maximal decrements in HRQOL and life satisfaction. The following HRQOL and life satisfaction domains were affected: Physical Functioning, Role Physical, Pain, General Health, Vitality, Social Functioning, Role Emotional, Mental Health, Occupation/Work and Character/Own Skills. Conclusion SOT recipients may face a major risk of transplantation- and treatment-related PTSS and the development of impairments to HRQOL and life satisfaction.
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Affiliation(s)
- Andreas Baranyi
- Department of Psychiatry, University of Medicine of Graz, Auenbruggerplatz 31, Graz 8036, Austria.
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34
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Singh TP, Almond CS, Piercey G, Gauvreau K. Risk Stratification and Transplant Benefit in Children Listed for Heart Transplant in the United States. Circ Heart Fail 2013; 6:800-8. [DOI: 10.1161/circheartfailure.112.000280] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tajinder P. Singh
- From the Department of Cardiology, Boston Children’s Hospital, Boston, MA (T.P.S., C.S.A., G.P., K.G.); Department of Pediatrics, Harvard Medical School, Boston, MA (T.P.S., C.S.A.); and Department of Biostatistics, Harvard School of Public Health, Boston, MA (K.G.)
| | - Christopher S. Almond
- From the Department of Cardiology, Boston Children’s Hospital, Boston, MA (T.P.S., C.S.A., G.P., K.G.); Department of Pediatrics, Harvard Medical School, Boston, MA (T.P.S., C.S.A.); and Department of Biostatistics, Harvard School of Public Health, Boston, MA (K.G.)
| | - Gary Piercey
- From the Department of Cardiology, Boston Children’s Hospital, Boston, MA (T.P.S., C.S.A., G.P., K.G.); Department of Pediatrics, Harvard Medical School, Boston, MA (T.P.S., C.S.A.); and Department of Biostatistics, Harvard School of Public Health, Boston, MA (K.G.)
| | - Kimberlee Gauvreau
- From the Department of Cardiology, Boston Children’s Hospital, Boston, MA (T.P.S., C.S.A., G.P., K.G.); Department of Pediatrics, Harvard Medical School, Boston, MA (T.P.S., C.S.A.); and Department of Biostatistics, Harvard School of Public Health, Boston, MA (K.G.)
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35
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Plonka C, Wearden PD, Morell VO, Miller SA, Webber SA, Feingold B. Successful heart transplantation from a donor with Ullrich congenital muscular dystrophy. Am J Transplant 2013; 13:1915-7. [PMID: 23668812 PMCID: PMC3782115 DOI: 10.1111/ajt.12246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 02/11/2013] [Accepted: 02/23/2013] [Indexed: 01/25/2023]
Abstract
Heart transplantation is the most effective therapy for children with end-stage heart disease; however, its use is limited by the number of donor organs available. This shortage may be further compounded by concerns about organ quality, leading to refusal of potential donor organ offers. We report on the successful transplantation and 5-year follow-up of a heart from a donor with Ullrich congenital muscular dystrophy (UCMD). The candidate was critically ill at the time of the transplant and the donor organ was declined repeatedly on the match run list due to concerns about organ quality, despite having normal cardiac function by echocardiography on minimal inotropic support. We believe the diagnosis of "muscular dystrophy" in the donor combined with a lack of understanding about the specifics of the diagnosis of UCMD enabled our candidate to receive a primary offer for this organ. We are unaware of any previous reports of the use of a heart from a donor with UCMD for orthotopic heart transplantation in adults or children.
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Affiliation(s)
- Caitlyn Plonka
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Peter D. Wearden
- Pediatric Cardiothoracic Surgery, Children's Hospital of
Pittsburgh of UPMC, Pittsburgh, PA
| | - Victor O. Morell
- Pediatric Cardiothoracic Surgery, Children's Hospital of
Pittsburgh of UPMC, Pittsburgh, PA
| | - Steven A. Miller
- Pediatric Cardiology, Children's Hospital of Pittsburgh of
UPMC, Pittsburgh, PA
| | | | - Brian Feingold
- Pediatric Cardiology, Children's Hospital of Pittsburgh of
UPMC, Pittsburgh, PA,Clinical and Translational Science, University of Pittsburgh School
of Medicine, Pittsburgh, PA
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36
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Estep JD, Bhimaraj A, Cordero-Reyes AM, Bruckner B, Loebe M, Torre-Amione G. Heart transplantation and end-stage cardiac amyloidosis: a review and approach to evaluation and management. Methodist Debakey Cardiovasc J 2013; 8:8-16. [PMID: 23227279 DOI: 10.14797/mdcj-8-3-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Cardiac amyloidosis is one of the most common of the infiltrative cardiomyopathies and is associated with a poor prognosis. The extent of cardiac involvement with amyloid deposition is an important determinant of treatment options and is the major determinant of outcome in patients with amyloidosis. Several small case series with sequential orthotopic heart transplantation and autologous stem cell transplant have demonstrated an improvement in post-transplant outcome and have revived enthusiasm about heart transplantation for patients with end-stage heart failure due to AL amyloidosis. The purpose of this review is to summarize the evaluation and management of cardiac amyloidosis and to provide our single-center experience with end-stage heart failure due to AL amyloidosis treated with heart transplantation followed by an autologous stem cell transplant.
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Affiliation(s)
- Jerry D Estep
- Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
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37
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Wever-Pinzon O, Drakos SG, Kfoury AG, Nativi JN, Gilbert EM, Everitt M, Alharethi R, Brunisholz K, Bader FM, Li DY, Selzman CH, Stehlik J. Morbidity and mortality in heart transplant candidates supported with mechanical circulatory support: is reappraisal of the current United network for organ sharing thoracic organ allocation policy justified? Circulation 2012; 127:452-62. [PMID: 23271796 DOI: 10.1161/circulationaha.112.100123] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Survival of patients on left ventricular assist devices (LVADs) has improved. We examined the differences in risk of adverse outcomes between LVAD-supported and medically managed candidates on the heart transplant waiting list. METHODS AND RESULTS We analyzed mortality and morbidity in 33,073 heart transplant candidates registered on the United Network for Organ Sharing (UNOS) waiting list between 1999 and 2011. Five groups were selected: patients without LVADs in urgency status 1A, 1B, and 2; patients with pulsatile-flow LVADs; and patients with continuous-flow LVADs. Outcomes in patients requiring biventricular assist devices, total artificial heart, and temporary VADs were also analyzed. Two eras were defined on the basis of the approval date of the first continuous-flow LVAD for bridge to transplantation in the United States (2008). Mortality was lower in the current compared with the first era (2.1%/mo versus 2.9%/mo; P<0.0001). In the first era, mortality of pulsatile-flow LVAD patients was higher than in status 2 (hazard ratio [HR], 2.15; P<0.0001) and similar to that in status 1B patients (HR, 1.04; P=0.61). In the current era, patients with continuous-flow LVADs had mortality similar to that of status 2 (HR, 0.80; P=0.12) and lower mortality compared with status 1A and 1B patients (HR, 0.24 and 0.47; P<0.0001 for both comparisons). However, status upgrade for LVAD-related complications occurred frequently (28%) and increased the mortality risk (HR, 1.75; P=0.001). Mortality was highest in patients with biventricular assist devices (HR, 5.00; P<0.0001) and temporary VADs (HR, 7.72; P<0.0001). CONCLUSIONS Mortality and morbidity on the heart transplant waiting list have decreased. Candidates supported with contemporary continuous-flow LVADs have favorable waiting list outcomes; however, they worsen significantly once a serious LVAD-related complication occurs. Transplant candidates requiring temporary and biventricular support have the highest risk of adverse outcomes. These results may help to guide optimal allocation of donor hearts.
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Affiliation(s)
- Omar Wever-Pinzon
- U.T.A.H. Cardiac Transplant Program, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA
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38
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Colvin-Adams M, Valapour M, Hertz M, Heubner B, Paulson K, Dhungel V, Skeans MA, Edwards L, Ghimire V, Waller C, Cherikh WS, Kasiske BL, Snyder JJ, Israni AK. Lung and heart allocation in the United States. Am J Transplant 2012; 12:3213-34. [PMID: 22974276 DOI: 10.1111/j.1600-6143.2012.04258.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Lung and heart allocation in the United States has evolved over the past 20-30 years to better serve transplant candidates and improve organ utilization. The current lung allocation policy, based on the Lung Allocation Score, attempts to take into account risk of death on the waiting list and chance of survival posttransplant. This policy is flexible and can be adjusted to improve the predictive ability of the score. Similarly, in response to the changing clinical phenotype of heart transplant candidates, heart allocation policies have evolved to a multitiered algorithm that attempts to prioritize organs to the most infirm, a designation that fluctuates with trends in therapy. The Organ Procurement and Transplantation Network and its committees have been responsive, as demonstrated by recent modifications to pediatric heart allocation and mechanical circulatory support policies and by ongoing efforts to ensure that heart allocation policies are equitable and current. Here we examine the development of US lung and heart allocation policy, evaluate the application of the current policy on clinical practice and explore future directions for lung and heart allocation.
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Affiliation(s)
- M Colvin-Adams
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
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Khemees TA, Shabsigh A. Regaining candidacy for heart transplantation after robotic assisted laparoscopic radical prostatectomy in left ventricular assist device patient. Case Rep Transplant 2012; 2012:716201. [PMID: 23259138 PMCID: PMC3505944 DOI: 10.1155/2012/716201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 09/14/2012] [Indexed: 01/11/2023] Open
Abstract
Several factors may highlight the relevance of prostate cancer to the pre-heart-transplant population. First, the expansion in candidate selection criteria led to increased number of men over the age of fifty to be considered for heart transplantation. With the introduction of left ventricular assist device (LVAD) therapy, waiting-list mortality has dramatically declined over the past decade. Additionally, transplant candidates are diligently screened for preexisting neoplasm while on the waiting list. Taken together, screening-detected prostate cancer may increasingly be diagnosed in patients on the waiting list. If discovered, it will pose unique challenge to clinicians as to date there has been no universally accepted management guideline. We report a case of LVAD-treated heart transplant candidate diagnosed with prostate cancer while on the waiting list. Patient screening demonstrated PSA elevation which prompted prostate biopsy. Low-risk clinically localized prostate cancer was confirmed and led to removal of patient from transplant list. When counseled regarding management of his cancer, the patient elected to undergo radical prostatectomy in a hope to regain candidacy for heart transplantation. Despite being of high surgical risk, multidisciplinary team approach led to successful management of prostate cancer and the patient eventually received heart transplant one year following prostatectomy.
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Affiliation(s)
- Tariq A. Khemees
- Department of Urology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43212, USA
| | - Ahmad Shabsigh
- Department of Urology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43212, USA
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Ritchie SA, Patel MJ, Miller SJ. Therapeutic options to decrease actinic keratosis and squamous cell carcinoma incidence and progression in solid organ transplant recipients: a practical approach. Dermatol Surg 2012; 38:1604-21. [PMID: 22646842 DOI: 10.1111/j.1524-4725.2012.02452.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Solid organ transplant recipients (SOTRs) have a 50 to 250 times greater risk of squamous cell carcinoma (SCC) than the general population and experience higher rates of invasive and metastatic disease. These greater risks are a product of the tumorigenic effects of their immunosuppressive medications. As the number of transplantations and the life expectancy of SOTRs increase, SCCs are becoming a major source of morbidity and mortality. OBJECTIVE To present a practical approach for busy practicing clinicians to the care of SOTRs who are developing SCCs. Topics include assessment and treatment of new and neglected SOTRs; the dermatologist's role with the transplantation team; and practical considerations in the choice of topical agents, systemic agents, and immunosuppressive therapy manipulation. METHODS AND MATERIALS An extensive literature search of the understanding of SCC pathophysiology and treatment in SOTRs was conducted. RESULTS Presented here is a logical, concise guide to the care of SOTRs who are developing actinic keratoses and SCCs. CONCLUSION Proper assessment of patients, understanding therapeutic alternatives and their application, and early institution of preventative and adjuvant therapies can help to decrease skin cancer-related morbidity and mortality in SOTRs.
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Affiliation(s)
- Simon A Ritchie
- Department of Dermatology, School of Medicine, University of Maryland, Baltimore, Maryland 21201, USA.
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Evaluation of GI bleeding after implantation of left ventricular assist device. Gastrointest Endosc 2012; 75:973-9. [PMID: 22341716 PMCID: PMC3835739 DOI: 10.1016/j.gie.2011.12.014] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 12/07/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) have revolutionized the management of end-stage heart failure (ESHF). However, unexpectedly high rates of GI bleeding (GIB) have been described, and etiology and outcome remain unclear. OBJECTIVE To determine the prevalence, etiology, and outcome of GIB in LVAD recipients. DESIGN Retrospective case series. SETTING Tertiary care academic university hospital. PATIENTS 154 ESHF patients (55.4 years, 122 men/32 women) with LVADs implanted over a 10-year period. MAIN OUTCOME MEASUREMENTS Overt or occult GIB prompting endoscopic evaluation ≥ 7 days after LVAD implantation. RESULTS Over a mean of 0.9 ± 0.1 years of follow-up, 29 patients (19%) experienced 44 GIB episodes. Patients with GIB were older and received anticoagulation therapy before devices were implanted (P ≤ .02 for each). GIB was overt (n = 31) rather than occult (n = 13), and most patients presented with melena (n = 22, 50%); hemodynamic instability was observed in 13.6%. Each bleeding episode required 2.1 ± 0.1 diagnostic or therapeutic procedures, and a source was localized in 71%. Upper endoscopy provided the highest diagnostic yield; peptic bleeding (n = 14) and vascular malformations (n = 8) dominated the findings. Endoscopy was safe and well tolerated. Overall mortality was 35%, none directly from GIB. LIMITATION Retrospective design. CONCLUSIONS Rates of GIB with LVADs are higher than that seen in other patient populations, including those receiving anticoagulation and antiplatelet therapy. GIB episodes are mostly overt and predominantly from the upper GI tract. Endoscopy is safe in the LVAD population.
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Affiliation(s)
- Michael M. Givertz
- From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Singh TP, Almond CS, Taylor DO, Graham DA. Decline in Heart Transplant Wait List Mortality in the United States Following Broader Regional Sharing of Donor Hearts. Circ Heart Fail 2012; 5:249-58. [DOI: 10.1161/circheartfailure.111.964247] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Tajinder P. Singh
- From the Department of Cardiology, Children's Hospital Boston, Boston, MA (T.P.S., C.S.A., D.A.G.); Department of Pediatrics, Harvard Medical School, Boston, MA (T.P.S., C.S.A., D.A.G.); Department of Cardiology, Cleveland Clinic, Cleveland, OH (D.O.T.)
| | - Christopher S. Almond
- From the Department of Cardiology, Children's Hospital Boston, Boston, MA (T.P.S., C.S.A., D.A.G.); Department of Pediatrics, Harvard Medical School, Boston, MA (T.P.S., C.S.A., D.A.G.); Department of Cardiology, Cleveland Clinic, Cleveland, OH (D.O.T.)
| | - David O. Taylor
- From the Department of Cardiology, Children's Hospital Boston, Boston, MA (T.P.S., C.S.A., D.A.G.); Department of Pediatrics, Harvard Medical School, Boston, MA (T.P.S., C.S.A., D.A.G.); Department of Cardiology, Cleveland Clinic, Cleveland, OH (D.O.T.)
| | - Dionne A. Graham
- From the Department of Cardiology, Children's Hospital Boston, Boston, MA (T.P.S., C.S.A., D.A.G.); Department of Pediatrics, Harvard Medical School, Boston, MA (T.P.S., C.S.A., D.A.G.); Department of Cardiology, Cleveland Clinic, Cleveland, OH (D.O.T.)
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Califano S, Pagani FD, Malani PN. Left Ventricular Assist Device–Associated Infections. Infect Dis Clin North Am 2012; 26:77-87. [DOI: 10.1016/j.idc.2011.09.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Comparison of Observed Survival After Ventricular Assist Device Placement Versus Predicted Survival Without Assist Device Using the Seattle Heart Failure Model. ASAIO J 2012; 58:93-7. [DOI: 10.1097/mat.0b013e31824450f9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
The Levitronix PediVAS is an extracorporeal magnetically levitated pediatric ventricular assist system with an optimal flow rate range of 0.3-1.5 L/min. The system is being tested in preclinical studies to assess hemodynamic performance and biocompatibility. The PediVAS was implanted in nine ovines for 30 days using either commercially available cannulae (n = 3) or customized Levitronix cannulae (n = 6). Blood biocompatibility in terms of circulating activated platelets was measured by flow cytometric assays to detect P-selectin. Platelet activation was further examined after exogenous agonist stimulation. Platelet activation increased after surgery and eventually returned to baseline in animal studies where minimal kidney infarcts were observed. Platelet activation remained elevated for the duration of the study in animals where a moderate number of kidney infarcts with or without thrombotic deposition in the cannulae were observed. When platelet activation did return to baseline, platelets appropriately responded to agonist stimulation, signifying conserved platelet function after PediVAS implant. Platelet activation returned to baseline in the majority of studies, representing a promising biocompatibility result for the Levitronix PediVAS.
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Canver CC, Al Buraiki JA, Saad E, Yousafzai SM, Al Ahmadi MD, Al Sanei AM. A high-volume heart transplantation center in an Islamic country. Asian Cardiovasc Thorac Ann 2012; 19:244-8. [PMID: 21885550 DOI: 10.1177/0218492311408732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac transplants are performed sporadically or not at all in the majority of predominantly Muslim countries in the Middle East. We examined our experience in 76 patients who underwent heart transplantation between January 2005 and May 2010 in our center in Saudi Arabia. Excluded were 50 transplants performed between 1989 and 2004, due to incomplete data. Primary outcomes were complications, 30-day and late mortality rates, and 1-year survival. The heart transplant activity between 2005 and 2010 (15.0 per year) was 4.5-fold higher than that between 1989 and 2004 (3.3 per year). There were 61 (80%) men and 15 (20%) women, with a mean age of 35 years (range, 13-57 years). The mean waiting list time was 64 days (range, 1-262 days), and hospital stay was 30 days (range, 12-166 days). Major complications were infection (10), low-grade rejection (9), reoperation for hemorrhage (8), and sternal dehiscence (2). The 30-day mortality was 7.8% (6/76). Actuarial survival was 87.4% at 1 year and 81.5% at 3 years. A hospital in a Muslim country can increase cardiac transplant activity with excellent 30-day mortality and early survival comparable to that in worldwide counterparts.
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Affiliation(s)
- Charles C Canver
- King Faisal Heart Institute, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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Singh TP, Almond CS, Piercey G, Gauvreau K. Trends in wait-list mortality in children listed for heart transplantation in the United States: era effect across racial/ethnic groups. Am J Transplant 2011; 11:2692-9. [PMID: 21883920 PMCID: PMC4243846 DOI: 10.1111/j.1600-6143.2011.03723.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We sought to evaluate trends in overall and race-specific pediatric heart transplant (HT) wait-list mortality in the United States (US) during the last 20 years. We identified all children <18 years old listed for primary HT in the US during 1989-2009 (N = 8096, 62% White, 19% Black, 13% Hispanic and 6% Other) using the Organ Procurement and Transplant Network database. Wait-list mortality was assessed in four successive eras (1989-1994, 1995-1999, 2000-2004 and 2005-2009). Overall wait-list mortality declined in successive eras (26%, 23%, 18% and 13%, respectively). The decline across eras remained significant in adjusted analysis (hazard ratio [HR] 0.70 in successive eras, 95% confidence interval [CI], 0.67-0.74) and was 67% lower for children listed during 2005-2009 versus those listed during 1989-1994 (HR 0.33; CI, 0.28-0.39). In models stratified by race, wait-list mortality decreased in all racial groups in successive eras. In models stratified by era, minority children were not at higher risk of wait-list mortality in the most recent era. We conclude that the risk of wait-list mortality among US children listed for HT has decreased by two-thirds during the last 20 years. Racial gaps in wait-list mortality present variably in the past are not present in the current era.
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Affiliation(s)
- T P Singh
- Department of Cardiology, Children's Hospital Boston, Boston, MA, USA.
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Ensor CR, Trofe-Clark J, Gabardi S, McDevitt-Potter LM, Shullo MA. Generic Maintenance Immunosuppression in Solid Organ Transplant Recipients. Pharmacotherapy 2011; 31:1111-29. [DOI: 10.1592/phco.31.11.1111] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Individuals afflicted with advanced systolic heart failure who have become unresponsive to standard medical and electrical therapies are categorized as having American Heart Association stage D heart failure. The high mortality rates for medically treated stage D heart failure have not improved in the last 10 years, and patients at this advanced stage require either palliative measures or surgical management of heart failure. In recent years, surgically implanted ventricular assist devices (VADs) have become available for long-term use and are now commonly used as a therapy for advanced heart failure. The data generated from this early experience have clearly shown that VADs improve survival and quality of life in patients with advanced heart failure when implanted as a temporary measure or as long-term support. However, with a growing heart failure population, there is much work to be done to continually improve VAD technology, patient selection criteria, and postimplantation management to define the optimal role for assist devices in the management of systolic heart failure.
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Affiliation(s)
- Chetan B Patel
- Division of Cardiology, Duke University Medical Center, Durham, NC 27710, USA
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