1
|
Firoz A, Geier S, Yanagida R, Hamad E, Rakita V, Zhao H, Kashem M, Toyoda Y. Heart Transplant Human Leukocyte Antigen Matching in the Modern Era. J Card Fail 2024; 30:362-372. [PMID: 37422273 DOI: 10.1016/j.cardfail.2023.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Although numerous reports have studied the consequences of human leukocyte antigen (HLA) mismatching in renal transplantation, there are limited and outdated data analyzing this association in thoracic organ transplantation. Therefore, our study reviewed the impact of HLA mismatching at both the total and the loci levels in the modern-era heart-transplant procedure on survival and chronic rejection outcomes. METHODS We performed a retrospective analysis of adult patients after heart transplant by using the United Network for Organ Sharing database from January 2005-July 2021. Total HLA and HLA-A, HLA-B and HLA-DR mismatches were analyzed. Survival and cardiac allograft vasculopathy were the outcomes of interest during a 10-year follow-up period using Kaplan-Meier curves, log-rank tests and multivariable regression models. RESULTS A total of 33,060 patients were included in this study. Recipients with a high degree of HLA mismatching had increased incidences of acute organ rejection. There were no significant differences in mortality rates among any of the total or loci level groups. Similarly, there were no significant differences between total HLA mismatch groups in time to first cardiac allograft vasculopathy, though mismatching at the HLA-DR locus was associated with an increased risk of cardiac allograft vasculopathy. CONCLUSION Our analysis suggests that HLA mismatch is not a significant predictor of survival in the modern era. Overall, the clinical implications of this study provide reassuring data for the continued use of non-HLA-matched donors in an effort to increase the donor pool. If HLA matching is to be considered for heart transplant donor-recipient selection, matching at the HLA-DR locus should take priority due to its association with cardiac allograft vasculopathy.
Collapse
Affiliation(s)
- Ahad Firoz
- Lewis Katz School of Medicine at Temple University, Philadelphia PA.
| | - Steven Geier
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia PA
| | - Roh Yanagida
- Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia PA
| | - Eman Hamad
- Heart and Vascular Institute, Temple University Hospital, Philadelphia PA
| | - Val Rakita
- Heart and Vascular Institute, Temple University Hospital, Philadelphia PA
| | - Huaqing Zhao
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine, Philadelphia PA
| | - Mohammed Kashem
- Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia PA
| | - Yoshiya Toyoda
- Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia PA.
| |
Collapse
|
2
|
Killian MO, Tian S, Xing A, Hughes D, Gupta D, Wang X, He Z. Prediction of Outcomes After Heart Transplantation in Pediatric Patients Using National Registry Data: Evaluation of Machine Learning Approaches. JMIR Cardio 2023; 7:e45352. [PMID: 37338974 DOI: 10.2196/45352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/17/2023] [Accepted: 05/10/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND The prediction of posttransplant health outcomes for pediatric heart transplantation is critical for risk stratification and high-quality posttransplant care. OBJECTIVE The purpose of this study was to examine the use of machine learning (ML) models to predict rejection and mortality for pediatric heart transplant recipients. METHODS Various ML models were used to predict rejection and mortality at 1, 3, and 5 years after transplantation in pediatric heart transplant recipients using United Network for Organ Sharing data from 1987 to 2019. The variables used for predicting posttransplant outcomes included donor and recipient as well as medical and social factors. We evaluated 7 ML models-extreme gradient boosting (XGBoost), logistic regression, support vector machine, random forest (RF), stochastic gradient descent, multilayer perceptron, and adaptive boosting (AdaBoost)-as well as a deep learning model with 2 hidden layers with 100 neurons and a rectified linear unit (ReLU) activation function followed by batch normalization for each and a classification head with a softmax activation function. We used 10-fold cross-validation to evaluate model performance. Shapley additive explanations (SHAP) values were calculated to estimate the importance of each variable for prediction. RESULTS RF and AdaBoost models were the best-performing algorithms for different prediction windows across outcomes. RF outperformed other ML algorithms in predicting 5 of the 6 outcomes (area under the receiver operating characteristic curve [AUROC] 0.664 and 0.706 for 1-year and 3-year rejection, respectively, and AUROC 0.697, 0.758, and 0.763 for 1-year, 3-year, and 5-year mortality, respectively). AdaBoost achieved the best performance for prediction of 5-year rejection (AUROC 0.705). CONCLUSIONS This study demonstrates the comparative utility of ML approaches for modeling posttransplant health outcomes using registry data. ML approaches can identify unique risk factors and their complex relationship with outcomes, thereby identifying patients considered to be at risk and informing the transplant community about the potential of these innovative approaches to improve pediatric care after heart transplantation. Future studies are required to translate the information derived from prediction models to optimize counseling, clinical care, and decision-making within pediatric organ transplant centers.
Collapse
Affiliation(s)
- Michael O Killian
- College of Social Work, Florida State University, Tallahassee, FL, United States
| | - Shubo Tian
- Department of Statistics, Florida State University, Tallahassee, FL, United States
| | - Aiwen Xing
- Department of Statistics, Florida State University, Tallahassee, FL, United States
| | - Dana Hughes
- College of Social Work, Florida State University, Tallahassee, FL, United States
| | - Dipankar Gupta
- Congenital Heart Center, Shands Children's Hospital, University of Florida, Gainesville, FL, United States
| | - Xiaoyu Wang
- Department of Statistics, Florida State University, Tallahassee, FL, United States
| | - Zhe He
- School of Information, Florida State University, Tallahassee, FL, United States
| |
Collapse
|
3
|
A Review of Biomarkers of Cardiac Allograft Rejection: Toward an Integrated Diagnosis of Rejection. Biomolecules 2022; 12:biom12081135. [PMID: 36009029 PMCID: PMC9405997 DOI: 10.3390/biom12081135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 12/22/2022] Open
Abstract
Despite major advances in immunosuppression, allograft rejection remains an important complication after heart transplantation, and it is associated with increased morbidity and mortality. The gold standard invasive strategy to monitor and diagnose cardiac allograft rejection, based on the pathologic evaluation of endomyocardial biopsies, suffers from many limitations including the low prevalence of rejection, sample bias, high inter-observer variability, and international working formulations based on arbitrary cut-offs that simplify the landscape of rejection. The development of innovative diagnostic and prognostic strategies—integrating conventional histology, molecular profiling of allograft biopsy, and the discovery of new tissue or circulating biomarkers—is one of the major challenges of translational medicine in solid organ transplantation, and particularly in heart transplantation. Major advances in the field of biomarkers of rejection have paved the way for a paradigm shift in the monitoring and diagnosis of cardiac allograft rejection. We review the recent developments in the field, including non-invasive biomarkers to minimize the number of protocol endomyocardial biopsies and tissue biomarkers as companion tools of pathology to refine the diagnosis of cardiac rejection. Finally, we discuss the potential role of these biomarkers to provide an integrated bio-histomolecular diagnosis of cardiac allograft rejection.
Collapse
|
4
|
Maidman SD, Gidea C, Reyentovich A, Rao S, Saraon T, Kadosh BS, Narula N, Carillo J, Smith D, Moazami N, Katz S, Goldberg RI. Pre-transplant immune cell function assay as a predictor of early cardiac allograft rejection. Clin Transplant 2022; 36:e14745. [PMID: 35678734 DOI: 10.1111/ctr.14745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION ImmuKnow, an immune cell function assay that quantifies overall immune system activity can assist in post-transplant immunosuppression adjustment. However, the utility of pre-transplant ImmuKnow results representing a patient's baseline immune system activity is unknown. This study sought to assess if pre-transplant ImmuKnow results are predictive of rejection at the time of first biopsy in our cardiac transplant population. METHODS This is a single center, retrospective observational study of consecutive patients from January 1, 2018 to October 1, 2020 who underwent orthotopic cardiac transplantation at NYU Langone Health. Patients were excluded if a pre-transplant ImmuKnow assay was not performed. ImmuKnow results were categorized according to clinical interpretation ranges (low, moderate, and high activity), and patients were divided into two groups: a low activity group versus a combined moderate-high activity group. Pre-transplant clinical characteristics, induction immunosuppression use, early postoperative tacrolimus levels, and first endomyocardial biopsy results were collected for all patients. Rates of clinically significant early rejection (defined as rejection ≥ 1R/1B) were compared between pre-transplant ImmuKnow groups. RESULTS Of 110 patients who underwent cardiac transplant, 81 had pre-transplant ImmuKnow results. The low ImmuKnow activity group was comprised of 15 patients, and 66 patients were in the combined moderate-high group. Baseline characteristics were similar between groups. Early rejection occurred in 0 (0%) patients with low pre-transplant ImmuKnow levels. Among the moderate- high pre-transplant ImmuKnow group, 16 (24.2%) patients experienced early rejection (P = .033). The mean ImmuKnow level in the non-rejection group was the 364.9 ng/ml of ATP compared to 499.3 ng/ml of ATP for those with rejection (P = .020). CONCLUSION Patients with low pre-transplant ImmuKnow levels had lower risk of early rejection when compared with patients with moderate or high levels. Our study suggests a possible utility in performing pre-transplant ImmuKnow to identify patients at-risk for early rejection who may benefit from intensified upfront immunosuppression as well as to recognize those where slower calcineurin inhibitor initiation may be appropriate.
Collapse
Affiliation(s)
- Samuel D Maidman
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Claudia Gidea
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Alex Reyentovich
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Shaline Rao
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Tajinderpal Saraon
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Bernard S Kadosh
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Navneet Narula
- Department of Pathology, New York University Grossman School of Medicine, New York, New York, USA
| | - Julius Carillo
- Department of Cardiac Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Deane Smith
- Department of Cardiac Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Nader Moazami
- Department of Cardiac Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Stuart Katz
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Randal I Goldberg
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| |
Collapse
|
5
|
Microcirculatory Resistance Predicts Allograft Rejection and Cardiac Events After Heart Transplantation. J Am Coll Cardiol 2021; 78:2425-2435. [PMID: 34886963 DOI: 10.1016/j.jacc.2021.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/07/2021] [Accepted: 10/05/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Single-center data suggest that the index of microcirculatory resistance (IMR) measured early after heart transplantation predicts subsequent acute rejection. OBJECTIVES The goal of this study was to validate whether IMR measured early after transplantation can predict subsequent acute rejection and long-term outcome in a large multicenter cohort. METHODS From 5 international cohorts, 237 patients who underwent IMR measurement early after transplantation were enrolled. The primary outcome was acute allograft rejection (AAR) within 1 year after transplantation. A key secondary outcome was major adverse cardiac events (MACE) (the composite of death, re-transplantation, myocardial infarction, stroke, graft dysfunction, and readmission) at 10 years. RESULTS IMR was measured at a median of 7 weeks (interquartile range: 3-10 weeks) post-transplantation. At 1 year, the incidence of AAR was 14.4%. IMR was associated proportionally with the risk of AAR (per increase of 1-U IMR; adjusted hazard ratio [aHR]: 1.04; 95% confidence interval [CI]: 1.02-1.06; p < 0.001). The incidence of AAR in patients with an IMR ≥18 was 23.8%, whereas the incidence of AAR in those with an IMR <18 was 6.3% (aHR: 3.93; 95% CI: 1.77-8.73; P = 0.001). At 10 years, MACE occurred in 86 (36.3%) patients. IMR was significantly associated with the risk of MACE (per increase of 1-U IMR; aHR: 1.02; 95% CI: 1.01-1.04; P = 0.005). CONCLUSIONS IMR measured early after heart transplantation is associated with subsequent AAR at 1 year and clinical events at 10 years. Early IMR measurement after transplantation identifies patients at higher risk and may guide personalized posttransplantation management.
Collapse
|
6
|
Shoji S, Kuno T, Kohsaka S, Amiya E, Asleh R, Alvarez P, Kampaktsis P, Staffa SJ, Zurakowski D, Doulamis I, Briasoulis A. Incidence and long-term outcome of heart transplantation patients who develop postoperative renal failure requiring dialysis. J Heart Lung Transplant 2021; 41:356-364. [PMID: 34953720 DOI: 10.1016/j.healun.2021.11.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Acute renal failure requiring dialysis after heart transplantation remains a significant clinical issue because of its increasing incidence. We aimed to investigate its time trends, clinical predictors, and long-term outcomes. METHODS Adult heart transplantation recipients registered in the United Network for Organ Sharing registry between 2009 and 2020 were identified. The patients were grouped according to the requirement for dialysis in the postoperative heart transplantation period. The independent risk predictors were identified, and the association between post-heart transplantation renal failure requiring dialysis and long-term mortality accounting for re-transplantation was investigated. RESULTS A total of 28,170 patients were included in the study, of which 3,371 (12%) required dialysis immediately post-heart transplantation. The incidence increased from 7.9% to 13.9% during the study period. Longer ischemic time, serum creatinine at transplantation >1.2 mg/dL, prior cardiac surgery, higher recipient body mass index, support of mechanical ventilation or extracorporeal membrane oxygenation, and history of congenital heart disease or restrictive/hypertrophic cardiomyopathy were its predictors (all p < 0.05). Patients on posttransplant dialysis had a higher risk of all-cause mortality (adjusted hazard ratio [aHR]: 5.2, 95% CI: 4.7-5.7, p < 0.001), 30 day mortality (aHR: 7.7, 95% CI: 6.3-9.6, p < 0.001) and 1 year mortality (aHR: 7.5, 95% CI: 6.6-8.6, p < 0.001). Post-transplant dialysis was associated with a risk of treated rejection at 1 year. CONCLUSION Acute renal failure requiring dialysis after heart transplantation is associated with significantly worse 30 day and long-term mortalities, and thus, early identification of high-risk patients is crucial to prevent severe renal complications.
Collapse
Affiliation(s)
- Satoshi Shoji
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rabea Asleh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Heart Institute, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Paulino Alvarez
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Polydoros Kampaktsis
- Division of Cardiovascular Medicine, Columbia University Medical Center, New York, New York
| | - Steven J Staffa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Departments of Anesthesiology and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Zurakowski
- Departments of Anesthesiology and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ilias Doulamis
- Division of Cardiac Surgery, Boston's Children Hospital, Boston, Massachusetts
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa City, Iowa; National and Kapodistrian University of Athens, Athens, Greece.
| |
Collapse
|
7
|
Guenthart BA, Krishnan A, Koyano T, La Francessca S, Chan J, Alassar A, Macarthur JW, Shudo Y, Hiesinger W, Woo YJ. Extended Static Hypothermic Preservation In Cardiac Transplantation: A Case Report. Transplant Proc 2021; 53:2509-2511. [PMID: 34521542 DOI: 10.1016/j.transproceed.2021.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The donor shortage poses a major limitation to use of heart transplantation. Novel strategies such as use of expanded-criteria donors with prolonged ischemia times are being employed to address this need. Recent developments in static hypothermia have allowed for the safe use of cardiac allografts with prolonged ischemic times. CASE REPORT We present the case of a 68-year-old woman with valvular cardiomyopathy refractory to medical therapy who underwent orthotopic heart transplantation with a cardiac allograft exposed to elevated ischemic times. This was achieved through use of the federally approved SherpaPak Cardiac Transport System for transportation of the allograft. This method of static hypothermic organ preservation allowed for a 330-minute total ischemic time, including 283 minutes of storage within the preservation system. The patient tolerated the procedure well and was discharged on postoperative day 10, with excellent graft function and no evidence of rejection 3 months postoperatively. CONCLUSIONS Though traditionally ischemic times of 240 minutes or less are recommended for cardiac allografts, we demonstrate, to our knowledge, the longest reported ischemic time of 330 minutes via use of a novel method of static hypothermia for organ preservation. The recipient had an excellent outcome postoperatively, demonstrating the potential for this new organ preservation system to expand the donor pool and improve access and use of heart transplantation.
Collapse
Affiliation(s)
- Brandon A Guenthart
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
| | - Aravind Krishnan
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Tiffany Koyano
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | | | - Joshua Chan
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Aiman Alassar
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - John W Macarthur
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - William Hiesinger
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| |
Collapse
|
8
|
Ayers B, Sandholm T, Gosev I, Prasad S, Kilic A. Using machine learning to improve survival prediction after heart transplantation. J Card Surg 2021; 36:4113-4120. [PMID: 34414609 DOI: 10.1111/jocs.15917] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/01/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study investigates the use of modern machine learning (ML) techniques to improve prediction of survival after orthotopic heart transplantation (OHT). METHODS Retrospective study of adult patients undergoing primary, isolated OHT between 2000 and 2019 as identified in the United Network for Organ Sharing (UNOS) registry. The primary outcome was 1-year post-transplant survival. Patients were randomly divided into training (80%) and validation (20%) sets. Dimensionality reduction and data re-sampling were employed during training. Multiple machine learning algorithms were combined into a final ensemble ML model. The discriminatory capability was assessed using the area under receiver-operating-characteristic curve (AUROC), net reclassification index (NRI), and decision curve analysis (DCA). RESULTS A total of 33,657 OHT patients were evaluated. One-year mortality was 11% (n = 3738). In the validation cohort, the AUROC of singular logistic regression was 0.649 (95% CI, 0.628-0.670) compared to 0.691 (95% CI, 0.671-0.711) with random forest, 0.691 (95% CI, 0.671-0.712) with deep neural network, and 0.653 (95% CI, 0.632-0.674) with Adaboost. A final ensemble ML model was created that demonstrated the greatest improvement in AUROC: 0.764 (95% CI, 0.745-0.782) (p < .001). The ensemble ML model improved predictive performance by 72.9% ±3.8% (p < .001) as assessed by NRI compared to logistic regression. DCA showed the final ensemble method improved risk prediction across the entire spectrum of predicted risk as compared to all other models (p < .001). CONCLUSIONS Modern ML techniques can improve risk prediction in OHT compared to traditional approaches. This may have important implications in patient selection, programmatic evaluation, allocation policy, and patient counseling and prognostication.
Collapse
Affiliation(s)
- Brian Ayers
- Department of Surgery, The Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Igor Gosev
- Division of Cardiac Surgery, The University of Rochester Medical Center, Rochester, New York, USA
| | - Sunil Prasad
- Division of Cardiac Surgery, The University of Rochester Medical Center, Rochester, New York, USA
| | - Arman Kilic
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
9
|
Rabbit Antithymocyte Globulin Induction in Heart Transplant Recipients at High Risk for Rejection. Ochsner J 2021; 21:133-138. [PMID: 34239371 PMCID: PMC8238107 DOI: 10.31486/toj.20.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Induction with lymphocyte-depleting antibodies may improve allograft outcomes in heart transplant recipients who are at high immunologic risk for rejection. Methods: We conducted a single-center retrospective cohort study that compared outcomes between adult patients receiving rabbit antithymocyte globulin (rATG) induction vs no induction from 2011 through 2017. Key exclusion criteria were patients who did not receive tacrolimus and mycophenolate and patients who did not meet high immunologic risk criteria. Results: A total of 50 patients were included in the analysis. At 1 year, the composite primary outcome of ≥2R rejection as defined by the International Society for Heart and Lung Transplantation, any treated rejection, development of cardiac allograft vasculopathy, or graft loss was not different between groups (P=0.474). Serious infections were also similar between groups (P=0.963). In accordance with institutional guidelines, prednisone exposure was decreased in the rATG induction group at 1 month (24.04 mg ± 13.74 vs 35.18 mg ± 16.95; P=0.014). Conclusion: These results suggest that while rATG induction does not improve heart allograft outcomes, it may enable reducing early corticosteroid exposure in patients at high immunologic risk.
Collapse
|
10
|
Imamura T. Risk stratification of post-heart transplant mortality in patients bridged with mechanical circulatory supports. J Card Surg 2021; 36:1574. [PMID: 33604966 DOI: 10.1111/jocs.15443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| |
Collapse
|
11
|
Choi AY, Mulvihill MS, Lee HJ, Zhao C, Kuchibhatla M, Schroder JN, Patel CB, Granger CB, Hartwig MG. Transplant Center Variability in Organ Offer Acceptance and Mortality Among US Patients on the Heart Transplant Waitlist. JAMA Cardiol 2021; 5:660-668. [PMID: 32293647 DOI: 10.1001/jamacardio.2020.0659] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Under the current Centers for Medicare & Medicaid Services guidelines, there is incentivization to optimize posttransplant outcomes regardless of mortality among patients on the waitlist and transplant rates; few data exist with regard to transplant center acceptance practices and survival to heart transplant. Objectives To evaluate the extent of variability in organ acceptance practices in the US and whether this center-level behavior is associated with heart transplant candidate survival. Design, Setting, and Participants In this retrospective cohort study, the US National Transplant Registry was queried for all match runs of adult candidates listed for isolated heart transplant between May 1, 2007, and March 31, 2017. Data analysis was conducted from October 30, 2018, to May 1, 2019. The final cohort included 93 transplant centers, 19 703 donors, and 9628 candidates. Main Outcomes and Measures Center acceptance rates for heart allografts offered to the highest-priority candidates, association between center acceptance rate and mortality among patients on the waitlist, and posttransplant outcomes between candidates who accepted their first-rank offers vs those who accepted previously declined offers. Results Among 19 703 unique organ offers, 6302 hearts (32.0%) were accepted for first-rank candidates. After adjustment for donor, candidate, and geographic covariates, transplant centers varied in acceptance rates (12.3%-61.5%) of offers made to first-rank candidates. Higher acceptance rates were associated with lower cumulative incidence of 1-year mortality among patients on the waitlist. For every 10% increase in adjusted center acceptance rate, the risk of mortality decreased by 27% (subdistribution hazard ratio, 0.73; 95% CI, 0.67-0.80). No statistically significant difference was observed in 5-year adjusted posttransplant patient survival (adjusted hazard ratio, 1.02; 95% CI, 0.94-1.11) and graft failure (subdistribution hazard ratio; 0.95; 95% CI, 0.83-1.09) between hearts accepted at the first-rank compared with lower-rank positions. Conclusions and Relevance Variability in heart allograft acceptance rates appears to exist among transplant centers, with candidates listed at lower acceptance rate centers being more likely to experience mortality while on the waitlist. Comparable posttransplant survival suggests that allografts that were declined as a first offer perform as well as those that were accepted at their first offer. These findings suggest that organ acceptance rate or time to transplant from being added to the waitlist may be an additional measure of heart transplant program performance.
Collapse
Affiliation(s)
- Ashley Y Choi
- Medical student, School of Medicine, Duke University, Durham, North Carolina
| | - Michael S Mulvihill
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Congwen Zhao
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Jacob N Schroder
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Chetan B Patel
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | | | - Matthew G Hartwig
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
12
|
[Pathology of heart transplantation: Where are we now?]. Ann Pathol 2021; 41:38-49. [PMID: 33413972 DOI: 10.1016/j.annpat.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 11/23/2022]
Abstract
Pathology is still the gold standard for the diagnosis of rejection in heart transplantation. During the last decade, molecular pathology has emerged as a powerful tool for the understanding of the processes implicated in allograft rejection. Transcriptomic analysis of the allograft may also help the pathologist for diagnosis and accurate classification of rejection. This review will describe the recent advances and perspectives of molecular pathology in the field of heart transplantation.
Collapse
|
13
|
Oprzędkiewicz A, Mado H, Szczurek W, Gąsior M, Szyguła-Jurkiewicz B. Donor-recipient Matching in Heart Transplantation. Open Cardiovasc Med J 2020. [DOI: 10.2174/18741924020140100042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Heart transplantation remains the treatment of choice for end-stage Heart Failure (HF). Due to the shortage of organs for transplantation and the occurrence of perioperative complications, a key problem is donor matching, which should result in increased survival and improved quality of life for patients. The success of this procedure depends on various parameters such as gender, weight, ABO blood group and Human Leukocyte Antigen (HLA) system of both the recipient and the donor. Furthermore, non-HLA antigens may also be valuable in donor-recipient matching. The aim of this article is to summarize the recent knowledge on the impact of various factors on accurate donor-recipient matching to heart transplantation.
Collapse
|
14
|
Diaz-Castrillon CE, Huckaby LV, Hickey G, Sultan I, Kilic A. Induction Immunosuppression and Renal Outcomes in Adult Heart Transplantation. J Surg Res 2020; 259:14-23. [PMID: 33278793 DOI: 10.1016/j.jss.2020.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/09/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study explores the use of induction therapy in orthotopic heart transplantation as it relates to preoperative renal function and evaluates the impact of its utilization on post-transplant outcomes. METHODS We conducted a retrospective analysis using the United Network for Organ Sharing database from 2000 to 2018 evaluating the initiation of de novo dialysis after transplantation. We examined the relationship between induction immunosuppression and pre-transplant estimated glomerular filtration rate with post-transplant outcomes, accounting for inter-center variability through a mixed-effects logistic regression model. RESULTS In total, 16,201 patients were included with a median age of 57 y (interquartile range 47, 63); 26% were women (n = 4222) and 28% (n = 4552) had a history of diabetes mellitus. The median estimated glomerular filtration rate (eGFR) was 67.5 mL/min (interquartile range 53.1, 86.7); 51.2% (n = 3068) of the recipients with eGFR < 60 received induction therapy compared to 42.5% (n = 4336) within the eGFR ≥ 60 group (P < 0.001). Adjusted multivariable analysis found that induction therapy was associated with de novo dialysis (odds ratio 1.25, 95% confidence interval 1.10-1.43, P < 0.001), with the most significant effect on patients with eGFR ≥ 60. Although significant, there was a weak correlation between center-level induction utilization and mean eGFR (r = -0.2, P < 0.001). CONCLUSION In this analysis, the use of induction immunosuppression in orthotopic heart transplantation varied widely between centers and did not correlate strongly with pre-transplant eGFR. In addition, its utilization did not mitigate the risk of renal replacement therapy after transplantation and in fact was associated with increased risk even after adjusting for confounders most notably in patients with eGFR ≥ 60.
Collapse
Affiliation(s)
| | - Lauren V Huckaby
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gavin Hickey
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| |
Collapse
|
15
|
Budiono GR, McCaffrey MH, Parr WCH, Choy WJ, Singh T, Pelletier MH, Mobbs RJ. Development of a Multivariate Prediction Model for Successful Oswestry Disability Index Changes in L5/S1 Anterior Lumbar Interbody Fusion for Degenerative Disc Disease. World Neurosurg 2020; 148:e1-e9. [PMID: 33189919 DOI: 10.1016/j.wneu.2020.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Lower back pain associated with degenerative disc disease (DDD) is a leading cause of disability worldwide. Anterior lumbar interbody fusion (ALIF) has been shown to be effective for treating refractory DDD, but it remains unclear which patients may benefit most from the procedure. This study aims to develop a predictive model for clinical success in L5/S1 ALIF for DDD. METHODS A retrospective cohort study of 68 patients with refractory DDD who underwent L5/S1 ALIF was performed. Clinical success was defined as an improvement in Oswestry Disability Index (ODI) of 20 points postoperatively. Exploratory analyses were performed on 16 preoperative clinical and radiographic parameters, followed by a multivariate logistic regression. Evaluation of the predictive model was performed. RESULTS After exploratory analyses, 4 parameters were suitable for inclusion in the multivariate model. Workers' compensation status (odds ratio [OR], 0.02; 95% confidence interval [CI], 0.001-0.262; P = 0.004) and preoperative ODI (OR, 1.13; 95% CI, 1.05-1.23; P = 0.002) were statistically significant parameters. Furthermore, posterior disc height and disc depth contributed significantly to the model variance (OR, 0.69, 95% CI, 0.44-1.09 and OR, 0.97, 95% CI, 0.81-1.15, respectively). The model had a sensitivity of 81.5%, specificity of 83.3%, C-statistic of 0.921, and a calibration plot similar to the 45° reference line. CONCLUSIONS This analysis confirms workers' compensation and low preoperative ODI as risk factors for successful L5/S1 ALIF performed for DDD. It also identifies novel prognostic factors, namely posterior disc height and disc depth. This model can aid in patient counseling and selection in the management of L5/S1 DDD.
Collapse
Affiliation(s)
- Gideon R Budiono
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; NeuroSpine Clinic, Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia.
| | - Miles H McCaffrey
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; NeuroSpine Clinic, Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - William C H Parr
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Sydney, New South Wales, Australia; 3DMorphic Pty Ltd., Sydney, New South Wales, Australia
| | - Wen J Choy
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; NeuroSpine Clinic, Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - Telvinderjit Singh
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; NeuroSpine Clinic, Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Sydney, New South Wales, Australia
| | - Matthew H Pelletier
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Sydney, New South Wales, Australia
| | - Ralph J Mobbs
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia; NeuroSpine Clinic, Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales (UNSW), Sydney, New South Wales, Australia; Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, Sydney, New South Wales, Australia
| |
Collapse
|
16
|
Diaz-Castrillon CE, Seese L, Mathier MA, Keebler ME, Hickey GW, McNamara D, Simon MA, Horn E, Kilic A. Nationwide variability in the use of induction immunosuppression for adult heart transplantation. J Card Surg 2020; 35:3053-3061. [PMID: 33016378 DOI: 10.1111/jocs.15075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/16/2020] [Accepted: 08/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Institutional factors have been shown to impact outcomes following orthotopic heart transplantation (OHT). This study evaluated center variability in the utilization of induction therapy for OHT and its implications on clinical outcomes. METHODS Adult OHT patients between 2010 and 2018 were identified from the United Network for Organ Sharing registry. Transplant centers were stratified based on their rates of induction therapy utilization. Mixed-effects logistic regression models were created with drug-treated rejection within 1 year as primary endpoint and individual centers as a random parameter. Risk-adjusted Cox regression was used to evaluate patient-level mortality outcomes. RESULTS In 17,524 OHTs performed at 100 centers, induction therapy was utilized in 48.6% (n = 8411) with substantial variability between centers (interquartile range, 21.4%-79.1%). There were 36, 30, and 34 centers in the low (<29%), intermediate (29%-66%), and high (>67%) induction utilization terciles groups, respectively. Induction therapy did not account for the observed variability in the treated rejection rate at 1 year among centers after adjusting for donor and recipient factors (p = .20). No differences were observed in postoperative outcomes among induction utilization centers groups (all, p > .05). Furthermore, there was a weak correlation between the percentage of induction therapy utilization at the center-level and recipients found to have moderate (r = .03) or high (r = .04) baseline risks for acute rejection at 1 year. CONCLUSIONS This analysis demonstrates that there is substantial variability in the use of induction therapy among OHT centers. In addition, there was a minimal correlation with baseline recipient risk or 1-year rejection rates, suggesting a need for better-standardized practices for induction therapy use in OHT.
Collapse
Affiliation(s)
- Carlos E Diaz-Castrillon
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Laura Seese
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael A Mathier
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mary E Keebler
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gavin W Hickey
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dennis McNamara
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marc A Simon
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ed Horn
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
17
|
Gossett JG, Amdani S, Khulbey S, Punnoose AR, Rosenthal DN, Smith J, Smits J, Dipchand AI, Kirk R, Miera O, Davies RR. Review of interactions between high-risk pediatric heart transplant recipients and marginal donors including utilization of risk score models. Pediatr Transplant 2020; 24:e13665. [PMID: 32198806 DOI: 10.1111/petr.13665] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Donor organ acceptance practices vary among pediatric heart transplant professionals. We sought to understand what is known about the interactions between the "high-risk" recipient and the "marginal donor," and how donor risk scores can impact this discussion. METHODS A systematic review of published literature on pediatric HTx was undertaken with the assistance of a medical librarian. Two authors independently assessed search results, and papers were reviewed for inclusion. RESULTS We found that there are a large number of individual factors, and clusters of factors, that have been used to label individual recipients "high-risk" and individual donors "marginal." The terms "high-risk recipient" and "marginal donor" have been used broadly in the literature making it virtually impossible to make comparisons between publications. In general, the data support that patients who could be easily agreed to be "sicker recipients" are at more risk compared to those who are clearly "healthier," albeit still "sick enough" to need transplantation. Given this variability in the literature, we were unable to define how being a "high-risk" recipient interplays with accepting a "marginal donor." Existing risk scores are described, but none were felt to adequately predict outcomes from factors available at the time of offer acceptance. CONCLUSIONS We could not determine what makes a donor "marginal," a recipient "high-risk," or how these factors interplay within the specific recipient-donor pair to determine outcomes. Until there are better risk scores predicting outcomes at the time of organ acceptance, programs should continue to evaluate each organ and recipient individually.
Collapse
Affiliation(s)
- Jeffrey G Gossett
- University of California Benioff Children's Hospitals, San Francisco, CA, USA
| | | | | | | | | | | | - Jacqueline Smits
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Richard Kirk
- Division of Pediatric Cardiology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum, Berlin, Germany
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
18
|
Kirk R, Dipchand AI, Davies RR, Miera O, Chapman G, Conway J, Denfield S, Gossett JG, Johnson J, McCulloch M, Schweiger M, Zimpfer D, Ablonczy L, Adachi I, Albert D, Alexander P, Amdani S, Amodeo A, Azeka E, Ballweg J, Beasley G, Böhmer J, Butler A, Camino M, Castro J, Chen S, Chrisant M, Christen U, Danziger-Isakov L, Das B, Everitt M, Feingold B, Fenton M, Garcia-Guereta L, Godown J, Gupta D, Irving C, Joong A, Kemna M, Khulbey SK, Kindel S, Knecht K, Lal AK, Lin K, Lord K, Möller T, Nandi D, Niesse O, Peng DM, Pérez-Blanco A, Punnoose A, Reinhardt Z, Rosenthal D, Scales A, Scheel J, Shih R, Smith J, Smits J, Thul J, Weintraub R, Zangwill S, Zuckerman WA. ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation. J Heart Lung Transplant 2020; 39:331-341. [PMID: 32088108 DOI: 10.1016/j.healun.2020.01.1345] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 12/14/2022] Open
Abstract
The number of potential pediatric heart transplant recipients continues to exceed the number of donors, and consequently the waitlist mortality remains significant. Despite this, around 40% of all donated organs are not used and are discarded. This document (62 authors from 53 institutions in 17 countries) evaluates factors responsible for discarding donor hearts and makes recommendations regarding donor heart acceptance. The aim of this statement is to ensure that no usable donor heart is discarded, waitlist mortality is reduced, and post-transplant survival is not adversely impacted.
Collapse
Affiliation(s)
- Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas.
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Jennifer Conway
- Department of Pediatrics, Division of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Denfield
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jeffrey G Gossett
- University of California Benioff Children's Hospitals, San Francisco, California
| | - Jonathan Johnson
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Michael McCulloch
- University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Martin Schweiger
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Vienna and Pediatric Heart Center Vienna, Vienna, Austria
| | - László Ablonczy
- Pediatric Cardiac Center, Hungarian Institute of Cardiology, Budapest, Hungary
| | - Iki Adachi
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Dimpna Albert
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Peta Alexander
- Department of Cardiology, Boston Children's Hospital Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | | | - Estela Azeka
- Heart Institute (InCor) University of São Paulo, São Paulo, Brazil
| | - Jean Ballweg
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital and Medical Center University of Nebraska Medical Center, Omaha, Nebraska
| | - Gary Beasley
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Jens Böhmer
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alison Butler
- Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Javier Castro
- Fundacion Cardiovascular de Colombia, Santander, Bucaramanga City, Colombia
| | | | - Maryanne Chrisant
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | - Urs Christen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lara Danziger-Isakov
- Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center & University of Cincinnati, Cincinnati, Ohio
| | - Bibhuti Das
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | | | - Brian Feingold
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew Fenton
- Great Ormond Street Hospital for Children Foundation Trust, London, United Kingdom
| | | | - Justin Godown
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dipankar Gupta
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Claire Irving
- Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Anna Joong
- Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | | | | | - Steven Kindel
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Kimberly Lin
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen Lord
- New England Organ Bank, Boston, Massachusetts
| | - Thomas Möller
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Deipanjan Nandi
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Oliver Niesse
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | | | | | - Ann Punnoose
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Angie Scales
- Pediatric and Neonatal Donation and Transplantation, Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | - Janet Scheel
- Washington University School of Medicine, St. Louis, Missouri
| | - Renata Shih
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | | | | | - Josef Thul
- Children's Heart Center, University of Giessen, Giessen, Germany
| | | | | | - Warren A Zuckerman
- Columbia University Medical Center, Morgan Stanley Children's Hospital of New York, New York, New York
| |
Collapse
|
19
|
Kilic A, Hickey G, Mathier M, Sultan I, Gleason TG, Horn E, Keebler ME. Outcomes of Adult Heart Transplantation Using Hepatitis C-Positive Donors. J Am Heart Assoc 2020; 9:e014495. [PMID: 31910781 PMCID: PMC7033844 DOI: 10.1161/jaha.119.014495] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background This study evaluated the impact of hepatitis C–positive (HCV+) donors on outcomes of heart transplantation in the United States. Methods and Results Adults undergoing isolated heart transplantation in the United States between January 1, 2016, and December 31, 2018, were included. The primary outcome was 1‐year post‐transplant survival. Multivariable Cox regression and 2:1 propensity matching were used to compare outcomes between transplants with HCV+ and hepatitis C–negative (HCV−) donors. A subanalysis was performed to evaluate the impact of nucleic acid amplification test positivity on outcomes. Of 7889 isolated heart transplants performed during the study period, 343 (4.4%) used HCV+ donors. Overall unadjusted 1‐year posttransplant survival was not statistically different between HCV− versus HCV+ donors (91.1% versus 90.2%; P=0.86), a finding that persisted after risk adjustment (hazard ratio, 1.05; 95% CI, 0.70–1.58; P=0.80). Propensity matching resulted in 675 well‐balanced patients (437 HCV− and 238 HCV+). Overall 1‐year posttransplant survival was not statistically different in propensity‐matched analysis (89.8% HCV− versus 89.2% HCV+; P=0.88). Rates of 1‐year drug‐treated rejection (21.1% versus 22.1%; P=0.84), postoperative dialysis (11.4% versus 14.7%; P=0.22), and stroke (4.6% versus 2.1%; P=0.10) were also not statistically different between HCV− and HCV+ groups, respectively. Outcomes were not statistically different between nucleic acid amplification test–negative and nucleic acid amplification test–positive HCV+ donors. Conclusions Adult heart transplants using HCV+ donors, including those that are nucleic acid amplification test positive, can be performed without an adverse impact on 1‐year survival. Wider implementation of protocols for using HCV+ donors and an assessment of longer‐term outcomes including seroconversion rates will be important in maximizing the effect of HCV+ donors on national donor shortages.
Collapse
Affiliation(s)
- Arman Kilic
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA
| | - Gavin Hickey
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA
| | - Michael Mathier
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA
| | - Ibrahim Sultan
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA
| | - Thomas G Gleason
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA
| | - Ed Horn
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA
| | - Mary E Keebler
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh PA
| |
Collapse
|
20
|
Khayata M, Al-Kindi SG, Oliveira GH. Contemporary characteristics and outcomes of adults with familial dilated cardiomyopathy listed for heart transplantation. World J Cardiol 2019; 11:38-46. [PMID: 30705741 PMCID: PMC6354074 DOI: 10.4330/wjc.v11.i1.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/01/2018] [Accepted: 01/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Familial dilated cardiomyopathy (FDCM) account for 20%-30% of non-ischemic cardiomyopathies (NICM). Previous published data showed that some patients with FDCM tend to have rapidly progressive disease; however, five-year mortality was not significantly different in the familial and non-familial forms of NICM with optimal medical therapy.
AIM To better define the characteristics and clinical outcomes of FDCM patients listed for heart transplantation (HT).
METHODS We queried the United Network for Organ Sharing Registry to identify FDCM patients listed for HT between January 2008 and September 2015 and compared them to NICM and ischemic cardiomyopathy (ICM) patients. We included all patients ≥ 18 years old and we separated patients to three groups: FDCM, NICM and ICM. Chi-square test was used to compare between categorical variables, the t-test was used to compare between continues variables, and Cox-proportional hazards model was used to perform time-dependent survival analyses.
RESULTS Of the 24809 adults listed for HT, we identified 677 patients (2.7%) with the diagnosis of FDCM. Compared to patients with NICM and ICM, FDCM patients were younger (FDCM 43.9 ± 13.5 vs NICM 50.9 ± 12.3, P < 0.001, vs ICM 58.5 ± 8.1, P < 0.001), more frequently listed as status 2 (FDCM 35.2% vs NICM 26.5%, P < 0.001), with significantly lower left ventricular assist device (LVAD) utilization (FDCM 18.4% vs NICM 25.1%, P < 0.001; vs ICM 25.6%, P < 0.001), but higher use of total artificial heart (FDCM 1.3% vs NICM 0.6%, P = 0.039; vs ICM 0.4%, P = 0.002). Additionally, patients with FDCM were less frequently delisted for clinical deterioration or death and more likely to be transplanted compared to those with NICM [hazard ratio (HR): 0.617, 95% confidence interval (CI): 0.47-0.81; HR: 1.25, 95%CI: 1.14-1.37, respectively], and ICM (HR: 0.5, 95%CI: 0.38-0.66; HR: 1.18, 95%CI: 1.08-1.3, respectively). There was more frequent rejection among patients with FDCM (FDCM 11.4% vs NICM 9.8%, P = 0.28; vs ICM 8.4%, P = 0.034). One, three, and five post-transplant survival of patients with FDCM (91%, 88% and 80%) was similar to those with NICM (91%, 84%, 79%, P = 0.225), but superior to those with ICM (89%, 82%, 75%, P = 0.008), respectively.
CONCLUSION End-stage FDCM patients are more likely to be transplanted, more likely to have early rejection, and have similar or higher survival than patients with other cardiomyopathies.
Collapse
Affiliation(s)
- Mohamed Khayata
- Cardiology Section, Department of Internal Medicine, University Hospitals Cleveland Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH 44106, United States
| | - Sadeer G Al-Kindi
- Cardiology Section, Department of Internal Medicine, University Hospitals Cleveland Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH 44106, United States
| | - Guilherme H Oliveira
- Cardiology Section, Department of Internal Medicine, University Hospitals Cleveland Medical Center, Harrington Heart and Vascular Institute, Cleveland, OH 44106, United States
| |
Collapse
|
21
|
Abstract
The heart transplant nurse coordinator plays a key role in educating and supporting the postoperative heart transplant patient to achieve the best outcomes for a long and healthy life. The time leading up to transplantation, wait-list candidates will hear vital information regarding life after they have received their life-sustaining heart transplant. Unfortunately, at times, the information is minimally retained. The first few days to weeks following surgery are a crucial period of time for education of patients to be discharged from the hospital setting to home where they will need to care for themselves independently. Education must be clear and concise and encompass patients' health involving their allograft heart and their body as a whole. The coordinator looks to the critical care nurse at the bedside to help teach and reiterate information to the patient in this critical period of time.
Collapse
|
22
|
Peled Y, Loewenthal R, Kassif Y, Raichlin E, Younis A, Younis A, Nachum E, Freimark D, Goldenberg I, Lavee J. Donor-recipient ethnic mismatching impacts short- and long-term results of heart transplantation. Clin Transplant 2018; 32:e13389. [DOI: 10.1111/ctr.13389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 07/28/2018] [Accepted: 08/20/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Yael Peled
- The Olga and Lev Leviev Heart Center; Sheba Medical Center; Ramat Gan Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Ron Loewenthal
- Tissue Typing Laboratory Sheba Medical Center; Tel Hashomer Israel
| | - Yigal Kassif
- The Olga and Lev Leviev Heart Center; Sheba Medical Center; Ramat Gan Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Eugenia Raichlin
- Cardiology Department; Loyola University Medical Center; Maywood Illinois
| | - Arwa Younis
- The Olga and Lev Leviev Heart Center; Sheba Medical Center; Ramat Gan Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Anan Younis
- The Olga and Lev Leviev Heart Center; Sheba Medical Center; Ramat Gan Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Eyal Nachum
- The Olga and Lev Leviev Heart Center; Sheba Medical Center; Ramat Gan Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Dov Freimark
- The Olga and Lev Leviev Heart Center; Sheba Medical Center; Ramat Gan Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Ilan Goldenberg
- The Olga and Lev Leviev Heart Center; Sheba Medical Center; Ramat Gan Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Jacob Lavee
- The Olga and Lev Leviev Heart Center; Sheba Medical Center; Ramat Gan Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| |
Collapse
|
23
|
Cole RT, Gandhi J, Bray RA, Gebel HM, Yin M, Shekiladze N, Young A, Grant A, Mahoney I, Laskar SR, Gupta D, Bhatt K, Book W, Smith A, Nguyen D, Vega JD, Morris AA. Racial differences in the development of de-novo donor-specific antibodies and treated antibody-mediated rejection after heart transplantation. J Heart Lung Transplant 2018; 37:503-512. [DOI: 10.1016/j.healun.2017.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 11/29/2022] Open
|
24
|
Keating BJ, Pereira AC, Snyder M, Piening BD. Applying genomics in heart transplantation. Transpl Int 2018; 31:278-290. [PMID: 29363220 PMCID: PMC5990370 DOI: 10.1111/tri.13119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/18/2017] [Accepted: 01/17/2018] [Indexed: 12/13/2022]
Abstract
While advances in patient care and immunosuppressive pharmacotherapies have increased the lifespan of heart allograft recipients, there are still significant comorbidities post-transplantation and 5-year survival rates are still significant, at approximately 70%. The last decade has seen massive strides in genomics and other omics fields, including transcriptomics, with many of these advances now starting to impact heart transplant clinical care. This review summarizes a number of the key advances in genomics which are relevant for heart transplant outcomes, and we highlight the translational potential that such knowledge may bring to patient care within the next decade.
Collapse
Affiliation(s)
- Brendan J. Keating
- Division of Transplantation, Department of Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Alexandre C. Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil
| | - Michael Snyder
- Department of Genetics, Stanford University, Stanford, CA, USA
| | | |
Collapse
|
25
|
The Paradoxical Relationship Between Donor Distance and Survival After Heart Transplantation. Ann Thorac Surg 2017; 103:1384-1391. [DOI: 10.1016/j.athoracsur.2017.01.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/01/2016] [Accepted: 01/10/2017] [Indexed: 11/18/2022]
|
26
|
Cardiac Rehabilitation After Complex Procedures. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0127-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Lee JH, Yeom SY, Hwang HY, Choi JW, Cho HJ, Lee HY, Huh JH, Kim KB. Twenty-Year Experience of Heart Transplantation: Early and Long-Term Results. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:242-9. [PMID: 27525232 PMCID: PMC4981225 DOI: 10.5090/kjtcs.2016.49.4.242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/05/2015] [Accepted: 10/05/2015] [Indexed: 12/18/2022]
Abstract
Background We evaluated early and long-term results after heart transplantation (HTPL). Methods One hundred five consecutive patients (male:female=80:25) who underwent HTPL between 1994 and 2013 were enrolled. Based on the changes in immunosuppressive regimen, the study patients were divided into two groups. Early and long-term clinical outcomes were evaluated and compared between the patients who underwent HTPL before (group E, n=41) and after July 2009 (group L, n=64). The group L patients were older (p<0.001), had higher incidence of hypertension (p=0.001) and chronic kidney disease (p<0.001), and more frequently needed preoperative mechanical ventilation (p=0.027) and mechanical circulatory support (p=0.014) than the group E patients. Results Overall operative mortality was 3.8%, and postoperative morbidities included acute kidney injury (n=31), respiratory complications (n=16), reoperation for bleeding (n=15) and wound complications (n=10). There were no significant differences in early results except acute kidney injury between group E and group L patients. Overall survival rates at 1, 5, and 10 years were 83.8%, 67.7%, and 54.9%, respectively, with no significant difference between the two patient groups. Rejection-free rates at 1 and 5 years were 63.0% and 59.7%, respectively; rates were significantly higher in group L than in group E (p<0.001). Conclusion Despite increased preoperative comorbidities, group L patients showed similar early and long-term outcomes and significantly higher rejection-free rates when compared with group E patients.
Collapse
Affiliation(s)
- Jae-Hong Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Sang Yoon Yeom
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Jae-Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Hyun-Jai Cho
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Hae-Young Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Jae-Hak Huh
- Department of Thoracic and Cardiovascular Surgery, Myongji Hospital, Seonam University College of Medicine
| | - Ki-Bong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| |
Collapse
|
28
|
Butts RJ, Savage AJ, Atz AM, Heal EM, Burnette AL, Kavarana MM, Bradley SM, Chowdhury SM. Validation of a Simple Score to Determine Risk of Early Rejection After Pediatric Heart Transplantation. JACC-HEART FAILURE 2016; 3:670-6. [PMID: 26362445 DOI: 10.1016/j.jchf.2015.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/07/2015] [Accepted: 04/18/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This study aimed to develop a reliable and feasible score to assess the risk of rejection in pediatric heart transplantation recipients during the first post-transplant year. BACKGROUND The first post-transplant year is the most likely time for rejection to occur in pediatric heart transplantation. Rejection during this period is associated with worse outcomes. METHODS The United Network for Organ Sharing database was queried for pediatric patients (age <18 years) who underwent isolated orthotopic heart transplantation from January 1, 2000 to December 31, 2012. Transplantations were divided into a derivation cohort (n = 2,686) and a validation (n = 509) cohort. The validation cohort was randomly selected from 20% of transplantations from 2005 to 2012. Covariates found to be associated with rejection (p < 0.2) were included in the initial multivariable logistic regression model. The final model was derived by including only variables independently associated with rejection. A risk score was then developed using relative magnitudes of the covariates' odds ratio. The score was then tested in the validation cohort. RESULTS A 9-point risk score using 3 variables (age, cardiac diagnosis, and panel reactive antibody) was developed. Mean score in the derivation and validation cohorts were 4.5 ± 2.6 and 4.8 ± 2.7, respectively. A higher score was associated with an increased rate of rejection (score = 0, 10.6% in the validation cohort vs. score = 9, 40%; p < 0.01). In weighted regression analysis, the model-predicted risk of rejection correlated closely with the actual rates of rejection in the validation cohort (R(2) = 0.86; p < 0.01). CONCLUSIONS The rejection score is accurate in determining the risk of early rejection in pediatric heart transplantation recipients. The score has the potential to be used in clinical practice to aid in determining the immunosuppressant regimen and the frequency of rejection surveillance in the first post-transplant year.
Collapse
Affiliation(s)
- Ryan J Butts
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
| | - Andrew J Savage
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Andrew M Atz
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Elisabeth M Heal
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Ali L Burnette
- Department of Transplant Services, Medical University of South Carolina, Charleston, South Carolina
| | - Minoo M Kavarana
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Scott M Bradley
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Shahryar M Chowdhury
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
29
|
Morris AA, Kransdorf EP, Coleman BL, Colvin M. Racial and ethnic disparities in outcomes after heart transplantation: A systematic review of contributing factors and future directions to close the outcomes gap. J Heart Lung Transplant 2016; 35:953-61. [PMID: 27080415 DOI: 10.1016/j.healun.2016.01.1231] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 12/24/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022] Open
Abstract
The demographics of patients undergoing heart transplantation in the United States have shifted over the last 10 years, with an increasing number of racial and ethnic minorities undergoing heart transplant. Multiple studies have shown that survival of African American patients after heart transplantation is lower compared with other ethnic groups. We review the data supporting the presence of this outcome disparity and examine the multiple mechanisms that contribute. With an increasingly diverse population in the United States, knowledge of these disparities, their mechanisms, and ways to improve outcomes is essential.
Collapse
Affiliation(s)
| | - Evan P Kransdorf
- Division of Cardiovascular Diseases, Cedars-Sinai Heart Institute, Beverly Hills, California
| | - Bernice L Coleman
- Nursing Research and Development, Cedars Sinai Medical Center, Los Angeles, California
| | - Monica Colvin
- Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
30
|
Auerbach SR. Taking First Steps Toward Modeling Risk of Rejection in Children. JACC-HEART FAILURE 2015; 3:677-80. [PMID: 26362446 DOI: 10.1016/j.jchf.2015.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 05/31/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Scott R Auerbach
- Children's Hospital Colorado Heart Institute, University of Colorado School of Medicine, Aurora, Colorado.
| |
Collapse
|
31
|
Race and ethnic differences in the epidemiology and risk factors for graft failure after heart transplantation. J Heart Lung Transplant 2015; 34:825-31. [DOI: 10.1016/j.healun.2014.12.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 11/21/2014] [Accepted: 12/17/2014] [Indexed: 11/23/2022] Open
|
32
|
Kilic A, Emani S, Sai-Sudhakar CB, Higgins RSD, Whitson BA. Donor selection in heart transplantation. J Thorac Dis 2014; 6:1097-104. [PMID: 25132976 DOI: 10.3978/j.issn.2072-1439.2014.03.23] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 03/17/2014] [Indexed: 01/17/2023]
Abstract
There is increased scrutiny on the quality in health care with particular emphasis on institutional heart transplant survival outcomes. An important aspect of successful transplantation is appropriate donor selection. We review the current guidelines as well as areas of controversy in the selection of appropriate hearts as donor organs to ensure optimal outcomes. This decision is paramount to the success of a transplant program as well as recipient survival and graft function post-transplant.
Collapse
Affiliation(s)
- Ahmet Kilic
- 1 The Department of Surgery, 2 The Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Sitaramesh Emani
- 1 The Department of Surgery, 2 The Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Chittoor B Sai-Sudhakar
- 1 The Department of Surgery, 2 The Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Robert S D Higgins
- 1 The Department of Surgery, 2 The Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Bryan A Whitson
- 1 The Department of Surgery, 2 The Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| |
Collapse
|
33
|
DePasquale EC, Schweiger M, Ross HJ. A contemporary review of adult heart transplantation: 2012 to 2013. J Heart Lung Transplant 2014; 33:775-84. [DOI: 10.1016/j.healun.2014.04.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 03/14/2014] [Accepted: 04/30/2014] [Indexed: 02/07/2023] Open
|
34
|
Butts RJ, Savage AJ, Nietert PJ, Kavarana M, Moussa O, Burnette AL, Atz AM. Effect of human leukocyte antigen-C and -DQ matching on pediatric heart transplant graft survival. J Heart Lung Transplant 2014; 33:1282-7. [PMID: 25128416 DOI: 10.1016/j.healun.2014.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/25/2014] [Accepted: 07/16/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND A higher degree of human leukocyte antigen (HLA) matching at the A, B, and DR loci has been associated with improved long-term survival after pediatric heart transplantation in multiple International Society for Heart and Lung Transplantation registry reports. The aim of this study was to investigate the association of HLA matching at the C and DQ loci with pediatric graft survival. METHODS The United Network of Organ Sharing database was queried for isolated heart transplants that occurred from 1988 to 2012 with a recipient age of 17 or younger and at least 1 postoperative follow-up encounter. When HLA matching at the C or DQ loci were analyzed, only transplants with complete typing of donor and recipient at the respective loci were included. Transplants were divided into patients with at least 1 match at the C locus (C-match) vs no match (C-no), and at least 1 match at the DQ (DQ-match) locus vs no match (DQ-no). Primary outcome was graft loss. Univariate analysis was performed with the log-rank test. Cox regression analysis was performed with the following patient factors included in the model: recipient age, ischemic time; recipient on ventilator, extracorporeal membrane oxygenation, ventricular assist device, or inotropes at transplant; recipient serum bilirubin and creatinine closest to transplant, ratio of donor weight to recipient weight, underlying cardiac diagnosis, crossmatch results, transplant year, and HLA matching at the A, B, and DR loci. RESULTS Complete typing at the C locus occurred in 2,429 of 4,731 transplants (51%), and complete typing at the DQ locus occurred in 3,498 of 4,731 transplants (74%). Patient factors were similar in C-match and C-no, except for year of transplant (median year, 2007 [interquartile range, 1997-2010] vs year 2005 [interquartile range, 1996-2009], respectively; p = 0.03) and the degree of HLA matching at the A, B, and DR loci (high level of HLA matching in 11.9% vs 3%, respectively; p < 0.01). Matching at the C locus was not associated with a decreased risk of graft loss (median graft survival: 13.1 years [95% confidence interval {CI}, 11.5-14.8] in C-no vs 15.1 years [95% CI, 13.5-16.6) in C-match, p = 0.44 log-rank; hazard ratio, 0.93; 95% CI, 0.76-1.15; p = 0.52). DQ-match did not differ from DQ-no in any of the analyzed patient factors, except DQ-match was more likely to have high degree of matching at the A, B, and DR loci vs DQ-no (9.8% vs 3.2%, p < 0.01). Matching at the DQ locus was not associated with decreased risk of graft loss (median graft survival: DQ-no, 13.1 years [95% CI, 11.7-14.6) vs DQ-match, 13.0 years [95% CI, 11.4-14.6], p = 0.80, log-rank; hazard ratio, 0.95; 95% CI, 0.81-1.1; p = 0.51. CONCLUSIONS Complete typing at the C locus of both donor and recipient occurs less often then typing at the DQ locus. A higher degree of donor-recipient HLA matching at the C locus or the DQ locus appears not to confer any graft survival advantage.
Collapse
Affiliation(s)
- Ryan J Butts
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston South Carolina.
| | - Andrew J Savage
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston South Carolina
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston South Carolina
| | - Minoo Kavarana
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston South Carolina
| | - Omar Moussa
- Division of HLA Laboratory, Department of Pathology and Laboratory, Medical University of South Carolina, Charleston South Carolina
| | - Ali L Burnette
- Department of Transplant Services, Medical University of South Carolina, Charleston South Carolina
| | - Andrew M Atz
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston South Carolina
| |
Collapse
|
35
|
Butts RJ, Scheurer MA, Atz AM, Moussa O, Burnette AL, Hulsey TC, Savage AJ. Association of human leukocyte antigen donor-recipient matching and pediatric heart transplant graft survival. Circ Heart Fail 2014; 7:605-11. [PMID: 24833649 DOI: 10.1161/circheartfailure.113.001008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The effect of donor-recipient human leukocyte antigen (HLA) matching on outcomes remains relatively unexplored in pediatric patients. The objective of this study was to investigate the effects of donor-recipient HLA matching on graft survival in pediatric heart transplantation. METHODS AND RESULTS The UNOS (United Network for Organ Sharing) database was queried for heart transplants occurring between October 31, 1987, and December 31, 2012, in a recipient aged ≤17 years with ≥1 postoperative follow-up visit. Retransplants were excluded. Transplants were divided into 3 donor-recipient matching groups: no HLA matches (HLA-no), 1 or 2 HLA matches (HLA-low), and 3 to 6 HLA matches (HLA-high). Primary outcome was graft loss. Four thousand four hundred seventy-one heart transplants met the study inclusion criteria. High degree of donor-recipient HLA matching occurred infrequently: HLA-high (n=269; 6%) versus HLA-low (n=2683; 60%) versus HLA-no (n=1495; 34%). There were no differences between HLA matching groups in the frequency of coronary vasculopathy (P=0.19) or rejection in the first post-transplant year (P=0.76). Improved graft survival was associated with a greater degree of HLA donor-recipient matching: HLA-high median survival, 17.1 (95% confidence interval, 14.0-20.2) years; HLA-low median survival, 14.2 (13.1-15.4) years; and HLA-no median survival, 12.1 (10.9-13.3 years) years; P<0.01, log-rank test. In Cox-regression analysis, HLA matching was independently associated with decreased graft loss: HLA-low versus HLA-no hazard ratio, 0.86 (95% confidence interval, 0.74-0.99), P=0.04; HLA-high versus HLA-no, 0.62 (95% confidence interval, 0.43-0.90), P<0.01. CONCLUSIONS Decreased graft loss in pediatric heart transplantation was associated with a higher degree of donor-recipient HLA matching, although a difference in the frequency of early rejection or development of coronary artery vasculopathy was not seen.
Collapse
Affiliation(s)
- Ryan J Butts
- From the Department of Pediatrics, Division of Cardiology (R.J.B., M.A.S., A.M.A., A.J.S.), Department of Pathology and Laboratory Medicine, Division of HLA Laboratory (O.M.), Department of Transplant Services, Division of Heart Transplant (A.L.B.), and Department of Pediatrics, Division of Epidemiology (T.C.H.), Medical University of South Carolina, Charleston.
| | - Mark A Scheurer
- From the Department of Pediatrics, Division of Cardiology (R.J.B., M.A.S., A.M.A., A.J.S.), Department of Pathology and Laboratory Medicine, Division of HLA Laboratory (O.M.), Department of Transplant Services, Division of Heart Transplant (A.L.B.), and Department of Pediatrics, Division of Epidemiology (T.C.H.), Medical University of South Carolina, Charleston
| | - Andrew M Atz
- From the Department of Pediatrics, Division of Cardiology (R.J.B., M.A.S., A.M.A., A.J.S.), Department of Pathology and Laboratory Medicine, Division of HLA Laboratory (O.M.), Department of Transplant Services, Division of Heart Transplant (A.L.B.), and Department of Pediatrics, Division of Epidemiology (T.C.H.), Medical University of South Carolina, Charleston
| | - Omar Moussa
- From the Department of Pediatrics, Division of Cardiology (R.J.B., M.A.S., A.M.A., A.J.S.), Department of Pathology and Laboratory Medicine, Division of HLA Laboratory (O.M.), Department of Transplant Services, Division of Heart Transplant (A.L.B.), and Department of Pediatrics, Division of Epidemiology (T.C.H.), Medical University of South Carolina, Charleston
| | - Ali L Burnette
- From the Department of Pediatrics, Division of Cardiology (R.J.B., M.A.S., A.M.A., A.J.S.), Department of Pathology and Laboratory Medicine, Division of HLA Laboratory (O.M.), Department of Transplant Services, Division of Heart Transplant (A.L.B.), and Department of Pediatrics, Division of Epidemiology (T.C.H.), Medical University of South Carolina, Charleston
| | - Thomas C Hulsey
- From the Department of Pediatrics, Division of Cardiology (R.J.B., M.A.S., A.M.A., A.J.S.), Department of Pathology and Laboratory Medicine, Division of HLA Laboratory (O.M.), Department of Transplant Services, Division of Heart Transplant (A.L.B.), and Department of Pediatrics, Division of Epidemiology (T.C.H.), Medical University of South Carolina, Charleston
| | - Andrew J Savage
- From the Department of Pediatrics, Division of Cardiology (R.J.B., M.A.S., A.M.A., A.J.S.), Department of Pathology and Laboratory Medicine, Division of HLA Laboratory (O.M.), Department of Transplant Services, Division of Heart Transplant (A.L.B.), and Department of Pediatrics, Division of Epidemiology (T.C.H.), Medical University of South Carolina, Charleston
| |
Collapse
|
36
|
Morris AA, Cole RT, Veledar E, Bellam N, Laskar SR, Smith AL, Gebel HM, Bray RA, Butler J. Influence of Race/Ethnic Differences in Pre-Transplantation Panel Reactive Antibody on Outcomes in Heart Transplant Recipients. J Am Coll Cardiol 2013; 62:2308-15. [DOI: 10.1016/j.jacc.2013.06.054] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/22/2013] [Accepted: 06/17/2013] [Indexed: 11/25/2022]
|
37
|
Hollander Z, Chen V, Sidhu K, Lin D, Ng RT, Balshaw R, Cohen-Freue GV, Ignaszewski A, Imai C, Kaan A, Tebbutt SJ, Wilson-McManus JE, McMaster RW, Keown PA, McManus BM. Predicting acute cardiac rejection from donor heart and pre-transplant recipient blood gene expression. J Heart Lung Transplant 2013; 32:259-65. [DOI: 10.1016/j.healun.2012.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 11/03/2012] [Accepted: 11/10/2012] [Indexed: 12/21/2022] Open
|
38
|
|