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Donald EM, Oren D, DeFilippis EM, Rubinstein G, Moeller CM, Lee HY, Maldonado A, Portera MV, Fuselier B, Jackson R, Clerkin KJ, Fried JA, Raikhelkar J, Lee SH, Latif F, Lytrivi ID, Zuckerman WA, Richmond ME, Sayer G, Uriel N. Long-term outcomes for pediatric heart transplant recipients transitioning to adult care teams. Clin Transplant 2024; 38:e15282. [PMID: 38546027 DOI: 10.1111/ctr.15282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/08/2024] [Accepted: 02/19/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND There are limited data evaluating the success of a structured transition plan specifically for pediatric heart transplant (HT) recipients following their transfer of care to an adult specialist. We sought to identify risk factors for poor adherence, graft failure, and mortality following the transfer of care to adult HT care teams. METHODS We retrospectively reviewed all patients who underwent transition from the pediatric to adult HT program at our center between January 2011 and June 2021. Demographic characteristics, comorbid conditions, and psychosocial history were collected at the time of HT, the time of transition, and the most recent follow-up. Adverse events including mortality, graft rejection, infection, and renal function were also captured before and after the transition. RESULTS Seventy-two patients were identified (54.1% male, 54.2% Caucasian). Mean age at the time of transition was 23 years after a median of 11.6 years in the pediatric program. The use of calcineurin inhibitors was associated with reduced mortality (HR .04, 95% CI .0-.6, p = .015), while prior psychiatric hospitalization (HR 45.3, 95% CI, 6.144-333.9, p = .0001) was associated with increased mortality following transition. Medication nonadherence and young age at the time of transition were markers for high-risk individuals prior to the transition of care. CONCLUSIONS Transition of HT recipients from a pediatric program to an adult program occurs during a vulnerable time of emerging adulthood, and we have identified risk factors for mortality following transition. Development of a formalized transition plan with a large multidisciplinary team with focused attention on high-risk patients, including those with psychiatric comorbidities, may favorably influence outcomes.
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Affiliation(s)
- Elena M Donald
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Daniel Oren
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Ersilia M DeFilippis
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Gal Rubinstein
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Catherine M Moeller
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Hannah Y Lee
- Department of Pediatrics, Division of Cardiology, New York Presbyterian Hospital/Morgan Stanley Children's Hospital, New York, New York, USA
| | - Alejandro Maldonado
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Mary Virginia Portera
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Byron Fuselier
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Ruslana Jackson
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Kevin J Clerkin
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Justin A Fried
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Jayant Raikhelkar
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Sun Hi Lee
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Farhana Latif
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Irene D Lytrivi
- Department of Pediatrics, Division of Cardiology, New York Presbyterian Hospital/Morgan Stanley Children's Hospital, New York, New York, USA
| | - Warren A Zuckerman
- Department of Pediatrics, Division of Cardiology, New York Presbyterian Hospital/Morgan Stanley Children's Hospital, New York, New York, USA
| | - Marc E Richmond
- Department of Pediatrics, Division of Cardiology, New York Presbyterian Hospital/Morgan Stanley Children's Hospital, New York, New York, USA
| | - Gabriel Sayer
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Nir Uriel
- Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
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Oren D, Uriel M, Moeller CM, Valledor AF, DeFilippis EM, Lotan D, Colombo PC, Yuzefpolskaya M, Topkara VK, Clerkin KJ, Raikhelkar JK, Fried JA, Oh DKT, Bae D, Lin E, Theodoropoulos K, Naka Y, Takeda K, Choe J, Jennings DL, Majure D, Latif F, Sayer G, Uriel N. Utility of a fusion protein T-cell co-stimulation blocker Belatacept in heart transplant recipients: Real world experience from a high volume center. Clin Transplant 2024; 38:e15251. [PMID: 38504576 DOI: 10.1111/ctr.15251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Belatacept (BTC), a fusion protein, selectively inhibits T-cell co-stimulation by binding to the CD80 and CD86 receptors on antigen-presenting cells (APCs) and has been used as immunosuppression in adult renal transplant recipients. However, data regarding its use in heart transplant (HT) recipients are limited. This retrospective cohort study aimed to delineate BTC's application in HT, focusing on efficacy, safety, and associated complications at a high-volume HT center. METHODS A retrospective cohort study was conducted of patients who underwent HT between January 2017 and December 2021 and subsequently received BTC as part of their immunosuppressive regimen. Twenty-one HT recipients were identified. Baseline characteristics, history of rejection, and indication for BTC use were collected. Outcomes included renal function, graft function, allograft rejection and mortality. Follow-up data were collected through December 2023. RESULTS Among 776 patients monitored from January 2017 to December 2021 21 (2.7%) received BTC treatment. Average age at transplantation was 53 years (± 12 years), and 38% were women. BTC administration began, on average, 689 [483, 1830] days post-HT. The primary indications for BTC were elevated pre-formed donor-specific antibodies in highly sensitized patients (66.6%) and renal sparing (23.8%), in conjunction with reduced calcineurin inhibitor dosage. Only one (4.8%) patient encountered rejection within a year of starting BTC. Graft function by echocardiography remained stable at 6 and 12 months posttreatment. An improvement was observed in serum creatinine levels (76.2% of patients), decreasing from a median of 1.58 to 1.45 (IQR [1.0-2.1] to [1.1-1.9]) over 12 months (p = .054). eGFR improved at 3 and 6 months compared with 3 months pre- BTC levels; however, this was not statistically significant (p = .24). Treatment discontinuation occurred in seven patients (33.3%) of whom four (19%) were switched back to full dose CNI. Infections occurred in 11 patients (52.4%), leading to BTC discontinuation in 4 patients (19%). CONCLUSION In this cohort, BTC therapy was used as alternative immunosuppression for management of highly sensitized patients or for renal sparing. BTC therapy when combined with CNI dose reduction resulted in stabilization in renal function as measured through renal surrogate markers, which did not, however, reach statistical significance. Patients on BTC maintained a low rejection rate and preserved graft function. Infections were common during BTC therapy and were associated with medication pause/discontinuation in 19% of patients. Further randomized studies are needed to assess the efficacy and safety of BTC in HT recipients.
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Affiliation(s)
- Daniel Oren
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Matan Uriel
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Cathrine M Moeller
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Andrea Fernandez Valledor
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
- Columbia University Irving Medical Center, New York, New York, USA
| | - Ersilia M DeFilippis
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Dor Lotan
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Veli K Topkara
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Kevin J Clerkin
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Jayant K Raikhelkar
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Justin A Fried
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - David Kyung Taek Oh
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - David Bae
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Eddie Lin
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Kleanthis Theodoropoulos
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Yoshifumi Naka
- Department of Cardiothoracic Surgery, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Koji Takeda
- Department of Cardiothoracic Surgery, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Jason Choe
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Douglas L Jennings
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - David Majure
- Division of Cardiology, Advanced Cardiac Care, Weill-Cornell Medical College, New York, New York, USA
| | - Farhana Latif
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Gabriel Sayer
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Irving Medical Center, Columbia University, New York Presbyterian, New York, New York, USA
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Rubinstein G, Moeller CM, Lotan D, Slomovich S, Fernandez-Valledor A, Oren D, Oh KT, Fried JA, Clerkin KJ, Raikhelkar JK, Topkara VK, Kaku Y, Takeda K, Naka Y, Burkhoff D, Latif F, Majure D, Colombo PC, Yuzefpolskaya M, Sayer GT, Uriel N. Hemodynamic Optimization by Invasive Ramp Test in Patients Supported With HeartMate 3 Left Ventricular Assist Device. ASAIO J 2024:00002480-990000000-00420. [PMID: 38373176 DOI: 10.1097/mat.0000000000002167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
In patients supported by the HeartMate 3 left ventricular assist device (HM3 LVAD), pump speed adjustments may improve hemodynamics. We investigated the hemodynamic implications of speed adjustments in HM3 recipients undergoing hemodynamic ramp tests. Clinically stable HM3 recipients who underwent routine invasive hemodynamic ramp tests between 2015 and 2022 at our center were included. Filling pressure optimization, defined as central venous pressure (CVP) <12 mm Hg and pulmonary capillary wedge pressure (PCWP) <18 mm Hg, was assessed at baseline and final pump speeds. Patients with optimized pressures were compared to nonoptimized patients. Overall 60 HM3 recipients with a median age of 62 years (56, 71) and time from LVAD implantation of 187 days (124, 476) were included. Optimized filling pressures were found in 35 patients (58%) at baseline speed. Speed was adjusted in 84% of the nonoptimized patients. Consequently, 39 patients (65%) had optimized pressures at final speed. There were no significant differences in hemodynamic findings between baseline and final speeds (p > 0.05 for all). Six and 12 month readmission-free rates were higher in optimized compared with nonoptimized patients (p = 0.03 for both), predominantly due to lower cardiac readmission-free rates (p = 0.052). In stable outpatients supported with HM3 who underwent routine ramp tests, optimized hemodynamics were achieved in only 2 of 3 of the patients. Patients with optimized pressures had lower all-cause readmission rates, primarily driven by fewer cardiac-related hospitalizations.
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Affiliation(s)
- Gal Rubinstein
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Cathrine M Moeller
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Dor Lotan
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Sharon Slomovich
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Andrea Fernandez-Valledor
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Daniel Oren
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Kyung T Oh
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Justin A Fried
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Kevin J Clerkin
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Jayant K Raikhelkar
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Veli K Topkara
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Yuji Kaku
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Koji Takeda
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Yoshifumi Naka
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | | | - Farhana Latif
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - David Majure
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Paolo C Colombo
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Melana Yuzefpolskaya
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Gabriel T Sayer
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Nir Uriel
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Staplin N, Haynes R, Judge PK, Wanner C, Green JB, Emberson J, Preiss D, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Seidi S, Landray MJ, Baigent C, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, Ellison R, Emberson J, Epp R, Er A, Espino-Obrero M, Estcourt S, Estienne L, Evans G, Evans J, Evans S, Fabbri G, Fajardo-Moser M, Falcone C, Fani F, Faria-Shayler P, Farnia F, Farrugia D, Fechter M, Fellowes D, Feng F, Fernandez J, Ferraro P, Field A, Fikry S, Finch J, Finn H, Fioretto P, Fish R, Fleischer A, Fleming-Brown D, Fletcher L, Flora R, Foellinger C, Foligno N, Forest S, Forghani Z, Forsyth K, Fottrell-Gould D, Fox P, Frankel A, Fraser D, Frazier R, Frederick K, Freking N, French H, Froment A, Fuchs B, Fuessl L, Fujii H, Fujimoto A, Fujita A, Fujita K, Fujita Y, Fukagawa M, Fukao Y, Fukasawa A, Fuller T, Funayama T, Fung E, Furukawa M, Furukawa Y, Furusho M, Gabel S, Gaidu J, Gaiser S, Gallo K, Galloway C, Gambaro G, Gan CC, Gangemi C, Gao M, Garcia K, Garcia M, Garofalo C, Garrity M, Garza A, Gasko S, Gavrila M, Gebeyehu B, Geddes A, Gentile G, George A, George J, Gesualdo L, Ghalli F, Ghanem A, Ghate T, Ghavampour S, Ghazi A, Gherman A, Giebeln-Hudnell U, Gill B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura 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Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Latif F, Iqbal R, Ambreen F, Kousar S, Ahmed T, Aziz S. Studies on bioaccumulation patterns, biochemical and genotoxic effects of copper on freshwater fish, Catla catla: an in vivo analysis. BRAZ J BIOL 2024; 84:e256905. [DOI: 10.1590/1519-6984.256905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/10/2021] [Indexed: 11/22/2022] Open
Abstract
Abstract During present study, the copper (Cu) mediated oxidative stress was measured that induced DNA damage by concentrating in the tissues of fish, Catla catla (14.45±1.24g; 84.68±1.45mm) (Hamilton,1822). Fish fingerlings were retained in 5 groups for 14, 28, 42, 56, 70 and 84 days of the exposure period. They were treated with 2/3, 1/3, 1/4 and 1/5 (T1-T4) of 96h lethal concentration of copper. Controls were run along with all the treatments for the same durations. A significant (p < 0.05) dose and time dependent concentration of Cu was observed in the gills, liver, kidney, muscles, and brain of C. catla. Among organs, the liver showed a significantly higher concentration of Cu followed by gills, kidney, brain, and muscles. Copper accumulation in these organs caused a significant variation in the activities of enzymes viz. superoxide dismutase (SOD), catalase (CAT) and peroxidase (POD). The SOD activity varied significantly in response to the exposure time of Cu as 56 > 70 > 42 > 84 > 28 > 14 days while CAT activity exhibited an inverse relationship with the increase in Cu concentration. POD activity showed a significant rise with an increase in Cu exposure duration. Comet assay exhibited significant DNA damage in the peripheral erythrocytes of Cu exposed C. catla. Among four exposure concentrations, 2/3rd of LC50 (T1) caused significantly higher damage to the nuclei compared to control. Increased POD and SOD activity, as well as a decrease in CAT activity in response to Cu, demonstrates the involvement of a protective mechanism against reactive oxygen species (ROS), whereas increased ROS resulted in higher DNA damage. These above-mentioned molecular markers can be efficiently used for the biomonitoring of aquatic environments and conservation of edible fish fauna.
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Affiliation(s)
- F. Latif
- Bahauddin Zakariya University, Pakistan
| | - R. Iqbal
- Bahauddin Zakariya University, Pakistan
| | - F. Ambreen
- Government College Women University, Pakistan
| | - S. Kousar
- Government College Women University, Pakistan
| | - T. Ahmed
- Khwaja Fareed University of Engineering and Information Technology, Pakistan
| | - S. Aziz
- University of Agriculture, Pakistan
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Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Batra J, DeFilippis EM, Clerkin K, Bae D, Oh KT, Lotan D, Topkara VK, Lee SH, Latif F, Colombo P, Yuzefpolskaya M, Raikhelkar J, Majure DT, Sayer G, Uriel N. A change of heart: Characteristics and outcomes of multiple cardiac retransplant recipients. Clin Transplant 2024; 38:e15214. [PMID: 38078705 DOI: 10.1111/ctr.15214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Among heart transplant (HT) recipients who develop advanced graft dysfunction, cardiac re-transplantation may be considered. A smaller subset of patients will experience failure of their second allograft and undergo repeat re-transplantation. Outcomes among these individuals are not well-described. METHODS Adult and pediatric patients in the United Network for Organ Sharing (UNOS) registry who received HT between January 1, 1990 and December 31, 2020 were included. RESULTS Between 1990 and 2020, 90 individuals received a third HT and three underwent a fourth HT. Recipients were younger than those undergoing primary HT (mean age 32 years). Third HT was associated with significantly higher unadjusted rates of 1-year mortality (18% for third HT vs. 13% for second HT vs. 9% for primary HT, p < .001) and 10-year mortality (59% for third HT vs. 42% for second HT vs. 37% for primary HT, p < .001). Mortality was highest amongst recipients aged >60 years and those re-transplanted for acute graft failure. Long-term rates of CAV, rejection, chronic dialysis, and hospitalization for infection were also higher. CONCLUSIONS Third HT is associated with higher morbidity and mortality than primary HT. Further consensus is needed regarding appropriate organ stewardship for this unique subgroup.
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Affiliation(s)
- Jaya Batra
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Ersilia M DeFilippis
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Kevin Clerkin
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - David Bae
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Kyung Taek Oh
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Dor Lotan
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Sun Hi Lee
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Farhana Latif
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Paolo Colombo
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Jayant Raikhelkar
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - David T Majure
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Gabriel Sayer
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
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8
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Mehlman Y, Valledor AF, Moeller C, Rubinstein G, Lotan D, Rahman S, Oh KT, Bae D, DeFilippis EM, Lin EF, Lee SH, Raikhelkar JK, Fried J, Theodoropoulos K, Colombo PC, Yuzefpolskaya M, Latif F, Clerkin KJ, Sayer GT, Uriel N. The utilization of molecular microscope in management of heart transplant recipients in the era of noninvasive monitoring. Clin Transplant 2023; 37:e15131. [PMID: 37897211 DOI: 10.1111/ctr.15131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION Monitoring for graft rejection is a fundamental tenet of post-transplant follow-up. In heart transplantation (HT) in particular, rejection has been traditionally assessed with endomyocardial biopsy (EMB). EMB has potential complications and noted limitations, including interobserver variability in interpretation. Additional tests, such as basic cardiac biomarkers, cardiac imaging, gene expression profiling (GEP) scores, donor-derived cell-free DNA (dd-cfDNA) and the novel molecular microscope diagnostic system (MMDx) have become critical tools in rejection surveillance beyond standard EMB. METHODS This paper describes an illustrative case followed by a review of MMDx within the context of other noninvasive screening modalities for rejection. CONCLUSIONS We suggest MMDx be used to assist with early detection of rejection in cases of discordance between EMB and other noninvasive studies.
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Affiliation(s)
- Yonatan Mehlman
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Andrea Fernendez Valledor
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Cathrine Moeller
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Gal Rubinstein
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Dor Lotan
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Salwa Rahman
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Kyung T Oh
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - David Bae
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Ersilia M DeFilippis
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Edward F Lin
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Sun Hi Lee
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Jayant K Raikhelkar
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Justin Fried
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Kleanthis Theodoropoulos
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Paolo C Colombo
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Melana Yuzefpolskaya
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Farhana Latif
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Kevin J Clerkin
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Gabriel T Sayer
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Nir Uriel
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York, USA
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9
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Oren D, Moeller CM, Haythe JH, Rubinstein G, Fernandez Valledor A, Lotan D, Rosenblum H, Colombo PC, Yuzefpolskaya M, Topkara VK, Clerkin KJ, Raikhelkar JK, Fried JA, Naka Y, Takeda K, Latif F, Sayer G, Uriel N. Pumping for Two: Pregnancy in Patients Supported With a Left Ventricular Assist Device. ASAIO J 2023:00002480-990000000-00346. [PMID: 37934714 DOI: 10.1097/mat.0000000000002082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
This review discusses the challenges and outcomes associated with pregnancy during left ventricular assist device (LVAD) support. Women account for a third of the heart failure population in the United States. Left ventricular assist devices have emerged as a safe and effective treatment option for patients with advanced heart failure. Pregnancy during LVAD support can occur, and it presents significant risks to both mother and fetus, including hemodynamic stress, thrombotic events, medication-associated teratogenicity, and uterine impingement. This literature review identified 10 cases of confirmed pregnancy during LVAD support, of which eight resulted in successful births. Maternal and fetal mortality occurred in one case, and there was a spontaneous abortion in one case. The review highlights the importance of a multidisciplinary approach, promotion of shared decision-making, thoughtful anticoagulation, adjustment of LVAD speed, and medication optimization to maintain hemodynamic support during pregnancy. Hemodynamic changes during pregnancy include increased cardiac output, heart rate, and plasma volume, as well as decreased systemic vascular resistance, which can impact LVAD support. Despite reduced pulsatility in LVAD-supported patients, ovulation and reproductive capacity might be preserved, and viable pregnancies may be achieved with appropriate management. The review provides insights into the risks and considerations for a viable pregnancy during LVAD support, including the need for ongoing research to inform joined decision-making.
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Affiliation(s)
- Daniel Oren
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Cathrine M Moeller
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Jennifer H Haythe
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Gal Rubinstein
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Andrea Fernandez Valledor
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Dor Lotan
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Hannah Rosenblum
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Paolo C Colombo
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Melana Yuzefpolskaya
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Veli K Topkara
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Kevin J Clerkin
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Jayant K Raikhelkar
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Justin A Fried
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Yoshifumi Naka
- Department of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Koji Takeda
- Department of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Farhana Latif
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Gabriel Sayer
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Nir Uriel
- From the Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
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10
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Harris E, Sewanan L, Topkara VK, Fried JA, Raikhelkar J, Colombo PC, Yuzefpolskaya M, DeFilippis EM, Latif F, Takeda K, Singh S, Uriel N, Sayer G, Clerkin KJ. New system, old problem: Increased wait time for high-priority transplant candidates. J Heart Lung Transplant 2023; 42:1497-1500. [PMID: 37506955 DOI: 10.1016/j.healun.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/11/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
The 2018 heart allocation policy sought to improve risk stratification and reduce waitlist mortality for the sickest patients. This study sought to evaluate changes in wait times for the highest priority patients since policy implementation. All adult single-organ transplant recipients were identified in the United Network for Organ Sharing registry from October 18, 2018, to July 8, 2022, and separated into 4 periods. Outcomes were compared by blood type and UNOS region. Over the study period, 897 of 9,143 patients were listed as status 1 with no significant change in median wait time by blood type or region. More patients were listed as status 2 (4,523/9,143), and each subsequent period postpolicy change was associated with a 4.2-day increase in mean status 2 waitlist time (95% confidence interval 3.0-5.5, p < 0.0001). Wait times were longest for candidates with blood type O and shortest for AB & A. Regional variations continued, however, wait time increased in every region over time.
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Affiliation(s)
- Erin Harris
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Lorenzo Sewanan
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Veli K Topkara
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Justin A Fried
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Jayant Raikhelkar
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Paolo C Colombo
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Melana Yuzefpolskaya
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Ersilia M DeFilippis
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Farhana Latif
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Koji Takeda
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Sameer Singh
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Nir Uriel
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Gabriel Sayer
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Kevin J Clerkin
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
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11
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Feng I, Kurlansky PA, Ning Y, Sun J, Naka Y, Topkara VK, Latif F, Sayer G, Uriel NY, Takeda K. Do age and functional dependence affect outcomes of simultaneous heart-kidney transplantation? JTCVS Open 2023; 15:262-289. [PMID: 37808044 PMCID: PMC10556940 DOI: 10.1016/j.xjon.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/26/2023] [Accepted: 05/18/2023] [Indexed: 10/10/2023]
Abstract
Objective This study assessed characteristics and outcomes of younger (18-65) versus older (>65) recipients of simultaneous heart-kidney (SHK) transplantation with varying functional dependence. Methods This study retrospectively analyzed 1398 patients from the United Network for Organ Sharing database who received SHK between 2010 and 2021. Patients who were <18 year old, underwent transplant of additional organs simultaneously, or had previous heart transplant were excluded. The primary end point was all-cause mortality, and secondary end points included adverse events and cause of death. Outcomes were also evaluated by propensity score-matched comparison. Results The number of annual SHK transplantation in the United States has significantly increased among both age groups over the past 2 decades (P < .0001). After propensity score matching of recipients aged 18 to 65 years (n = 1162) versus age >65 years (n = 236), baseline characteristics were similar and well-balanced between the 2 cohorts. Between matched cohorts, older recipients did not have increased posttransplant mortality compared with younger recipients (90-day survival, P = .85; 7-year survival, P = .61). Multivariable Cox regression analysis found that age (hazard ratio [HR], 1.039 [0.975-1.106], P = .2415) and pretransplant functional status with interaction term for age (some assistance, HR, 0.965 [0.902-1.033], P = .3079; total assistance, HR, 0.976 [0.914-1.041], P = .4610) were not significant risk factors for 7-year post-SHK transplantation mortality. Conclusions Older and more functionally dependent recipients in this study did not have increased post-SHK transplantation mortality. These findings have important implications for organ allocation among elderly patients, as they support the need for thorough assessment of SHK candidates in terms of comorbidities, rather than exclusion solely based on age and functional dependence.
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Affiliation(s)
- Iris Feng
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Paul A. Kurlansky
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
- Department of Surgery, Center of Innovation and Outcomes Research, Columbia University, New York, NY
| | - Yuming Ning
- Department of Surgery, Center of Innovation and Outcomes Research, Columbia University, New York, NY
| | - Jocelyn Sun
- Department of Surgery, Center of Innovation and Outcomes Research, Columbia University, New York, NY
| | - Yoshifumi Naka
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Veli K. Topkara
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Farhana Latif
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Gabriel Sayer
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Nir Y. Uriel
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Koji Takeda
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
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12
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Tao A, Raikhelkar J, Benvenuto L, Topkara VK, Brenner K, Fried J, Salako O, Colombo PC, Yuzefpolskaya M, Takeda K, Restaino S, Latif F, Uriel N, Sayer GT, Clerkin KJ. Impact of preheart transplant spirometry and DCLO measurement on post-transplant pulmonary outcomes. J Heart Lung Transplant 2023; 42:819-827. [PMID: 36806438 PMCID: PMC10192045 DOI: 10.1016/j.healun.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 01/06/2023] [Accepted: 01/18/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Pulmonary function tests (PFT) are a frequent component of heart transplant evaluation. In cardiac surgery abnormal PFTs, especially reduced DLCO, have been associated with poor outcomes. We sought to evaluate the impact of pretransplant PFTs on post-transplant pulmonary outcomes and patient survival. METHODS Among the 652 adult heart transplant recipients between January 1, 2010 and July 31, 2021, 462 had PFTs and constituted the patient cohort. Obstructive ventilatory defects (OVD), restrictive ventilatory defects (RVD), and reduced DLCO were defined according to established criteria. The primary outcome was the combined endpoint of a post-transplant pulmonary complication defined as reintubation, postoperative pneumonia, prolonged intubation, or tracheostomy. Secondary outcomes included 90-day all-cause mortality, length of stay, and the odds of individual pulmonary complications. Kaplan-Meier survival analysis, multivariable Cox proportional-hazards regression, and multivariable logistic regression were performed to compare outcomes between the groups. RESULTS Patients with severe OVD (OR 1.48, 95% CI 1.18-5.23, p = 0.02) or severely reduced DLCO (OR 1.95, 95% CI 1.19-3.20, p = 0.008) had increased odds of post-transplant pulmonary complications. Following multivariable adjustment, severe OVD (aOR 2.67, 95% CI 1.15-6.19, p = 0.02) and severely reduced DLCO (aOR 1.79, 95% CI 1.05-3.04) remained strongly associated with post-transplant pulmonary complications. Patients with any degree of extrinsic RVD, moderate or less OVD, or moderately reduced DLCO or less did not have increased odds of post-transplant pulmonary complications. Ninety-day post-transplant survival was significantly reduced for both severe OVD (97.2% vs 86.5%, p = 0.04) and severely reduced DLCO (97.3% vs 90.4%, p = 0.004). Post-transplant ICU and hospital length of stay were nominally longer for both groups as well. CONCLUSIONS Severe OVD or severely reduced DLCO on preheart transplant PFTs were associated with increased odds of post-transplant pulmonary complications and early mortality.
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Affiliation(s)
- Alice Tao
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Jayant Raikhelkar
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Luke Benvenuto
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Veli K Topkara
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Keith Brenner
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Justin Fried
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Oluwafeyijimi Salako
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Paolo C Colombo
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Melana Yuzefpolskaya
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Koji Takeda
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Susan Restaino
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Farhana Latif
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Nir Uriel
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Gabriel T Sayer
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Kevin J Clerkin
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
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13
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DeFilippis E, Oren D, Lotan D, Harris E, Clerkin K, Fried J, Raikhelkar J, Yuzefpolskaya M, Colombo P, Lin E, Oh K, Latif F, Uriel N, Sayer G. Comparison of Two Commercially Available Donor-Derived Cell-Free DNA Assays for Surveillance of Rejection in Heart Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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14
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Yuzefpolskaya M, Bohn B, Ladanyi A, Mondellini G, Pinsino A, Antler K, Clerkin K, Latif F, Kurlansky P, Sayer G, Uriel N, Takeda K, Uhlemann A, Colombo P, Demmer R. Association of Sarcopenia and Gut Microbiome in HF, LVAD and Heart Transplant. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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15
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Batra J, Topkara V, Clerkin K, Latif F, Fried J, Raikhelkar J, Lotan D, Donald E, Lumish H, Oh K, Yuzefpolskaya M, Colombo P, Lin E, Sayer G, Uriel N. Multi-Organ Transplantation in Hiv-Positive Recipients - Patient Characteristics and Outcomes. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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16
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Lotan D, Park R, Rubinstein G, Moeller C, DeFilippis E, Oh K, Slomovich S, Oren D, Lin E, Clerkin K, Latif F, Colombo P, Yuzefpolskaya M, Topkara V, Kim J, Majure D, Sayer G, Jonathan W, Uriel N. The Utility and Characteristics of Cardiovascular Magnetic Resonance Imaging in Suspected Chronic Allograft Rejection. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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17
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Rubinstein G, Lotan D, Moeller C, Slomovich S, Oren D, Fried J, Clerkin K, Topkara V, Raikhelkar J, Oh K, Takeda K, Naka Y, Kaku Y, Colombo P, Yuzefpolskaya M, Latif F, Sayer G, Uriel N. The Hemodynamic Effects of Pump Speed Adjustments in Patients with Heartmate 3 Left Ventricular Assist Device. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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18
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Sewanan L, Harris E, Topkara V, Fried J, Raikhelkar J, Colombo P, Sayer G, Castillo M, Lam E, Chernovolenko M, Yuzefpolskaya M, DeFilippis E, Latif F, Takeda K, Johnson L, Uriel N, Einstein A, Clerkin K. Visually Estimated Coronary Artery Calcium is an Independent Prognostic Marker Following Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Moeller C, Oren D, DeFilippis E, Lotan D, Rubinstein G, Mehlman Y, Raja A, Slomovich S, Fried J, Raikhelkar J, Lin E, Oh K, Lee S, Topkara V, Majure D, Latif F, Sayer G, Uriel N, Clerkin K. Donor-Derived Cell-Free DNA in Heart Transplant Recipients with Coronary Allograft Vasculopathy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Moeller C, Oren D, Rubinstein G, Lotan D, Slomovich S, Clerkin K, Fried J, Raikhelkar J, Mehlman Y, Lin E, Lee S, Kleet A, Oh K, Topkara V, DeFilippis E, Majure D, Latif F, Uriel N, Sayer G. Clinical Utility of Donor Derived Cell-Free DNA in the Multiorgan Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Mehlman Y, Lotan D, Rubinstein G, Moeller C, Oren D, Slomovich S, Latif F, Lee S, Oh K, Lin E, Raikhelkar J, Clerkin K, Fried J, Yuzefpolskaya M, DeFilippis E, Colombo P, Topkara V, Lewis M, Sayer G, Axsom K, Uriel N. Donor-Derived Cell-Free DNA in Heart Transplant Recipients with a History of Congenital Heart Disease. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Rosenblum H, Lee C, DeFilippis E, Latif F, Fried J, Lotan D, Clerkin K, Aaron J, Takeda K, Kaku Y, Santoriello D, Sayer G, Uriel N, Raikhelkar J. Severe Myocardial Necrosis and Acute Allograft Failure from Fulminant Clostridium Perfringens Sepsis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Oren D, Moeller C, Rubinstein G, Lotan D, DeFilippis E, Mehlman Y, Raja A, Slomovich S, Clerkin K, Fried J, Raikhelkar J, Lin E, Oh K, Lee S, Topkara V, Latif F, Majure D, Sayer G, Uriel N. Evaluation of Donor Derived Cell-Free DNA in ABO Mismatched Heart Transplant Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Hassanein M, Singh S, Spragan D, Kaku Y, Kurlansky P, Latif F, Sayer G, Uriel N, Takeda K. Geographic Variation Exists in Heart Transplantation for Status One and Two Patients after the 2018 Heart Allocation Policy Change. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Latif F, Sayer G, Lotan D, Mendoza J, Regan M, Tsapepas D, Ramakrishnan A, DeFilippis E, Yuzefpolskaya M, Colombo P, Kennel P, Raikhelkar J, Clerkin K, Fried J, Lin E, Lee S, Naka Y, Takeda K, Uriel N. The Effect of Temperature Control Versus Icebox Preservation on Post Heart Transplant Outcome. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Lotan D, Rubinstein G, Moeller C, Slomovich S, Oren D, DeFilippis E, Raikhelkar J, Clerkin K, Fried J, Majure D, Naka Y, Kaku Y, Takeda K, Oh K, Lin E, Lee S, Topkara V, Colombo P, Yuzefpolskaya M, Latif F, Sayer G, Uriel N, Miroslav S. The Effect of Preservation Modality on Myocardial Injury - A Single Blinded Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Concha D, Chung A, Lumish H, Batra J, Sayer G, Clerkin K, Raikhelkar J, Colombo P, Naka Y, Latif F, Takeda K, Fried J, Yuzefpolskaya M, Kaku Y, Uriel N. Actual-to-Expected Advanced Heart Failure Therapy Utilization in the United States by Race/Ethnicity. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Lotan D, Moeller C, Rubinstein G, Rosenblum H, DeFilippis E, Clerkin K, Raikhelkar J, Batra J, Oh K, Lin E, Fried J, Latif F, Kennel P, McLeod J, Colombo P, Lee S, Topkara V, Yuzefpolskaya M, Sayer G, Uriel N. Against All Odds - Transplanting Against 100% Reactive Antibodies and the Role of Non-Invasive Monitoring. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Slomovich S, Rubinstein G, Moeller C, Lotan D, Mehlman Y, Donald E, Batra J, Oren D, Oh K, Clerkin K, Fried J, DeFilippis E, Topkara V, Kleet A, Colombo P, Yuzefpolskaya M, Lin E, Lee S, Majure D, Latif F, Sayer G, Uriel N, Raikhelkar J. Donor-Derived Cell-Free DNA in Cancer Survivors Following Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Rubinstein G, Lotan D, Moeller C, Slomovich S, Oren D, Mehlman Y, DeFilippis E, Lin E, Raikhelkar J, Clerkin K, Donald E, Oh K, Kleet A, Majure D, Lee S, Topkara V, Colombo P, Latif F, Yuzefpolskaya M, Sayer G, Uriel N. Donor-Derived Cell-Free DNA in Heart Transplant Recipients Bridged with Left Ventricular Assist Device. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Harris E, Sewanan L, Topkara V, Fried J, Raikhelkar J, Colombo P, Yuzefpolskaya M, DeFilippis E, Latif F, Castillo M, Lam E, Takeda K, Chernovolenko M, Einstein A, Johnson L, Uriel N, Sayer G, Clerkin K. Isolated Microvascular Cardiac Allograft Vasculopathy is Associated with an Increased Risk of Death or Retransplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Oren D, Moeller C, Lotan D, Rubinstein G, Slomovich S, Fried J, Raikhelkar J, Oh K, Topkara V, DeFilippis E, Colombo P, Yuzefpolskaya M, Lin E, Lee S, Latif F, Sayer G, Uriel N, Clerkin K. Donor-Derived Cell-Free Dna in Heart Transplant Recipients with Microvascular Cardiac Allograft Vasculopathy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Harris E, Sewanan L, Topkara V, Fried J, Raikhelkar J, Colombo P, Yuzefpolskaya M, DeFilippis E, Latif F, Takeda K, Hassanein M, Singh S, Sayer G, Uriel N, Clerkin K. New System, Familiar Problem: Increased Wait Time for High Priority Heart Transplant Candidates. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Lotan D, Moeller C, Rubinstein G, Oren D, Mehlman Y, Slomovich S, Aishwarya R, DeFilippis E, Fried J, Clerkin K, Raikhelkar J, Oh K, Lin E, Lee S, Colombo P, Kleet A, Yuzefpolskaya M, Topkara V, Latif F, Sayer G, Uriel N. Persistently Elevated Donor-Derived Cell-Free DNA in Heart Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Lotan D, Rubinstein G, Moeller C, Oren D, Slomovich S, Mehlman Y, DeFilippis E, Rosenblum H, Raikhelkar J, Clerkin K, Fried J, Oh K, Lin E, Lee S, Topkara V, Latif F, Colombo P, Yuzefpolskaya M, Sayer G, Uriel N. The Effect of Persistently Elevated Dd-Cfdna with De-Novo Donor Specific Antibody on Heart Transplant Recipients Outcomes. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Batra J, Rosenblum H, DeFilippis E, Donald E, Clerkin K, Topkara V, Lee S, Latif F, Yuzefpolskaya M, Colombo P, Oh K, Lotan D, Raikhelkar J, Sayer G, Uriel N. Characteristics and Outcomes of Multiple Cardiac Re-Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Lotan D, DeFilippis EM, Oren D, Vinogradsky A, Rubinstein G, Mathur A, Takeda K, Hua M, Gaglio PJ, Szabolcs MJ, Sayer G, Uriel N, Iglesias AD, Latif F. Combined heart and liver transplantation in a patient supported by left ventricular assist device (LVAD) with propionic acidemia. Nutr Metab Cardiovasc Dis 2023; 33:667-670. [PMID: 36710110 DOI: 10.1016/j.numecd.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/01/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023]
Abstract
Propionic acidemia (PA) is a rare inherited metabolic disease due to inborn errors of metabolism. PA results in the accumulation of abnormal organic acid metabolites in multiple systems, mainly the central nervous system and the heart. Cardiac complications include dilated cardiomyopathy (DCM) and carry a 40-50% increased mortality risk. Liver transplantation (LT) is required in PA patients when medical treatment fails and may prevent or slow down the cardiomyopathy progression. However, severe heart disease may be a serious contraindication to LT. We present a complicated case of a PA patient, supported with a Left Ventricular Assist Device, who underwent a heart and Liver transplant. PA patients are at increased risk for metabolic acidosis during surgery, with increased anion gap and hyperammonemia. A strict multi-disciplinary approach is needed to prevent and treat metabolic decompensation. The patient had a successful heart and liver transplant after a strict treatment protocol in the pre, intra, and post-operative periods. His case highlights the complexity of PA patients and the increased risk for metabolic decompensation during surgery and provides an insight into how to manage such complicated patients.
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Affiliation(s)
- Dor Lotan
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, NY, USA.
| | - Ersilia M DeFilippis
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, NY, USA
| | - Daniel Oren
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, NY, USA
| | - Alice Vinogradsky
- Department of Surgery, Division of Cardiac Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Gal Rubinstein
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, NY, USA
| | - Abhishek Mathur
- Department of Surgery, Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Koji Takeda
- Department of Surgery, Division of Cardiac Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - May Hua
- Department of Anesthesiology, Columbia University, New York, NY, USA
| | - Paul J Gaglio
- Department of Medicine, Center for Liver Disease and Transplantation Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Matthias J Szabolcs
- The Department of Pathology & Laboratory Medicine, New York Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Gabriel Sayer
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, NY, USA
| | - Nir Uriel
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, NY, USA
| | - Alejandro Daniel Iglesias
- Division of Clinical Genetics, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Farhana Latif
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital New York, NY, USA
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Batra J, DeFilippis EM, Golob S, Lumish H, Clerkin K, Topkara VK, Restaino S, Lee SH, Latif F, Raikhelkar J, Fried J, Oh KT, Lin E, Colombo PC, Yuzefpolskaya M, Sayer G, Uriel N. Early post-transplant leukopenia in heart transplant recipients and its impact on outcomes. Clin Transplant 2023; 37:e14934. [PMID: 36798992 DOI: 10.1111/ctr.14934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/11/2023] [Accepted: 02/08/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Leukopenia in the early period following heart transplantation (HT) is not well-studied. The aim of this study was to evaluate risk factors for the development of post-transplant leukopenia and its consequences for HT recipients. METHODS Adult patients at a large-volume transplant center who received HT between January 1, 2010 and December 31, 2020 were included. The incidence of leukopenia (WBC ≤3 × 103 /μL) in the first 90-days following HT, individual risk factors, and its effect on 1-year outcomes were evaluated. RESULTS Of 506 HT recipients, 184 (36%) developed leukopenia within 90-days. Median duration of the first leukopenia episode was 15.5 days (IQR 8-42.5 days). Individuals who developed leukopenia had lower pre-transplant WBC counts compared to those who did not (6.1 × 103 /μL vs. 6.9 × 103 /μL, p = .02). Initial immunosuppressive and infectious chemoprophylactic regimens were not significantly different between groups. Early leukopenia was associated with a higher mortality at 1-year (6.6% vs. 2.1%, p = .008; adjusted HR 3.0) and an increased risk of recurrent episodes. Rates of infection and rejection were not significantly different between the two groups. CONCLUSIONS Leukopenia in the early period following HT is common and associated with an increased risk of mortality. Further study is needed to identify individuals at highest risk for leukopenia prior to transplant and optimize immunosuppressive and infectious chemoprophylactic regimens for this subgroup.
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Affiliation(s)
- Jaya Batra
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Ersilia M DeFilippis
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Stephanie Golob
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Heidi Lumish
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Kevin Clerkin
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Susan Restaino
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Sun Hi Lee
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Farhana Latif
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Jayant Raikhelkar
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Justin Fried
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Kyung Taek Oh
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Edward Lin
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Gabriel Sayer
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Golob S, Batra J, DeFilippis EM, Uriel M, Carey M, Gaine M, Mabasa A, Fried J, Raikelkar J, Restaino S, Hi Lee S, Latif F, Yuzefpolskaya M, Colombo PC, Choe J, Majure D, Jennings D, Pereira MR, Clerkin K, Sayer G, Uriel N. Letermovir for cytomegalovirus prophylaxis in high-risk heart transplant recipients. Clin Transplant 2022; 36:e14808. [PMID: 36086937 DOI: 10.1111/ctr.14808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/28/2022] [Accepted: 08/10/2022] [Indexed: 12/27/2022]
Abstract
Letermovir is a novel agent for the prevention of cytomegalovirus (CMV) infection and disease that, unlike traditional CMV DNA polymerase inhibitors, does not carry the risk of myelosuppression. The purpose of this study was to evaluate the safety, efficacy, and clinical application of letermovir for CMV prophylaxis in heart transplant (HT) recipients. Between November 1, 2019, and October 1, 2021, at a single, tertiary care hospital, 17 HT recipients were initiated on letermovir due to leukopenia while on valganciclovir. Fifteen (88%) had high-risk mismatch (CMV D+/R-). Median time on letermovir was 5 months (interquartile range, 2-8 months.) At the end of the study period, nine of 17 patients (52.9%) were still on letermovir and four of the 17 (23.5%) had successfully completed the prophylaxis window on letermovir and been switched to the pre-emptive strategy. One patient developed clinically significant CMV viremia in the setting of being unable to obtain medication due to insurance barriers but was later successfully restarted on letermovir. One patient was unable to tolerate letermovir due to symptoms of headache and myalgias. Two patients developed low-level non-clinically significant CMV viremia and were switched back to valacyclovir. All patients had tacrolimus dosages reduced at time of letermovir initiation to minimize the risk of supratherapeutic tacrolimus concentration. One patient required hospitalization due to symptomatic tacrolimus toxicity. For HT recipients who cannot tolerate valganciclovir, letermovir presents an alternative for CMV prophylaxis. Close monitoring for breakthrough CMV and calcineurin inhibitor levels is necessary. Larger studies are required to further delineate its use and help provide further evidence of its safety and efficacy.
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Affiliation(s)
- Stephanie Golob
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Jaya Batra
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Ersilia M DeFilippis
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Matan Uriel
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Matt Carey
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Maureen Gaine
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Angelo Mabasa
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Justin Fried
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Jayant Raikelkar
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Susan Restaino
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Sun Hi Lee
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Farhana Latif
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Jason Choe
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - David Majure
- Division of Cardiology, Department of Medicine, Cornell University, Ithaca, New York, USA
| | - Douglas Jennings
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Marcus R Pereira
- Division of Infectious Disease, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Kevin Clerkin
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Gabriel Sayer
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Driggin E, Chung A, Concha D, Stanton L, Topkara VK, Maurer MS, Fried JA, Latif F, Takeda K, Sayer G, Uriel N, Clerkin KJ. The impact of pre-transplant weight loss on survival following cardiac transplantation. Clin Transplant 2022; 36:e14831. [PMID: 36271917 PMCID: PMC9984247 DOI: 10.1111/ctr.14831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/07/2022] [Accepted: 09/24/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Significant weight loss due to cardiac cachexia is an independent predictor of mortality in many heart failure (HF) clinical trials. The impact of significant weight loss while on the waitlist for heart transplant (HT) has yet to be studied with respect to post-transplant survival. METHODS Adult HT recipients from 2010 to 2021 were identified in the UNOS registry. Patients who experienced an absolute weight change from the time of listing to transplant were included and classified into two groups by percent weight loss from time of listing to time of transplant using a cut-off of 10%. The primary endpoint was 1-year survival following HT. RESULTS 5951 patients were included in the analysis, of whom 763 (13%) experienced ≥10% weight loss from the time of listing to transplant. Weight loss ≥ 10% was associated with reduced 1-year post-transplant survival (86.9% vs. 91.0%, long-rank p = .0003). Additionally, weight loss ≥ 10% was an independent predictor of 1-year mortality in a multivariable model adjusting for significant risk factors (adjusted HR 1.23, 95% CI 1.04-1.46). In secondary analyses, weight loss ≥ 10% was associated with reduced 1-year survival independent of hospitalized status at time of transplant as well as obesity status at listing (i.e., body mass index [BMI] < 30 kg/m2 and BMI ≥ 30 kg/m2 ). CONCLUSIONS Preoperative weight loss ≥ 10% is associated with reduced survival in patients listed for HT. Nutrition interventions prior to transplant may prove beneficial in this population.
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Affiliation(s)
- Elissa Driggin
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Alice Chung
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Daniella Concha
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Liam Stanton
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Veli K Topkara
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Mathew S Maurer
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Justin A Fried
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Farhana Latif
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Koji Takeda
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Gabriel Sayer
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Nir Uriel
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
| | - Kevin J Clerkin
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, Division of Cardiology, New York, New York, USA
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41
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Clerkin KJ, Topkara VK, Farr MA, Jain R, Colombo PC, Restaino S, Sayer G, Castillo M, Lam EY, Chernovolenko M, Yuzefpolskaya M, DeFilippis E, Latif F, Zorn E, Takeda K, Johnson LL, Uriel N, Einstein AJ. Noninvasive Physiologic Assessment of Cardiac Allograft Vasculopathy Is Prognostic for Post-Transplant Events. J Am Coll Cardiol 2022; 80:1617-1628. [PMID: 36265957 PMCID: PMC9758655 DOI: 10.1016/j.jacc.2022.08.751] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/11/2022] [Accepted: 08/10/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) causes impaired blood flow in both epicardial coronary arteries and the microvasculature. A leading cause of post-transplant mortality, CAV affects 50% of heart transplant recipients within 10 years of heart transplant. OBJECTIVES This analysis examined the outcomes of heart transplant recipients with reduced myocardial blood flow reserve (MBFR) and microvascular CAV detected by 13N-ammonia positron emission tomography (PET) myocardial perfusion imaging. METHODS A total of 181 heart transplant recipients who underwent PET to assess for CAV were included with a median follow-up of 4.7 years. Patients were classified into 2 groups according to the total MBFR: >2.0 and ≤2.0. Microvascular CAV was defined as no epicardial CAV detected by PET and/or coronary angiography, but with an MBFR ≤2.0 by PET. RESULTS In total, 71 (39%) patients had an MBFR ≤2.0. Patients with an MBFR ≤2.0 experienced an increased risk for all outcomes: 7-fold increase in death or retransplantation (HR: 7.05; 95% CI: 3.2-15.6; P < 0.0001), 12-fold increase in cardiovascular death (HR: 12.0; 95% CI: 2.64-54.12; P = 0.001), and 10-fold increase in cardiovascular hospitalization (HR: 10.1; 95% CI: 3.43-29.9; P < 0.0001). The 5-year mean survival was 302 days less than those with an MBFR >2.0 (95% CI: 260.2-345.4 days; P < 0.0001). Microvascular CAV (adjusted HR: 3.86; 95% CI: 1.58-9.40; P = 0.003) was independently associated with an increased risk of death or retransplantation. CONCLUSIONS Abnormal myocardial blood flow reserve, even in the absence of epicardial CAV, identifies patients at a high risk of death or retransplantation. Measures of myocardial blood flow provide prognostic information in addition to traditional CAV assessment.
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Affiliation(s)
- Kevin J Clerkin
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Veli K Topkara
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA. https://twitter.com/VeliKTopkaraMD
| | - Maryjane A Farr
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA. https://twitter.com/MaryjaneFarrMD
| | - Rashmi Jain
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Paolo C Colombo
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Susan Restaino
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Gabriel Sayer
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Michelle Castillo
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Elaine Y Lam
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Margarita Chernovolenko
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Melana Yuzefpolskaya
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ersilia DeFilippis
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA. https://twitter.com/ersied727
| | - Farhana Latif
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Emmanuel Zorn
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Koji Takeda
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Lynne L Johnson
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Nir Uriel
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA. https://twitter.com/NirUrielMD
| | - Andrew J Einstein
- Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA. https://twitter.com/AndrewEinstein7
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42
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Braghieri L, Jennings DL, Bohn B, Habal M, Pinsino A, Mondellini GM, Ladanyi A, Latif F, Clerkin K, Restaino S, Kurlansky P, Takeda K, Naka Y, Demmer RT, Sayer GT, Uriel N, Colombo PC, Yuzefpolskaya M. Temporal shifts in safety and efficacy profile of mycophenolate mofetil 2 g versus 3 g daily early after heart transplantation. Pharmacotherapy 2022; 42:697-706. [DOI: 10.1002/phar.2724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Lorenzo Braghieri
- Department of Internal Medicine Cleveland Clinic Cleveland Ohio USA
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Douglas L. Jennings
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Bruno Bohn
- Division of Epidemiology and Community Health University of Minnesota Minneapolis Minnesota USA
| | - Marlena Habal
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Alberto Pinsino
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Giulio M. Mondellini
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Annamaria Ladanyi
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Farhana Latif
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Kevin Clerkin
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Susan Restaino
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Paul Kurlansky
- Department of Surgery, Division of Cardiac Surgery Columbia University New York New York USA
| | - Koji Takeda
- Department of Surgery, Division of Cardiac Surgery Columbia University New York New York USA
| | - Yoshifumi Naka
- Department of Surgery, Division of Cardiac Surgery Columbia University New York New York USA
| | - Ryan T. Demmer
- Division of Epidemiology and Community Health University of Minnesota Minneapolis Minnesota USA
- Department of Epidemiology, Mailman School of Public Health Columbia University Irving Medical Center New York New York USA
| | - Gabriel T. Sayer
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Nir Uriel
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Paolo C. Colombo
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
| | - Melana Yuzefpolskaya
- Division of Cardiology Department of Medicine, Columbia University New York New York USA
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43
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Kainuma A, Ning Y, Kurlansky PA, Wang AS, Latif F, Sayer GT, Uriel N, Kaku Y, Naka Y, Takeda K. Predictors of one-year outcome after cardiac re-transplantation: Machine learning analysis. Clin Transplant 2022; 36:e14761. [PMID: 35730923 DOI: 10.1111/ctr.14761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/02/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND As cardiac re-transplantation is associated with inferior outcomes compared with primary transplantation, allocating scarce resources to appropriate re-transplant candidates is important. The aim of this study is to elucidate the factors associated with 1-year mortality in cardiac re-transplantation using the random forests algorithm for survival analysis. METHODS We retrospectively reviewed the United Network for Organ Sharing registry and identified all adult (>17 years old) recipients who underwent cardiac re-transplantation between January 2000 and March 2020. The random forest algorithm on Cox modeling was used to calculate the variable importance (VIMP) of independent variables for contributing to one-year mortality. RESULTS A total of 1294 patients underwent cardiac re-transplantation. Of these, 137 patients were re-transplanted within one year of their first transplant, while 1157 patients were re-transplanted more than one year after their first transplant. One-year mortality was significantly higher for patients receiving early transplantation compared with those receiving late transplantation (Early 40.6% vs. Late 13.6%, log-rank P<0.001). Machine learning analysis showed that total bilirubin (>2 mg/dl) (VIMP, 2.99%) was an independent predictor of one-year mortality after early re-transplant. High BMI (>30.0 kg/m2) (VIMP, 1.43%) and ventilator dependence (VIMP, 1.47%) were independent predictors of one-year mortality for the late re-transplantation group. CONCLUSION Machine learning showed that optimal one-year survival following cardiac re-transplantation was significantly related to liver function in early re-transplantation, and to obesity and preoperative ventilator dependence in late re-transplantation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Atsushi Kainuma
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Yuming Ning
- Center for Innovation and Outcomes Research, Columbia University, New York, NY, USA
| | - Paul A Kurlansky
- Center for Innovation and Outcomes Research, Columbia University, New York, NY, USA.,Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Amy S Wang
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Farhana Latif
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Gabriel T Sayer
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Nir Uriel
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Yuji Kaku
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
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44
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Liang LW, Kalia I, Latif F, Waase MP, Shimada YJ, Sayer G, Reilly MP, Uriel N. The use of telemedicine in cardiogenetics clinical practice during the COVID-19 pandemic. Mol Genet Genomic Med 2022; 10:e1946. [PMID: 35388985 PMCID: PMC9184656 DOI: 10.1002/mgg3.1946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/25/2022] [Indexed: 11/11/2022] Open
Abstract
Background The COVID‐19 pandemic has necessitated the rapid and widespread adoption of novel mechanisms of service delivery, including the use of telemedicine. The aim of this study was to examine the impact of COVID‐19 on cardiogenetics practices. Methods We retrospectively analyzed the clinical characteristics of patients who were seen for cardiogenetics visits pre‐pandemic (1 April–23 December 2019) and during the pandemic (1 April–23 December 2020) at Columbia University Irving Medical Center. Results Six percent (n = 6) of visits in 2019 were remote telemedicine encounters, whereas 80% (n = 106) of visits in 2020 were telemedicine encounters. In 2019, only 18% (n = 19) of the patients seen for genetic counseling were family members of probands; this percentage increased to 34% in 2020 (n = 45; p = .01). In 2020, the geographic reach of genetic counseling also extended far beyond New York State, reaching a total of 11 states as well as one patient in Puerto Rico. Genetic testing results were similar in 2019 and 2020. Conclusion Despite the health‐care delivery barriers created by the COVID‐19 pandemic, the use of telemedicine allowed us to expand the reach of cardiovascular genetic counseling and testing.
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Affiliation(s)
- Lusha W. Liang
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Isha Kalia
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Irving Institute for Clinical and Translational ResearchColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Farhana Latif
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Marc P. Waase
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Yuichi J. Shimada
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Gabriel Sayer
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Muredach P. Reilly
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Irving Institute for Clinical and Translational ResearchColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Nir Uriel
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
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45
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Kainuma A, Ning Y, Kurlansky PA, Wang AS, Latif F, Farr MA, Sayer GT, Uriel N, Takayama H, Naka Y, Takeda K. Deep vein thrombosis and pulmonary embolism after heart transplantation. Clin Transplant 2022; 36:e14705. [PMID: 35545895 DOI: 10.1111/ctr.14705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Venous thromboembolism (VTE), such as deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important and serious postoperative complication after heart transplantation. We sought to characterize in-hospital VTE after heart transplantation and its association with clinical outcomes. METHOD Adult (≧18 years) patients undergoing heart transplantation from 2015 to 2019 at our center were retrospectively reviewed. Post-transplant VTE was defined as newly diagnosed venous system thrombus by imaging studies. RESULTS There were 254 patients. The cohort's median age was 55 years. A total of 61 patients were diagnosed with VTE, including 1 with right atrial thrombus, 54 with upper extremity DVT in which one patient subsequently developed PE, 4 with lower extremity DVT, and 2 with upper and lower extremity DVT. The cumulative incidence of VTE was 42% at 60-days of post heart transplant. Patients with VTE had longer hospital stay (p<0.001), higher in-hospital mortality (p = 0.010), and worse 5-year survival (p = 0.009). On the multivariable Cox analysis, history of DVT/PE and intubation for more than 3 days were associated with an increased risk of in hospital VTE. CONCLUSION The incidence of VTE in heart transplant recipients is high. Post-transplant surveillance, and appropriate preventive measures and treatment strategies after diagnosis are warranted. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Atsushi Kainuma
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Yuming Ning
- Center for Innovation and Outcomes Research, Columbia University, New York, New York, USA
| | - Paul A Kurlansky
- Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York, New York, USA.,Center for Innovation and Outcomes Research, Columbia University, New York, New York, USA
| | - Amy S Wang
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Farhana Latif
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Maryjane A Farr
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Gabriel T Sayer
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Nir Uriel
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Hiroo Takayama
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Yoshifumi Naka
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Koji Takeda
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
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46
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DeFilippis E, Clerkin K, Latif F, Raikelkar J, Topkara V, Einstein A, Sayer G, Uriel N, Weisberg S, Habal M, Restaino S. Improvement in Coronary Allograft Vasculopathy Following Treatment with a Regimen Including Extracorporeal Photophoresis in a Heart Transplant Recipient. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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47
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Uriel M, Oren D, Yopes M, Clerkin K, Raikhelkar J, Fried J, Griffin J, Gaine M, Restaino S, Lee S, Choe J, Jennings D, Topkara V, Takeda K, Naka Y, Majure D, Yuzefpolskaya M, Colombo P, Latif F, Uriel N, Sayer G, Habal M. The Efficacy and Safety of Belatacept in Heart Transplant Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1400] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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48
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Braghieri L, Bohn B, Jennings D, Mondellini G, Kim A, Ladanyi A, Clerkin K, Latif F, Takeda K, Naka Y, Sayer G, Uriel N, Demmer R, Colombo P, Yuzefpolskaya M. Association of Gut Bacterial Beta Glucuronidase Activity with Mycophenolate Mofetil Induced Cytopenia. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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49
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Lumish H, Kennel P, Concha D, Chung A, Oren D, Jain S, Jennings D, Clerkin K, Fried J, Raikhelkar J, Yuzefpolskaya M, Majure D, Choe J, Latif F, Uriel N, Sayer G. New-Onset Diabetes in Patients Post-Heart Transplantation; the Role of Hypertension and Novel Diabetic Medications. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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50
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Tao A, Raikhelkar J, Griffin J, Benvenuto L, Fried J, Topkara V, Takeda K, Restaino S, Latif F, Yuzefpolskaya M, Colombo P, Uriel N, Sayer G, Clerkin K. Impact of Pre-Heart Transplant Pulmonary Function Tests on Post-Transplant Pulmonary Outcomes. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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