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Grzyb C, Du D, Nair N. Artificial Intelligence Approaches for Predicting the Risks of Durable Mechanical Circulatory Support Therapy and Cardiac Transplantation. J Clin Med 2024; 13:2076. [PMID: 38610843 PMCID: PMC11013005 DOI: 10.3390/jcm13072076] [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: 02/19/2024] [Revised: 03/24/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The use of AI-driven technologies in probing big data to generate better risk prediction models has been an ongoing and expanding area of investigation. The AI-driven models may perform better as compared to linear models; however, more investigations are needed in this area to refine their predictability and applicability to the field of durable MCS and cardiac transplantation. Methods: A literature review was carried out using Google Scholar/PubMed from 2000 to 2023. Results: This review defines the knowledge gaps and describes different AI-driven approaches that may be used to further our understanding. Conclusions: The limitations of current models are due to missing data, data imbalances, and the uneven distribution of variables in the datasets from which the models are derived. There is an urgent need for predictive models that can integrate a large number of clinical variables from multicenter data to account for the variability in patient characteristics that influence patient selection, outcomes, and survival for both durable MCS and HT; this may be fulfilled by AI-driven risk prediction models.
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Affiliation(s)
- Chloe Grzyb
- PennState College of Medicine, Heart and Vascular Institute, Milton S. Hershey Medical Center, 500 University Dr, Hershey, PA 17033, USA;
| | - Dongping Du
- Department of Industrial and Structural Engineering, Texas Tech University, Lubbock, TX 79409, USA;
| | - Nandini Nair
- PennState College of Medicine, Heart and Vascular Institute, Milton S. Hershey Medical Center, 500 University Dr, Hershey, PA 17033, USA;
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Pállinger É, Székely A, Töreki E, Bencsáth EZ, Szécsi B, Losoncz E, Oleszka M, Hüttl T, Kosztin A, Buzas EI, Radovits T, Merkely B. Donor Pericardial Interleukin and Apolipoprotein Levels May Predict the Outcome after Human Orthotopic Heart Transplantation. Int J Mol Sci 2023; 24:ijms24076780. [PMID: 37047753 PMCID: PMC10095178 DOI: 10.3390/ijms24076780] [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: 02/07/2023] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
The proinflammatory cascade that is activated at the time of brain death plays a crucial role in organ procurement. Our aim of this study was to explore the relationship between the clinical outcome of orthotopic heart transplantation, as well as cytokine and apolipoprotein profiles of the pericardial fluid obtained at donation. Interleukin, adipokine and lipoprotein levels in the pericardial fluid, as well as clinical data of twenty donors after brain death, were investigated. Outcome variables included primary graft dysfunction, the need for posttransplantation mechanical cardiac support and International Society for Heart and Lung Transplantation grade ≥ 2R rejection. Hormone management and donor risk scores were also investigated. Lower levels of IL-6 were observed in primary graft dysfunction (median: 36.72 [IQR: 19.47–62.90] versus 183.67 [41.21–452.56]; p = 0.029) and in the need for mechanical cardiac support (44.12 [20.12–85.70] versus 247.13 [38.51–510.38]; p = 0.043). Rejection was associated with lower ApoAII (p = 0.021), ApoB100 (p = 0.032) and ApoM levels (p = 0.025). Lower adipsin levels were detected in those patients receiving desmopressin (p = 0.037); moreover, lower leptin levels were found in those patients receiving glucocorticoid therapy (p = 0.045), and higher T3 levels were found in those patients treated with L-thyroxine (p = 0.047) compared to those patients not receiving these hormone replacement therapies. IL-5 levels were significantly associated with UNOS-D score (p = 0.004), Heart Donor Score (HDS) and Adapted HDS (p < 0.001). The monitoring of immunological and metabolic changes in donors after brain death may help in the prediction of potential complications after heart transplantation, thus potentially optimizing donor heart allocation.
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Affiliation(s)
- Éva Pállinger
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, 1085 Budapest, Hungary
| | - Andrea Székely
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary
| | - Evelin Töreki
- Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Erzsébet Zsófia Bencsáth
- Doctoral School of Theoretical and Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Balázs Szécsi
- Doctoral School of Theoretical and Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Eszter Losoncz
- Doctoral School of Theoretical and Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Máté Oleszka
- Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Tivadar Hüttl
- Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary
| | - Annamária Kosztin
- Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary
| | - Edit I. Buzas
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, 1085 Budapest, Hungary
- HCEMM-SU Extracellular Vesicle Research Group, Semmelweis University, 1085 Budapest, Hungary
- ELKH-SE Translational Extracellular Vesicle Research Group, Semmelweis University, 1085 Budapest, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary
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Rhee Y, Kim HJ, Kim JJ, Kim MS, Lee SE, Yun TJ, Lee JW, Jung SH. Primary Graft Dysfunction After Isolated Heart Transplantation - Incidence, Risk Factors, and Clinical Implications Based on a Single-Center Experience. Circ J 2021; 85:1451-1459. [PMID: 33867405 DOI: 10.1253/circj.cj-20-0960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Since the international consensus on primary graft dysfunction (PGD) following heart transplantation (HT) was reported in 2014, few clinical studies have been reported. We aimed to analyze the incidence, predictive factors, and clinical implications of PGD following the International Society of Heart and Lung Transplant criteria in a single center.Methods and Results:This study enrolled 570 consecutive adult patients undergoing isolated HT between November 1992 and December 2017. Under a new set of criteria, PGD-left ventricle (PGD-LV) occurred in 35 patients (6.1%; mild, n=1 [0.2%]; moderate, n=14 [2.5%]; severe, n=20 [3.5%]), whereas PGD-right ventricle (PGD-RV) occurred in 3 (0.5%). Multivariable analysis demonstrated that preoperative admission (odds ratio [OR] 4.20; 95% confidence interval [CI] 1.24-14.26; P=0.021), preoperative extracorporeal membrane oxygenation (OR 4.03; 95% CI 1.75-9.26; P=0.001), and prolonged total ischemic time (OR 1.09; 95% CI 1.02-1.15; P=0.006) were significant predictors of moderate to severe PGD-LV. Moderate to severe PGD-LV was an independent and significant risk factor for early death (OR 55.64; 95% CI 11.65-265.73; P<0.001), with its effects extending up to 3 months after HT. CONCLUSIONS Moderate to severe PGD-LV, as defined by the new guidelines, is an important predictor of early mortality, with effects extending up to 3 months after HT. Efforts to reduce the occurrence of moderate to severe PGD-LV may lead to better outcomes.
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Affiliation(s)
- Younju Rhee
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jae-Joong Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Min-Seok Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Sang Eun Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Tae-Jin Yun
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
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Galeone A, Lebreton G, Coutance G, Demondion P, Schmidt M, Amour J, Varnous S, Leprince P. A single‐center long‐term experience with marginal donor utilization for heart transplantation. Clin Transplant 2020; 34:e14057. [DOI: 10.1111/ctr.14057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Antonella Galeone
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Guillaume Lebreton
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Guillaume Coutance
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Pierre Demondion
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Matthieu Schmidt
- Medical Intensive Care Unit Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Julien Amour
- Department of Anesthesiology Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Shaida Varnous
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Pascal Leprince
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
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5
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Loforte A, Fiorentino M, Murana G, Gliozzi G, Cavalli GG, Mariani C, Martin Suarez S, Pacini D. Mechanically Supported Early Graft Failure After Heart Transplantation. Transplant Proc 2020; 53:311-317. [PMID: 32768287 DOI: 10.1016/j.transproceed.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The occurrence of early graft failure (EGF) after heart transplantation (Htx) often requires a mechanical circulatory support (MCS) therapy. The aims of our study were to identify risk factors of mechanically supported severe EGF and evaluate their impact on both early and late outcomes. METHODS Between January 2000 and December 2019, 499 consecutive adult patients underwent Htx at our institution. Severe EGF was defined as the need for extracorporeal life support (ECLS) within 24 hours after surgery. All available recipient and donor variables were retrospectively analyzed. RESULTS Overall, EGF occurred in 58 (11.6%) patients. Post-Htx peripheral or central ECLS was necessary in 32 (6.4%) cases. Independent predictors of severe EGF were, in the recipient group, preoperative transpulmonary gradient (TPG) >12 mm Hg (odds ratio [OR] 4.1, P = .013), preoperative inotropic score >10 (OR 7.3, P = .0001), and pre-Htx ECLS support (OR 5.2, P = .015), while in the donors, a Eurotransplant donor score ≥17 (OR 8.5, P = .005). The absence of EGF was related with a better survival at 1 year and 5 years (94% and 85%, respectively) compared with EGF requiring ECLS population (36% and 28% at 1 year and 5 years, respectively; P < .001). A five-year conditional survival rate did not differ significantly (85% no EGF vs 83% EGF requiring ECLS). CONCLUSION Both donor and recipient factors may influence EGF occurrence. Post-Htx ECLS may impact negatively early; however, patients weaned from ECLS eventually benefit from such a rescue treatment with outcomes comparable with Htx patients who did not suffer EGF.
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Affiliation(s)
- Antonio Loforte
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna University, Bologna, Italy.
| | - Mariafrancesca Fiorentino
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna University, Bologna, Italy
| | - Giacomo Murana
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna University, Bologna, Italy
| | - Gregorio Gliozzi
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna University, Bologna, Italy
| | - Giulio Giovanni Cavalli
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna University, Bologna, Italy
| | - Carlo Mariani
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna University, Bologna, Italy
| | - Sofia Martin Suarez
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna University, Bologna, Italy
| | - Davide Pacini
- Cardio-Thorac-Vascular Department, Cardiac Surgery Unit, S. Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna University, Bologna, Italy
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6
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Zimpfer D, Alexander PMA, Davies RR, Dipchand AI, Feingold B, Joong A, Lord K, Kirk R, Scales A, Shih R, Miera O. Pediatric donor management to optimize donor heart utilization. Pediatr Transplant 2020; 24:e13679. [PMID: 32198844 DOI: 10.1111/petr.13679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 12/25/2022]
Abstract
Optimal management of pediatric cardiac donors is essential in order to maximize donor heart utilization and minimize the rate of discarded organs. This review was performed after a systematic literature review and gives a detailed overview on current practices and guidelines. The review focuses on optimal monitoring of pediatric donors, donor workup, hormonal replacement, and obliterating the adverse effects of brain death. The current evidence on catecholamine support and thyroid hormone replacement is also discussed. Recognizing and addressing this shall help in a standardized approach toward donor management and optimal utilization of pediatric heart donors organs.
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Affiliation(s)
- Daniel Zimpfer
- Department of Cardiac Surgery, Pediatric Heart Center Vienna, Vienna, Austria
| | - Peta M A Alexander
- Department of Pediatric Cardiology, Boston Children's Hospital Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Brian Feingold
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anna Joong
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | | | - Richard Kirk
- Division of Pediatric Cardiology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Angie Scales
- Paediatric and Neonatal Donation and Transplantation, Organ Donation and Transplantation, NHS Blood and Transplant, London, UK
| | - Renata Shih
- Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum, Berlin, Germany
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7
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Kirk R, Dipchand AI, Davies RR, Miera O, Chapman G, Conway J, Denfield S, Gossett JG, Johnson J, McCulloch M, Schweiger M, Zimpfer D, Ablonczy L, Adachi I, Albert D, Alexander P, Amdani S, Amodeo A, Azeka E, Ballweg J, Beasley G, Böhmer J, Butler A, Camino M, Castro J, Chen S, Chrisant M, Christen U, Danziger-Isakov L, Das B, Everitt M, Feingold B, Fenton M, Garcia-Guereta L, Godown J, Gupta D, Irving C, Joong A, Kemna M, Khulbey SK, Kindel S, Knecht K, Lal AK, Lin K, Lord K, Möller T, Nandi D, Niesse O, Peng DM, Pérez-Blanco A, Punnoose A, Reinhardt Z, Rosenthal D, Scales A, Scheel J, Shih R, Smith J, Smits J, Thul J, Weintraub R, Zangwill S, Zuckerman WA. ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation. J Heart Lung Transplant 2020; 39:331-341. [PMID: 32088108 DOI: 10.1016/j.healun.2020.01.1345] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 12/14/2022] Open
Abstract
The number of potential pediatric heart transplant recipients continues to exceed the number of donors, and consequently the waitlist mortality remains significant. Despite this, around 40% of all donated organs are not used and are discarded. This document (62 authors from 53 institutions in 17 countries) evaluates factors responsible for discarding donor hearts and makes recommendations regarding donor heart acceptance. The aim of this statement is to ensure that no usable donor heart is discarded, waitlist mortality is reduced, and post-transplant survival is not adversely impacted.
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Affiliation(s)
- Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas.
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Jennifer Conway
- Department of Pediatrics, Division of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Denfield
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jeffrey G Gossett
- University of California Benioff Children's Hospitals, San Francisco, California
| | - Jonathan Johnson
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Michael McCulloch
- University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Martin Schweiger
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Vienna and Pediatric Heart Center Vienna, Vienna, Austria
| | - László Ablonczy
- Pediatric Cardiac Center, Hungarian Institute of Cardiology, Budapest, Hungary
| | - Iki Adachi
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Dimpna Albert
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Peta Alexander
- Department of Cardiology, Boston Children's Hospital Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | | | - Estela Azeka
- Heart Institute (InCor) University of São Paulo, São Paulo, Brazil
| | - Jean Ballweg
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital and Medical Center University of Nebraska Medical Center, Omaha, Nebraska
| | - Gary Beasley
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Jens Böhmer
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alison Butler
- Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Javier Castro
- Fundacion Cardiovascular de Colombia, Santander, Bucaramanga City, Colombia
| | | | - Maryanne Chrisant
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | - Urs Christen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lara Danziger-Isakov
- Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center & University of Cincinnati, Cincinnati, Ohio
| | - Bibhuti Das
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | | | - Brian Feingold
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew Fenton
- Great Ormond Street Hospital for Children Foundation Trust, London, United Kingdom
| | | | - Justin Godown
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dipankar Gupta
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Claire Irving
- Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Anna Joong
- Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | | | | | - Steven Kindel
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Kimberly Lin
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen Lord
- New England Organ Bank, Boston, Massachusetts
| | - Thomas Möller
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Deipanjan Nandi
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Oliver Niesse
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | | | | | - Ann Punnoose
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Angie Scales
- Pediatric and Neonatal Donation and Transplantation, Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | - Janet Scheel
- Washington University School of Medicine, St. Louis, Missouri
| | - Renata Shih
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | | | | | - Josef Thul
- Children's Heart Center, University of Giessen, Giessen, Germany
| | | | | | - Warren A Zuckerman
- Columbia University Medical Center, Morgan Stanley Children's Hospital of New York, New York, New York
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8
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Abstract
PURPOSE OF REVIEW Primary graft dysfunction (PGD) is common early postheart transplantation; however, use of standardized definitions remains inconsistent. This review focuses on understanding the incidence, classification, risk factors, and management of PGD. RECENT FINDINGS The incidence and mortality of PGD in heart transplant varies considerably in the published literature ranging from 1.0% to 31% and 3% to 75%, respectively. There is also considerable variation in management strategies with current data favoring early intervention. SUMMARY PGD in heart transplantation remains a challenging problem associated with significant mortality and morbidity. There is need for a consistent and accessible definition to better define associated risk factors and optimize management strategies.
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Jacob S, Lima B, Gonzalez‐Stawinski GV, El‐Sayed Ahmed MM, Patel PC, Belli EV, Makey IA, Thomas M, Landolfo K, Landolfo C, Leoni Moreno JC, Yip DS, Pham SM. Extracorporeal membrane oxygenation as a salvage therapy for patients with severe primary graft dysfunction after heart transplant. Clin Transplant 2019; 33:e13538. [DOI: 10.1111/ctr.13538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/27/2019] [Accepted: 03/09/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Samuel Jacob
- Department of Cardiothoracic Surgery Mayo Clinic Jacksonville Florida
| | - Brian Lima
- Department of Cardiothoracic Surgery Baylor University Medical Center Dallas Texas
| | | | - Magdy M. El‐Sayed Ahmed
- Department of Cardiothoracic Surgery Mayo Clinic Jacksonville Florida
- Department of Surgery, Faculty of Medicine Zagazig University Zagazig Egypt
| | - Parag C. Patel
- Division of Transplant Medicine Mayo Clinic Jacksonville Florida
| | - Erol V. Belli
- Department of Cardiothoracic Surgery Mayo Clinic Jacksonville Florida
| | - Ian A. Makey
- Department of Cardiothoracic Surgery Mayo Clinic Jacksonville Florida
| | - Mathew Thomas
- Department of Cardiothoracic Surgery Mayo Clinic Jacksonville Florida
| | - Kevin Landolfo
- Department of Cardiothoracic Surgery Mayo Clinic Jacksonville Florida
| | - Carolyn Landolfo
- Department of Cardiovascular Medicine Mayo Clinic Jacksonville Florida
| | | | - Daniel S. Yip
- Division of Transplant Medicine Mayo Clinic Jacksonville Florida
| | - Si M. Pham
- Department of Cardiothoracic Surgery Mayo Clinic Jacksonville Florida
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10
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Mowers KL, Simpson KE, Gazit AZ, Eghtesady P, Canter CE, Castleberry CD. Moderate-severe primary graft dysfunction after pediatric heart transplantation. Pediatr Transplant 2019; 23:e13340. [PMID: 30609166 DOI: 10.1111/petr.13340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/16/2018] [Accepted: 10/24/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND PGD is a complication after heart transplantation (OHT) and a significant cause of mortality, particularly in infant recipients. Lack of standardized definition of PGD in the pediatric population makes the prevalence and magnitude of impact unclear. METHODS ISHLT PGD consensus guidelines, which include inotrope scores and need for MCS, were applied retrospectively to 208 pediatric OHT recipients from a single institution from 1/2005-5/2016. PGD was defined as: moderate PGD-inotrope score >10 on postoperative day 1 (24-48 hours), and severe PGD-MCS within 24 hours (in the absence of detectable rejection). RESULTS PGD occurred in 34 patients (16.3%); 14 of which had severe PGD (6.7%). Multivariate risk factors for PGD included CPB time (OR 10.3/10 min, 95% 10.05, 10.2, P = 0.03), Fontan palliation (OR 1.9, 95% 1.2, 3.97), and PCM (OR 5.65, 95% 1.52, 22.4); but not age, weight, ischemic time, or donor characteristics. Upon sub-analysis excluding patients with PCM, increased CPB was a significant multivariate risk factor (OR 10.09, 95% 9.89, 10.12, P = 0.003). Patients with PGD had decreased discharge survival compared to those without PGD (85% vs 96%, P < 0.01). Severe PGD was associated with the poorest 1-year survival (57% vs 91% without PGD, P = 0.04). CONCLUSION Patients with prolonged CPB are potentially at risk for developing PGD. Neither infant recipients nor donor characteristics were associated with an increased risk of PGD in the current era.
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Affiliation(s)
- Katie L Mowers
- Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, Missouri
| | - Kathleen E Simpson
- Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, Missouri
| | - Avihu Z Gazit
- Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, Missouri
| | - Pirooz Eghtesady
- Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, Missouri
| | - Charles E Canter
- Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, Missouri
| | - Chesney D Castleberry
- Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, Missouri
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11
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Abstract
PURPOSE OF REVIEW Despite the improvement in medical therapy for heart failure and the advancements in mechanical circulatory support, heart transplantation (HT) still remains the best therapeutic option to improve survival and quality of life in patients with advanced heart failure. Nevertheless, HT recipients are exposed to the risk of several potential complications that may impair their outcomes. In this article, we aim to provide a practical and scholarly framework for clinicians approaching heart transplant medicine, as well as a concise update for the experienced readers on the most relevant post-HT complications. RECENT FINDINGS While recognizing that most of the treatments herein discussed are based more on experience than on solid scientific evidence, significant step forward has been made in particular in the recognition and management of primary graft dysfunction, antibody-mediated rejection, and renal dysfunction. Complications after HT may vary according to the time from surgery and can be related to graft function and pathology or to diseases and dysfunctions occurring in other organs or systems, mainly as side effects of immunosuppressive drugs and progression of pre-existing conditions. Future research needs to focus on improving precision diagnostics of causes of graft dysfunction and on reaching an optimal and customized balance between efficacy and toxicities of immunosuppressive strategies.
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Affiliation(s)
- Luciano Potena
- Heart Transplant Program, Bologna Academic Hospital, Policlinico S. Orsola-Malpighi, Building 25, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Francesco Barberini
- Heart Transplant Program, Bologna Academic Hospital, Policlinico S. Orsola-Malpighi, Building 25, Via Massarenti, 9, 40138, Bologna, Italy
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12
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Gong TA, Joseph SM, Lima B, Gonzalez-stawinski GV, Jamil AK, Felius J, Qin H, Saracino G, Rafael AE, Kale P, Hall SA. Donor predicted heart mass as predictor of primary graft dysfunction. J Heart Lung Transplant 2018; 37:826-35. [DOI: 10.1016/j.healun.2018.03.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/27/2018] [Accepted: 03/14/2018] [Indexed: 12/20/2022] Open
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13
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Nicoara A, Ruffin D, Cooter M, Patel CB, Thompson A, Schroder JN, Daneshmand MA, Hernandez AF, Rogers JG, Podgoreanu MV, Swaminathan M, Kretzer A, Stafford-Smith M, Milano CA, Bartz RR. Primary graft dysfunction after heart transplantation: Incidence, trends, and associated risk factors. Am J Transplant 2018; 18:1461-1470. [PMID: 29136325 DOI: 10.1111/ajt.14588] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [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: 12/27/2016] [Revised: 10/28/2017] [Accepted: 11/08/2017] [Indexed: 01/25/2023]
Abstract
Changes in heart transplantation (HT) donor and recipient demographics may influence the incidence of primary graft dysfunction (PGD). We conducted a retrospective study to evaluate PGD incidence, trends, and associated risk factors by analyzing consecutive adult patients who underwent HT between January 2009 and December 2014 at our institution. Patients were categorized as having PGD using the International Society for Heart & Lung Transplantation (ISHLT)-defined criteria. Variables, including clinical and demographic characteristics of donors and recipients, were selected to assess their independent association with PGD. A time-trend analysis was performed over the study period. Three-hundred seventeen patients met inclusion criteria. Left ventricular PGD, right ventricular PGD, or both, were observed in 99 patients (31%). Risk factors independently associated with PGD included ischemic time, recipient African American race, and recipient amiodarone treatment. Over the study period, there was no change in the PGD incidence; however, there was an increase in the recipient pretransplantation use of amiodarone. The rate of 30-day mortality was significantly elevated in those with PGD versus those without PGD (6.06% vs 0.92%, P = .01). Despite recent advancements, incidence of PGD remains high. Understanding associated risk factors may allow for implementation of targeted therapeutic interventions.
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Affiliation(s)
- Alina Nicoara
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - David Ruffin
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Mary Cooter
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Chetan B Patel
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Annemarie Thompson
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Jacob N Schroder
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Mani A Daneshmand
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Joseph G Rogers
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Mihai V Podgoreanu
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Madhav Swaminathan
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Adam Kretzer
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Mark Stafford-Smith
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - Carmelo A Milano
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Raquel R Bartz
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Phan K, Luc JGY, Xu J, Maltais S, Stulak JM, Yan TD, Tchantchaleishvili V. Utilization and Outcomes of Temporary Mechanical Circulatory Support for Graft Dysfunction After Heart Transplantation. ASAIO J 2017; 63:695-703. [PMID: 28906273 DOI: 10.1097/MAT.0000000000000599] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Graft dysfunction is the main cause of early mortality after heart transplantation. In cases of severe graft dysfunction, temporary mechanical circulatory support (TMCS) may be necessary. The aim of this systematic review was to examine the utilization and outcomes of TMCS in patients with graft dysfunction after heart transplantation. Electronic search was performed to identify all studies in the English literature assessing the use of TMCS for graft dysfunction. All identified articles were systematically assessed for inclusion and exclusion criteria. Of the 5,462 studies identified, 41 studies were included. Among the 11,555 patients undergoing heart transplantation, 695 (6.0%) required TMCS with patients most often supported using venoarterial extracorporeal membrane oxygenation (79.4%) followed by right ventricular assist devices (11.1%), biventricular assist devices (BiVADs) (7.5%), and left ventricular assist devices (LVADs) (2.0%). Patients supported by LVADs were more likely to be supported longer (p = 0.003), have a higher death by cardiac event (p = 0.013) and retransplantation rate (p = 0.015). In contrast, patients supported with BiVAD and LVAD were more likely to be weaned off support (p = 0.020). Overall, no significant difference was found in pooled 30 day survival (p = 0.31), survival to discharge (p = 0.19), and overall survival (p = 0.51) between the subgroups. Temporary mechanical circulatory support is an effective modality to support patients with graft dysfunction after heart transplantation. Further studies are needed to establish the optimal threshold and strategy for TMCS and to augment cardiac recovery and long-term survival.
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Angleitner P, Kaider A, Gökler J, Moayedifar R, Osorio-Jaramillo E, Zuckermann A, Laufer G, Aliabadi-Zuckermann A. High-dose catecholamine donor support and outcomes after heart transplantation. J Heart Lung Transplant 2017; 37:596-603. [PMID: 29370971 DOI: 10.1016/j.healun.2017.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 09/07/2017] [Revised: 12/08/2017] [Accepted: 12/17/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Higher dose norepinephrine donor support is a frequent reason for donor heart decline, but its associations with outcomes after heart transplantation are unclear. METHODS We retrospectively analyzed 965 patients transplanted between 1992 and 2015 in the Heart Transplant Program Vienna. Stratification was performed according to donor norepinephrine dose administered before organ procurement (Group 0: 0 µg/kg/min; Group 1: 0.01 to 0.1 µg/kg/min; Group 2: >0.1 µg/kg/min). Sub-stratification of Group 2 was performed for comparison of high-dose subgroups (Group HD 1: 0.11 to 0.4 µg/kg/min; Group HD 2: >0.4 µg/kg/min). Associations between groups and outcome variables were investigated using a multivariable Cox proportional hazards model and logistic regression analyses. RESULTS Donor norepinephrine dose groups were not associated with overall mortality (Group 1 vs 0: hazard ratio [HR] 1.12, 95% confidence interval [CI] 0.87 to 1.43; Group 2 vs 0: HR 1.07, 95% CI 0.82 to 1.39; p = 0.669). No significant group differences were found for rates of 30-day mortality (p = 0.35), 1-year mortality (p = 0.897), primary graft dysfunction (p = 0.898), prolonged ventilation (p = 0.133) and renal replacement therapy (p = 0.324). Groups 1 and 2 showed higher rates of prolonged intensive care unit stay (18.9% vs 28.5% vs 27.5%, p = 0.005). High-dose subgroups did not differ significantly in 1-year mortality (Group HD 1: 14.3%; Group HD 2: 17.8%; p = 0.549). CONCLUSIONS Acceptance of selected donor hearts supported by higher doses of norepinephrine may be a safe option to increase the donor organ pool.
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Affiliation(s)
- Philipp Angleitner
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kaider
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Johannes Gökler
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Roxana Moayedifar
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Emilio Osorio-Jaramillo
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Zuckermann
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
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Braulio R, Sanches MD, Teixeira Junior AL, Costa PHN, Moreira MDCV, Rocha MA, Andrade SAD, Gelape CL. Associated Clinical and Laboratory Markers of Donor on Allograft Function After Heart Transplant. Braz J Cardiovasc Surg 2017; 31:89-97. [PMID: 27556306 PMCID: PMC5062732 DOI: 10.5935/1678-9741.20160025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 03/08/2016] [Indexed: 11/20/2022] Open
Abstract
Introduction Primary graft dysfunction is a major cause of mortality after heart
transplantation. Objective To evaluate correlations between donor-related clinical/biochemical markers
and the occurrence of primary graft dysfunction/clinical outcomes of
recipients within 30 days of transplant. Methods The prospective study involved 43 donor/recipient pairs. Data collected from
donors included demographic and echocardiographic information, noradrenaline
administration rates and concentrations of soluble tumor necrosis factor
receptors (sTNFR1 and sTNFR2), interleukins (IL-6 and IL-10), monocyte
chemoattractant protein-1, C-reactive protein and cardiac troponin I. Data
collected from recipients included operating, cardiopulmonary bypass,
intensive care unit and hospitalization times, inotrope administration and
left/right ventricular function through echocardiography. Results Recipients who developed moderate/severe left ventricular dysfunction had
received organs from significantly older donors (P =0.020).
Recipients from donors who required moderate/high doses of noradrenaline
(>0.23 µg/kg/min) around harvesting time exhibited lower
post-transplant ventricular ejection fractions (P =0.002)
and required longer CPB times (P =0.039). Significantly
higher concentrations of sTNFR1 (P =0.014) and sTNFR2
(P =0.030) in donors were associated with reduced
intensive care unit times (≤5 days) in recipients, while higher donor
IL-6 (P =0.029) and IL-10 (P =0.037)
levels were correlated with reduced hospitalization times (≤25 days)
in recipients. Recipients who required moderate/high levels of noradrenaline
for weaning off cardiopulmonary bypass were associated with lower donor
concentrations of sTNFR2 (P =0.028) and IL-6
(P =0.001). Conclusion High levels of sTNFR1, sTNFR2, IL-6 and IL-10 in donors were associated with
enhanced evolution in recipients. Allografts from older donors, or from
those treated with noradrenaline doses >0.23 µg/kg/min, were more
frequently affected by primary graft dysfunction within 30 days of
surgery.
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Affiliation(s)
- Renato Braulio
- Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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Sabatino M, Vitale G, Manfredini V, Masetti M, Borgese L, Maria Raffa G, Loforte A, Martin Suarez S, Falletta C, Marinelli G, Clemenza F, Grigioni F, Potena L. Clinical relevance of the International Society for Heart and Lung Transplantation consensus classification of primary graft dysfunction after heart transplantation: Epidemiology, risk factors, and outcomes. J Heart Lung Transplant 2017; 36:1217-1225. [DOI: 10.1016/j.healun.2017.02.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 02/11/2017] [Accepted: 02/15/2017] [Indexed: 11/25/2022] Open
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Wright M, Takeda K, Mauro C, Jennings D, Kurlansky P, Han J, Truby L, Stein S, Topkara V, Garan AR, Yuzefpolskaya M, Colombo P, Naka Y, Farr M, Takayama H. Dose-dependent association between amiodarone and severe primary graft dysfunction in orthotopic heart transplantation. J Heart Lung Transplant 2017; 36:1226-33. [DOI: 10.1016/j.healun.2017.05.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/06/2017] [Accepted: 05/18/2017] [Indexed: 11/20/2022] Open
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20
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Quintana-Quezada RA, Rajapreyar I, Postalian-Yrausquin A, Yeh YC, Choi S, Akkanti B, Sieg A, Weeks P, Patel M, Patel J, Nathan S, Kar B, Loyalka P, Gregoric I. Clinical Factors Implicated in Primary Graft Dysfunction After Heart Transplantation: A Single-center Experience. Transplant Proc 2017; 48:2168-71. [PMID: 27569965 DOI: 10.1016/j.transproceed.2016.02.073] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/16/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Primary graft dysfunction (PGD) is a frequent complication after cardiac transplantation and remains one of the leading causes of mortality in these patients. The objective of this case-control study is to identify donor and surgical procedure's factors associated with PGD, and further guide possible strategies to prevent PGD. METHODS Retrospective analysis of the medical records of patients who underwent cardiac transplantation at Memorial Hermann Hospital at Texas Medical Center between October 2012 and February 2015. RESULTS The study population included 99 patients, of which 18 developed PGD. Univariate analysis of donor characteristics revealed opioid use (P = .049) and death owing to anoxia (P = .021) were associated with PGD. The recipient/donor blood type match AB/A was significantly associated with PGD (P = .031). Time from brain death to aortic cross clamp (TBDACC) of ≥3 and ≥5 days were also found to be associated with PGD (P = .0011 and .0003, respectively). Multivariate analysis confirmed that patients with a time from brain death to aortic cross clamp ≥3 and ≥5 days had lesser odds of developing PGD (odds ratio, 0.098 [P = .0026] and OR, 0.092 [P = .0017], respectively]. CONCLUSIONS Our study showed that a longer time from brain death to aortic cross clamp was associated with lower odds of developing PGD. Therefore, postponing heart procurement for a few days after brain death seems to be beneficial in preventing PGD.
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Affiliation(s)
- R A Quintana-Quezada
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas.
| | - I Rajapreyar
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - A Postalian-Yrausquin
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Y C Yeh
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - S Choi
- Division of Clinical and Translational Sciences, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas
| | - B Akkanti
- Division of Critical Care, Pulmonary and Sleep, University of Texas Medical School at Houston, Houston, Texas
| | - A Sieg
- Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, Texas
| | - P Weeks
- Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, Texas
| | - M Patel
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - J Patel
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - S Nathan
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - B Kar
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - P Loyalka
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - I Gregoric
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
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DiStefano YE, Cvetkovic D, Malekan R, McGoldrick KE. Anesthetic Management of Combined Heart-Liver Transplantation in a Patient With Ischemic Cardiomyopathy and Cardiac Cirrhosis: Lessons Learned. J Cardiothorac Vasc Anesth 2017; 31:646-652. [DOI: 10.1053/j.jvca.2016.05.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Indexed: 11/11/2022]
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22
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Guihaire J, Noly PE, Martin A, Rojo M, Aymami M, Ingels A, Lelong B, Chabanne C, Verhoye JP, Flécher E. Impact of donor comorbidities on heart transplant outcomes in the modern era. Interact Cardiovasc Thorac Surg 2017; 24:898-904. [DOI: 10.1093/icvts/ivx014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 12/11/2016] [Indexed: 11/13/2022] Open
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23
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Thomas JJ, Periappuram JC, Ranganathan B, Pillai SB. Primary graft failure following cardiac transplantation—our experience over 18 months. Indian J Thorac Cardiovasc Surg 2016; 32:235-8. [DOI: 10.1007/s12055-016-0448-z] [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: 11/27/2022] Open
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24
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Fujino T, Kinugawa K, Nitta D, Imamura T, Maki H, Amiya E, Hatano M, Kimura M, Kinoshita O, Nawata K, Komuro I, Ono M. Donor age is a predictor of early low output after heart transplantation. J Cardiol 2016; 67:477-82. [DOI: 10.1016/j.jjcc.2015.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/24/2015] [Accepted: 07/09/2015] [Indexed: 11/21/2022]
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Szarszoi O, Besik J, Smetana M, Maly J, Urban M, Maluskova J, Lodererova A, Hoskova L, Tucanova Z, Pirk J, Netuka I. Biomarkers of cellular apoptosis and necrosis in donor myocardium are not predictive of primary graft dysfunction. Physiol Res 2015; 65:251-7. [PMID: 26447521 DOI: 10.33549/physiolres.933105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Primary graft dysfunction (PGD) is a life-threatening complication among heart transplant recipients and a major cause of early mortality. Although the pathogenesis of PGD is still unclear, ischemia/reperfusion injury has been identified as a predominant factor. Both necrosis and apoptosis contribute to the loss of cardiomyocytes during ischemia/reperfusion injury, and this loss of cells can ultimately lead to PGD. The aim of our prospective study was to find out whether cell death, necrosis and apoptosis markers present in the donor myocardium can predict PGD. The prospective study involved 64 consecutive patients who underwent orthotopic heart transplantation at our institute between September 2010 and January 2013. High-sensitive cardiac troponin T (hs-cTnT) as a marker of minor myocardial necrosis was detected from arterial blood samples before the donor's pericardium was opened. Apoptosis (caspase-3, active + pro-caspase-3, bcl-2, TUNEL) was assessed from bioptic samples taken from the right ventricle prior graft harvesting. In our study, 14 % of transplant recipients developed PGD classified according to the standardized definition proposed by the ISHLT Working Group. We did not find differences between the groups in regard to hs-cTnT serum levels. The mean hs-cTnT value for the PGD group was 57.4+/-22.9 ng/l, compared to 68.4+/-10.8 ng/l in the group without PGD. The presence and severity of apoptosis in grafted hearts did not differ between grafts without PGD and hearts that subsequently developed PGD. In conclusion, our findings did not demonstrate any association between measured myocardial cell death, necrosis or apoptosis markers in donor myocardium and PGD in allograft recipients. More detailed investigations of cell death signaling pathways in transplanted hearts are required.
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Affiliation(s)
- O Szarszoi
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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Seguchi O, Fujita T, Murata Y, Sunami H, Sato T, Watanabe T, Nakajima S, Kuroda K, Hisamatsu E, Sato T, Yanase M, Hata H, Wada K, Ishibashi-Ueda H, Kobayashi J, Nakatani T. Incidence, etiology, and outcome of primary graft dysfunction in adult heart transplant recipients: a single-center experience in Japan. Heart Vessels 2015; 31:555-62. [DOI: 10.1007/s00380-015-0649-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 02/06/2015] [Indexed: 01/29/2023]
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27
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Chew HC, Kumarasinghe G, Iyer A, Hicks M, Gao L, Doyle A, Jabbour A, Dhital K, Granger E, Jansz P, Hayward C, Keogh A, Kotlyar E, Spratt P, Macdonald P. Primary Graft Dysfunction After Heart Transplantation. Curr Transpl Rep 2014; 1:257-65. [DOI: 10.1007/s40472-014-0033-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Chen JW, Chen YS, Chi NH, Huang SC, Yu HY, Chou NK, Wang CH, Wang SS. Risk Factors and Prognosis of Patients With Primary Graft Failure After Heart Transplantation: An Asian Center Experience. Transplant Proc 2014; 46:914-9. [DOI: 10.1016/j.transproceed.2013.11.107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/15/2013] [Indexed: 12/21/2022]
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29
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Kobashigawa J, Zuckermann A, Macdonald P, Leprince P, Esmailian F, Luu M, Mancini D, Patel J, Razi R, Reichenspurner H, Russell S, Segovia J, Smedira N, Stehlik J, Wagner F. Report from a consensus conference on primary graft dysfunction after cardiac transplantation. J Heart Lung Transplant 2014; 33:327-40. [DOI: 10.1016/j.healun.2014.02.027] [Citation(s) in RCA: 307] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 02/28/2014] [Indexed: 10/25/2022] Open
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30
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Cosío Carmena MDG, Gómez Bueno M, Almenar L, Delgado JF, Arizón JM, González Vilchez F, Crespo-Leiro MG, Mirabet S, Roig E, Pérez Villa F, Fernández-Yañez JF, Lambert JL, Manito N, Fuente L, Sanz Julve ML, Pascual D, Rábago G, Millán I, Alonso-Pulpón LA, Segovia J. Primary graft failure after heart transplantation: Characteristics in a contemporary cohort and performance of the RADIAL risk score. J Heart Lung Transplant 2013; 32:1187-95. [DOI: 10.1016/j.healun.2013.08.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 07/09/2013] [Accepted: 08/01/2013] [Indexed: 11/28/2022] Open
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Abstract
Perioperative anesthetic management for cardiac transplantation is reviewed. Recent developments in adult cardiac transplantation are noted. This review includes demographics and historical results, recipient and donor selection and evaluation, mechanical circulatory support and heart transplantation techniques, and patient management immediately postimplantation.
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Affiliation(s)
- Sofia Fischer
- Department of Anesthesiology, Emory University School of Medicine, 550 Peachtree Street, Atlanta, GA 30308, USA
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32
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Abstract
The successful delivery of optimal peri-operative care to pediatric heart transplant recipients is a vital determinant of their overall outcomes. The practitioner caring for these patients must be familiar with and treat multiple simultaneous issues in a patient who may have been critically ill preoperatively. In addition to the complexities involved in treating any child following cardiac surgery, caretakers of newly transplanted patients encounter multiple transplant-specific issues. This chapter details peri-operative management strategies, frequently encountered early morbidities, initiation of immunosuppression including induction, and short-term outcomes.
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Yang HY, Lin CY, Tsai YT, Lee CY, Tsai CS. Experience of heart transplantation from hemodynamically unstable brain-dead donors with extracorporeal support. Clin Transplant 2012; 26:792-6. [DOI: 10.1111/j.1399-0012.2011.01585.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kim YH, Sohn GY, Jung YJ, Kyoung KH, Hong SK. Successful Management of Potential Non-Heart-Beating Donor with Extracorporeal Membrane Oxygenation - A Case Report -. Korean J Crit Care Med 2012. [DOI: 10.4266/kjccm.2012.27.4.279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Young Hwan Kim
- Division of Trauma and Surgical Critical Care, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gui Yun Sohn
- Division of Trauma and Surgical Critical Care, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Kyu Hyouck Kyoung
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Suk-Kyung Hong
- Division of Trauma and Surgical Critical Care, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Iyer A, Kumarasinghe G, Hicks M, Watson A, Gao L, Doyle A, Keogh A, Kotlyar E, Hayward C, Dhital K, Granger E, Jansz P, Pye R, Spratt P, Macdonald PS. Primary graft failure after heart transplantation. J Transplant 2011; 2011:175768. [PMID: 21837269 PMCID: PMC3151502 DOI: 10.1155/2011/175768] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 05/09/2011] [Indexed: 11/17/2022] Open
Abstract
Primary graft failure (PGF) is a devastating complication that occurs in the immediate postoperative period following heart transplantation. It manifests as severe ventricular dysfunction of the donor graft and carries significant mortality and morbidity. In the last decade, advances in pharmacological treatment and mechanical circulatory support have improved the outlook for heart transplant recipients who develop this complication. Despite these advances in treatment, PGF is still the leading cause of death in the first 30 days after transplantation. In today's climate of significant organ shortages and growing waiting lists, transplant units worldwide have increasingly utilised "marginal donors" to try and bridge the gap between "supply and demand." One of the costs of this strategy has been an increased incidence of PGF. As the threat of PGF increases, the challenges of predicting and preventing its occurrence, as well as the identification of more effective treatment modalities, are vital areas of active research and development.
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Affiliation(s)
- Arjun Iyer
- Heart & Lung Transplant Unit, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
- Cardiac Physiology and Transplant Program, Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia
| | - Gayathri Kumarasinghe
- Heart & Lung Transplant Unit, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
- Cardiac Physiology and Transplant Program, Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia
| | - Mark Hicks
- Cardiac Physiology and Transplant Program, Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia
| | - Alasdair Watson
- Cardiac Physiology and Transplant Program, Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia
| | - Ling Gao
- Cardiac Physiology and Transplant Program, Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia
| | - Aoife Doyle
- Cardiac Physiology and Transplant Program, Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia
| | - Anne Keogh
- Heart & Lung Transplant Unit, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
- Cardiac Physiology and Transplant Program, Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia
| | - Eugene Kotlyar
- Heart & Lung Transplant Unit, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
| | - Christopher Hayward
- Heart & Lung Transplant Unit, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
| | - Kumud Dhital
- Heart & Lung Transplant Unit, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
| | - Emily Granger
- Heart & Lung Transplant Unit, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
| | - Paul Jansz
- Heart & Lung Transplant Unit, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
| | - Roger Pye
- Heart & Lung Transplant Unit, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
| | - Phillip Spratt
- Heart & Lung Transplant Unit, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
| | - Peter Simon Macdonald
- Heart & Lung Transplant Unit, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
- Cardiac Physiology and Transplant Program, Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia
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