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Dhillon M, Kobashigawa JA, Kittleson M, Jain R, Patel N, Singer-Englar T, Zhang X, Hakimi M, Aintablian T, Vescio R, Dilibero D, Kransdorf E, Czer L, Nikolova AP, Patel JK. Does bortezomib influence pre-transplant desensitization therapy or benefit post-heart transplant outcomes for highly sensitized patients? Clin Transplant 2024; 38:e15165. [PMID: 37837612 DOI: 10.1111/ctr.15165] [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: 07/28/2023] [Revised: 09/19/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND The use of bortezomib which is a proteasome inhibitor has been demonstrated to be efficacious in small number of patients as a desensitization strategy in heart transplant. We reviewed our single center's experience using Bortezomib along with plasmapheresis as desensitization therapy for highly sensitized patients to assess pre- and post-transplant outcomes. METHOD We assessed 43 highly sensitized patients awaiting HTx (defined as cPRA > 50%) between 2010 and 2021 who underwent desensitization therapy with bortezomib. Only those patients who subsequently underwent HTx were included in this study. Enrolled patients received up to four doses of bortezomib (1.3 mg/m2 ) over 2 weeks in conjunction with plasmapheresis. The efficacy of PP/BTZ was assessed by comparing the calculated panel reactive antibodies to HLA class I or class II antigens. Post-transplant outcomes including overall survival and incidence of rejection were compared to those of non-sensitized patients (PRA < 10%, n = 649) from the same center. RESULTS The average cPRA prior to PP/BTZ was 94.5%. Post-PP/BTZ there was no statistically significant decline in mean cPRA, class I cPRA, or class II cPRA, though the average percentage decrease in class I cPRA (8.7 ± 17.0%) was higher than the change in class II cPRA (4.4 ± 13.3%). Resulted were also replicated with C1q-binding antibodies showing more effect on I class compared to class II (15.0 ± 37.4% vs. 6.8 ± 33.6%) as well as with 1:8 dilutional assay (14.0 ± 23.0% vs. 9.1 ± 34.9%). Additionally, PP/BTZ treated patients and the control group of non-sensitized patients had similar overall 1 year survival (95.4 vs. 92.5%) but patients with PP/BTZ had increased incidence of AMR (79.1% vs. 97.1%, p = < .001), any treated rejection (62.8% vs. 86.7%, p = < .001) and de novo DSA development (81.4% vs. 92.5%, p = .007). Major side effects of PP/BTZ included thrombocytopenia (42%), infection requiring antibiotics (28%), and neuropathy (12%). CONCLUSION The use of bortezomib in highly sensitized patients does not significantly lower circulating antibodies prior to heart transplantation. However, its use may improve the chances of obtaining an immuno-compatible donor heart and contribute to acceptable post-transplant outcomes.
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Affiliation(s)
- Manvir Dhillon
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | | | | | - Rashmi Jain
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Nikhil Patel
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | | | - Xiaohai Zhang
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Matthew Hakimi
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | | | - Robert Vescio
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | | | - Evan Kransdorf
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Lawrence Czer
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
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Chen Q, Malas J, Gianaris K, Esmailian G, Emerson D, Megna D, Catarino P, Czer L, Bowdish ME, Chikwe J, Patel J, Kobashigawa J, Esmailian F. Simultaneous heart-kidney transplant in patients with borderline estimated glomerular filtration rate without dialysis dependency. Clin Transplant 2023; 37:e14986. [PMID: 37026791 DOI: 10.1111/ctr.14986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/21/2022] [Revised: 03/07/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Appropriate patient selection for simultaneous heart-kidney transplantation (sHK) in patients with moderate renal dysfunction remains challenging. METHODS From the United Network for Organ Sharing database (2003-2020), we identified 5678 adults with an estimated pre-transplant glomerular filtration rate (eGFR) between 30 and 45 mL/min/1.73 m2 and no pre-transplant dialysis. Patients undergoing sHK (n = 293) were compared with those undergoing heart transplantation alone (n = 5385) using 1:3 propensity score matching. RESULTS The sHK utilization rate increased from 1.8% in 2003 to 12.2% in 2020 (p < .001). After matching, 1 and 5-year survival was 87.7% (95% confidence interval [CI] 83.3-91.0) and 80.0% (95% CI 74.2-84.6) after sHK, and 87.3% (95% CI 85.2-89.1) and 71.8% (95% CI 68.4-74.9) after heart transplant alone (p = .04). In the subgroup analysis, sHK was associated with a 5-year survival benefit only in patients with 30 < eGFR ≤ 35 mL/min/1.73 m2 (p = .05) but not in those with 35 < eGFR < 45 mL/min/1.73 m2 (p = .45). Patients who underwent heart transplants alone also had a higher incidence of becoming chronic dialysis-dependent after transplant within 5-year follow-up (10.2%, 95% CI 8.0-12.6 vs. 3.8%, 95% CI 1.7-7.1, p = .004). The 5-year incidence of subsequent kidney waitlisting and transplants after heart transplants alone was 5.6% and 1.9%, respectively. CONCLUSION Among propensity-matched patients without pre-transplant dialysis, compared to heart transplants alone, sHK had improved 5-year survival in those with 30 < eGFR ≤ 35 but not in those with 35 < eGFR < 45 mL/min/1.73 m2 . One-year survival was similar irrespective of eGFR. Receiving a kidney after a heart transplant alone is rare under the current allocation system.
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Affiliation(s)
- Qiudong Chen
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jad Malas
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kevin Gianaris
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Gabriel Esmailian
- The George Washington School of Medicine and Health Sciences, Washington, D.C., USA
| | - Dominic Emerson
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dominick Megna
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Pedro Catarino
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Lawrence Czer
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael E Bowdish
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jignesh Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jon Kobashigawa
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Fardad Esmailian
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Malas J, Chen Q, Emerson D, Megna D, Catarino P, Czer L, Patel J, Kittleson M, Kobashigawa J, Chikwe J, Bowdish ME, Esmailian F. Heart retransplant recipients with renal dysfunction benefit from simultaneous heart-kidney transplantation. J Heart Lung Transplant 2023; 42:1045-1053. [PMID: 37098375 PMCID: PMC10524580 DOI: 10.1016/j.healun.2023.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/05/2023] [Revised: 02/15/2023] [Accepted: 04/14/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Given ongoing donor shortages, appropriate patient selection for dual-organ transplantation is critical. We evaluated outcomes of heart retransplant with simultaneous kidney transplant (HRT-KT) vs isolated heart retransplant (HRT) across varying levels of renal dysfunction. METHODS The United Network for Organ Sharing database identified 1189 adult patients undergoing heart retransplantation between 2005 and 2020. Recipients undergoing HRT-KT (n = 251) were compared to those undergoing HRT (n = 938). The primary outcome was 5-year survival; subgroup analyses and multivariable adjustment were performed utilizing the following 3 estimated glomerular filtration (eGFR) groups: <30 ml/min/1.73m2, 30-45 ml/min/1.73m2, and >45 ml/min/1.73m2. RESULTS HRT-KT recipients were older and had longer waitlist times, longer inter-transplant periods, and lower eGFR levels. HRT-KT recipients were less likely to require pretransplant ventilator (1.2% vs 9.0%, p < 0.001) or ECMO (2.0% vs 8.3%, p < 0.001) support but were more likely to have severe functional limitation (63.4% vs 52.6%, p = 0.001). After retransplantation, HRT-KT recipients had less treated acute rejection (5.2% vs 9.3%, p = 0.02) and more dialysis requirement (29.1% vs 20.2%, p < 0.001) before discharge. Survival at 5-years was 69.1% after HRT and 80.5% after HRT-KT (p < 0.001). After adjustment, HRT-KT was associated with improved 5-year survival among recipients with eGFR <30 ml/min/1.73m2 (HR:0.42, 95% CI: 0.26-0.67) and 30 to 45 ml/min/1.73m2 (HR:0.29, 95% CI 0.13-0.65), but not among those with eGFR>45 ml/min/1.73sm2 (HR 0.68, 95% CI 0.30-1.54). CONCLUSION Simultaneous kidney transplantation is associated with improved survival following heart retransplantation in patients with eGFR <45 ml/min/1.73m2 and should be strongly considered to optimize organ allocation stewardship.
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Affiliation(s)
- Jad Malas
- Department of Cardiac Surgery, Cedars Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Qiudong Chen
- Department of Cardiac Surgery, Cedars Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Dominic Emerson
- Department of Cardiac Surgery, Cedars Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Dominick Megna
- Department of Cardiac Surgery, Cedars Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Pedro Catarino
- Department of Cardiac Surgery, Cedars Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Lawrence Czer
- Department of Cardiology, Cedars Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Jignesh Patel
- Department of Cardiology, Cedars Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Michelle Kittleson
- Department of Cardiology, Cedars Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Jon Kobashigawa
- Department of Cardiology, Cedars Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Joanna Chikwe
- Department of Cardiology, Cedars Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Michael E Bowdish
- Department of Cardiac Surgery, Cedars Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Fardad Esmailian
- Department of Cardiac Surgery, Cedars Sinai Medical Center, Smidt Heart Institute, Los Angeles, California.
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Thomas J, Chen Q, Roach A, Wolfe S, Osho AA, Sundaram V, Wisel SA, Megna D, Emerson D, Czer L, Esmailian F, Chikwe J, Kim I, Catarino P. Donation after circulatory death heart procurement strategy impacts utilization and outcomes of concurrently procured abdominal organs. J Heart Lung Transplant 2023; 42:993-1001. [PMID: 37037750 DOI: 10.1016/j.healun.2023.02.1497] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/01/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION The impact of donation after circulatory death (DCD) heart procurement techniques on the utilization and outcomes of concurrently procured DCD livers and kidneys remains unclear. METHODS Using the United Network for Organ Sharing database, we identified 246 DCD donors whose heart was procured using direct procurement and ex-situ machine perfusion and 128 DCD donors whose heart was procured using in-situ thoracoabdominal normothermic regional perfusion (12/2019-03/2022). We evaluated the transplantation rate of concurrently procured DCD livers and kidneys (defined as the number of organs transplanted/total number of organs available for procurement) and their post-transplant outcomes. RESULTS The transplantation rate of concurrently procured DCD livers was higher with in-situ perfusion compared to direct procurement (67.1% vs 56.5%, p = 0.045). After excluding pediatric, multiorgan, and repeat transplant recipients, there was no difference in 6-month liver graft failure rate (direct procurement 0.9% vs in-situ perfusion 0%, p > 0.99). Recipients of kidneys procured with in-situ perfusion had less delayed graft function (11.3% vs 41.5%, p < 0.0001) shorter length of stay, and lower serum creatinine at discharge (both p < 0.05). Six-month recipient survival in the direct procurement and in-situ perfusion group were similar after DCD liver and kidney transplantation (p = 0.24 and 0.79 respectively). CONCLUSIONS Compared to direct procurement, DCD heart procurement with in-situ thoracoabdominal normothermic regional perfusion was associated with increased utilization of DCD livers and a lower incidence of delayed graft function in concurrently procured DCD kidneys. Broader implementation of DCD heart transplantation must maximize the transplant potential of concurrently procured abdominal organs and ensure their successful outcomes.
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Affiliation(s)
- Jason Thomas
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Qiudong Chen
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Amy Roach
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stanley Wolfe
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Asishana A Osho
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Vinay Sundaram
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Steven A Wisel
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dominick Megna
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dominic Emerson
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lawrence Czer
- Department of Cardiology, Smidt Heart Institute, Los Angeles, California
| | - Fardad Esmailian
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Irene Kim
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Pedro Catarino
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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Malas J, Chen Q, Emerson D, Megna D, Catarino P, Czer L, Patel J, Kittleson M, Kobashigawa J, Chikwe J, Bowdish M, Esmailian F. Heart Retransplant Recipients with Borderline Renal Dysfunction Benefit from Combined Heart-Kidney Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.209] [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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Lam L, Czer L, Runyan C, Otarola I, Jang J, Lau J, Gau M, Hernandez K, Ngo T, Cole R, Moriguchi J. Outcome of Enoxaparin Bridging in Left Ventricular Assist Devices (LVAD) in an Ambulatory Setting: A Continuation Study at Cedars Sinai Medical Center (CSMC). J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1380] [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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Malas J, Chen Q, Akhmerov A, Tremblay P, Egorova N, Moriguchi J, Kobashigawa J, Czer L, Cole R, Emerson D, Chikwe J, Arabia F, Esmailian F. Does Extracorporeal Membrane Oxygenation Duration as a Bridge to Total Artificial Heart Affect Outcomes. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.144] [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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Srivastava P, Zhang X, Moriguchi J, Chang D, Czer L, Cole R, Kittleson M, Kransdorf E, Kobashigawa J, Patel J. Extreme HLA Homozygosity Contributing to Extreme HLA Sensitization. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.452] [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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Stern L, Patel J, Kittleson M, Chang D, Patel N, Singer-Englar T, Velleca A, Norland K, Hamilton M, Czer L, Esmailian F, Kobashigawa J. Proceeding with Heart Transplant in Flow Positive Cyto-Negative Prospective Donor-Specific Crossmatch in Highly Sensitized Patients: Saving Lives. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1667] [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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Kobashigawa J, Kittleson M, Kim S, Singer-Englar T, Esmailian G, Runyan C, Cole R, Moriguchi J, Megna D, Czer L, Patel J. The Outcome of Heart Transplant Patients with Severe Rejection Requiring ECMO Support: Is it Futile. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.590] [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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Patel J, Kittleson M, Patel N, Singer-Englar T, Kim S, Thein S, Norland K, Hage A, Czer L, Emerson D, Kobashigawa J. High HDL Levels are Associated with Survival Benefit after Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.457] [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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Patel J, Kittleson M, Moriguchi J, Singer-Englar T, Kim S, De Leon F, Runyan C, Czer L, Emerson D, Megna D, Esmailian F, Kobashigawa J. Does Right Ventricular Support with Mechanical Assist Devices Compromise Outcome for Heart Transplantation? J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.806] [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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Gianaris K, Czer L, Catarino P, Esmailian F, Megna D, Emerson D, Cheng W, Kobashigawa J, Trento A. Impact of Professional Organ Procurement Organizations and Statewide Collaboration on Expanding Organ Donor Registry and Organ Transplantation in California. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1614] [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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Stachel M, Patel J, Kittleson M, Chang D, Patel N, Singer-Englar T, Ross V, De Leon F, Hamilton M, Czer L, Esmailian F, Kobashigawa J. Revisiting Hemodynamic Compromise Rejection in the Current Era of Heart Transplantation: Still Problematic. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1212] [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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Patel J, Kittleson M, Chang D, Kim S, Singer-Englar T, Dixon V, Azarbal B, Czer L, Hage A, Esmailian F, Kobashigawa J. Does Donor Age Impact Outcomes for MCS Patients Undergoing Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.775] [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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Shen A, Patel J, Kittleson M, Chang D, Esmailian G, Singer-Englar T, De Leon F, Hamilton M, Geft D, Czer L, Megna D, Kobashigawa J. Transthyretin Amyloid May Have a Protective Effect for Rejection after Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.544] [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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Kittleson M, Patel J, Moriguchi J, Cole R, Singer-Englar T, Patel N, Runyan C, Welton M, Czer L, Catarino P, Kobashigawa J. Do Older LVAD Patients Have Compromised Outcome after Heart Transplantation: Should They Stay as Destination Therapy? J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.190] [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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Kittleson M, Patel J, Nikolova A, Patel N, Singer-Englar T, Hu J, De Leon F, Hamilton M, Czer L, Esmailian F, Kobashigawa J. What Should the GFR Threshold Be for Redo Heart Transplant Patients to Qualify for Combined Heart-Kidney Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.524] [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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Kittleson M, Patel J, Hage A, Geft D, Singer-Englar T, Kim S, Velleca A, Hamilton M, Czer L, Esmailian F, Kobashigawa J. Oversized Donors for Patients with Pulmonary Hypertension Awaiting Heart Transplant: Busting the Myth of Using Female Donors. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.534] [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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Kittleson M, Patel J, Azarbal B, Patel N, Singer-Englar T, Yeomans T, Esmailian G, Nikolova A, Hage A, Emerson D, Czer L, Kobashigawa J. In-Stent Re-Stenosis for Cardiac Allograft Vasculopathy in the Current Era for Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.459] [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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Kittleson M, Patel J, Singer-Englar T, Kim S, Patel N, Wakefield Z, Welton M, Czer L, Esmailian F, Kobashigawa J. Are Redo Heart Transplant Patients Appropriately Listed as Status 4 on the Waitlist. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.525] [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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Kittleson M, Patel J, Chang D, Patel N, Esmailian G, Singer-Englar T, Runyan C, Moriguchi J, Czer L, Esmailian F, Kobashigawa J. Is Chronic Kidney Disease Truly a Contraindication for Total Artificial Heart Candidacy and Subsequent Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.774] [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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Patel N, Kittleson M, Chang D, Patel J, Azarbal B, Singer-Englar T, Geft D, Czer L, Esmailian F, Kobashigawa J. Validation of the Cardiac Allograft Vasculopathy (CAV) Trajectory Score after Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.458] [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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Chang D, Kittleson M, Patel J, Singer-Englar T, Kim S, Hage P, Norland K, Czer L, Esmailian F, Jordan S, Kobashigawa J. Outcome of the Kidney in Heart-Kidney Transplant - Does It Take an Immune Hit. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.523] [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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Kittleson M, Patel J, Azarbal B, Kim S, Singer-Englar T, Trajano R, Velleca A, Geft D, Megna D, Czer L, Kobashigawa J. Cardiac Allograft Vasculopathy Trajectory Score Helpful to Avoid Annual Angiograms in Heart-Kidney Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.456] [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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Kim I, Youn J, Chang D, Nishihara K, Kransdorf E, Kittleson M, Patel J, Cole R, Nikolova A, Esmailian F, Czer L, Kobashigawa J. The Validation of Cardiac Rehabilitation after Heart Transplantation from Anonymized Patient-Reported Outcomes. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1262] [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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Malas J, Chen Q, Akhmerov A, Tremblay LP, Egorova N, Krishnan A, Moriguchi J, Kobashigawa J, Czer L, Cole R, Emerson D, Chikwe J, Arabia F, Esmailian F. Experience With SynCardia Total Artificial Heart as a Bridge to Transplantation in 100 Patients. Ann Thorac Surg 2023; 115:725-732. [PMID: 36521527 DOI: 10.1016/j.athoracsur.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/03/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The SynCardia temporary total artificial heart (TAH-t) is an effective bridge to transplantation for patients with severe biventricular failure. However, granular single-center data from high-volume centers are lacking. We report our experience with the first 100 TAH-t recipients. METHODS A prospective institutional database was used to identify 100 patients who underwent 101 TAH-t implantations between 2012 and 2022. Patients were stratified and compared according to Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1 vs 2 or greater. Median follow-up on device support was 94 days (interquartile range, 33-276), and median follow-up after transplantation was 4.6 years (interquartile range, 2.1-6.0). RESULTS Overall, 61 patients (61%) were successfully bridged to transplantation and 39 (39%) died on TAH-t support. Successful bridge rates between INTERMACS profile 1 and INTERMACS profile 2 or greater patients were similar (55.6% [95% CI, 40.4%-68.3%] vs 67.4% [95% CI, 50.5%-79.6%], respectively; P = .50). The most common adverse events (rates per 100 patient-months) on TAH-t support included infection (15.8), ischemic stroke (4.6), reoperation for mediastinal bleeding (3.5), and gastrointestinal bleeding requiring intervention (4.3). The most common cause of death on TAH-t support was multisystem organ failure (n = 20, 52.6%). Thirty-day survival after transplantation was 96.7%; survival at 6 months, 1 year, and 5 years after transplantation was 95.1% (95% CI, 85.4%-98.4%), 86.6% (95% CI, 74.9%-93.0%), and 77.5% (95% CI, 64.2%-86.3%), respectively. CONCLUSIONS Acceptable outcomes can be achieved in the highest acuity patients using the TAH-t as a bridge to heart transplantation.
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Affiliation(s)
- Jad Malas
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Qiudong Chen
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Akbarshakh Akhmerov
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Louis Philippe Tremblay
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | | | - Aasha Krishnan
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Jaime Moriguchi
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Jon Kobashigawa
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Lawrence Czer
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Robert Cole
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Dominic Emerson
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Francisco Arabia
- Advanced Heart Program, Banner University Medical Group, Phoenix, Arizona
| | - Fardad Esmailian
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California.
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Cao L, Kim SK, Schwartz B, Cole R, Patel J, Czer L, Esmailian F, Kobashigawa JA, Hamilton MA, Kittleson MM. The impact of the United Network of Organ Sharing allocation change on waitlist trajectories of inpatients listed with inotropic support: A single-center analysis. Clin Transplant 2023; 37:e14834. [PMID: 36259510 DOI: 10.1111/ctr.14834] [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: 06/06/2022] [Revised: 07/24/2022] [Accepted: 10/03/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND In the United Network of Organ Sharing (UNOS) allocation scheme prior to October 18, 2018, heart transplant (HTx) candidates with extracorporeal membrane oxygenation (ECMO), temporary mechanical circulatory support (MCS), or pulmonary artery (PA) catheter inotropic support all received Status 1A priority. In revised scheme, patients with PA catheter and inotropic support are Status 3 after those on ECMO (Status 1) or temporary MCS (Status 2). We examined the impact of the allocation change on HTx candidates listed Status 1A versus Status 3 at a high-volume transplant center. METHODS Between January 2017 and January 2021, 75 patients were listed with a PA catheter and inotropic support prior to the allocation change (Era 1) and 48 were listed after (Era 2). Clinical characteristics and outcomes were compared for these 123 patients. RESULTS Heart transplant (HTx) candidates in Era 2 had higher median inotrope doses at listing. There was no significant difference in inpatient wait list days (12 vs. 20 days, P = .15), transition to temporary MCS (33.3% vs. 22.7%, P = .15), or wait list mortality (6.3% vs. 4.0%, P = .68). There was also no significant difference in survival to transplantation (91.7% vs. 94.7%, P = .71). There were no differences in post-transplant outcomes including 1-year survival (88.6% vs. 93.0%, P = .38). CONCLUSION At a high-volume transplant center, the UNOS allocation change did not result in increased wait list time, use of temporary MCS, or mortality on the waitlist or post-transplant for candidates on inotropic support with continuous hemodynamic monitoring.
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Affiliation(s)
- Louie Cao
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Seong Kyu Kim
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Brandon Schwartz
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Robert Cole
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jignesh Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Lawrence Czer
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Fardad Esmailian
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jon A Kobashigawa
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michele A Hamilton
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Hansen B, Singer Englar T, Cole R, Catarino P, Chang D, Czer L, Emerson D, Geft D, Kobashigawa J, Megna D, Ramzy D, Moriguchi J, Esmailian F, Kittleson M. Extracorporeal membrane oxygenation as a bridge to durable mechanical circulatory support or heart transplantation. Int J Artif Organs 2022; 45:604-614. [PMID: 35658592 DOI: 10.1177/03913988221103284] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with cardiogenic shock may require extracorporeal membrane oxygenation (ECMO) prior to durable mechanical circulatory support (dMCS) or heart transplantation (HTx). METHODS We investigated the clinical characteristics and outcomes of adult patients with ECMO support as bridge to dMCS or HTx between 1/1/13 and 12/31/20. RESULTS Of 57 patients who underwent bridging ECMO, 41 (72%) received dMCS (approximately half with biventricular support) and 16 (28%) underwent HTx, 13 (81%) after the 2018 UNOS allocation system change. ECMO → HTx patients had shorter ventilatory time (3.5 vs 7.5 days; p = 0.018), ICU stay (6 vs 18 days; p = 0.001), and less need for inpatient rehabilitation (18.8% vs 57.5%; p = 0.016). The 1-year survival post HTx was 81.3% in the ECMO → HTx group and 86.4% in the ECMO → dMCS group (p = 0.11). For those patients in the ECMO → dMCS group who did not undergo HTx, 1-year survival was significantly lower, 31.6% (p = 0.001). CONCLUSION Patients on ECMO who undergo HTx, with or without dMCS bridge, have acceptable post-HTx survival. These findings suggest that HTx from ECMO is a viable option for carefully selected patients deemed acceptable to proceed with definitive advanced therapies, especially in the era of the new UNOS allocation system.
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Affiliation(s)
| | | | - Robert Cole
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | | | - David Chang
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | | | | | - Dael Geft
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | | | | | - Danny Ramzy
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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Esmailian G, Patel N, Patel JK, Czer L, Rafiei M, Megna D, Emerson D, Ramzy D, Trento A, Chikwe J, Esmailian F, Kobashigawa JA. Heart transplant recipient 1-year outcomes during the COVID-19 pandemic. Clin Transplant 2022; 36:e14697. [PMID: 35543382 PMCID: PMC9348427 DOI: 10.1111/ctr.14697] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/26/2022] [Accepted: 05/03/2022] [Indexed: 12/02/2022]
Abstract
The COVID‐19 pandemic initially brought forth considerable challenges to the field of heart transplantation. To prevent the spread of the virus and protect immunocompromised recipients, our center made the following modifications to post‐transplant outpatient management: eliminating early coronary angiograms, video visits for postoperative months 7, 9, and 11, and home blood draws for immunosuppression adjustments. To assess if these changes have impacted patient outcomes, the current study examines 1‐year outcomes for patients transplanted during the pandemic. Between March and September 2020, we assessed 50 heart transplant patients transplanted during the pandemic. These patients were compared to patients who were transplanted during the same months between 2011 and 2019 (n = 482). Endpoints included subsequent 1‐year survival, freedom from cardiac allograft vasculopathy, any‐treated rejection, acute cellular rejection, antibody‐mediated rejection, nonfatal major adverse cardiac events (NF‐MACE), and hospital and ICU length of stay. Patients transplanted during the pandemic had similar 1‐year endpoints compared to those of patients transplanted from years prior apart from 1‐year freedom from NF‐MACE which was significantly higher for patients transplanted during the pandemic. Despite necessary changes being made to outpatient management of heart transplant recipients, heart transplantation continues to be safe and effective with similar 1‐year outcomes to years prior.
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Affiliation(s)
- Gabriel Esmailian
- The George Washington University School of Medicine and Health Sciences, Washington DC, USA.,Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Nikhil Patel
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Jignesh K Patel
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Lawrence Czer
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Matthew Rafiei
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Dominick Megna
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Dominic Emerson
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Danny Ramzy
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Alfredo Trento
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Joanna Chikwe
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Fardad Esmailian
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
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Chen Q, Singer-Englar T, Kobashigawa JA, Roach A, Emerson D, Megna D, Ramzy D, Catarino P, Patel JK, Kittleson M, Czer L, Chikwe J, Esmailian F. Long-term outcomes after heart transplantation using ex vivo allograft perfusion in standard risk donors: A single-center experience. Clin Transplant 2022; 36:e14591. [PMID: 35030278 DOI: 10.1111/ctr.14591] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/20/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Organ Care System (OCS) is an ex vivo perfusion platform for donor heart preservation. Short/mid-term post-transplant outcomes after its use are comparable to standard cold storage (CS). We evaluated long-term outcomes following its use. METHODS Between 2011 and 2013, 38 patients from a single center were randomized as a part of the PROCEED II trial to receive allografts preserved with CS (n = 19) or OCS (n = 19). Endpoints included 8-year survival, survival free from graft-related deaths, freedom from cardiac allograft vasculopathy (CAV), non-fatal major adverse cardiac events (NF-MACE), and rejections. RESULTS Eight-year survival was 57.9% in the OCS group and 73.7% in the CS group (p = .24). Freedom from CAV was 89.5% in the OCS group and 67.8% in the CS group (p = .13). Freedom from NF-MACE was 89.5% in the OCS group and 67.5% in the CS group (p = .14). Eight-year survival free from graft-related death was equivalent between the two groups (84.2% vs. 84.2%, p = .93). No differences in rejection episodes were observed (all p > .5). CONCLUSIONS In select patients receiving OCS preserved allografts, late post-transplant survival trended lower than those transplanted with an allograft preserved with CS. This is based on a small single-center series, and larger numbers are needed to confirm these findings.
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Affiliation(s)
- Qiudong Chen
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tahli Singer-Englar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jon A Kobashigawa
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Amy Roach
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dominic Emerson
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dominick Megna
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Danny Ramzy
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Pedro Catarino
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jignesh K Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michelle Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Lawrence Czer
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Fardad Esmailian
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Singer-Englar T, Patel J, Kittleson M, Chang D, Patel N, Kim S, Azarbal B, Emerson D, Czer L, Kobashigawa J. Does the Degree of Diastolic Dysfunction in the First Year After Heart Transplant Affect Subsequent Outcomes? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.794] [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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Kransdorf E, Patel J, Kittleson M, Singer-Englar T, Patel N, Ravellette K, Kim S, Geft D, Czer L, Esmailian F, Kobashigawa J. The Effects of Hypomagnesemia Post Heart Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.795] [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: 11/25/2022] Open
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Kittleson M, Patel J, Kransdorf E, Singer-Englar T, Patel N, Rubio M, Musto N, Hamilton M, Emerson D, Czer L, Kobashigawa J. Are Markedly Oversized Donor Hearts Associated with Poor Outcome After Heart Transplantation? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1384] [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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Kittleson M, Patel J, Chang D, Patel N, Singer-Englar T, Oda M, Azarbal B, Trento A, Czer L, Kobashigawa J. Is Sacubitril/Valsartan a Risk Factor for Vasoplegia/Primary Graft Dysfunction After Heart Transplantation? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.235] [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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Dhillon M, Patel J, Kittleson M, Chang D, Patel N, Singer-Englar T, Hamilton M, Czer L, Megna D, Kobashigawa J. Experience with Eculizumab in Highly Sensitized Patients Undergoing Heart Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.213] [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: 11/25/2022] Open
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Zhang X, Patel J, Kittleson M, Czer L, Jordan S, Kobashigawa J. Can Heart Allografts Protect Simultaneous Kidney Allografts from Antibody Injury? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1141] [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: 11/30/2022] Open
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Jamero G, Patel J, Kittleson M, Singer-Englar T, Patel N, Kim S, Nikolova A, Esmailian F, Czer L, Kobashigawa J. What is the Meaning of Culture Negative Leukocytosis Immediately After Heart Transplantation? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1642] [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: 11/16/2022] Open
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Volod O, Lam L, Robert C, Moriguchi J, Yur J, Garcia M, Zhou J, Wilde A, Czer L. Determining Cause for Activated Partial Thromboplastin Time and Anti-Factor Xa Discordance in Mechanical Circulatory Support Patients on Heparin; Can Thromboelastogram Help? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1170] [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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Velleca A, Kittleson M, Patel J, Singer-Englar T, Patel N, Washington C, Jamero G, Czer L, Esmailian F, Zakowski P, Kobashigawa J. COVID Pandemic and Social Mitigations Decrease Hospitalizations for Heart Transplant Patients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1411] [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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Allison Z, Kittleson M, Patel J, Kransdorf E, Singer-Englar T, Patel N, Geft D, Azarbal B, Czer L, Esmailian F, Kobashigawa J. Is Delayed Graft Function Worse in Simultaneous Heart-Kidney Transplant vs Kidney Transplant Alone? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.236] [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: 11/30/2022] Open
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Patel J, Kittleson M, Kransdorf E, Patel N, Singer-Englar T, Hu J, Kim S, Trento A, Czer L, Kobashigawa J. Are Calcineurin Inhibitor-Free Protocols Safe and Effective in the Long-Term After Heart Transplant? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1404] [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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Patel J, Kittleson M, Kransdorf E, Singer-Englar T, Patel N, Kim S, Hage A, Hamilton M, Czer L, Kobashigawa J. Treatment and Outcome of AL Amyloid After Heart Transplantation: Is It Viable? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1109] [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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Cole R, Moriguchi J, Kittleson M, Patel J, Chang D, Patel N, Singer-Englar T, Azarbal B, Emerson D, Czer L, Kobashigawa J. Do Temporary Mechanical Circulatory Support Devices Activate Sensitization Pathways in Patients Awaiting Heart Transplantation? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1184] [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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Kittleson M, Patel J, Chang D, Singer-Englar T, Patel N, Mishalani L, Kim S, Ramzy D, Czer L, Kobashigawa J. Who is at Risk for Seizures After Heart Transplantation? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.797] [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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Deen J, Patel J, Kittleson M, Chang D, Singer-Englar T, Patel N, Nikolova A, Ramzy D, Czer L, Kobashigawa J. Efficacy of Tocilizumab for Refractory Sensitized Patients Awaiting Heart Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1402] [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: 11/26/2022] Open
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47
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Kittleson M, Patel J, Chang D, Patel N, Singer-Englar T, Sindha I, Truong M, Hage A, Ramzy D, Czer L, Kobashigawa J. Sex Disparities in Heart Transplant Waitlist Status After the Donor Heart Allocation Policy Change. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1383] [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: 11/16/2022] Open
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48
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Kittleson M, Patel J, Chang D, Singer-Englar T, Patel N, Velleca A, Czer L, Kobashigawa J, Zabner R, Zakowski P. The Outcome of West Nile Virus Infection After Heart Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.819] [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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49
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Jamero G, De Leon F, Ackerman M, Welton M, Kissling N, Velleca A, White M, Czer L, Nikolova A, Kransdorf E, Chang D, Kittleson M, Patel J, Kobashigawa J. NP Telehealth Blood Pressure Management in Heart Transplant Patients - A Single Center Experience. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1572] [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: 11/30/2022] Open
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50
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Patel N, Kittleson M, Patel J, Singer-Englar T, Chang D, Hage A, Azarbal B, Czer L, Esmailian F, Kobashigawa J. Is ATG Induction with Delayed Initiation of CNI Protective of Renal Function in Patients with Mild Renal Insufficiency? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1105] [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: 11/26/2022] Open
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