Combined amiodarone and digitalis therapy before heart transplantation is associated with increased post‐transplant mortality

AbstractImmunosuppressive therapy can decrease rejection episodes and increase the risk of severe and fatal infections in heart transplantation (HT) recipients. Immunosuppressive therapy can also decrease the absolute lymphocyte count (ALC), but the relationship between early post-transplant ALC and early cytomegalovirus (CMV) infection is largely unknown, especially in HT. We retrospectively analyzed 58 HT recipients who tested positive for CMV IgG antibody and received basiliximab induction therapy. We collected preoperative and 2-month postoperative data on ALC and CMV load. The CMV load > 1200 IU/mL was used as the cutoff value to define early CMV infection. Post-transplant lymphopenia was defined as an ALC of < 500 cells/μL at postoperative day (POD) #7. On POD #7, 29 (50.0%) patients had post-transplant lymphopenia and 29 (50.0%) patients did not. The incidence of CMV infection within 1 or 2 months of HT was higher in the post-transplant lymphopenia group than in the non-lymphopenia group (82.8% vs. 48.3%, P = 0.013; 89.7% vs. 65.5%, P = 0.028, respectively). ALC < 500 cells/μL on POD #7 was an independent risk factor for early CMV infection within 1 month of HT (odds ratio, 4.14; 95% confidence interval, 1.16–14.77; P = 0.029). A low ALC after HT was associated with a high risk of early CMV infection. Post-transplant ALC monitoring is simple and inexpensive and can help identify patients at high risk of early CMV infection.

Download Full-text

Six-Month Post-Transplant Outcomes in Patients Bridged to Heart Transplantation with IABP or Impella Following 2018 UNOS Allocation Policy Change

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2021.01.730 ◽

2021 ◽

Vol 40 (4) ◽

pp. S256

Author(s):

R.O. Lee ◽

A.S. Vaidya ◽

A.M. Wolfson ◽

E.C. DePasquale

Keyword(s):

Heart Transplantation ◽

Policy Change ◽

Allocation Policy ◽

Post Transplant ◽

Transplant Outcomes

Download Full-text

Increased Frequency of Heart Transplantation, Shortened Waitlist Time and Preserved Post‐Transplant Survival in Adults with Congenital Heart Disease, on the New Heart Transplant Allocation System

Clinical Transplantation ◽

10.1111/ctr.14205 ◽

2020 ◽

Author(s):

Milena Jani ◽

Stephen Cook ◽

Si Hong Huang ◽

Theodore Boeve ◽

Marzia Leacche ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Heart Transplantation ◽

Heart Transplant ◽

Congenital Heart ◽

Transplant Survival ◽

Allocation System ◽

Post Transplant

Download Full-text

Sirolimus-Based Immunosuppression Is Associated with Decreased Incidence of Post-Transplant Lymphoproliferative Disorder after Heart Transplantation: A Double-Center Study

Journal of Clinical Medicine ◽

10.3390/jcm11020322 ◽

2022 ◽

Vol 11 (2) ◽

pp. 322

Author(s):

Rabea Asleh ◽

Darko Vucicevic ◽

Tanya M. Petterson ◽

Walter K. Kremers ◽

Naveen L. Pereira ◽

...

Keyword(s):

Heart Transplantation ◽

Lymphoproliferative Disorder ◽

Univariate Analysis ◽

Mammalian Target Of Rapamycin ◽

Mtor Inhibitors ◽

Lymphoid Cells ◽

Post Transplant ◽

Barr Virus ◽

Increased Risk ◽

Epstein Barr

Mammalian target of rapamycin (mTOR) inhibitors have been shown to reduce proliferation of lymphoid cells; thus, their use for immunosuppression after heart transplantation (HT) may reduce post-transplant lymphoproliferative disorder (PTLD) risk. This study sought to investigate whether the sirolimus (SRL)-based immunosuppression regimen is associated with a decreased risk of PTLD compared with the calcineurin inhibitor (CNI)-based regimen in HT recipients. We retrospectively analyzed 590 patients who received HTs at two large institutions between 1 June 1988 and 31 December 2014. Cox proportional-hazard modeling was used to examine the association between type of primary immunosuppression and PTLD after adjustment for potential confounders, including Epstein–Barr virus (EBV) status, type of induction therapy, and rejection. Conversion from CNI to SRL as primary immunosuppression occurred in 249 patients (42.2%). During a median follow-up of 6.3 years, 30 patients developed PTLD (5.1%). In a univariate analysis, EBV mismatch was strongly associated with increased risk of PTLD (HR 10.0, 95% CI: 3.8–26.6; p < 0.001), and conversion to SRL was found to be protective against development of PTLD (HR 0.19, 95% CI: 0.04–0.80; p = 0.02). In a multivariable model and after adjusting for EBV mismatch, conversion to SRL remained protective against risk of PTLD compared with continued CNI use (HR 0.12, 95% CI: 0.03–0.55; p = 0.006). In conclusion, SRL-based immunosuppression is associated with lower incidence of PTLD after HT. These findings provide evidence of a benefit from conversion to SRL as maintenance therapy for mitigating the risk of PTLD, particularly among patients at high PTLD risk.

Download Full-text

Profiles and predictors of the course of psychological distress across four years after heart transplantation

Psychological Medicine ◽

10.1017/s0033291705004563 ◽

2005 ◽

Vol 35 (8) ◽

pp. 1215-1227 ◽

Cited By ~ 45

Author(s):

MARY AMANDA DEW ◽

LARISSA MYASKOVSKY ◽

GALEN E. SWITZER ◽

ANDREA F. DiMARTINI ◽

HERBERT C. SCHULBERG ◽

...

Keyword(s):

Psychological Distress ◽

Heart Transplantation ◽

Social Supports ◽

Psychological Needs ◽

Physical Impairment ◽

Transplant Recipients ◽

Post Transplant ◽

High Distress ◽

Clinically Significant ◽

Over Time

Background. Like individuals exposed to other life stressors, patients undergoing organ transplantation typically show elevated psychological distress initially post-transplant, with improvement thereafter. However, this ‘average’ pattern may conceal subgroups with differing profiles of psychological response. We sought to identify unique temporal distress profiles, and their predictors, after heart transplantation.Method. A total of 156 transplant recipients (refusal rate, 6%) were enrolled and assessed at 2, 7, 12, 36, and 42 months post-transplant. Cluster analysis was used to identify distinct distress profiles over time. Multivariate analyses examined health and psychosocial predictors of the profiles.Results. Five groups were identified, with either: (a) low distress at all time-points (45% of the sample), (b) high, clinically significant distress at all times (21%), (c) high distress over several years with low distress only at final assessment (12%), (d) high distress during the first several months with decline thereafter (6%), or (e) fluctuating distress levels (16%). Patients showing any distress (versus none) were more likely to have a pre-transplant psychiatric history, poorer social supports and more physical impairment early post-transplant, and continued physical impairment over time. Among distressed patients, those with persistent (versus declining) distress were most likely to be female, waited more briefly for transplant, and were most physically impaired early post-transplant. While persistently distressed patients had better social supports early post-transplant, these supports subsequently worsened.Conclusions. Individuals differ in whether and when psychological distress abates after heart transplantation. Findings regarding distress profiles and their predictors may inform the design of interventions to address each transplant recipient's unique psychological needs.

Download Full-text