Circulating C-type natriuretic peptide is increased in orthotopic cardiac transplant recipients and associated with cardiac allograft vasculopathy

2000 ◽  
Vol 99 (5) ◽  
pp. 467-472 ◽  
Author(s):  
Martin G. BUCKLEY ◽  
Geraint H. JENKINS ◽  
Andrew G. MITCHELL ◽  
Magdi H. YACOUB ◽  
Donald R. J. SINGER
Keyword(s):  
Heart Transplantation ◽  
Plasma Levels ◽  
Healthy Subjects ◽  
Cardiac Transplantation ◽  
Cardiac Allograft Vasculopathy ◽  
Cardiac Allograft ◽  
Cardiac Transplant ◽  
Transplant Recipients ◽  
Allograft Vasculopathy ◽  
Post Transplant

C-type natriuretic peptide (CNP) is a potent, endothelial-derived relaxant and growth-inhibitory factor. Accelerated vascular disease is an important cause of morbidity in cardiac transplant recipients, and endothelial dysfunction is now well recognized in patients with cardiovascular disease. CNP has not previously been investigated following cardiac transplantation. We therefore studied plasma levels of immunoreactive CNP in patients early and late after heart transplantation, compared with levels in healthy subjects. We measured CNP in extracted human plasma using an antibody against human CNP-(1–22). CNP levels were significantly elevated in 13 cardiac recipients 2 weeks post-transplant [2.64±0.26 pmol/l (mean±S.E.M.)] compared with those in the normal healthy subjects (0.62±0.04 pmol/l; n = 20, P < 0.001). Plasma levels of CNP were also significantly elevated in a second group of established cardiac transplant recipients (1.15±0.07 pmol/l; n = 46) studied 1–13 years post-transplant when compared with the healthy subjects (P < 0.001). In the group studied later after transplantation, CNP levels were significantly associated with systolic blood pressure (P < 0.05) and were higher in patients with angiographic post-transplant coronary artery disease (P = 0.032). In conclusion, these findings clearly demonstrate that CNP is elevated soon after cardiac transplantation and remains raised in patients even several years post-transplant. CNP may be important as a circulating or local hormone involved in vascular contractile function and in the pathophysiology of cardiac allograft vasculopathy following heart transplantation.

Heart Transplantation

2014 ◽  
Author(s):  
Michael M. Givertz
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Heart Transplant ◽  
Cardiac Allograft Vasculopathy ◽  
Cardiac Allograft ◽  
Transplant Recipients ◽  
Allograft Vasculopathy ◽  
Adult Heart ◽  
Heart Transplantations ◽  
Heart Transplant Recipients

Heart failure is a major public health problem with significant associated morbidity and mortality. Heart transplantation remains the standard of care for highly selected patients with end-stage heart failure and absence of contraindications to transplantation. This chapter discusses indications and contraindications for transplantation; recipient evaluation, selection, and management; donor selection; timing of the procedure and surgical technique; medical management, including immunosuppression, prevention and treatment of infections, and other standard or preventive therapy; late complications; and functional status and long-term survival. Tables describe patient referral to a specialized center for heart transplantations; guidelines of indications for cardiac transplantation; organ dysfunction; pretransplantation evaluation; waiting lists; therapeutic options for patients with advanced or refractory heart failure; treating highly sensitized patients; suggested vaccinations; guidelines for donor hearts with severe infection; high-risk donor behavior; hemodynamic effect of commonly used parenteral agents; frequency of follow-up evaluations; revised International Society for Heart and Lung Transplantation (ISHLT) formulation for diagnosis of cardiac allograft rejection and suggested treatment; function of immunosuppressive agents; administration, dosing, monitoring, and adverse effects of commonly used immunosuppressants; common agents that interfere with tacrolimus and cyclosporine; cytomegalovirus prophylaxis and valganciclovir based on estimated renal function; cumulative morbidity rates in adult heart transplant survivors; and therapies to prevent and treat osteoporosis posttransplantation. Figures depict the progression of heart failure; change in functional status over time in patients with chronic heart failure; US heart transplantations in 2012; percentage of US adult wait-listed patients who received a donor heart transplant within a year and donation rates by state; bicaval surgical technique; endomyocardial biopsies; timeline of infection following solid-organ transplantation; cardiac allograft vasculopathy; and squamous cell carcinomas in a heart transplant patient. Graphs show adult worldwide heart transplantation volume from 1982 to 2010; changing characteristics of US adult heart transplant recipients; relative risk of death and development of cardiac allograft vasculopathy; posttransplantation immunosuppression at 1 and 5 years in the ISHLT Registry; older donor age and risk of developing cardiac allograft vasculopathy; freedom from malignancy in the ISHLT Registry; employment status of adult heart transplant recipients; adult heart transplant survival; and patient survival among US heart transplant recipients by gender and race. This review contains 18 highly rendered figures, 20 tables, and 109 references.

Low Serum IGF-1 Is a Risk Factor for Cardiac Allograft Vasculopathy in Cardiac Transplant Recipients

2012 ◽  
Vol 93 (3) ◽  
pp. 309-313 ◽  
Author(s):  
Seyedhossein Aharinejad ◽  
Mohamed Salama ◽  
Susanne Rödler ◽  
Marek Ehrlich ◽  
Andreas Zuckermann ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cardiac Allograft Vasculopathy ◽  
Cardiac Allograft ◽  
Cardiac Transplant ◽  
Transplant Recipients ◽  
Allograft Vasculopathy ◽  
Low Serum

Identification of trajectories of cardiac allograft vasculopathy after heart transplantation: a nationwide comparison

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Bonnet ◽  
G Coutance ◽  
J Van Keer ◽  
M Raynaud ◽  
O Aubert ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Heart Transplant ◽  
Latent Class ◽  
External Validation ◽  
Cardiac Allograft Vasculopathy ◽  
Cardiac Allograft ◽  
Transplant Recipients ◽  
Allograft Vasculopathy ◽  
The Us ◽  
Heart Transplant Recipients

Abstract Background Cardiac allograft vasculopathy (CAV) is a major contributor of heart transplant recipient's mortality. However, little is known about CAV trajectories at a population level. Purpose We aimed to identify the different profiles of CAV trajectories. Methods Heart transplant recipients receiving care at 4 academic centers (2004 to 2016) were included. Patients underwent prospective, protocol-based monitoring consisting of repeated coronary angiographies together with systematic assessment of clinical, functional, histological and immunological parameters. The mainoutcome was the CAV trajectories, identified with unsupervised latent class mixed models. Results Overall, 1,301 patients were included (609 in France, 206 in Belgium and 486 in the US). The median follow-up post-transplant was 6.6 years (IQR=4.7) with 4,710 coronary angiographies analyzed (3.6±1.6 CAV assessments per patient). In the French development cohort, we identified 4 distinct profiles of CAV trajectories over 10 years that were characterized by i) Patients without CAV at baseline and non-progression (n=317, 52.1%), ii) patients without CAV at baseline and late onset CAV progression (n=52, 8.5%), iii) patients with mild baseline CAV and mild progression (n=151, 24.8%), iv) patients with mild baseline CAV and accelerated CAV progression (n=89, 14.6%, discrimination 0.92). The 4 CAV trajectories were independently validated in the external validation cohorts from Belgium (discrimination=0.92) and the US (discrimination=0.97). Conclusion In a large multicentric and highly phenotyped prospective cohort of heart transplant recipients, we identified and validated 4 distinct CAV trajectories corresponding to specific initial CAV grades and subsequent evolutions. Our results provide the basis for a trajectory-based assessment for risk stratification at early-stage post heart transplantation. Figure 1. Cardiac allograft vasculopathy trajectories in France (n=609), in Belgium (n=206), in USA (n=486). Thick lines represent latent class trajectory; thin lines represent CAV individual patient trajectory. Funding Acknowledgement Type of funding source: None

Determinants of trajectories of cardiac allograft vasculopathy after heart transplantation: a population based study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Bonnet ◽  
G Coutance ◽  
J Van Keer ◽  
M Raynaud ◽  
O Aubert ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Latent Class ◽  
Structural Parameters ◽  
Cardiac Allograft Vasculopathy ◽  
Cardiac Allograft ◽  
Transplant Recipients ◽  
Allograft Vasculopathy ◽  
Derivation Cohort ◽  
Post Transplant ◽  
Heart Transplant Recipients

Abstract Background Cardiac allograft vasculopathy (CAV) is a major contributor of heart transplant recipient's mortality. Little is known about determinants of CAV trajectories at a population level. Purpose We aimed to identify the respective contribution of immune and non-immune factors in the different evolutive profiles of CAV. Methods Heart transplant recipients receiving care at 2 academic centers (2004 to 2016) were included. Patients underwent prospective, protocol-based monitoring consisting of repeated coronary angiographies together with systematic assessment of clinical, functional, histological and immunological parameters. The outcome was CAV trajectories, identified with unsupervised latent class mixed models. The independent, predictive factors of CAV trajectories were investigated with multinomial regressions (NCT04117152). Results Overall, 815 patients were included. The median follow-up post-transplant was 7.7 years (IQR=5.14) with 2,742 coronary angiographies analyzed. We identified 4 distinct profiles of CAV trajectories over 10 years that were characterized by i) Patients without CAV at baseline and non-progression (n=459, 56.3%), ii) patients without CAV at baseline and late onset CAV progression (n=62, 7.6%), iii) patients with mild baseline CAV and mild progression (n=188 23.1%), iv) patients with mild baseline CAV and accelerated CAV progression (n=106, 13.0%, discrimination 0.92). Six early independent predictors of CAV trajectories were identified: donor age (p&lt;0.001), donor male gender (p&lt;0.001), donor tobacco consumption (p=0.001), recipient post-transplant dyslipidemia (p=0.009), preexisting or de novo class II anti-HLA donor-specific antibodies (p=0.004) and episode of acute cellular rejection ≥2R during the first year post transplantation (p=0.028). Conclusion In a large multicentric and highly phenotyped prospective cohort of heart transplant recipients, we identified 4 robust CAV trajectories and their respective immune and non-immune determinants. Our results provide the basis for a trajectory-based assessment of heart transplant patients for early patient risk stratification and patient monitoring. Factors associated CAV trajectories in multivariate analyses in the derivation cohort. This table shows the association of clinical, immunological, functional and structural parameters associated with CAV trajectories in multivariate multinomial regression analysis. The trajectory of reference was trajectory #1, including patients with no CAV at baseline and stable CAV grade over time. Funding Acknowledgement Type of funding source: None

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