Association of Tacrolimus Time‐to‐Therapeutic Range on Renal Dysfunction and Acute Cellular Rejection after Orthotopic Heart Transplantation in a high use Basiliximab Population

2021 ◽  
Author(s):  
Alexis N. Nanni ◽  
Matthew Harris ◽  
Mara Watson ◽  
Zidanyue Yang ◽  
Hui‐Jie Lee ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Renal Dysfunction ◽  
Therapeutic Range ◽  
Acute Cellular Rejection ◽  
Orthotopic Heart Transplantation ◽  
Cellular Rejection

scholarly journals Three-Dimensional Self-Navigated T2 Mapping for the Detection of Acute Cellular Rejection After Orthotopic Heart Transplantation

2017 ◽  
Vol 3 (4) ◽  
pp. e149 ◽  
Author(s):  
Ruud B. van Heeswijk ◽  
Davide Piccini ◽  
Piergiorgio Tozzi ◽  
Samuel Rotman ◽  
Philippe Meyer ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
T2 Mapping ◽  
Three Dimensional ◽  
Acute Cellular Rejection ◽  
Orthotopic Heart Transplantation ◽  
Cellular Rejection

A Single-Center Experience of the Optimal Initial Immunosuppressive Strategy for Preventing Early Acute Cellular Rejection in Orthotopic Heart Transplantation Associated With Renal Dysfunction

2019 ◽  
Vol 29 (4) ◽  
pp. 327-334
Author(s):  
Juan Mundisugih ◽  
Himavan Fernando ◽  
Peter Bergin ◽  
James Hare ◽  
David Kaye ◽  
...  
Keyword(s):  
Acute Rejection ◽  
Heart Transplantation ◽  
Renal Dysfunction ◽  
Standard Therapy ◽  
Calcineurin Inhibitor ◽  
Calcineurin Inhibitors ◽  
Acute Cellular Rejection ◽  
Rank Test ◽  
Post Transplant ◽  
Cellular Rejection

Background: Renal dysfunction is a common complication following heart transplantation that may be worsened by the early initiation of calcineurin inhibitors. Antithymocyte globulin (ATG) or basiliximab has been used to delay or avoid calcineurin inhibitors. The most effective strategy for preventing early acute cellular rejection in this context is uncertain. Methods: We retrospectively reviewed all heart transplant cases between January 2012 and June 2017. The standard therapy consisted of mycophenolate mofetil, prednisolone, and tacrolimus. In patients at high risk of post-transplant renal dysfunction, an early calcineurin inhibitor-free regimen with basiliximab and/or ATG was used. Patients were assigned to cohorts based on the initial immunosuppressive strategy. The primary end point was the freedom rate of acute cellular rejection within 4 weeks post-transplant. Results: Of 93 cases, 21 patients received standard therapy, 64 patients received an initial calcineurin inhibitor-free regimen with basiliximab, and 8 patients received ATG and basiliximab. Freedom from acute rejection was greater in the ATG plus basiliximab group (all rejection free), compared to 40 (63%) of 64 patients treated with basiliximab and 10 (48%) of 21 patients treated with standard therapy ( P < .05, log rank test). In patients treated with basiliximab, early administration (<24 hours) was associated with a higher freedom from acute rejection compared to ≥24 hours, (72% vs 29%, P < .05). Conclusions: The combination of ATG and basiliximab was more effective in preventing acute cellular rejection. In those patients treated with basiliximab, rejection rates were no worse than standard therapy; however, it was only effective when administered within 24 hours.

Alemtuzumab Induction Versus Conventional Immunosuppression in Heart Transplant Recipients

2019 ◽  
Vol 24 (5) ◽  
pp. 435-441 ◽  
Author(s):  
Stormi E. Gale ◽  
Bharath Ravichandran ◽  
Van-Khue Ton ◽  
Si Pham ◽  
Brent N. Reed
Keyword(s):  
Renal Function ◽  
Heart Transplantation ◽  
Induction Therapy ◽  
Standard Therapy ◽  
Infectious Complications ◽  
Acute Cellular Rejection ◽  
Orthotopic Heart Transplantation ◽  
Antibody Mediated Rejection ◽  
End Point ◽  
Cellular Rejection

The use of alemtuzumab for induction therapy in orthotopic heart transplantation remains controversial, despite its observed benefits in other transplant populations. This study aimed to evaluate whether alemtuzumab conferred a lower risk of rejection while reducing toxicities commonly attributed to standard immunosuppression in orthotopic heart transplantation. We included adult patients who underwent orthotopic heart transplantation and received induction therapy with alemtuzumab (n = 26) or standard immunosuppression (n = 26). The primary end point was freedom from grade ≥2 rejection at 12 months. Baseline characteristics were similar between the groups with the exception of poorer renal function in the alemtuzumab group ( P < .05). The primary end point of freedom from grade ≥2 rejection at 12 months was not different between alemtuzumab and standard therapy (76.9% vs 96.2%, P = .077), likely due to similarities in the rates of antibody-mediated rejection in the 2 groups. However, grade ≥2 acute cellular rejection was considerably lower with alemtuzumab (0% vs 19.2%, P = .02), as was acute cellular rejection of any severity (50% vs 7.7%, P = .004). Deterioration in renal function was significantly greater among patients receiving standard therapy as evidenced by decreases in glomerular filtration rate (−25.6 vs −9.2 mL/min, P = .032). No differences in hematologic or infectious complications were observed. In conclusion, alemtuzumab reduced several important rejection-related outcomes while ameliorating the toxicities associated with standard immunosuppression therapy, making it a promising agent for induction in orthotopic heart transplantation.

scholarly journals Correction to: Usefulness of speckle tracking echocardiography and biomarkers for detecting acute cellular rejection after heart transplantation

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Cecilia Beatriz Bittencourt Viana Cruz ◽  
Ludhmila A. Hajjar ◽  
Fernando Bacal ◽  
Marco S. Lofrano-Alves ◽  
Márcio S. M. Lima ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Acute Cellular Rejection ◽  
Cellular Rejection

An amendment to this paper has been published and can be accessed via the original article.

scholarly journals Usefulness of Speckle Tracking Echocardiography and Biomarkers for Detecting Acute Cellular Rejection After Heart Transplantation

2020 ◽  
Author(s):  
Cecília Beatriz Bittencourt Viana Cruz ◽  
Ludhmila A. Hajjar ◽  
Fernando Bacal ◽  
Marco S. Lofrano-Alves ◽  
Márcio S.M. Lima ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Right Ventricular ◽  
Speckle Tracking ◽  
Troponin I ◽  
Speckle Tracking Echocardiography ◽  
Left Ventricular ◽  
Acute Cellular Rejection ◽  
Control Group ◽  
Transplant Patients ◽  
Cellular Rejection

Abstract Background: Acute cellular rejection (ACR) is a major complication after heart transplantation. Endomyocardial biopsy (EMB) remains the gold standard for its diagnosis, but it has concerning complications. We evaluated the usefulness of speckle tracking echocardiography (STE) and biomarkers for detecting ACR after heart transplantation.Methods: We prospectively studied 60 transplant patients with normal left and right ventricular systolic function who underwent EMB for surveillance six months after transplantation. Sixty age- and sex-matched healthy individuals constituted the control group. Conventional echocardiographic parameters, left ventricular global longitudinal, radial and circumferential strain (LV-GLS, LV-GRS and LV-GCS, respectively), left ventricular systolic twist (LV-twist) and right ventricular free wall longitudinal strain (RV-FWLS) were analyzed just before the procedure. We also measured biomarkers at the same moment. Results: Among the included 60 patients, 17 (28%) had severe ACR (grade ≥ 2R), and 43 (72%) had no significant ACR (grade 0 – 1R). The absolute values of LV-GLS, LV-twist and RV-FWLS were lower in transplant patients with ACR degree ≥ 2 R than in those without ACR (12.5% ± 2.9% vs 14.8% ± 2.3%, p=0.002; 13.9° ± 4.8° vs 17.1° ± 3.2°, p=0.048; 21.4%± 3.2% vs 16.6% ± 2.9%, p<0.001; respectively), while no differences were observed between the LV-GRS or LV-GCS. All of these parameters were lower in the transplant group without ACR than in the nontransplant control group, except for the LV-twist. Cardiac troponin I levels were significantly higher in patients with significant ACR than in patients without significant ACR [0.19 ng/mL (0.09–1.31) vs. 0.05 ng/mL (0.01–0.18), p=0.007]. The combination of troponin with LV-GLS, RV FWLS and LV-Twist had an AUC (area under curve) for the detection of ACR of 0.80 (0.68 – 0.92), 0.89 (0.81 – 0.93) and 0.79 (0.66 – 0.92), respectively. Conclusion: Heart transplant patients have altered left ventricular dynamics compared with control individuals. The combination of troponin with strain parameters had higher accuracy for the detection of ACR than the isolated variables and this association might select patients with a higher risk for ACR who will benefit from an EMB procedure in the first year after heart transplantation.

High-Sensitivity Cardiac Troponin is not Associated with Acute Cellular Rejection after Heart Transplantation

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Sarah J Fitzsimons ◽  
Jonathan D.W. Evans ◽  
Doris M Rassl ◽  
Kuan Ken Lee ◽  
Fiona E Strachan ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Cardiac Troponin ◽  
High Sensitivity ◽  
Acute Cellular Rejection ◽  
Cellular Rejection

Myocardial deformation and acute cellular rejection after heart transplantation: Impact of inter‐vendor variability in diagnostic effectiveness

2019 ◽  
Vol 36 (12) ◽  
pp. 2185-2194 ◽  
Author(s):  
Martín Ruiz‐Ortiz ◽  
Sara Rodriguez‐Diego ◽  
Mónica Delgado ◽  
Jiwon Kim ◽  
Jonathan W. Weinsaft ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Acute Cellular Rejection ◽  
Myocardial Deformation ◽  
Cellular Rejection
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