Paediatric heart transplantation: an update

2019 ◽  
Vol 104 (12) ◽  
pp. 1216-1222
Author(s):  
Zdenka Reinhardt
Keyword(s):  
Heart Transplantation ◽  
Organ Procurement ◽  
Surgical Techniques ◽  
Immunosuppressive Drugs ◽  
Lymphoproliferative Disease ◽  
Current Status ◽  
Term Survival ◽  
Post Transplant ◽  
Monitoring Strategies ◽  
End Stage

Heart transplantation is a standard treatment for selected paediatric patients with end-stage heart disease. With improvement in surgical techniques, organ procurement and preservation strategies, immunosuppressive drugs, and more sophisticated monitoring strategies, survival following transplantation has increased over time. However, rejection, infection, renal failure, post-transplant lymphoproliferative disease and post-transplant cardiac allograft vasculopathy still preclude long-term survival. Therefore, continued multidisciplinary scientific efforts are needed for future gains. This review focuses on the current status, outcomes and ongoing challenges including patient selection, indications and contraindications, national and international survivals, post-transplant complications and quality of life.

Current status of heart transplantation

2018 ◽  
pp. 223-240
Author(s):  
Ayyaz Ali ◽  
Robert L. Kormos
Keyword(s):  
Heart Transplantation ◽  
Cardiac Transplantation ◽  
Organ Procurement ◽  
Severe Heart Failure ◽  
Surgical Techniques ◽  
Current Status ◽  
Definitive Treatment ◽  
Term Survival ◽  
The Many ◽  
End Stage

Cardiac transplantation has extended and improved the lives of patients suffering from severe heart failure over many decades. Despite advances in medical therapy, cardiac transplantation remains the definitive treatment for end-stage heart disease. Surgical techniques for organ procurement and implantation, development of appropriate methods for preserving the heart, and understanding the immunological challenges associated with transplantation were among the many areas which required focused investigation. In the current era, heart transplantation is associated with a low operative mortality and excellent long-term survival, however, the major obstacle of shortage of suitable donor organs remains. In the following chapter, recipient selection and management, donor organ procurement and preservation, and surgical techniques of heart transplantation are described in detail.

scholarly journals Risk Factors, Treatment and Prognosis of Patients with Lung Cancer after Heart Transplantation

Life ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 1344
Author(s):  
Karsten M. Heil ◽  
Matthias Helmschrott ◽  
Fabrice F. Darche ◽  
Tom Bruckner ◽  
Philipp Ehlermann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Heart Transplantation ◽  
Smoking Status ◽  
Lung Cancer Screening ◽  
Immunosuppressive Drugs ◽  
Term Survival ◽  
Lung Cancer Patients ◽  
Post Transplant ◽  
Diagnosis Of Lung Cancer

Long-term survival after heart transplantation (HTX) is impacted by adverse effects of immunosuppressive pharmacotherapy, and post-transplant lung cancer is a common occurrence. This study aimed to examine the risk factors, treatment, and prognosis of patients with post-transplant lung cancer. We included 625 adult patients who received HTX at Heidelberg Heart Center between 1989 and 2018. Patients were stratified by diagnosis and staging of lung cancer after HTX. Analysis comprised donor and recipient characteristics, medications including immunosuppressive drugs, and survival after diagnosis of lung cancer. A total of 41 patients (6.6%) were diagnosed with lung cancer after HTX, 13 patients received curative care and 28 patients had palliative care. Mean time from HTX until diagnosis of lung cancer was 8.6 ± 4.0 years and 1.8 ± 2.7 years from diagnosis of lung cancer until last follow-up. Twenty-four patients (58.5%) were switched to an mTOR-inhibitor after diagnosis of lung cancer. Multivariate analysis showed recipient age (HR: 1.05; CI: 1.01–1.10; p = 0.02), COPD (HR: 3.72; CI: 1.88–7.37; p < 0.01), and history of smoking (HR: 20.39; CI: 2.73–152.13; p < 0.01) as risk factors for post-transplant lung cancer. Patients in stages I and II had a significantly better 1-year (100.0% versus 3.6%), 2-year (69.2% versus 0.0%), and 5-year survival (53.8% versus 0.0%) than patients in stages III and IV (p < 0.01). Given the poor prognosis of late-stage post-transplant lung cancer, routine reassessment of current smoking status, providing smoking cessation support, and intensified lung cancer screening in high-risk HTX recipients are advisable.

A Comprehensive and Contemporary Review on Immunosuppression Therapy for Heart Transplantation

2020 ◽  
Vol 26 (28) ◽  
pp. 3351-3384
Author(s):  
Livia A. Goldraich ◽  
Santiago A. Tobar Leitão ◽  
Fernando L. Scolari ◽  
Fabiana G. Marcondes-Braga ◽  
Marcely G. Bonatto ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Immune Modulation ◽  
Immunosuppressive Agents ◽  
Graft Function ◽  
Surgical Techniques ◽  
Immunosuppressive Drugs ◽  
Fine Tuning ◽  
Comprehensive Overview ◽  
Cardiovascular Medications ◽  
End Stage

: Heart transplantation is the standard of therapy for patients with end-stage heart disease. Since the first human-to-human heart transplantation, performed in 1967, advances in organ donation, surgical techniques, organ preservation, perioperative care, immunologic risk assessment, immunosuppression agents, monitoring of graft function and surveillance of long-term complications have drastically increased recipient survival. However, there are yet many challenges in the modern era of heart transplantation in which immunosuppression may play a key role in further advances in the field. A fine-tuning of immune modulation to prevent graft rejection while avoiding side effects from over immunosuppression has been the vital goal of basic and clinical research. Individualization of drug choices and strategies, taking into account the recipient's clinical characteristics, underlying heart failure diagnosis, immunologic risk and comorbidities seem to be the ideal approaches to improve post-transplant morbidity and survival while preventing both rejection and complications of immunosuppression. : The aim of the present review is to provide a practical, comprehensive overview of contemporary immunosuppression in heart transplantation. Clinical evidence for immunosuppressive drugs is reviewed and practical approaches are provided. Cardiac allograft rejection classification and up-to-date management are summarized. Expanding therapies, such as photophoresis, are outlined. Drug-to-drug interactions of immunosuppressive agents focused on cardiovascular medications are summarized. Special situations involving heart transplantation such as sarcoidosis, Chagas diseases and pediatric immunosuppression are also reviewed. The evolution of phamacogenomics to individualize immunosuppressive therapy is described. Finally, future perspectives in the field of immunosuppression in heart transplantation are highlighted.

Cardiac Transplantation – Status in 2011

2011 ◽  
Vol 7 (4) ◽  
pp. 273 ◽  
Author(s):  
Kiran K Khush ◽  
Sharon A Hunt ◽  
◽  
Keyword(s):  
Heart Transplantation ◽  
Surgical Techniques ◽  
Immunosuppressive Drugs ◽  
Current Status ◽  
Circulatory Support ◽  
Operative Care ◽  
Mechanical Circulatory Support Devices ◽  
Transplant Candidates

Heart transplantation finally became a reality in 1967 and it continues to evolve, with changes in donor availability, recipient characteristics, waiting list times and post-transplant outcomes. Improvements in donor management, surgical techniques and post-operative care, development of potent immunosuppressive drugs and advances in the management of long-term complications have improved the quality of life and survival of heart transplant recipients. The introduction of mechanical circulatory support devices is providing an increasingly safe and effective alternative treatment for patients who are awaiting transplantation or those who are not transplant candidates. In this article, we review the current status of heart transplantation in 2011, with an eye towards future directions.

Liver Transplantation for the Gastroenterologist

2015 ◽  
Author(s):  
Andreea M. Catana ◽  
Michael P. Curry
Keyword(s):  
United States ◽  
Liver Transplantation ◽  
Liver Disease ◽  
Organ Procurement ◽  
The United States ◽  
Waiting Lists ◽  
Liver Graft ◽  
Term Survival ◽  
End Stage Liver Disease ◽  
End Stage

The first liver transplantation (LT) was performed in 1963, and currently more than 65,000 people in the United States are living with a transplanted liver. In 2012, the number of adults who registered on the LT waiting list decreased for the first time since 2002; 10,143 candidates were added compared with 10,359 in 2011. LT offers long-term survival for complications of end-stage liver disease and prolongs life in properly selected patients, but problems such as donor deficit, geographic disparities, and long waiting lists remain. This overview of LT for the gastroenterologist details the indications for LT and patient selection, evaluation, liver organ allocation, prioritization for transplantation, transplantation benefit by the Model for End-Stage Liver Disease (MELD), MELD limitations, sources of liver graft, strategies employed to decrease the donor deficit, complications, and outcomes. Figures include indications for LT in Europe and the United States, Organ Procurement and Transplantation Network regions in the United States, the number of transplants and size of active waiting lists, mortality by MELD, regional disparity, patient survival rates with and without hepatitis C virus, and unadjusted patient and graft survival. Tables list LT milestones, indications for LT, contraindications for LT, minimal listing criteria for LT, criteria for LT in acute liver failure, LT evaluation process, adult recipient listing status 1A, and early posttransplantation complications. This review contains 7 highly rendered figures, 8 tables, and 46 references. 

scholarly journals Review: Ischemia Reperfusion Injury—A Translational Perspective in Organ Transplantation

2020 ◽  
Vol 21 (22) ◽  
pp. 8549
Author(s):  
André Renaldo Fernández ◽  
Rodrigo Sánchez-Tarjuelo ◽  
Paolo Cravedi ◽  
Jordi Ochando ◽  
Marcos López-Hoyos
Keyword(s):  
Reperfusion Injury ◽  
Organ Transplantation ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Graft Loss ◽  
Surgical Techniques ◽  
Immunosuppressive Drugs ◽  
Donation Process ◽  
End Stage ◽  
Significant Injury

Thanks to the development of new, more potent and selective immunosuppressive drugs together with advances in surgical techniques, organ transplantation has emerged from an experimental surgery over fifty years ago to being the treatment of choice for many end-stage organ diseases, with over 139,000 organ transplants performed worldwide in 2019. Inherent to the transplantation procedure is the fact that the donor organ is subjected to blood flow cessation and ischemia during harvesting, which is followed by preservation and reperfusion of the organ once transplanted into the recipient. Consequently, ischemia/reperfusion induces a significant injury to the graft with activation of the immune response in the recipient and deleterious effect on the graft. The purpose of this review is to discuss and shed new light on the pathways involved in ischemia/reperfusion injury (IRI) that act at different stages during the donation process, surgery, and immediate post-transplant period. Here, we present strategies that combine various treatments targeted at different mechanistic pathways during several time points to prevent graft loss secondary to the inflammation caused by IRI.

Paediatric renal transplantation

2015 ◽  
Author(s):  
Minnie M. Sarwal ◽  
Ron Shapiro
Keyword(s):  
Fluid Management ◽  
Surgical Techniques ◽  
Normal Growth ◽  
Paediatric Population ◽  
The United States ◽  
Immunosuppressive Drugs ◽  
Postoperative Management ◽  
Paediatric Renal Transplantation ◽  
Stage Renal Disease ◽  
End Stage

Approximately 1 in 65,000 children develops end-stage renal disease (ESRD) each year with almost 1200 children (aged 0–19 years) in the United States developing ESRD annually. Kidney transplantation is the primary method of treating ESRD in the paediatric population. The special issues in children and adolescents with ESRD include achieving normal growth and cognitive development. This chapter discusses the advances in surgical techniques, patient selection, transplant evaluation/preparing for transplantation, postoperative management (including fluid management in infants and small children), and the evolution of immunosuppressive drugs that have resulted in improved quality of life and a reduction in the mortality rate of children with chronic renal failure.

scholarly journals Current status of lung transplantation

2018 ◽  
pp. 241-262
Author(s):  
Varun Puri ◽  
G. Alexander Patterson
Keyword(s):  
Lung Transplantation ◽  
Causes Of Death ◽  
Surgical Techniques ◽  
Bronchiolitis Obliterans Syndrome ◽  
Current Status ◽  
First Year ◽  
Full Potential ◽  
Optimal Outcomes ◽  
Donor Shortage ◽  
End Stage

Lung transplantation is well established as a viable therapy for end-stage lung disease. Appropriate patient and donor selection, meticulous attention to technique, and continued improvement in the postoperative care of these patients will lead to optimal outcomes. Donor shortage and chronic allograft rejection continue to be the biggest hurdles preventing lung transplantation from reaching its full potential. Indications, recipient selection, donor procurement, surgical techniques, and postoperative outcomes are reviewed. The major identified causes of death in the first 30 days postoperatively are graft failure and non-cytomegalovirus (CMV) infections. After the first year, bronchiolitis obliterans syndrome and non-CMV infections were the predominant causes of death. Death caused by malignancies rises consistently until the 10-year mark, accounting for 12% of all deaths between 5 and 10 years after transplant.

scholarly journals Survival of Post-Transplant Lymphoproliferative Disorder after Kidney Transplantation in Patients under Rapamycin Treatment

2021 ◽  
Author(s):  
Farzaneh Ashrafi ◽  
Shahrzad Shahidi ◽  
Valiollah Mehrzad ◽  
Mojgan Mortazavi ◽  
Sayyideh Forough Hosseini
Keyword(s):  
Calcineurin Inhibitors ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Immunosuppressive Drugs ◽  
Lymphoproliferative Disease ◽  
Mortality And Morbidity ◽  
Post Transplant ◽  
Causes Of Mortality ◽  
The Mean ◽  
Transplanted Kidneys

Background: One of the important causes of mortality and morbidity in kidney transplanted patients is Post Transplant Lymphoproliferative Disease (PTLD), which is due to immunosuppression therapy and viral activity. It seems that Rapamycin, with dual antineoplastic and immunosuppressive effects, may have a pivotal role in the treatment of PTLD patients and preserving transplanted kidneys. Methods and Materials: Twenty patients with PTLD were enrolled.  Immunosuppressive therapy was reduced or ceased, and Rapamycin was initiated at the time of PTLD diagnosis. We evaluated the effects of switching immunosuppressive drugs to Rapamycin on graft status, the response of tumor, and 6, 12 months, and 5-year survival in patients. Results: PTLD remission was achieved in 14 patients, while six patients died; no relapse was detected in recovered patients. The median of PTLD free time was 25 months, and the mean overall survival in patients with PTLD treated by Rapamycin was 84.8 (95% CI=61.3-108.23).The five-year survival rate was 67%, 12 months survival was 73.8%, and six months' survival was 80%. The response rate to Rapamycin and immunosuppression reduction alone was 46.6%. Four out of 13 Diffuse Large B-Cell Lymphoma patients achieved a complete response just only after the reduction of immunosuppressive drugs and the consumption of Rapamycin. Conclusion: The present study demonstrated the effectiveness of conversion from immunosuppressive medication, particularly of Calcineurin inhibitors to Rapamycin in PTLD patients. However, more research is needed to confirm the Rapamycin effect on patients with PTLD.  

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