Abstract 2959: Granulocyte-Colony Stimulating Factor Therapy is Associated with Reduced Incidence of Acute Rejections and Allograft Vasculopathy in Heart Transplant Recipients

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Francois Haddad ◽  
Bojan Vrtovec ◽  
Michael Pham ◽  
Tobias Deuse ◽  
William Fearon ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Heart Transplant ◽  
Medical Center ◽  
Granulocyte Colony Stimulating Factor ◽  
Transplant Recipients ◽  
Colony Stimulating Factor ◽  
Allograft Vasculopathy ◽  
Stenotic Lesion ◽  
Heart Transplant Recipients ◽  
Stimulating Factor

Background. Granulocyte-colony stimulating factor (G-CSF) has been shown to attenuate coronary disease in non-transplant population and decrease the incidence of acute rejections in experimental models of heart transplantation. Hypothesis. We hypothesized that G-CSF may decrease the incidence of allograft vasculopathy and rejection in heart transplant recipients. Methods. Of 247 patients who underwent heart transplantation at Stanford University Medical Center from 2000 to 2007 we enrolled 52 (21%) patients who presented with leukopenia (WBC < 2.5 x 10 9 cells/L) in the absence of active infection, rejection or malignancy. In 24 (46%) patients leukopenia was treated with G-CSF (mean dose 348 ± 78 mcg daily; G-CSF Group), and 28 (54%) patients received no G-CSF therapy (non-GCSF group). All patients were followed for 1 year after leukopenia occurence for the development of allograft vasculopathy (any new stenotic lesion on annual coronary angiography) and rejection incidence (ISHLT grade ≥3A or higher, or severe non-cellular rejection). Results. At baseline, G-CSF Group and non-G-CSF Group did not differ in age (54 ± 16 vs. 47 ± 14 years, respectively, P = 0.1), gender (male: 17% vs. 35%, P = 0.12), race (Caucasian: 79%, vs. 78%, P = 0.96), heart failure etiology (ischemic: 26% vs. 45%, P = 0.12), creatinine (1.6 ± 1.1 mg/dl vs. 1.5 ± 0.6 mg/dl, P = 0.6), LVEF (64 ± 8% vs. 64 ± 7%, P = 0.81), immunosupressive regimen (CyA/MMF/Prednisone: 42% vs. 54%, P = 0.4), or post-transplant time of leukopenia occurence (284 ± 396 days in the G-CSF Group vs. 347 ± 365 days in Controls, P = 0.57). During 1-year follow-up there were no events in the G-CSF Group, and 1 death in the non-G-CSF Group ( P = 0.34). Rejection incidence was significantly lower in the G-CSF Group (8% vs. 36% in Controls, P = 0.019), as was cardiac allograft vasculopathy (4% vs. 29%, P = 0.02). Conclusions. G-CSF therapy appears to be associated with decreased incidence of acute rejections and allograft vasculopathy in heart transplant recipients, suggesting that G-CSF may have immunomodulatory effects.

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.

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

scholarly journals Early Inflammatory Markers Are Independent Predictors of Cardiac Allograft Vasculopathy in Heart-Transplant Recipients

PLoS ONE ◽  
2014 ◽  
Vol 9 (12) ◽  
pp. e113260 ◽  
Author(s):  
Carlos A. Labarrere ◽  
John R. Woods ◽  
James W. Hardin ◽  
Beate R. Jaeger ◽  
Marian Zembala ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Inflammatory Markers ◽  
Cardiac Allograft Vasculopathy ◽  
Cardiac Allograft ◽  
Transplant Recipients ◽  
Allograft Vasculopathy ◽  
Heart Transplant Recipients
Sign in / Sign up

Export Citation Format

Share Document