Abstract 14108: Does Primary Graft Dysfunction Increase First Year Intimal Thickness After Heart Transplantation?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Keith Nishihara ◽  
Babak Azarbal ◽  
Evan P Kransdorf ◽  
Lillian Benck ◽  
Jignesh K Patel ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Cell Injury ◽  
Coronary Intervention ◽  
First Year ◽  
Intimal Thickening ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Cardiac Events ◽  
Antibody Mediated Rejection ◽  
Transplant Patients

Introduction: Primary graft dysfunction (PGD) has been reported in between 7-30% of heart transplant recipients with severe PGD known to have poor outcome. Due to graft dysfunction and potential for endothelial cell injury, it is not known whether all grades of PGD can increase first year intimal thickening, which may be a harbinger for clinical cardiac allograft vasculopathy (CAV). Methods: Between 2010 and 2017, we assessed 769 heart transplant patients and divided them into those patients with mild PGD (n=12), moderate PGD (n=35), severe PGD (n=36) and no PGD (n=686). Endpoints included 3-year survival and freedom from angiographic CAV (stenosis ≥30%) and non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, percutaneous coronary intervention, new congestive heart failure, pacemaker/implantable cardioverter-defibrillator placement, stroke); and 1-year freedom from any treated rejection (ATR), acute cellular rejection (ACR), antibody mediated rejection (AMR). First year intravascular ultrasound (IVUS) was performed at baseline 4-8 weeks and at 1 year after transplant. IVUS parameters included first-year average change in MIT and change in MIT ≥0.5mm. Results: First year change in average MIT and MIT ≥0.5mm and 3-year freedom from CAV were not significantly different in all groups. The severe PGD group compared to all groups had significantly lower 3-year survival and freedom from NF-MACE. There was lower freedom from various types of rejection in the PGD groups compared to the no PGD group. Specifically, 1-year freedom from ACR was significantly lower in the mild PGD group compared to the moderate PGD group and the no PGD group (see table). Conclusions: PGD grades do not appear to lead to increased first year intimal thickening or angiographic CAV at 3 years. Lower freedom from ACR in the mild PGD group and ATR in the severe PGD group will need further study. Larger numbers of patients are needed to confirm these findings.

Abstract 13933: High Urgency Candidates for Heart Transplantation Does Not Correlate to the Development of Primary Graft Dysfunction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rafael Skorka ◽  
Keith Nishihara ◽  
Adriana Shen ◽  
Evan P Kransdorf ◽  
Lillian Benck ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Heart Transplant ◽  
Survival Rates ◽  
Control Group ◽  
High Dose ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Assist Device ◽  
Transplant Patients ◽  
High Urgency

Introduction: Primary Graft Dysfunction (PGD) after Heart Transplantation (HTx) is seen in approximately 7-30% of heart transplant patients as described by the literature. Many of these patients have severe PGD which requires support with ECMO. It has been reported that patients who are severely ill on high dose inotropes or on assists devices have greater propensity to develop severe PGD. Many of these patients have borderline blood pressure due to poor cardiac function which may contribute to PGD with its associated vasoplegia. In order to asses risk for the development of PGD we evaluated our patients in terms of their status at the time of transplant to assess risk. Methods: Between 2010 and 2019 we assessed 44 Heart Transplant patients who developed severe PGD immediately after HTx. The UNOS Status at the time of Transplant was recorded along with the presence of a durable assist device, temporary assist device, or no Inotropes or assist device. 30 Day and 1 Year survival were assessed for all status groups including a control group (no PGD, n=799). Results: High urgency status at the time of transplant was not the overwhelming majority of patients that developed severe PGD. Approximately 32% of these patients were patients who were waiting for transplant at home, who were not on Intravenous Inotropes and not on assist devices. 1 Year survival was compromised in all patients who developed severe PGD with survival rates that were significantly lower than patients without PGD in our program (47.7% vs 93.6%, p<0.001) (see Table). Conclusions: High urgency status is not solely associated with the development of severe PGD. Further assessment into these non-urgent patients who develop severe PGD is warranted and is under investigation. Inflammatory markers should be assessed in all patients who develop severe PGD.

Prior Amiodarone Exposure Reduces Tacrolimus Dosing Requirements in Heart Transplant Recipients

2019 ◽  
Vol 29 (2) ◽  
pp. 129-134 ◽  
Author(s):  
Nadine T. Breslin ◽  
David M. Salerno ◽  
Veli K. Topkara ◽  
Farhana Latif ◽  
Susan Restaino ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Organ Transplant ◽  
Patient Characteristics ◽  
Tacrolimus Concentration ◽  
Transplant Recipients ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Transplant Patients ◽  
Significant Difference ◽  
And Control

Introduction: Amiodarone use prior to heart transplant is independently associated with a higher rate of severe primary graft dysfunction and in-hospital mortality. Amiodarone may also alter the pharmacokinetics of medications metabolized via cytochrome P450. No data exist regarding the interaction between pretransplant amiodarone and tacrolimus concentrations. Design: Single-center retrospective study of transplant patients between January 1, 2014, and June 30, 2016. A therapeutic tacrolimus concentration was defined as a trough level between 8 and 15 ng/mL for 2 consecutive days. The primary outcome was the tacrolimus therapeutic weight-based dosing requirements (mg/kg/day) for patients receiving amiodarone prior to transplant when compared to those without prior receipt of amiodarone. Secondary outcomes include the incidence of cellular rejection and mortality within 6 months posttransplant. Results: Multi-organ transplant recipients (n = 3), retransplants (n = 9), those who died prior to a therapeutic level (n = 1), and those receiving amiodarone posttransplant (n = 7) were excluded from the analysis. Of the 80 patients included, 34 (42%) received amiodarone prior to transplant. Patient characteristics were similar, with the exception of primary graft dysfunction incidence (38% in amiodarone vs 8.5% in control, P = .001). The median therapeutic dose was 0.1 (interquartile range [IQR]: 0.07-0.12) versus 0.13 (IQR: 0.09-0.17) in the amiodarone and control groups, respectively, ( P < .01). No significant difference in mortality or rejection was noted. Conclusion: Patients receiving amiodarone prior to transplant require a lower weight-based dose of tacrolimus.

Heightened Immune Response in Heart Transplant Patients Surviving Severe Primary Graft Dysfunction

2019 ◽  
Vol 38 (4) ◽  
pp. S294
Author(s):  
J. Patel ◽  
M. Kittleson ◽  
D. Chang ◽  
E. Kransdorf ◽  
R. Levine ◽  
...  
Keyword(s):  
Immune Response ◽  
Heart Transplant ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Transplant Patients

scholarly journals Antibody-mediated rejection 16 years post-cardiac transplantation: a case report of an uncommon late presentation in a middle-aged woman

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Charles Miller ◽  
Knarik Arkun ◽  
David DeNofrio ◽  
Marwa Sabe
Keyword(s):  
Heart Transplant ◽  
Diagnostic Yield ◽  
Stress Test ◽  
Late Presentation ◽  
Infectious Complications ◽  
Graft Dysfunction ◽  
Post Transplant ◽  
Antibody Mediated Rejection ◽  
Transplant Patients ◽  
Aged Woman

Abstract Background  Very late antibody-mediated rejection (AMR) in heart transplant patients (over 10 years post-transplant) is very rare. It is associated with high mortality, graft dysfunction, and fulminant coronary artery vasculopathy (CAV) and should remain in the differential for patients presenting with late graft dysfunction. Case summary  A 57-year-old woman 16 years of post-heart transplant with a previously unremarkable post-transplant course including protocol driven biopsies showing no rejection and a recent unremarkable screening nuclear stress test presented to our institution with clinical heart failure. Echocardiogram revealed graft dysfunction and endomyocardial biopsy showed no signs of cellular rejection, but evidence of AMR. The patient was treated with steroid and immunotherapy with clinical improvement but suffered several infectious complications and renal dysfunction requiring haemodialysis related to her immunotherapy treatment. Despite aggressive AMR management, donor-specific antibodies and symptoms persisted and CAV progressed. Discussion  This case illustrates the poor diagnostic yield of non-invasive testing for AMR, and highlights importance to clinicians of considering AMR even if the patient over 10 years post-transplant when the diagnosis is rare.

scholarly journals Recent advances in lung transplantation

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1684 ◽  
Author(s):  
Keith C Meyer
Keyword(s):  
Lung Transplantation ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Donor Pool ◽  
Post Transplant ◽  
Antibody Mediated Rejection ◽  
The Past ◽  
End Stage ◽  
Transplant Complications

Lung transplantation can improve quality of life and prolong survival for individuals with end-stage lung disease, and many advances in the realms of both basic science and clinical research aspects of lung transplantation have emerged over the past few decades. However, many challenges must yet be overcome to increase post-transplant survival. These include successfully bridging patients to transplant, expanding the lung donor pool, inducing tolerance, and preventing a myriad of post-transplant complications that include primary graft dysfunction, forms of cellular and antibody-mediated rejection, chronic lung allograft dysfunction, and infections. The goal of this manuscript is to review salient recent and evolving advances in the field of lung transplantation.

Primary Graft Dysfunction in Heart Transplant Recipients—Risk Factors and Longitudinal Outcomes

ASAIO Journal ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Nicholas F. Smith ◽  
Sina Salehi Omran ◽  
Michael V. Genuardi ◽  
Edward T. Horn ◽  
Arman Kilic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Transplant ◽  
Transplant Recipients ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Longitudinal Outcomes ◽  
Heart Transplant Recipients

scholarly journals Evaluation of Myocardial Perfusion and Immune Cell Response in Cardiac Allograft Dysfunction of Heart-Transplant Patients

2020 ◽  
Author(s):  
Paul J. Kim ◽  
Francisco Contijoch ◽  
Gerald Morris ◽  
Darrin Wong ◽  
Patricia Nguyen
Keyword(s):  
T Cells ◽  
Myocardial Perfusion ◽  
Heart Transplant ◽  
Immune Cell ◽  
Cardiac Allograft ◽  
Normal Heart ◽  
Graft Dysfunction ◽  
Stress Myocardial Perfusion ◽  
Transplant Patients ◽  
Immune Cell Response

BackgroundWe investigated the myocardial perfusion differences and changes in immune cell response in heart-transplant patients with nonspecific graft dysfunction (NGD) compared to cardiac allograft vasculopathy (CAV) patients and normal heart-transplant patients.Methods and ResultsWe prospectively studied 17 heart-transplant patients (59.8±14.1 years, 78% male) from January to June 2016. Regadenoson stress cardiac MRI was performed in the patients and peripheral blood obtained contemporaneously to isolate peripheral blood mononuclear cells (PBMCs). Stress myocardial perfusion showed significantly decreased myocardial perfusion using maximum upslope method in NGD and CAV patients compared to normal heart-transplant patients. Myocardial scar by late gadolinium enhancement also was significantly increased in nonspecific graft dysfunction patients compared to normal. Evaluation of PBMCs by flow cytometry showed a trend towards increased activated HLA-DR+ T cells in NGD patients compared to normal. Clinical outcomes for cardiac hospitalization, allograft loss/retransplant, death were assessed at 3 years.ConclusionsNGD shows decreased stress myocardial perfusion by cardiac MRI and a trend towards increased activated T cells in PBMCs, suggestive of an immune-mediated cause for allograft dysfunction.

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