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Pulmonary homograft stenosis in the Ross procedure: Incidence, clinical impact and predictors in long-term follow-up.

Wed, 12/13/2017 - 13:45
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Pulmonary homograft stenosis in the Ross procedure: Incidence, clinical impact and predictors in long-term follow-up.

Arch Cardiovasc Dis. 2017 Apr;110(4):214-222

Authors: Pardo González L, Ruiz Ortiz M, Delgado M, Mesa D, Villalba R, Rodriguez S, Hidalgo FJ, Alados P, Casares J, Suarez de Lezo J

Abstract
BACKGROUND: The Ross procedure is used in the treatment of selected patients with aortic valve disease. Pulmonary graft stenosis can appear in the long-term follow-up after the Ross intervention, but the factors involved and its clinical implications are not fully known.
AIM: To describe the incidence, clinical impact and predictors of homograft stenosis and reintervention after the Ross procedure in a prospective series in a tertiary referral hospital.
METHODS: From 1997 to 2009, 107 patients underwent the Ross procedure (mean age: 30±11 years; 69% men; 21 aged<18 years), and were followed for echocardiographic homograft stenosis (peak gradient>36mmHg) and surgical or percutaneous homograft reintervention.
RESULTS: After 15 years of follow-up (median: 11 years), echocardiographic and clinical data were available in 91 (85%) and 104 (98%) patients, respectively: 26/91 (29%) patients developed homograft stenosis; 10/104 (10%) patients underwent 13 homograft reintervention procedures (three patients underwent surgical replacement, three received a percutaneous pulmonary valve and one needed stent implantation). The other three patients underwent two consecutive procedures in follow-up; one died because of a procedure-related myocardial infarction. Rates of survival free from homograft stenosis and reintervention at 1, 5 and 10 years were 96%, 82% and 75% and 99%, 94% and 91%, respectively. Paediatric patients had worse survival free from homograft stenosis (hazard ratio [HR] 3.50, 95% confidence interval [CI]: 1.56-7.90; P=0.002), although there were no significant differences regarding reintervention (HR: 2.01, 95% CI: 0.52-7.78; P=0.31). Younger age of homograft donor was also a stenosis predictor (HR: 0.97, 95% CI: 0.94-0.99; P=0.046).
CONCLUSIONS: The probabilities of homograft stenosis and reintervention 10 years after the Ross procedure were 29% and 10%, respectively; only one patient had a reintervention-related death. Younger donor and recipient age were associated with a higher rate of stenosis.

PMID: 28043783 [PubMed - indexed for MEDLINE]

Outcome of AL amyloidosis after high-dose melphalan and autologous stem cell transplantation in Sweden, long-term results from all patients treated in 1994-2009.

Wed, 12/13/2017 - 13:45
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Outcome of AL amyloidosis after high-dose melphalan and autologous stem cell transplantation in Sweden, long-term results from all patients treated in 1994-2009.

Bone Marrow Transplant. 2016 Dec;51(12):1569-1572

Authors: Rosengren S, Mellqvist UH, Nahi H, Forsberg K, Lenhoff S, Strömberg O, Ahlberg L, Linder O, Carlson K

Abstract
High-dose melphalan and autologous stem cell transplantation (HDM/ASCT) is widely used in immunoglobulin light chain (AL) amyloidosis, but the benefit is debated mainly because of the high treatment-related mortality (24% in a randomised study comparing HDM/ASCT with oral melphalan/dexamethasone). We report here on the long-term outcome of all patients treated with HDM/ASCT for AL amyloidosis in Sweden between 1994 and 2009. Seventy-two patients were treated at eight Swedish centres. Median follow-up was 67.5 months. At least partial response (organ or haematological) was seen in 64% of the patients. Median overall survival was 98 months or 8.2 years, with 5-year survival 63.9% and 10-year survival 43.4%. In patients with cardiac involvement or multiple organ involvement, survival was significantly shorter, median overall survival 49 and 56 months, respectively. All mortality within 100 days from ASCT was 12.5% for all patients and 17.2% in the patients with cardiac involvement. For patients treated in the earlier time period (1994-2001), 100-day mortality was 23.8% compared with 7.8% in the later period (2002-2009). In conclusion, long survival times can be achieved in patients with AL amyloidosis treated with HDM/ASCT, also in smaller centres. Early mortality is high, but with a decreasing trend over time.

PMID: 27694943 [PubMed - indexed for MEDLINE]

Prosthesis embolization into the left ventricle during transcatheter aortic valve implantation.

Wed, 12/13/2017 - 13:45
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Prosthesis embolization into the left ventricle during transcatheter aortic valve implantation.

J Cardiovasc Med (Hagerstown). 2016 Dec;17 Suppl 2:e191-e192

Authors: Follis F, Gandolfo C, Santise G, Stabile A, Benedetto M, Cirrincione G, Arcadipane A, Centineo L, Follis M

Abstract
: Images and movie clips documenting the rare occurrence of a percutaneous prosthesis embolization into the left ventricle are presented. The case outcome and the circumstances leading to the event are discussed.

PMID: 25517877 [PubMed - indexed for MEDLINE]

Myeloid Neoplasms Following Solid Organ Transplantation: Clinicopathologic Studies of 23 Cases.

Tue, 12/12/2017 - 16:48

Myeloid Neoplasms Following Solid Organ Transplantation: Clinicopathologic Studies of 23 Cases.

Am J Clin Pathol. 2017 Dec 07;:

Authors: Wu B, Ingersoll K, Jug R, Yang LH, Luedke C, Lo A, Su P, Liu X, Rehder C, Gong J, Lu CM, Wang E

Abstract
Objectives: Myeloid neoplasms (MNs) after solid organ transplant are rare, and their clinicopathologic features have not been well characterized.
Methods: We retrospectively analyzed 23 such cases.
Results: The ages ranged from 2 to 76 years, with a median of 59 years at the diagnosis. The median interval between the transplant and diagnosis was 56 months (range, 8-384 months). The transplanted organs included liver in five, kidney in six, lung in five, heart in six, and heart/lung in one case(s). The types of MN included acute myeloid leukemia (AML) in 12, myelodysplastic syndrome (MDS) in five, chronic myelogenous leukemia (CML) in four, and myeloproliferative neoplasms (MPNs) in two cases. Cytogenetics demonstrated clonal abnormalities in 18 (78.3%) cases, including unbalanced changes in 10 (55.6%), Philadelphia chromosome in four (22.2%), and other balanced aberrations in four (22.2%) cases. Thirteen (56.5%) patients died, with an estimated median survival of 9 months. With disease stratification, AML and MDS have short median survivals (3.5 and 7 months, respectively), with an initial precipitous decline of the survival curve.
Conclusions: Posttransplant MNs have a latency period between that seen in AML/MDS related to alkylators and that associated with topoisomerase II inhibitors. The cytogenetic profile suggests a mutagenic effect on leukemogenesis. The clinical outcome for AML/MDS is dismal, with death occurring at an early phase of treatment.

PMID: 29228125 [PubMed - as supplied by publisher]

Lung transplantation for chronic obstructive pulmonary disease: past, present, and future directions.

Tue, 12/12/2017 - 16:48

Lung transplantation for chronic obstructive pulmonary disease: past, present, and future directions.

Curr Opin Pulm Med. 2017 Dec 07;:

Authors: Siddiqui FM, Diamond JM

Abstract
PURPOSE OF REVIEW: Lung transplantation offers an effective treatment modality for patients with end-stage chronic obstructive pulmonary disease (COPD). The exact determination of when to refer, list, and offer transplant as well as the preferred transplant procedure type remains unclear. Additionally, there are special considerations specific to patients with COPD being considered for lung transplantation, including the implications of single lung transplantation on lung cancer risk, native lung hyperinflation, and overall survival.
RECENT FINDINGS: The International Society for Heart and Lung Transplantation's most recent recommendations rely on an assessment of COPD severity based on BODE index. Despite the lack of evidence supporting a mortality benefit of bilateral over single lung transplantation for COPD patients, the majority of transplants performed in this population remain bilateral. Some of the concerns specific to single lung transplantation remain the possibility of de novo native lung cancer and the hemodynamic and physiologic implications of acute native lung hyperinflation.
SUMMARY: COPD remains the most common worldwide indication for lung transplantation. Ongoing study is still required to assess the overall survival benefit of lung transplantation and assess the overall quality of life impact on the COPD patient population.

PMID: 29227305 [PubMed - as supplied by publisher]

The Present Situation and Clinical Topics of Ventricular Assist Device and Heart Transplantation in Japan.

Tue, 12/12/2017 - 16:48

The Present Situation and Clinical Topics of Ventricular Assist Device and Heart Transplantation in Japan.

Fukuoka Igaku Zasshi. 2016 Dec;107(12):213-22

Authors: Tanoue Y, Shiose A

Abstract
Surgical treatment for heart failure includes coronary artery bypass grafting to ischemic heart disease, valvular disease surgery such as mitral valvuloplasty, left ventricular restoration, ventricular assist device (VAD), and heart transplantation. In addition, HeartSheet which is regenerative medicine using autologous skeletal myoblast sheets has been started from the spring of 2016. Formal insurance reimbursement of implantable LVAD was obtained in April 2011, and the life prognosis of patients with severe heart failure improved markedly. However, the indication for implantable LVAD is limited to bridge use for heart transplantation. Implantable LVAD cannot be implanted in patients over 65 years old under health insurance because the adaptive age of heart transplantation in Japan is under 65 years old. It is a problem that the indication of implantable LVAD is identical to that of heart transplantation. Clinical trial of destination therapy is in progress for the purpose of optimizing the implantable LVAD indication. I strongly pray that VAD treatment including destination therapy (DT) and transplant medical treatment based on good intentions will be accepted socially as general treatment.

PMID: 29227072 [PubMed - in process]

Integrative Assessment of Congestion in Heart Failure Throughout the Patient Journey.

Tue, 12/12/2017 - 16:48

Integrative Assessment of Congestion in Heart Failure Throughout the Patient Journey.

JACC Heart Fail. 2017 Nov 27;:

Authors: Girerd N, Seronde MF, Coiro S, Chouihed T, Bilbault P, Braun F, Kenizou D, Maillier B, Nazeyrollas P, Roul G, Fillieux L, Abraham WT, Januzzi J, Sebbag L, Zannad F, Mebazaa A, Rossignol P, INI-CRCT, Great Network, and the EF-HF Group

Abstract
Congestion is one of the main predictors of poor patient outcome in patients with heart failure. However, congestion is difficult to assess, especially when symptoms are mild. Although numerous clinical scores, imaging tools, and biological tests are available to assist physicians in ascertaining and quantifying congestion, not all are appropriate for use in all stages of patient management. In recent years, multidisciplinary management in the community has become increasingly important to prevent heart failure hospitalizations. Electronic alert systems and communication platforms are emerging that could be used to facilitate patient home monitoring that identifies congestion from heart failure decompensation at an earlier stage. This paper describes the role of congestion detection methods at key stages of patient care: pre-admission, admission to the emergency department, in-hospital management, and lastly, discharge and continued monitoring in the community. The multidisciplinary working group, which consisted of cardiologists, emergency physicians, and a nephrologist with both clinical and research backgrounds, reviewed the current literature regarding the various scores, tools, and tests to detect and quantify congestion. This paper describes the role of each tool at key stages of patient care and discusses the advantages of telemedicine as a means of providing true integrated patient care.

PMID: 29226815 [PubMed - as supplied by publisher]

Fatal cardiac arrest in pediatric heart transplant recipients: Query of the UNOS database.

Tue, 12/12/2017 - 16:48
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Fatal cardiac arrest in pediatric heart transplant recipients: Query of the UNOS database.

Pediatr Transplant. 2017 Dec 10;:

Authors: Loar RW, Denfield SW, Morris SA, Tunuguntla HP, Cabrera AG, Price JF, Zhang W, Hosek K, Kim JJ, Dreyer WJ, Jeewa A

Abstract
The incidence of death by CA after PHTx is unknown. We aimed to determine the incidence and factors for fatal CA after PHTx, and whether a PM affects survival. Retrospective cohort study utilizing the United Network of Organ Sharing registry of patients transplanted ≤18 years. Multivariable analyses in hazard-function domain and Kaplan-Meier analyses were performed for an outcome of death due to CA. There were 7719 PHTx patients queried. CA was the reported cause of death in 11%. Age ≥13 years at time of transplant, presence of a PM, and depressed EF were identified as significant factors for fatal CA. Death due to CA beyond 10 years post-transplant was associated with depressed EF, CAV, and presence of a PM. Kaplan-Meier analysis demonstrated higher likelihood of fatal CA in patients with CAV and in those with a PM vs those without. In total, 15% of patients with a PM died from CA. CA is a relatively common cause of death after PHTx. The benefit of a PM remains unclear, but its presence does not confer complete protection. Patients with associated factors warrant vigilant surveillance and consideration for retransplantation.

PMID: 29226563 [PubMed - as supplied by publisher]

Case Report: Treatment of Light Chain Amyloidosis with Daratumumab Monotherapy in Two Patients.

Tue, 12/12/2017 - 16:48
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Case Report: Treatment of Light Chain Amyloidosis with Daratumumab Monotherapy in Two Patients.

Eur J Haematol. 2017 Dec 11;:

Authors: Gran C, Gahrton G, Alici E, Nahi H

Abstract
Immunoglobulin light-chain amyloidosis (AL) affects multiple organs, most prominently the kidney and the heart. Renal and cardiac impairment are both associated with poor prognosis.(1) Typical treatment regimens for AL include proteasome inhibitors, alkylating agents, and steroids as well as autologous stem cell transplantation (ASCT) for younger, fit patients. Complete response after treatment is associated with a better outcome and can be measured by free light chain (FLC) reduction.(2, 3) Monoclonal antibodies such as daratumumab (Dara, human IgG1 anti-CD38) have shown promising efficacy for the treatment of relapsed and refractory multiple myeloma. Recently, encouraging results were reported on patients with AL who received Dara treatment.(4, 5). This article is protected by copyright. All rights reserved.

PMID: 29226427 [PubMed - as supplied by publisher]

Immediate response in markers of inflammation and angiogenesis during exercise: a randomised cross-over study in heart transplant recipients.

Tue, 12/12/2017 - 16:48
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Immediate response in markers of inflammation and angiogenesis during exercise: a randomised cross-over study in heart transplant recipients.

Open Heart. 2017;4(2):e000635

Authors: Yardley M, Ueland T, Aukrust P, Michelsen A, Bjørkelund E, Gullestad L, Nytrøen K

Abstract
Background: The present study explored and compared the immediate responses in markers of inflammation and angiogenesis in maintenance heart transplant (HTx) recipients before, during and after sessions of high-intensity interval training (HIT) versus moderate-intensity continuous training (MICT). The study aimed to explain some of the trigger mechanisms behind HIT in HTx recipients.
Methods: This cross-over study included 14 HTx patients (mean±SD age: 53±13 years; time since HTx, 3±2 years). All participants underwent baseline blood samples and a cardiopulmonary exercise test during their first visit. The next two visits included one HIT session and one MICT session, in randomised order. Blood samples were taken during and after each exercise session. Myokines and inflammatory markers related to vascular inflammation, blood-platelet activation and modulation of angiogenesis were analysed.
Results: The main findings in this study were (1) exercise, regardless of intensity, induced a significant immediate response in several vascular, angiogenetic and in particular platelet-derived inflammatory mediators in HTx recipients. (2) HIT showed trends to induce an increased response in von Willebrand factor, vascular endothelial growth factor-1 and angiopoetin-2, and a decreased response in growth differentiation factor-15, compared with MICT.
Conclusions: This pattern and in particular the trend towards an increased angiogenetic mediator response could contribute to the beneficial effects of HIT in HTx recipients.
Trial registration number: NCT02602834.

PMID: 29225901 [PubMed]

Understanding Landmarking and Its Relation with Time-Dependent Cox Regression.

Tue, 12/12/2017 - 16:48
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Understanding Landmarking and Its Relation with Time-Dependent Cox Regression.

Stat Biosci. 2017;9(2):489-503

Authors: Putter H, van Houwelingen HC

Abstract
Time-dependent Cox regression and landmarking are the two most commonly used approaches for the analysis of time-dependent covariates in time-to-event data. The estimated effect of the time-dependent covariate in a landmarking analysis is based on the value of the time-dependent covariate at the landmark time point, after which the time-dependent covariate may change value. In this note we derive expressions for the (time-varying) regression coefficient of the time-dependent covariate in the landmark analysis, in terms of the regression coefficient and baseline hazard of the time-dependent Cox regression. These relations are illustrated using simulation studies and using the Stanford heart transplant data.

PMID: 29225713 [PubMed]

Role of Doppler echocardiography for cardiac output assessment in Fontan patients.

Tue, 12/12/2017 - 16:48
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Role of Doppler echocardiography for cardiac output assessment in Fontan patients.

Am Heart J. 2018 Jan;195:91-98

Authors: Egbe A, Khan AR, Khan SF, Anavekar NS, Said SM, Young PM, Akintoye E, Miranda WR, Al-Otaibi MN, Veldtman GR, Connolly HM

Abstract
BACKGROUND: To determine (1) correlation between Doppler stroke volume index (SVI) and cardiac magnetic resonance imaging (CMRI) SVI and (2) association between Doppler SVI and Fontan-associated diseases (FAD) and Fontan failure.
METHODS: Review of Fontan patients who underwent same-day CMRI and transthoracic echocardiography (TTE), 2005 to 2015. We defined FAD as cardiac thrombus, protein-losing enteropathy, arrhythmia, and hospitalization for heart failure. Fontan failure was defined as Fontan conversion or revision, heart transplantation or listing, or death.
RESULTS: Fifty-three patients with systemic left ventricle (LV) underwent 86 sets of TTE/CMRI. Mean (SD) age 31 (6) years. SVI (45 [16] vs 42 [13] mL/m2), CI (3.0 [1.1] vs 2.8 [0.8] L min-1 m-2), and ejection fraction (53 [4]% vs 51 [5]%) were similar for both modalities (P>.05 for all). Doppler SVI correlated with CMRI (r=0.68; P<.001). Sixteen patients had cirrhosis, and these patients had a higher CI (3.9 [0.9] vs 2.8 [1.0] L min-1 m-2; P<.01). Among the 37 patients without cirrhosis, Doppler SVI <39 mL/m2 was associated with FAD (odds ratio [OR], 2.11; 95% confidence limit, 1.26-3.14; P=.02); Fontan failure was more common in patients with CI was <2.5 L min-1 m-2 (3/9 [33%] vs 0/28 [0%], P=.01). Another 11 patients with systemic right ventricle (RV) underwent 17 sets of TTE/CMRI, mean (SD) age 17 (3) years, and CMRI SVI also correlated with Doppler SVI (r=0.75; P<.001).
CONCLUSION: Doppler SVI correlated with CMRI SVI in patients with systemic LV and systemic RV. The association between output measures (SVI and CI) and FAD were seen only in single LV patients (single RV patients not assessed for this outcome due to small numbers). An association between low Doppler CI and Fontan failure was suggested in a small number of single LV patients.

PMID: 29224651 [PubMed - in process]

External validation of the Revised Cardiac Risk Index and update of its renal variable to predict 30-day risk of major cardiac complications after non-cardiac surgery: rationale and plan for analyses of the VISION study.

Tue, 12/12/2017 - 16:48
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External validation of the Revised Cardiac Risk Index and update of its renal variable to predict 30-day risk of major cardiac complications after non-cardiac surgery: rationale and plan for analyses of the VISION study.

BMJ Open. 2017 Jan 09;7(1):e013510

Authors: Roshanov PS, Walsh M, Devereaux PJ, MacNeil SD, Lam NN, Hildebrand AM, Acedillo RR, Mrkobrada M, Chow CK, Lee VW, Thabane L, Garg AX

Abstract
INTRODUCTION: The Revised Cardiac Risk Index (RCRI) is a popular classification system to estimate patients' risk of postoperative cardiac complications based on preoperative risk factors. Renal impairment, defined as serum creatinine >2.0 mg/dL (177 µmol/L), is a component of the RCRI. The estimated glomerular filtration rate has become accepted as a more accurate indicator of renal function. We will externally validate the RCRI in a modern cohort of patients undergoing non-cardiac surgery and update its renal component.
METHODS AND ANALYSIS: The Vascular Events in Non-cardiac Surgery Patients Cohort Evaluation (VISION) study is an international prospective cohort study. In this prespecified secondary analysis of VISION, we will test the risk estimation performance of the RCRI in ∼34 000 participants who underwent elective non-cardiac surgery between 2007 and 2013 from 29 hospitals in 15 countries. Using data from the first 20 000 eligible participants (the derivation set), we will derive an optimal threshold for dichotomising preoperative renal function quantified using the Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi) glomerular filtration rate estimating equation in a manner that preserves the original structure of the RCRI. We will also develop a continuous risk estimating equation integrating age and CKD-Epi with existing RCRI risk factors. In the remaining (approximately) 14 000 participants, we will compare the risk estimation for cardiac complications of the original RCRI to this modified version. Cardiac complications will include 30-day non-fatal myocardial infarction, non-fatal cardiac arrest and death due to cardiac causes. We have examined an early sample to estimate the number of events and the distribution of predictors and missing data, but have not seen the validation data at the time of writing.
ETHICS AND DISSEMINATION: The research ethics board at each site approved the VISION protocol prior to recruitment. We will publish our results and make our models available online at http://www.perioperativerisk.com.
TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT00512109.

PMID: 28069624 [PubMed - indexed for MEDLINE]

Concise Review: Getting to the Core of Inherited Bone Marrow Failures.

Tue, 12/12/2017 - 16:48
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Concise Review: Getting to the Core of Inherited Bone Marrow Failures.

Stem Cells. 2017 Feb;35(2):284-298

Authors: Adam S, Melguizo Sanchis D, El-Kamah G, Samarasinghe S, Alharthi S, Armstrong L, Lako M

Abstract
Bone marrow failure syndromes (BMFS) are a group of disorders with complex pathophysiology characterized by a common phenotype of peripheral cytopenia and/or hypoplastic bone marrow. Understanding genetic factors contributing to the pathophysiology of BMFS has enabled the identification of causative genes and development of diagnostic tests. To date more than 40 mutations in genes involved in maintenance of genomic stability, DNA repair, ribosome and telomere biology have been identified. In addition, pathophysiological studies have provided insights into several biological pathways leading to the characterization of genotype/phenotype correlations as well as the development of diagnostic approaches and management strategies. Recent developments in bone marrow transplant techniques and the choice of conditioning regimens have helped improve transplant outcomes. However, current morbidity and mortality remain unacceptable underlining the need for further research in this area. Studies in mice have largely been unable to mimic disease phenotype in humans due to difficulties in fully replicating the human mutations and the differences between mouse and human cells with regard to telomere length regulation, processing of reactive oxygen species and lifespan. Recent advances in induced pluripotency have provided novel insights into disease pathogenesis and have generated excellent platforms for identifying signaling pathways and functional mapping of haplo-insufficient genes involved in large-scale chromosomal deletions-associated disorders. In this review, we have summarized the current state of knowledge in the field of BMFS with specific focus on modeling the inherited forms and how to best utilize these models for the development of targeted therapies. Stem Cells 2017;35:284-298.

PMID: 27870251 [PubMed - indexed for MEDLINE]

Continuous Acquisition of MHC:Peptide Complexes by Recipient Cells Contributes to the Generation of Anti-Graft CD8+ T Cell Immunity.

Tue, 12/12/2017 - 16:48
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Continuous Acquisition of MHC:Peptide Complexes by Recipient Cells Contributes to the Generation of Anti-Graft CD8+ T Cell Immunity.

Am J Transplant. 2017 Jan;17(1):60-68

Authors: Smyth LA, Lechler RI, Lombardi G

Abstract
Understanding the evolution of the direct and indirect pathways of allorecognition following tissue transplantation is essential in the design of tolerance-promoting protocols. On the basis that donor bone marrow-derived antigen-presenting cells are eliminated within days of transplantation, it has been argued that the indirect response represents the major threat to long-term transplant survival, and is consequently the key target for regulation. However, the detection of MHC transfer between cells, and particularly the capture of MHC:peptide complexes by dendritic cells (DCs), led us to propose a third, semidirect, pathway of MHC allorecognition. Persistence of this pathway would lead to sustained activation of direct-pathway T cells, arguably persisting for the life of the transplant. In this study, we focused on the contribution of acquired MHC-class I on recipient DCs during the life span of a skin graft. We observed that MHC-class I acquisition by recipient DCs occurs for at least 1 month following transplantation and may be the main source of alloantigen that drives CD8+ cytotoxic T cell responses. In addition, acquired MHC-class I:peptide complexes stimulate T cell responses in vivo, further emphasizing the need to regulate both pathways to induce indefinite survival of the graft.

PMID: 27495898 [PubMed - indexed for MEDLINE]

Does DCD Donor Time-to-Death Affect Recipient Outcomes? Implications of Time-to-Death at a High-Volume Center in the United States.

Tue, 12/12/2017 - 16:48
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Does DCD Donor Time-to-Death Affect Recipient Outcomes? Implications of Time-to-Death at a High-Volume Center in the United States.

Am J Transplant. 2017 Jan;17(1):191-200

Authors: Scalea JR, Redfield RR, Arpali E, Leverson GE, Bennett RJ, Anderson ME, Kaufman DB, Fernandez LA, D'Alessandro AM, Foley DP, Mezrich JD

Abstract
For donation after circulatory death (DCD), many centers allow 1 h after treatment withdrawal to donor death for kidneys. Our center has consistently allowed 2 h. We hypothesized that waiting longer would be associated with worse outcome. A single-center, retrospective analysis of DCD kidneys transplanted between 2008 and 2013 as well as a nationwide survey of organ procurement organization DCD practices were conducted. We identified 296 DCD kidneys, of which 247 (83.4%) were transplanted and 49 (16.6%) were discarded. Of the 247 recipients, 225 (group 1; 91.1%) received kidneys with a time to death (TTD) of 0-1 h; 22 (group 2; 8.9%) received grafts with a TTD of 1-2 h. Five-year patient survival was 88.8% for group 1, and 83.9% for group 2 (p = 0.667); Graft survival was also similar, with 5-year survival of 74.1% for group 1, and 83.9% for group 2 (p = 0.507). The delayed graft function rate was the same in both groups (50.2% vs. 50.0%, p = 0.984). TTD was not predictive of graft failure. Nationally, the average maximum wait-time for DCD kidneys was 77.2 min. By waiting 2 h for DCD kidneys, we performed 9.8% more transplants without worse outcomes. Nationally, this practice would allow for hundreds of additional kidney transplants, annually.

PMID: 27375072 [PubMed - indexed for MEDLINE]

Vascular Regression After Pinguecula Excision and Conjunctival Autograft Using Fibrin Glue.

Tue, 12/12/2017 - 16:48
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Vascular Regression After Pinguecula Excision and Conjunctival Autograft Using Fibrin Glue.

Eye Contact Lens. 2017 May;43(3):199-202

Authors: Jung S, Kwon JW, Hwang HS, Chuck RS

Abstract
OBJECTIVES: To determine the change in local vascularization after pinguecula excision and conjunctival autograft secured with fibrin glue at 12 months.
METHODS: Thirty-one eyes of 31 patients which underwent excision and conjunctival autografting with fibrin glue were retrospectively reviewed. Anterior segment photography was obtained before and after the surgery. Cosmetic outcome was evaluated by patient self-grading (five-point scale; excellent (5), good (4), acceptable (3), poor (2), and very poor (1)), and medical evaluation of treatment outcome was based on subjective evaluation of vascularization on anterior segment photography (four-point severity scale; 0 [low] to 3 [high]). Clinical outcome and complications are reported at 12 months.
RESULTS: Overall cosmetic results were excellent or good in 93.5% (29 of 31) (score 4.68±0.60). Anterior segment photography showed that most cases demonstrated complete removal of pinguecula and regression of surrounding vascularization with mean change in score from 2.13±0.34 preoperatively to 0.09±0.30 postoperatively.
CONCLUSIONS: Pinguecula excision and conjunctival autograft using fibrin glue is an effective and safe method to remove pinguecula for cosmetic purposes. The method presented facilitated regression of vascularization.

PMID: 27058827 [PubMed - indexed for MEDLINE]

[Heart transplantation in an HIV-infected patient].

Mon, 12/11/2017 - 11:05

[Heart transplantation in an HIV-infected patient].

Medicina (B Aires). 2017;77(6):509-511

Authors: Mouras P, Barcán L, Belziti C, Pizarro R, Mañez N, Marenchino R

Abstract
Because of its own unfavourable evolution, HIV infection was until recently considered a contraindication for organ transplantation. The introduction of highly active antiretroviral therapy prolonged the life expectancy of these patients and allowed the manifestation of disorders directly or indirectly related to HIV infection, mainly liver, kidney and cardiovascular diseases. We present a case of cardiac transplantation due to dilated cardiomyopathy that was performed in a patient with a recently detected HIV infection. At 24 month follow-up, the patient is in very good health status, his CD4 are increasing and the viral load is undetectable. He did not present transplant rejection or any other complication. To our knowledge, there is no previous publication on heart transplantation in patients with HIV in South America. In view of the successful outcome of our case and of the few cases reported in the international literature, we consider that heart transplantation is a therapeutic option in correctly selected HIV patients.

PMID: 29223945 [PubMed - in process]

REVEAL risk scores applied to riociguat-treated patients in PATENT-2: Impact of changes in risk score on survival.

Mon, 12/11/2017 - 11:05

REVEAL risk scores applied to riociguat-treated patients in PATENT-2: Impact of changes in risk score on survival.

J Heart Lung Transplant. 2017 Nov 11;:

Authors: Benza RL, Farber HW, Frost A, Ghofrani HA, Gómez-Sánchez MA, Langleben D, Rosenkranz S, Busse D, Meier C, Nikkho S, Hoeper MM

Abstract
BACKGROUND: The Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) risk score (RRS) calculator was developed using data derived from the REVEAL registry, and predicts survival in patients with pulmonary arterial hypertension (PAH) based on multiple patient characteristics. Herein we applied the RRS to a pivotal PAH trial database, the 12-week PATENT-1 and open-label PATENT-2 extension studies of riociguat. We examined the effect of riociguat vs placebo on RRS in PATENT-1, and investigated the prognostic implications of change in RRS during PATENT-1 on long-term outcomes in PATENT-2.
METHODS: RRS was calculated post hoc for baseline and Week 12 of PATENT-1, and Week 12 of PATENT-2. Patients were grouped into risk strata by RRS. Kaplan-Meier estimates were made for survival and clinical worsening-free survival in PATENT-2 to evaluate the relationship between RRS in PATENT-1 and long-term outcomes in PATENT-2.
RESULTS: A total of 396 patients completed PATENT-1 and participated in PATENT-2. In PATENT-1, riociguat significantly improved RRS (p = 0.031) and risk stratum (p = 0.018) between baseline and Week 12 compared with placebo. RRS at baseline, and at PATENT-1 Week 12, and change in RRS during PATENT-1 were significantly associated with survival (hazard ratios for a 1-point reduction in RRS: 0.675, 0.705 and 0.804, respectively) and clinical worsening-free survival (hazard ratios of 0.736, 0.716 and 0.753, respectively) over 2 years in PATENT-2.
CONCLUSIONS: RRS at baseline and Week 12, and change in RRS, were significant predictors of both survival and clinical worsening-free survival. These data support the long-term predictive value of the RRS in a controlled study population.

PMID: 29223470 [PubMed - as supplied by publisher]

Outcomes of cardiac pacing in adult patients after a Fontan operation.

Mon, 12/11/2017 - 11:05

Outcomes of cardiac pacing in adult patients after a Fontan operation.

Am Heart J. 2017 Dec;194:92-98

Authors: Egbe AC, Huntley GD, Connolly HM, Ammash NM, Deshmukh AJ, Khan AR, Said SM, Akintoye E, Warnes CA, Kapa S

Abstract
BACKGROUND: Cardiac pacing can be challenging after a Fontan operation, and limited data exist regarding pacing in adult Fontan patients. The objectives of our study were to determine risk factors for pacing and occurrence of device-related complications (DRCs) and pacemaker reinterventions.
METHODS: We performed a retrospective review of Fontan patients from 1994 through 2014. We defined DRCs as lead failure, lead recall, cardiac perforation, lead thrombus/vegetation, or device-related infection, and cardiovascular adverse events (CAEs) as venous thrombosis, stroke, death, or heart transplant. Pacemaker reintervention was defined as lead failure or recall.
RESULTS: Of 439 patients, 166 (38%) had pacemakers implanted (79 during childhood; 87, adulthood); 114 patients (69%) received epicardial leads initially, and 52 (31%), endocardial leads. Pacing was initially atrial in 52 patients (31%); ventricular, 30 (18%); or dual chamber, 84 (51%). There were 37 reinterventions (1.9% per year) and 48 DRCs (2.4% per year). Pacemaker implantation during childhood was a risk factor for DRCs (hazard ratio, 2.01 [CI, 1.22-5.63]; P = .03). There were 70 CAEs (venous thrombosis, 5; stroke, 11; transplant, 8; and death, 46), yielding a rate of 3.5% per year. DRCs, CAEs, and reintervention rates were comparable for patients with epicardial or endocardial leads.
CONCLUSIONS: More than one-third of adult Fontan patients referred to Mayo Clinic had pacemaker implantation. Epicardial leads were associated with high rate of pacemaker reinterventions but similar DRC rates in comparison to endocardial leads.

PMID: 29223440 [PubMed - in process]

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