Heart Retransplantation: Candidacy, Outcomes, and Management
AbstractPurpose of ReviewTo describe the incidence and epidemiology of heart retransplantation in adults and children and to review the risk factors associated with adverse outcome following retransplantation to help guide recipient selection.Recent FindingsHeart retransplantation is associated with inferior short-term and long-term survival when compared with primary heart transplantation and its use remains controversial although less so in the pediatric heart transplant population.SummaryIn the most recent era of heart transplantation, patients retransplanted for CAV, greater than 1 year from their primary transplant, and who are not in critical condition have improved survival compared with other retransplant recipients. Survival with retransplantation can approach that of primary transplantation when patients are appropriately selected. More research is needed regarding the optimal timing for retransplantation and the optimal management for patients after retransplantation.
We thank Dr. Imamura for his interest in our study, which suggests that long-term milrinone therapy is effective and safe, in select patients, as a bridge to heart transplantation . We agree with Dr. Imamura that clinician bias may limit this real-world analysis. However, in our analysis we found that failure patients demonstrated hemodynamic deterioration with worsening (increasing) pulmonary artery pressure from baseline to the study endpoint. This data is displayed in Figure 1 of the article and provides objective evidence of the failure patients' need for mechanical support.
Gastroparesis is frequently identified following lung transplantation with incidence rates as high as 44%.1 Gastroparesis post lung transplant is of significant concern, as complications directly related to gastroparesis, specifically gastroesophageal reflux and aspiration, have been linked to the development of bronchiolitis obliterans syndrome (BOS), the primary cause of graft failure and the main cause of late morbidity and mortality following lung transplantation.1 The therapy for medically refractory post lung transplant gastroparesis represents a significant therapeutic challenge, as current therapies (such as botuli...
AbstractUndeterred by all the advancement in the field of cardiac transplantation, heart transplant rejection remained its mammoth quandary. Management of heart transplant recipients has drastically improved with current regimens of immunosuppressive drugs. The adverse effects of calcineurin inhibitors are lacking with the use of belatacept, which is a costimulation inhibitor that interferes with the interaction between CD28 on T cells and the B7 ligands on antigen-presenting cells. It was originally approved for use in renal transplant recipients but it has shown promising results in heart transplant recipients.
ESC Heart Failure, EarlyView.
AbstractBackgroundThe prevalence of heart failure (HF) is rising with ageing population and constitutes a major health problem globally. A common complication of HF is pulmonary hypertension (PH) which negatively impacts survival. A pathophysiological association between HF and PH with tumorigenic processes has been suggested. We aimed to identify the plasma levels of, and the association between tumour-related proteins and hemodynamic improvements in patients with HF and PH due to left heart disease (LHD) before and 1-year after heart transplantation (HT).MethodsForty-eight tumour-related proteins were measured with proxi...
In 2009, The International Society for Heart and Lung Transplantation recognized the importance and challenges surrounding generic drug immunosuppression. As experience with generics has expanded and comfort has increased, substantial issues have arisen since that time with other aspects of immunomodulation that have not been addressed, such as: access to medicines, alternative immunosuppression formulations, additional generics, implications on therapeutic drug monitoring, and implications to special populations such as pediatrics and older adults.
In recent years academic interest has grown in the study of the gut microbiome. Researchers are making inroads into understanding the considerable influence of these microbial populations over the progression of health and aging. The gut microbiome may be as influential as physical activity in these matters. The balance of microbial populations shifts unfavorably over time, for reasons that are yet to be fully mapped and understood. This leads to greater numbers of inflammatory microbes, or those that produce harmful byproducts, and fewer microbes that produce beneficial metabolites. Researchers have identified some of the...
Conclusion: In HLHS patients undergoing Fontan, preoperative weight and IVC diameter appeared to have no influence on immediate postoperative outcomes. Performing the Fontan off CPB and with a fenestration also conferred no added clinical benefit. These observations should be considered when deciding optimal timing for Fontan completion.
Conclusion: The results suggest acceptable short term outcomes in Indian pediatric patients can be achieved after heart transplantation in the current era. Significant rejection episodes and coronary allograft vasculopathy need careful follow up.