Mid-Term Effectiveness of Everolimus on Heart Transplant Recipients with Renal Dysfunction or Transplant Coronary Artery Atherosclerosis
Everolimus (EVL) can be utilized after heart reduce calcineurin inhibitor (CNI) associated nephrotoxicity, due to cell cycle inhibitor adverse effects, and as adjunct therapy for rejection and cardiac allograft vasculopathy (TCAV). Since 2007, we have primarily considered converting from mycophenolate mofetil with standard-dose CNIs to EVL with low-dose CNIs for the following recipients: 1) recipients with impaired renal function; 2) those with increases in or an initially large maximal intimal thickness (MIT) on routine intravascular ultrasound (IVUS) examinations; 3) donor derived TCAV; and 4) those with MMF-related leukopenia.
Intravascular ultrasound (IVUS) assessment of cardiac allograft vasculopathy (CAV) provides diagnostic and prognostic information. Multivessel analysis has high sensitivity for detecting CAV, but is time consuming, costly and associated with procedural risks compared to single-vessel examination. We evaluated the regional distribution and plaque characteristics of CAV to guide clinical evaluation by IVUS.
Intravascular ultrasound (IVUS) has been used in adult heart transplant (HTX) recipients early after transplant to assess risk for long-term outcomes, along with differences in therapeutic targets for the treatment of cardiac allograft vasculopathy (CAV). Little is known about the utility of IVUS early after pediatric HTX. We evaluated the use of IVUS early (
Angiography and intravascular ultrasound (IVUS) of the epicardial coronary vasculature are routinely undertaken for cardiac allograft vasculopathy (CAV) assessment. Microvascular disease is common in CAV and may occur independently of epicardial disease. The purpose of this study was to examine the relationship between microvascular disease, epicardial disease and microvascular dysfunction in heart transplant (HT) patients.
Cardiac allograft vasculopathy (CAV) is a leading cause of death and re-transplantation (tx). Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are increasingly used for earlier detection, but lengthen procedure time and cost, and are unsuitable in small children. Coronary angiography is routine in all age groups but may be subjectively interpreted. We hypothesized that serial analysis of quantitative coronary angiography (QCA) is possible in infants and children and may also predict disease progression.
Coronary artery vasculopathy (CAV) remains a significant limitation for long-term survival after heart transplantation (HT), observed in 30-45% of recipients by 5 years and 50-65% by 10 years post-HT. Despite the increased fidelity, the detection of CAV at the level of the vessel remains invasive and with various modalities used in CAV screening, the ability to detect sub-occlusive disease or disease in vessels less than 1.5 mm diameter remains problematic. Donor ‐derived, cell‐free DNA (dd‐cfDNA (AlloSure)), detected in recipient blood, has been established as a non-invasive marker of allograft injury, useful in the...
Coronary allograft vasculopathy (CAV) continues to be a common cause of morbidity and mortality in heart transplant recipients. Little is known about the timing of onset or progression of CAV after heart transplantation (HTx), or its relationship to donor acquired disease. We sought to assess the incidence of donor acquired disease and impact on disease progression in the first year post transplant.
The development of cardiac allograft vasculopathy (CAV) is known to be induced by a biphasic process involving early intimal thickening and late constrictive remodeling. However, change of intimal thickening long-term period post heart transplantation (HTx) is still unknown. Our aim of this study was to investigate the change of intimal thickening of CAV long-term period post-HTx.
Enhanced platelet reactivity may play a role in the development and progression of cardiac allograft vasculopathy (CAV). Although aspirin is often a part of the medication regimen after heart transplantation (HT), limited evidence is available on its effects on CAV and related outcomes. In this large study, we sought to investigate whether aspirin treatment has an independent impact on CAV progression using coronary intravascular ultrasound (IVUS) follow-up studies and clinical outcomes after long-term follow-up post HT.
AbstractBackgroundWe previously demonstrated high diagnostic accuracy of Rubidium-82 positron emission tomography (PET) myocardial blood flow (MBF) quantification for CAV. The purpose of this study was to validate multiparametric PET detection of CAV by combined rate-pressure-product-corrected myocardial flow reserve (cMFR), stress MBF, and coronary vascular resistance (CVR) assessment.Methods and ResultsDiagnostic CAV cut-offs of cMFR
In patients awaiting heart transplantation (HTx), end-stage disease of a second organ may occasionally require consideration of simultaneous multiorgan transplantation. As cardiac and renal disease are related physiologically and often co-exist, the population of combined heart and kidney transplantation (HKTx) has significantly increased over the last few years along with the growing number of patients wait listed for heart.1,2 Interestingly, short-term survival rates after HKTx have been reported to be comparable to those after isolated HTx.