A Multi-Center, Randomized, Open-Label, Parallel Group Phase IV Trial Investigating the Outcome on Renal Function, Efficacy and Safety of CNI-Reduction or Elimination With Everolimus in De Novo Heart Transplant: Recipients: The MANDELA Study Design

The MANDELA study (NCT00862979) is designed to assess the benefit of either CNI-free or CNI-minimized EVR-based regimen after early conversion from standard treatment in de novo heart transplant recipients (HTxR).There is growing evidence on the beneficial use of everolimus (EVR) in heart transplantation supporting reduction or withdrawal of calcineurin inhibitor (CNI) therapy, mainly to maintain renal function, to avoid malignancies and to reduce progression of cardiac allograft vasculopathy.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Source Type: research

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The number of patients surviving to stage D heart failure has been increasing, while the supply of donor hearts has remained relatively stable.1-2 Importantly, cardiac allografts from extended-criteria donors, such as those with history of cocaine use, are frequently discarded due to concern over organ quality. Cocaine use particularly raises concerns for cardiac complications including risk of myocardial ischemia, coronary artery vasospasm, myocarditis, and arrhythmias.3 Prior data however, suggests that use of donors with cocaine use does not result in worse outcomes after heart transplantation, though longer-term data r...
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Editorial Source Type: research
Current diagnostics in lung transplantation are not meeting our patients ’ needs. While we can identify phenotypes of acute rejection, such as perivascular (A-grade), bronchiolar (B-grade), and antibody-mediated rejection, the link between these pathologies and chronic lung allograft dysfunction (CLAD) is clear only for the more severe cases (1). Most lung transplant r ecipients go on to develop CLAD without clear warning (2). Moreover, interrater reliability for acute rejection pathologies is low (3).
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Editorial Source Type: research
Azithromycin prophylaxis (AP) in lung transplant recipients has been shown to reduce the composite end-point of death or chronic lung allograft dysfunction (CLAD) onset but without a clear effect on overall survival. Our program began using AP in 2010. We sought to evaluate the association between AP and survival and the risk of CLAD and baseline lung allograft dysfunction (BLAD).
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: ORIGINAL CLINICAL SCIENCE Source Type: research
Azithromycin prophylaxis (AP) in lung transplant recipients has been shown to reduce the composite endpoint of death or chronic lung allograft dysfunction (CLAD) onset but without a clear effect on overall survival. Our program began using AP in 2010. We sought to evaluate the association between AP and survival, the risk of CLAD and baseline lung allograft dysfunction (BLAD).
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Original Clinical Science Source Type: research
Purpose of review Understanding the mechanisms involved in immune protection provided by a hepatic allograft is imperative as further therapies for highly sensitized patients could be developed and thus expanding the donor pool and improving outcomes. Recent findings The clinical data from immune protection comes mainly from combined liver and kidney transplants with excellent results in overall survival and also that of the allograft. This phenomenon has also been observed in dual liver transplants with heart, lung, skin and intestines, albeit with less data. In heart transplant recipients, the liver allograft has pr...
Source: Current Opinion in Organ Transplantation - Category: Surgery Tags: COMBINED HEART AND LIVER TRANSPLANTATION: Edited by Juliet Emamaullee and Eugene DePasquale Source Type: research
Chronic Lung Allograft Dysfunction (CLAD) is the major complication limiting long-term survival in lung transplant recipients (LTRs), with those developing donor-specific anti-HLA antibodies (DSA) previously found to have increased risk for CLAD. However, as DSA responses vary in timing of development, specificity, breadth, persistence and complement-binding capacity, we hypothesized that these characteristics would impact CLAD and survival outcomes.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Source Type: research
Chronic lung allograft dysfunction (CLAD) is the major complication limiting long-term survival in lung transplant recipients (LTRs), with those developing donor-specific anti –human leukocyte antigen (HLA) antibodies (DSAs) previously found to have increased risk for CLAD. However, as DSA responses vary in timing of development, specificity, breadth, persistence, and complement-binding capacity, we hypothesized that these characteristics would impact CLAD and survival outcomes.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: ORIGINAL CLINICAL SCIENCE Source Type: research
In recent years, emerging data has demonstrated that organs from Hepatitis C Virus (HCV)-infected donors can be transplanted into uninfected recipients with excellent outcomes. Critical to this success is the use of pre-emptive or prophylactic direct-acting antiviral (DAA) therapy, with the intent to minimize any viral transmission and block viral replication. The optimal timing to employ such therapy, whether at the time of transplant or following the detection of viremia, remains a matter of ongoing debate.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Editorial Source Type: research
In recent years, emerging data have demonstrated that organs from donors infected with hepatitis C virus (HCV) can be transplanted into uninfected recipients with excellent outcomes. Critical to this success is the use of pre-emptive or prophylactic direct-acting anti-viral (DAA) therapy, with the intent to minimize any viral transmission and block viral replication. The optimal timing to employ such therapy, whether at the time of transplantation or after the detection of viremia, remains a matter of ongoing debate.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: EDITORIAL COMMENTARY Source Type: research
In conclusion, using a large cohort with rich health and DNA methylation data, we provide the first comparison of six major epigenetic measures of biological ageing with respect to their associations with leading causes of mortality and disease burden. DNAm GrimAge outperformed the other measures in its associations with disease data and associated clinical traits. This may suggest that predicting mortality, rather than age or homeostatic characteristics, may be more informative for common disease prediction. Thus, proteomic-based methods (as utilised by DNAm GrimAge) using large, physiologically diverse protein sets for p...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
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