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Renal failure and heart transplant

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https://www.readbyqxmd.com/read/29123005/percutaneous-ablation-for-hepatocellular-carcinoma-and-peritoneal-dialysis
#1
Annabel Boyer, Marc-Antoine Jegonday, Antoine Lanot, Maxence Ficheux, Thierry Lobbedez, Clémence Bechade
Hepatocellular carcinoma (HCC) is the second leading cause of death by cancer worldwide. Resection and liver transplantation are the gold standards, but only a minority of people are eligible. Percutaneous ablation therapies, such as microwave ablation (MWA), have consequently been developed. There is a lack of guidelines regarding the treatment of HCCs in end-stage renal disease (ESRD) patients. Here, we report the case of a 67-year-old patient who was undergoing peritoneal dialysis (PD) for chronic congestive heart failure and who presented with an HCC while undergoing PD...
November 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/29122900/a-30-year-delayed-presentation-of-disseminated-histoplasmosis-in-a-heart-transplant-recipient-diagnostic-challenges-in-a-non-endemic-area
#2
Aneela Majeed, Vikas Kapoor, Azka Latif, Tirdad Zangeneh
A 70-year-old man with history of heart transplant performed in 1986, presented with altered mental status. CT scan of brain showed ring-enhancing lesions, raising suspicion for metastatic malignancy. Work-up revealed bilateral adrenal masses, biopsy showed granulomatous changes consistent with histoplasmosis. The possibility of histoplasmosis was less likely as the patient had no prior history of symptomatic disease and had lived in the endemic area 30 years prior to presentation. Brain biopsy confirmed central nervous system involvement...
November 8, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29110796/long-term-outcomes-and-management-of-the-heart-transplant-recipient
#3
REVIEW
Sharon L McCartney, Chetan Patel, J Mauricio Del Rio
Cardiac transplantation remains the gold standard in the treatment of advanced heart failure. With advances in immunosuppression, long-term outcomes continue to improve despite older and higher risk recipients. The median survival of the adult after heart transplantation is currently 10.7 years. While early graft failure and multiorgan system dysfunction are the most important causes of early mortality, malignancy, rejection, infection, and cardiac allograft vasculopathy contribute to late mortality. Chronic renal dysfunction is common after heart transplantation and occurs in up to 68% of patients by year 10, with 6...
June 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29110789/long-term-management-of-end-stage-heart-failure
#4
REVIEW
Marlena V Habal, A Reshad Garan
End-stage heart failure manifests as severe and often relentless symptoms that define the clinical syndrome of heart failure, namely congestion and hypoperfusion. These patients suffer from dyspnea, fatigue, abdominal discomfort, and ultimately cardiac cachexia. Renal and hepatic dysfunction frequently further complicates the process. Recurrent hospitalizations, cardiac arrhythmias, and intolerance to standard heart failure therapies are common as the disease progresses. Management focuses on controlling symptoms, correcting precipitants, avoiding triggers, and maximizing therapies with demonstrable survival benefit...
June 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29065351/end-organ-recovery-post-ventricular-assist-device-can-prognosticate-survival
#5
Joseph Philip, Dalia Lopez-Colon, Ravi S Samraj, Giri Kaliki, Maria V Irwin, Biagio A Pietra, Frederick J Fricker, Mark S Bleiweis
BACKGROUND: This study examines our institutional ventricular assist devices (VADs) experience over two decades to understand trends towards predictors of mortality. METHODS: Retrospective study of patients aged 0-21years supported with a VAD from January 1996 to May 2015. Patient data was examined pre and post-VAD implant among survivors and non-survivors. RESULTS: Thirty-six patients identified (8 supported by Thoratec® VAD and 28 supported by EXCOR Berlin Heart®)...
October 16, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29056228/comparison-of-clinical-characteristics-complications-and-outcomes-in-recipients-having-heart-transplants-65-years-of-age-versus-%C3%A2-65-years-of-age
#6
Aayla Jamil, Huanying Qin, Joost Felius, Giovanna Saracino, Aldo E Rafael, Juan C MacHannaford, Gonzalo V Gonzalez-Stawinski, Brian Lima
Advanced recipient age remains a limiting factor for heart transplant candidacy, with many centers reluctant to transplant older patients. Here, we report our experience with recipients aged ≥65 years compared with younger recipients in terms of baseline characteristics, intraoperative and immediate postoperative experiences, and post-transplant morbidity and survival. The main study outcome was primary graft dysfunction (PGD), which has not been widely studied in this population. Donor and recipient data from 255 heart transplantations performed between 2012 and 2016 were reviewed...
September 15, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29055603/end-stage-renal-disease-after-pediatric-heart-transplantation-a-25-year-national-cohort-study
#7
Swati Choudhry, Vikas R Dharnidharka, Chesney D Castleberry, Charles W Goss, Kathleen E Simpson, Kenneth B Schechtman, Charles E Canter
BACKGROUND: End-stage renal disease (ESRD), defined as the need for chronic dialysis and/or kidney transplantation (KTx), is a known complication after heart transplant (HTx). However, factors associated with ESRD are not well elucidated. The objectives of this study were to determine the prevalence, risk factors, and outcomes associated with ESRD after pediatric HTx. METHODS: Scientific Registry of Transplant Recipients data were linked, using direct identifiers, to the United States Renal Data System to identify patients (aged ≤ 18 years) who underwent primary HTx between 1989 and 2013...
October 2, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/29045285/milrinone-dosing-and-a-culture-of-caution-in-clinical-practice
#8
Luke Yong Zheng Chong, Kumar Satya, Bernard Kim, Robert Berkowitz
Milrinone is an invaluable agent in the treatment of end-stage heart failure patients who are refractory to optimal medical therapy. In addition to its use in acute decompensated heart failure, milrinone can also be employed as a home infusion therapy or a bridge to cardiac transplant. Concerns about its adverse effects, such as an increased risk of arrhythmias and hypotension, often limit the doses of milrinone used in clinical practice. In addition, milrinone is infrequently used or avoided entirely in patients with acute renal failure or end-stage renal disease since the drug is primarily cleared by renal excretion...
October 17, 2017: Cardiology in Review
https://www.readbyqxmd.com/read/29019615/haemodynamic-profiles-of-children-with-end-stage-heart-failure
#9
Sharon Chen, John C Dykes, Doff B McElhinney, Robert J Gajarski, Andrew Y Shin, Seth A Hollander, Melanie E Everitt, Jack F Price, Ravi R Thiagarajan, Steven J Kindel, Joseph W Rossano, Beth D Kaufman, Lindsay J May, Elizabeth Pruitt, David N Rosenthal, Christopher S Almond
Aims: To evaluate associations between haemodynamic profiles and symptoms, end-organ function and outcome in children listed for heart transplantation. Methods and results: Children <18 years listed for heart transplant between 1993 and 2013 with cardiac catheterization data [pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), and cardiac index (CI)] in the Pediatric Heart Transplant Study database were included. Outcomes were New York Heart Association (NYHA)/Ross classification, renal and hepatic dysfunction, and death or clinical deterioration while on waitlist...
October 7, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28979779/a-clinical-genetic-approach-to-assessing-cardiovascular-risk-in-patients-with-ckd
#10
Emilio Rodrigo, Sara Pich, Isaac Subirana, Gema Fernandez-Fresnedo, Paloma Barreda, Carles Ferrer-Costa, Ángel Luis M de Francisco, Eduardo Salas, Roberto Elosua, Manuel Arias
BACKGROUND: Coronary heart disease (CHD) is the primary cause of death in individuals with chronic kidney disease (CKD), but current equations for assessing coronary risk have low accuracy in this group. We have reported that the addition of a genetic risk score (GRS) to the Framingham risk function improved its predictive capacity in the general population. The aims of this study were to evaluate the association between this GRS and coronary events in the CKD population and to determine whether the addition of the GRS to coronary risk prediction functions improves the estimation of coronary risk at the earliest possible stages of kidney disease...
October 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28977259/reintubation-of-patients-submitted-to-cardiac-surgery-a-retrospective-analysis
#11
Cíntia Yukie Shoji, Luciana Castilho de Figuereido, Eveline Maria Calixtre, Cristiane Delgado Alves Rodrigues, Antonio Luis Eiras Falcão, Pedro Paulo Martins, Ana Paula Ragonete Dos Anjos, Desanka Dragosavac
OBJECTIVES: To analyze patients after cardiac surgery that needed endotracheal reintubation and identify factors associated with death and its relation with the severity scores. METHODS: Retrospective analysis of information of 1,640 patients in the postoperative period of cardiac surgery between 2007 and 2015. RESULTS: The reintubation rate was 7.26%. Of those who were reintubated, 36 (30.3%) underwent coronary artery bypass surgery, 27 (22...
April 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28972944/delayed-development-of-hemolytic-anemia-with-fragmented-red-blood-cells-and-cardiac-and-renal-impairments-after-high-dose-chemotherapy-and-autologous-hematopoietic-stem-cell-transplantation-for-malignant-lymphoma
#12
Futoshi Iioka, Yusuke Toda, Yuya Nagai, Takashi Akasaka, Daiki Shimomura, Katsuyo Tsuda, Fumihiko Nakamura, Hitoshi Ohno
Among 42 consecutive patients with malignant lymphoma who underwent high-dose chemotherapy (HDC) followed by autologous hematopoietic stem cell transplantation (AHSCT), 5 developed hemolytic anemia with fragmented red blood cells (HA-FrRBCs) on days 87-125 (median 107) of AHSCT. Nadir Hb levels ranged between 5.0 and 6.4 g/dL with 2.2-5.6% FrRBCs. All patients developed grade ≥3 hypoxia and heart failure, and 4 developed grade ≥3 hypertension. The ejection fraction of the left ventricle assessed by echocardiography was significantly reduced in 3 patients...
October 4, 2017: Acta Haematologica
https://www.readbyqxmd.com/read/28930797/optimizing-the-safety-profile-of-everolimus-by-delayed-initiation-in-de-novo-heart-transplant-recipients-results-of-the-prospective-randomized-study-everheart
#13
Luciano Potena, Carlo Pellegrini, Francesco Grigioni, Cristiano Amarelli, Ugolino Livi, Massimo Maccherini, Gabriella Masciocco, Giuseppe Faggian, Paola Lilla Della Monica, Gino Gerosa, Nicola Marraudino, Marco Corda, Massimo Boffini
BACKGROUND: Although everolimus potentially improves long-term heart transplantation (HTx) outcomes, its early postoperative safety profile had raised concerns and needs optimization. METHODS: This 6-month, open-label, multicenter randomized trial was designed to compare the cumulative incidence of a primary composite safety endpoint comprising wound healing delays, pericardial effusion (PCEs), pleural effusion (PLEs) needing drainage, and renal insufficiency events (estimated glomerular filtration rate [eGFR] ≤30/mL/min/1...
September 19, 2017: Transplantation
https://www.readbyqxmd.com/read/28930049/experience-with-the-syncardia-total-artificial-heart-in-a-canadian-centre
#14
Anthony Nguyen, Michel Pellerin, Louis P Perrault, Michel White, Anique Ducharme, Normand Racine, Michel Carrier
BACKGROUND: The SynCardia total artificial heart (TAH) provides complete circulatory support by replacing both native ventricles. Accepted indications include bridge to transplantation and destination therapy. We review our experience with TAH implantation during a period when axial flow pump became available. METHODS: We retrospectively analyzed the demographics, clinical characteristics and survival of all patients receiving the TAH. RESULTS: From September 2004 to November 2016, 13 patients (12 men, mean age 45 ± 13 yr) received the TAH for refractory cardiogenic shock secondary to idiopathic (56%) or ischemic (17%) cardiomyopathy and to other various causes (33%)...
October 1, 2017: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/28881060/outcome-of-kidney-transplant-in-primary-repeat-and-kidney-after-nonrenal-solid-organ-transplantation-15-year-analysis-of-recent-unos-database
#15
A El-Husseini, A Aghil, J Ramirez, B Sawaya, N Rajagopalan, M Baz, X Mei, D L Davenport, R Gedaly
The number of nonrenal solid-organ transplants increased substantially in the last few decades. Many of these patients develop renal failure and receive kidney transplantation. The aim of this study was to evaluate patient and kidney allograft survival in primary, repeat, and kidney-after-nonrenal organ transplantation using national data reported to United Network for Organ Sharing (UNOS) from January 2000 through December 2014. Survival time for each patient was stratified into the following: Group A (comparison group)-recipients of primary kidney transplant (178 947 patients), Group B-recipients of repeat kidney transplant (17 819 patients), and Group C-recipients of kidney transplant performed after either a liver, heart, or lung transplant (2365 patients)...
November 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28856732/predictive-model-and-risk-factors-associated-with-a-revised-definition-of-early-allograft-dysfunction-in-liver-transplant-recipients
#16
Ramona Nicolau-Raducu, Ari J Cohen, Amjad Bokhari, Humberto Bohorquez, David Bruce, Ian Carmody, Emily Bugeaud, John Seal, Dennis Sonnier, Bobby Nossaman, George Loss
INTRODUCTION: Early allograft dysfunction (EAD) is a well-defined clinical syndrome that reflects overall graft function within the first week after transplant. The aim of this study was to further refine the definition for EAD. METHOD: In this study, 1124 patients were included for analysis. Logistic regression was performed to identify markers of liver injury associated with 6-month patient and graft failure. RESULTS: Recursive partitioning identified cut-points for ALT/AST > 3000/6000 IU/dL observed within first week, with bilirubin ≥ 10 mg/dL and INR ≥ 1...
August 30, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28845472/a-clinical-prediction-score-to-guide-referral-of-elderly-dialysis-patients-for-kidney-transplant-evaluation
#17
Ling-Xin Chen, Michelle A Josephson, Donald Hedeker, Kellie Hunter Campbell, Nicole Stankus, Milda R Saunders
INTRODUCTION: Dialysis patients aged ≥70 years derive improved life expectancy through kidney transplantation compared to their waitlisted counterparts, but guidelines are not clear about how to identify appropriate transplantation candidates. We developed a clinical prediction score to identify elderly dialysis patients with expected 5-year survival appropriate for kidney transplantation (>5 years). METHODS: Incident dialysis patients in 2006-2009 aged ≥70 were identified from the United States Renal Data System database and divided into derivation and validation cohorts...
July 2017: KI Reports
https://www.readbyqxmd.com/read/28844518/usefulness-of-sodium-bicarbonate-for-the-prevention-of-contrast-induced-nephropathy-in-patients-undergoing-cardiac-resynchronization-therapy
#18
RANDOMIZED CONTROLLED TRIAL
Pau Alonso, Jorge Sanz, Ana García-Orts, Samuel Reina, Sonia Jiménez, Joaquín Osca, Oscar Cano, Ana Andrés, María José Sancho-Tello, Luis Martínez
The use of contrast media during cardiac resynchronization therapy (CRT) devices implantation is associated with the risk of contrast-induced nephropathy (CIN). The aim of this study was to evaluate the possible beneficial role of periprocedural intravenous volume expansion with isotonic saline and sodium bicarbonate solution in patients who undergo CRT implantation. Eligible patients were randomly assigned in a 1:1 ratio to receive hydration plus one-sixth molar sodium bicarbonate (study group) or not (control group)...
November 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28811048/receipt-of-nephrology-care-and-clinical-outcomes-among-veterans-with-advanced-ckd
#19
Enrica Fung, Tara I Chang, Glenn M Chertow, I-Chun Thomas, Steven M Asch, Manjula Kurella Tamura
BACKGROUND: Clinical practice guidelines recommend referral to nephrology when estimated glomerular filtration rate (eGFR) decreases to <30mL/min/1.73m(2); however, evidence for benefits of nephrology care are mixed. STUDY DESIGN: Observational cohort using landmark analysis. SETTINGS & PARTICIPANTS: A national cohort of veterans with advanced chronic kidney disease, defined as an outpatient eGFR≤30mL/min/1.73m(2) for January 1, 2010, through December 31, 2010, and a prior eGFR<60mL/min/1...
November 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28807220/health-characteristics-of-heart-transplant-recipients-surviving-into-their-80s
#20
Deborah R Tabachnick, Megan E Bowen, Josef Stehlik, Abdallah G Kfoury, William T Caine, Craig H Selzman, Stephen H McKellar
BACKGROUND: Heart transplantation (HTx) is the preferred treatment for patients with end-stage heart failure and has been successful for >30 y. The clinical course of recipients at the extreme of age is unknown. We reviewed our experience to determine the overall health and prevalence of Tx-related medical problems for recipients in their ninth decade. METHODS: We reviewed the UCTP experience from 1985 to present to identify patients who survived into their 80s and matched (1:1) with other recipients for gender and age at HTx, but did not survive to ≥80 y...
August 2017: Journal of Surgical Research
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