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Cardiac allograft vasculopathy

Heidi J Reich, Jon A Kobashigawa, Tamar Aintablian, Danny Ramzy, Michelle M Kittleson, Fardad Esmailian
Using older donor hearts in cardiac transplantation may lead to inferior outcomes: older donors have more comorbidities that reduce graft quality, including coronary artery disease, hypertension, diabetes mellitus, and dyslipidemia. Shorter cold ischemic times might overcome the detrimental effect of older donor age. We examined the relationship between donor allograft age and cold ischemic time on the long-term outcomes of heart transplant recipients. rom 1994 through 2010, surgeons at our hospital performed 745 heart transplantations...
February 2018: Texas Heart Institute Journal
Neslihan Arzu Akgün, Orçun Çiftci, Kerem Can Yılmaz, Emir Karaçağlar, Alp Aydınalp, Atilla Sezgin, I Haldun Müderrisoğlu, Mehmet Haberal
OBJECTIVES: Coronary vasospasm in heart transplant recipients occurs through various mechanisms. It has been linked to allograft rejection and coronary vasculopathy, which can result in mortality during follow-up. Here, we investigated the prevalence of coronary vasospasm among heart transplant recipients undergoing surveillance coronary angiography procedures. MATERIALS AND METHODS: This study was prospectively performed at Başkent University Faculty of Medicine by retrospectively analyzing medical information of patients who underwent bicaval heart transplant between 2003 and 2016 and subsequently had coronary angiography to rule out allograft vasculopathy...
March 2018: Experimental and Clinical Transplantation
Marianne C Jacobsen, Maria D I Manunta, Emma S Pincott, Matthew Fenton, Gavin L Simpson, Nigel J Klein, Michael Burch
BACKGROUND: Cytomegalovirus (CMV) infection is implicated in endothelial dysfunction and graft damage after pediatric heart transplantation. CMV specific immune responses are thought to be necessary for CMV viral control but there is little data in pediatric heart transplantation. METHODS: We studied 28 consecutive pediatric heart transplant recipients for 1-year posttransplant. CMV-specific T cells expressing IFN-γ, TNF-α and IL-2 in response to ex-vivo stimulation with CMV lysates or peptides were measured...
March 5, 2018: Transplantation
Marianne Yardley, Lars Gullestad, Kari Nytrøen
One of the most important prognostic factors in heart failure patients is physical capacity. Patients with very poor physical performance and otherwise eligible, may be listed as candidates for heart transplantation (HTx). After such surgery, life-long immunosuppression therapy is needed to prevent rejection of the new heart. The dark side of immunosuppression is the increased risk of infections, kidney failure, cancer and advanced atherosclerosis (cardiac allograft vasculopathy), with the two latter conditions as the main causes of later mortality...
February 24, 2018: World Journal of Transplantation
Gilles Benichou, Aurore Prunevieille
Recipient pro-inflammatory T cells recognizing donor MHC molecules in a direct fashion trigger early acute rejection of cardiac allografts. In clinical settings, prevention of acute rejection is regularly achieved via continuous suppression of these T cells using immunosuppressive drugs, including calcineurin inhibitors. Nevertheless, within 5 years post-transplantation, up to 50% patients suffer late cardiac allograft failure whose major pathological manifestation is chronic allograft vasculopathy (CAV). CAV is characterized by intimal thickening, smooth muscle cell proliferation, and accumulation of extracellular matrix, which result in arterial narrowing and eventually graft ischemia and fibrosis...
March 5, 2018: American Journal of Transplantation
Anne I Dipchand
Pediatric heart transplantation is standard of care for children with end-stage heart failure. The diverse age range, diagnoses, and practice variations continue to challenge the development of evidence-based practices and new technologies. Outcomes in the most recent era are excellent, especially with the more widespread use of ventricular assist devices (VADs). Waitlist mortality remains high and knowledge of risk factors for death while waiting and following transplantation contributes to decision-making around transplant candidacy and timing of listing...
January 2018: Annals of Cardiothoracic Surgery
Jessica G Y Luc, Jae Hwan Choi, Syed-Saif Abbas Rizvi, Kevin Phan, Ester Moncho Escrivà, Sinal Patel, Gordon R Reeves, Andrew J Boyle, John W Entwistle, Rohinton J Morris, H Todd Massey, Vakhtang Tchantchaleishvili
Background: Transplant coronary artery vasculopathy (TCAV) is the major cause of late allograft failure and death in heart transplant recipients. The aim of this systematic review was to examine the outcomes of percutaneous coronary interventions (PCIs) as compared to coronary artery bypass grafting (CABG) surgery in the management of TCAV. Our secondary objective was to compare the use and outcomes of drug eluting stents (DES) as compared to bare metal stents (BMS) in this patient population...
January 2018: Annals of Cardiothoracic Surgery
Nadia Bouabdallaoui, Pierre Demondion, Sylvestre Maréchaux, Shaida Varnous, Guillaume Lebreton, Frédéric Mouquet, Pascal Leprince
BACKGROUND: Peripartum cardiomyopathy is an idiopathic disorder defined by the occurrence of acute heart failure during late pregnancy or post-partum period in the absence of any other definable cause. Its clinical course is variable and severe cases might require heart transplantation. OBJECTIVE: To investigate long-term outcomes after heart transplantation (HT) for peripartum cardiomyopathy (PPCM). METHODS: Out of a single-center series of 1938 HT, 14 HT were performed for PPCM...
February 19, 2018: Arquivos Brasileiros de Cardiologia
Mandy Langstraat, Kyra J S Musters, Olivier Manintveld, Marco Masetti, Luciano Potena
BACKGROUND: Cardiac allograft vasculopathy (CAV) remains one of the main long-term complications after heart transplantation. We performed a systematic review focused on articles published in the previous 6 years to reappraise the novel evidences supporting risk-factors, pathology, prevention and treatment of CAV. METHODS: We identified a search string for a literature search on PubMed. We excluded articles specifically focused on diagnosis/biomarkers/imaging only or complications of other diseases...
February 17, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Rabea Asleh, Alexandros Briasoulis, Walter K Kremers, Rosalyn Adigun, Barry A Boilson, Naveen L Pereira, Brooks S Edwards, Alfredo L Clavell, John A Schirger, Richard J Rodeheffer, Robert P Frantz, Lyle D Joyce, Simon Maltais, John M Stulak, Richard C Daly, Jonella Tilford, Woong-Gil Choi, Amir Lerman, Sudhir S Kushwaha
BACKGROUND: Small studies have reported superiority of sirolimus (SRL) over calcineurin inhibitor (CNI) in mitigating cardiac allograft vasculopathy (CAV) after heart transplantation (HT). However, data on the long-term effect on CAV progression and clinical outcomes are lacking. OBJECTIVES: The aim of this study was to test the long-term safety and efficacy of conversion from CNI to SRL as maintenance therapy on CAV progression and outcomes after HT. METHODS: A cohort of 402 patients who underwent HT and were either treated with CNI alone (n = 134) or converted from CNI to SRL (n = 268) as primary immunosuppression was analyzed...
February 13, 2018: Journal of the American College of Cardiology
Riccardo Marano, Biagio Merlino, Luigi Natale, Giancarlo Savino, Vincenzo Vingiani, Giuseppe Rovere, Anna Rita Larici, Roberto Iezzi, Nicola Magarelli, Antonella Lombardo, Massimo Pasquale, Riccardo Manfredi
PURPOSE: An accurate evaluation of left ventricular volumes, mass, and ejection fraction (EF) and an early exclusion or detection of significant coronary artery disease or cardiac allograft vasculopathy are mandatory for clinical management and prognosis assessment of heart-transplanted patients (HTP). The purpose of this article was to evaluate the role of dual-step prospective electrocardiography-triggered Dual-Source CT (pECGdual-step-DSCT) in HTP for the assessment of left-ventricular function, in comparison with echocardiography (echo) and cardiac magnetic resonance (CMR) performed on the same day, and of the coronary arteries as well...
January 31, 2018: Journal of Thoracic Imaging
Ana C Alba, Farid Foroutan, Nicholas Kwet Vong Ng Fat Hing, Chun-Po S Fan, Cedric Manlhiot, Heather J Ross
PORPUSE: Sudden cardiac death (SCD) is an important post-transplant problem being responsible for approximately 10% of deaths. We conducted a systematic review and meta-analysis to evaluate incidence and predictors of post-heart transplant SCD, and use of implantable cardiac defibrillator (ICD). METHODS: Citations were identified in electronic databases and references of included studies. Observational studies on adults reporting on incidence and predictors of post-transplant SCD and ICD use were selected...
January 19, 2018: Clinical Transplantation
Sangita Sudharshan, Ali Javaheri
PURPOSE OF REVIEW: Cholesterol metabolism is increasingly recognized in inflammatory diseases including transplantation. This review discusses the mechanistic underpinnings that tie macrophage cholesterol efflux capacity (CEC) of high-density lipoprotein (HDL) to chronic rejection in transplanted patients. RECENT FINDINGS: Animal studies suggest that administration of apolipoprotein A-I, the main protein constituent of HDL, can prevent transplant arteriosclerosis...
January 13, 2018: Current Opinion in Endocrinology, Diabetes, and Obesity
Tianshu Zhang, Agnes M Azimzadeh, Wenji Sun, Natalie A O'Neill, Evelyn Sievert, Emily Bergbower, Gheorghe Braileanu, Lars Burdorf, Xiangfei Cheng, Thomas Monahan, Siamak Dahi, Donald Harris, Elana Rybak, Emily Welty, Anthony Kronfli, Chris Avon, Richard N Pierson
BACKGROUND: Selective CD28 inhibition is actively pursued as an alternative to B7 blockade using CTLA4-Ig based on the hypothesis that the checkpoint immune regulators CTLA-4 and PD-L1 will induce tolerogenic immune signals. We previously showed that blocking CD28 using a monovalent nonactivating reagent (single chain anti-CD28 Fv fragment linked to alpha-1 anti-trypsin: sc28AT) synergizes with calcineurin inhibitors in nonhuman primate (NHP) kidney and heart transplantation. Here, we explored the efficacy of combining a 3-week 'induction" sc28AT treatment with prolonged CD154 blockade...
January 10, 2018: Transplantation
Anne Günther, Lars Aaberge, Andreas Abildgaard, Asgrimur Ragnarsson, Thor Edvardsen, Jarl Jakobsen, Rune Andersen
Background Cardiac allograft vasculopathy (CAV) is an accelerated form of atherosclerosis unique to heart transplant (HTX) patients. Purpose To investigate the detection of significant coronary artery stenosis and CAV, determinants of image quality, and the radiation dose in coronary computed tomography angiography (CCTA) of HTX patients with 64-slice multidetector CT (64-MDCT). Material and Methods Fifty-two HTX recipients scheduled for invasive coronary angiography (ICA) were prospectively enrolled and underwent CCTA before ICA with intravascular ultrasound (IVUS)...
January 1, 2017: Acta Radiologica
Paco E Bravo, Brian A Bergmark, Tomas Vita, Viviany R Taqueti, Ankur Gupta, Sara Seidelmann, Thomas E Christensen, Michael T Osborne, Nishant R Shah, Nina Ghosh, Jon Hainer, Courtney F Bibbo, Meagan Harrington, Fred Costantino, Mandeep R Mehra, Sharmila Dorbala, Ron Blankstein, Akshay Desai, Lynne Stevenson, Michael M Givertz, Marcelo F Di Carli
Aims: Cardiac allograft vasculopathy (CAV) is a leading cause of death in orthotopic heart transplant (OHT) survivors. Effective non-invasive screening methods are needed. Our aim was to investigate the added diagnostic and prognostic value of myocardial blood flow (MBF) to standard myocardial perfusion imaging (MPI) with positron emission tomography (PET) for CAV detection. Methods and results: We studied 94 OHT recipients (prognostic cohort), including 66 who underwent invasive coronary angiography and PET within 1 year (diagnostic cohort)...
December 8, 2017: European Heart Journal
William F Fearon, Yuhei Kobayashi
Traditionally, invasive coronary physiological assessment has focused on the epicardial coronary artery. More recently, appreciation of the importance of the coronary microvasculature in determining patient outcomes has grown. Several invasive modalities for interrogating microvascular function have been proposed. Angiographic techniques have been limited by their qualitative and subjective nature. Doppler wire-derived coronary flow reserve has been applied in research studies, but its clinical role has been limited by its lack of reproducibility, its lack of a clear normal value, and the fact that it is not specific for the microvasculature but interrogates the entire coronary circulation...
December 2017: Circulation. Cardiovascular Interventions
Vincent Floré, Adam J Brown, Stephen J Pettit, Nick E J West, Clive Lewis, Jayan Parameshwar, Stephen P Hoole
OBJECTIVE: Cardiac allograft vasculopathy (CAV) can be detected early with intravascular ultrasound (IVUS), but there is limited information on the most efficient imaging protocol. METHODS: Coronary angiography and IVUS of the three coronary arteries were performed. Volumetric IVUS analysis was performed, and a Stanford grade determined for each vessel. RESULTS: Eighteen patients were included 18 (range 12-24) months after transplantation...
February 2018: Clinical Transplantation
Sharon A Hunt
No abstract text is available yet for this article.
December 2017: JACC. Heart Failure
Maxime Tremblay-Gravel, Normand Racine, Simon de Denus, Anique Ducharme, Guy B Pelletier, Geneviève Giraldeau, Mark Liszkowski, Marie-Claude Parent, Michel Carrier, Annik Fortier, Michel White
OBJECTIVES: This study investigated temporal changes in the demographics and the prognosis of cardiac allograft vasculopathy (CAV) over 30 years following heart transplantation (HTx). BACKGROUND: Effects of the changing HTx demographics on CAV outcomes, based on International Society for Heart and Lung Transplantation (ISHLT) classification of CAV, have been incompletely investigated. METHODS: Patients who underwent HTx at the Montreal Heart Institute were classified according to the severity of CAV (CAV 0 is no presence of CAV; CAV 1 is mild, CAV 2 to 3 is moderate to severe) and era of HTx (early: 1983 to 1998; recent: 1999 to 2011)...
December 2017: JACC. Heart Failure
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