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Cardiac allograft vasculopathy

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https://www.readbyqxmd.com/read/28781013/early-aspirin-use-and-the-development-of-cardiac-allograft-vasculopathy
#1
Miae Kim, Brian A Bergmark, Thomas A Zelniker, Mandeep R Mehra, Garrick C Stewart, Deborah S Page, Erica L Woodcome, Jennifer A Smallwood, Steven Gabardi, Michael M Givertz
BACKGROUND: Cardiac allograft vasculopathy (CAV) remains a leading cause of morbidity and mortality after orthotopic heart transplantation (OHT). Little is known about the influence of aspirin on clinical expression of CAV. METHODS: We followed 120 patients with OHT at a single center for a median of 7 years and categorized them by the presence or absence of early aspirin therapy post-transplant (aspirin treatment ≥6 months in the first year). The association between aspirin use and time to the primary end-point of angiographic moderate or severe CAV (International Society for Heart and Lung Transplantation grade ≥2) was investigated...
July 3, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28775077/chronic-rejection-of-cardiac-allografts-is-associated-with-increased-lymphatic-flow-and-cellular-trafficking
#2
Lindsey A Edwards, Anna K Nowocin, Nazila V Jafari, Lucy Meader, Kathryn Brown, Aurélien Sarde, Carolyn Lam, Alex Murray, Wilson Wong
Background -Cardiac transplantation is an excellent treatment for end-stage heart disease. However, rejection of the donor graft, particularly by chronic rejection leading to cardiac allograft vasculopathy, remains a major cause of graft loss. The lymphatic system plays a crucial role in the alloimmune response, facilitating trafficking of antigen presenting cells (APCs) to draining lymph nodes (dLN). The encounter of APCs with T lymphocytes in secondary lymphoid organs is essential for the initiation of alloimmunity...
August 3, 2017: Circulation
https://www.readbyqxmd.com/read/28754566/impact-of-asymmetric-dimethylarginine-on-coronary-physiology-early-after-heart-transplantation
#3
Rushi V Parikh, Kiran K Khush, Helen Luikart, Vedant S Pargaonkar, Yuhei Kobayashi, Jang Hoon Lee, Seema Sinha, Garrett Cohen, Hannah A Valantine, Alan C Yeung, William F Fearon
Cardiac allograft vasculopathy is a major cause of long-term graft failure following heart transplantation. Asymmetric dimethylarginine (ADMA), a marker of endothelial dysfunction, has been mechanistically implicated in the development of cardiac allograft vasculopathy, but its impact on coronary physiology early after transplantation is unknown. Invasive indices of coronary physiology, namely, fractional flow reserve (FFR), the index of microcirculatory resistance, and coronary flow reserve, were measured with a coronary pressure wire in the left anterior descending artery within 8 weeks (baseline) and 1 year after transplant...
June 29, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28708333/conversion-from-calcineurin-inhibitors-to-mtor-inhibitors-as-primary-immunosuppressive-drugs-in-pediatric-heart-transplantation
#4
Alfred Asante-Korang, Jennifer Carapellucci, Diane Krasnopero, Abigail Doyle, Brian Brown, Ernest Amankwah
There are only a few reports of successful use of mammalian target of rapamycin (mTORI) as primary immunosuppression in pediatric heart transplantation. Compared to calcineurin inhibitors, mTORI have less side effects, especially nephrotoxicity, infections, and malignancies. A retrospective study was conducted at our institution of all 170 heart transplants from 1995 to 2015. Nineteen patients were switched from tacrolimus (n=15) or cyclosporin (n=4) to everolimus (n=4) or sirolimus (n=15) due to nephrotoxicity (n=5), malignancy (n=8), EBV viremia/reactive plasmacytic changes (n=5), and immune hemolytic anemia (n=1)...
July 14, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28672061/thalidomide-treatment-prevents-chronic-graft-rejection-after-aortic-transplantation-in-rats
#5
Katharine K Miller, Dong Wang, Xiaomeng Hu, Xiaoqin Hua, Tobias Deuse, Evgenios Neofytou, Thomas Renne, Joachim Velden, Hermann Reichenspurner, Sonja Schrepfer, Daniel Bernstein
BACKGROUND: Cardiac allograft vasculopathy (CAV) affects approximately 30% of cardiac transplant patients at five years post-transplantation. To date there are few CAV treatment or prevention options, none of which are highly effective. The aim of the study was to investigate the effect of thalidomide on the development of CAV. METHODS: The effect of thalidomide treatment on chronic rejection was assessed in rat orthotopic aortic transplants in allogeneic F344 or syngeneic Lew rats (n=6/group)...
July 3, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/28627046/donor-specific-antibodies-are-associated-with-micro-and-macrovascular-coronary-disease-restrictive-myocardial-damage-and-poor-outcome-in-heart-transplanted-patients
#6
Tor Skibsted Clemmensen, Pernille Koefoed-Nielsen, Lis-Ann Jensen, Steen Hvitfeldt Poulsen, Niels Ramsing Holm, Brian Bridal Løgstrup, Evald Høj Christiansen, Jouke Dijkstra, Kamilla Pernille Bjerre Valen, Hans Eiskjaer
AIMS: We examined the relationship between donor-specific HLA antibody (DSA) presence and graft function, hemodynamics, cardiac allograft vasculopathy (CAV), and major adverse cardiac events (MACE) in stable long-term heart-transplanted (HTx) patients. METHODS: Sera from 79 patients (median 7.5 years after HTx) were analyzed for DSA presence. Graft function was evaluated by echocardiography and right heart catheterization. CAV-burden was determined by coronary angiography, optical coherence tomography (OCT), and coronary flow velocity reserve (CFVR)...
June 19, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28595701/angiotensin-converting-enzyme-inhibitors-for-cardiac-allograft-vasculopathy-after-heart-transplantation
#7
EDITORIAL
Howard J Eisen, Shelley Hankins, Denise Wang
No abstract text is available yet for this article.
June 13, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28595700/angiotensin-converting-enzyme-inhibition-early-after-heart-transplantation
#8
RANDOMIZED CONTROLLED TRIAL
William F Fearon, Kozo Okada, Jon A Kobashigawa, Yuhei Kobayashi, Helen Luikart, Sean Sana, Tiffany Daun, Steven A Chmura, Seema Sinha, Garett Cohen, Yasuhiro Honda, Michael Pham, David B Lewis, Daniel Bernstein, Alan C Yeung, Hannah A Valantine, Kiran Khush
BACKGROUND: Cardiac allograft vasculopathy (CAV) remains a leading cause of mortality after heart transplantation (HT). Angiotensin-converting enzyme inhibitors (ACEIs) may retard the development of CAV but have not been well studied after HT. OBJECTIVES: This study tested the safety and efficacy of the ACEI ramipril on the development of CAV early after HT. METHODS: In this prospective, multicenter, randomized, double-blind, placebo-controlled trial, 96 HT recipients were randomized to undergo ramipril or placebo therapy...
June 13, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28580728/late-graft-failure-in-heart-transplant-recipients-incidence-risk-factors-and-clinical-outcomes
#9
Ángela López-Sainz, Eduardo Barge-Caballero, Gonzalo Barge-Caballero, David Couto-Mallón, María J Paniagua-Martin, Leticia Seoane-Quiroga, Carmen Iglesias-Gil, José M Herrera-Noreña, José J Cuenca-Castillo, José M Vázquez-Rodríguez, María G Crespo-Leiro
AIM: To analyse the incidence, risk factors and clinical outcomes of late graft failure after heart transplantation. METHODS AND RESULTS: We conducted an observational, single-centre study based on 547 patients who underwent cardiac transplantation from 1991 to 2014 and who survived the in-hospital postoperative period. Late graft failure was defined as the first hospitalization due to this condition after discharge. Over a mean follow-up of 8.4 ± 6, 178 (32...
June 5, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28579240/first-observation-of-a-golden-tube-after-complete-resorption-of-a-bioresorbable-vascular-scaffold-in-a-transplanted-patient-with-cardiac-allograft-vasculopathy
#10
Flavio Ribichini, Roberto Scarsini, Claudia Zanetti, Gabriele Pesarini
No abstract text is available yet for this article.
May 25, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28516902/role-of-transient-receptor-potential-channels-in-heart-transplantation-a-potential-novel-therapeutic-target-for-cardiac-allograft-vasculopathy
#11
Shuo Ma, Yue Jiang, Weiting Huang, Xintao Li, Shuzhuang Li
Heart transplantation has evolved as the criterion standard therapy for end-stage heart failure, but its efficacy is limited by the development of cardiac allograft vasculopathy (CAV), a unique and rapidly progressive form of atherosclerosis in heart transplant recipients. Here, we briefly review the key processes in the development of CAV during heart transplantation and highlight the roles of transient receptor potential (TRP) channels in these processes during heart transplantation. Understanding the roles of TRP channels in contributing to the key procedures for the development of CAV during heart transplantation could provide basic scientific knowledge for the development of new preventive and therapeutic approaches to manage patients with CAV after heart transplantation...
May 18, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/28501318/mortality-rehospitalization-and-post-transplant-complications-in-gender-mismatched-heart-transplant-recipients
#12
MULTICENTER STUDY
Anne Jalowiec, Kathleen L Grady, Connie White-Williams
BACKGROUND: Limited research has been published on outcomes in heart transplant (HT) recipients with gender-mismatched donors. OBJECTIVE: Compare 3-year post-transplant outcomes in 2 groups of gender-mismatched HT recipients and a no-mismatch group. METHODS: Sample: 347 HT recipients: 21.3% (74) received a heart from the opposite gender: Group 1: same gender donor/recipient (273, 78.7%); Group 2: female donor/male recipient (40, 11.5%); Group 3: male donor/female recipient (34, 9...
July 2017: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/28465118/development-and-validation-of-a-major-adverse-transplant-event-mate-score-to-predict-late-graft-loss-in-pediatric-heart-transplantation
#13
Christopher S Almond, Helena Hoen, Joseph W Rossano, Chesney Castleberry, Scott R Auerbach, Lingyao Yang, Ashwin K Lal, Melanie D Everitt, Matthew Fenton, Seth A Hollander, Elfriede Pahl, Elizabeth Pruitt, David N Rosenthal, Doff B McElhinney, Kevin P Daly, Manisha Desai
BACKGROUND: There is inadequate power to perform a valid clinical trial in pediatric heart transplantation (HT) using a conventional end-point, because the disease is rare and hard end-points, such as death or graft loss, are infrequent. We sought to develop and validate a surrogate end-point involving the cumulative burden of post-transplant complications to predict death/graft loss to power a randomized clinical trial of maintenance immunosuppression in pediatric HT. METHODS: Pediatric Heart Transplant Study (PHTS) data were used to identify all children who underwent an isolated orthotopic HT between 2005 and 2014 who survived to 6 months post-HT...
March 24, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28463861/everolimus-immunosuppression-for-renal-protection-reduction-of-allograft-vasculopathy-and-prevention-of-allograft-rejection-in-de-novo-heart-transplant-recipients-could-we-have-it-all
#14
Einar Gude, Lars Gullestad, Arne K Andreassen
PURPOSE OF REVIEW: De-novo introduction of everolimus (Eve) in heart transplant recipients opens for early reduction of calcineurin inhibitors (CNI) and potential of preserving renal function, attenuate progression of coronary allograft vasculopathy (CAV) and maintain rejection efficacy. RECENT FINDINGS: The first trials demonstrated adequate rejection prophylaxis and favorable outcomes on CAV, but observed enhanced nephrotoxicity because of insufficient CNI reduction...
June 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28425200/high-dose-calcineurin-inhibitor-free-everolimus-as-a-maintenance-regimen-for-heart-transplantation-may-be-a-risk-factor-for-pneumocystis-pneumonia
#15
Yu-Ning Hu, Nan-Yao Lee, Jun-Neng Roan, Chi-Hsin Hsu, Chwan-Yau Luo
BACKGROUND: Everolimus reduces the incidence of cardiac-allograft vasculopathy (CAV) and is less renally toxic than are calcineurin inhibitors (CNIs). We evaluated the safety of CNI-free everolimus for post-heart transplant (HTx) patients. METHODS: We retrospectively reviewed the records of 36 consecutive patients who had undergone an HTx between January 2006 and December 2013 in National Cheng Kung University Hospital. All patients initially had been treated with the standard tacrolimus regimen...
August 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/28413189/heart-transplantation-in-asia
#16
Hae-Young Lee, Byung-Hee Oh
Heart transplantation (HTx) is the effective way to improve quality of life as well as survival in terminal heart failure (HF) patients. Since the first heart transplant in 1968 in Japan and in earnest in 1987 at Taiwan, HTx has been continuously increasing in Asia. Although the current percentage of heart transplants from Asia comprises only 5.7% of cases in the International Society of Heart and Lung Transplantation (ISHLT) registry, the values were under-reported and soon will be greatly increased. HTx in Asia shows comparable with or even better results compared with ISHLT registry data...
April 11, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28394814/percutaneous-mechanical-circulatory-support-using-impella%C3%A2-devices-for-decompensated-cardiogenic-shock-a-pediatric-heart-center-experience
#17
Dhaval Parekh, Aamir Jeewa, Sebastian C Tume, William J Dreyer, Ricardo Pignatelli, David Horne, Henri Justino, Athar M Qureshi
Cardiogenic shock remains a significant cause of mortality and morbidity in children with heart failure. Percutaneous mechanical circulatory support may be an additional tool to augment left heart support and decompression in addition to conventional therapies. This report aims to review the clinical and hemodynamic outcomes of the Impella® device at a pediatric center. A retrospective review of all implants between October 2014 and November 2016 was conducted. Clinical outcomes, device implant techniques, complications, and hemodynamic data were collected...
April 6, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28390683/prognostic-utility-of-right-ventricular-free-wall-strain-in-low-risk-patients-after-orthotopic-heart-transplantation
#18
Amr F Barakat, Brett W Sperry, Randall C Starling, Amgad Mentias, Zoran B Popovic, Brian P Griffin, Milind Y Desai
Global longitudinal strain (GLS) by speckle-tracking echocardiography is a sensitive measure of regional left and right ventricular (LV and RV) dysfunction, before onset of overt systolic dysfunction. We sought to evaluate the prognostic utility of measuring LV-GLS and RV free wall strain (FWS) in low risk patients at 1 year after orthotopic heart transplantation (OHT). We retrospectively studied 96 OHT recipients (age 52 ± 14 years, 64% men) free of antibody-mediated rejection or moderate to severe coronary allograft vasculopathy (CAV, grade 2 to 3) at 1 year after transplant...
June 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28347533/influence-of-drugs-carried-in-lipid-nanoparticles-in-coronary-disease-of-rabbit-transplanted-heart
#19
Lucas R Barbieri, Domingos D Lourenço-Filho, Elaine R Tavares, Priscila O Carvalho, Paulo S Gutierrez, Raul C Maranhão, Noedir A G Stolf
BACKGROUND: Coronary allograft vasculopathy is an inflammatory-proliferative process that compromises the long-term success of heart transplantation and currently has no effective prevention and treatment. Lipid nanoparticles, termed LDE can carry chemotherapeutic agents in the circulation and concentrates them in the heart. METHODS: Twenty-eight rabbits fed a cholesterol-rich diet and submitted to heterotopic heart transplantation were treated with cyclosporine A (10 mg/kg daily) and allocated to four groups of 7 animals treated with intravenous LDE-methotrexate (MTX; 4 mg/kg weekly), with LDE-paclitaxel (PACLI; 4 mg/kg weekly), or with LDE-PACLI (4 mg/kg weekly) and LDE-MTX (4 mg/kg weekly)...
August 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28330670/layered-fibrotic-plaques-are-the-predominant-component-in-cardiac%C3%A2-allograft-vasculopathy-systematic-findings-and-risk-stratification-by-oct
#20
Tor Skibsted Clemmensen, Niels Ramsing Holm, Hans Eiskjær, Brian Bridal Løgstrup, Evald Høj Christiansen, Jouke Dijkstra, Trine Ørhøj Barkholt, Christian Juhl Terkelsen, Michael Maeng, Steen Hvitfeldt Poulsen
OBJECTIVES: The aims of this study were to characterize cardiac allograft vasculopathy (CAV) phenotypes using optical coherence tomography (OCT) and to evaluate the prognostic significance of OCT-determined CAV severity. BACKGROUND: Intravascular OCT enables in vivo characterization of CAV microstructure after heart transplantation. METHODS: Sixty-two patients undergoing heart transplantation were enrolled at routine angiography from September 2013 through October 2015 and prospectively followed until censoring on May 27, 2016...
July 2017: JACC. Cardiovascular Imaging
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