Browsing by Subject "Heart transplant"
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Item Adult cardiac transplantation utilizing donors after circulatory death(AME, 2024) Rajah, Tanisha; Blitzer, David; Silvestry, Scott; Copeland, Hannah; Surgery, School of MedicineDonation after circulatory death (DCD) presents both opportunities and challenges in the realm of heart transplantation. Its emergence holds promise for narrowing the gap between patients in need of organs and the available donor pool. The rapid emergence of DCD use has allowed heart transplant volume to increase worldwide. Long-term outcomes and best practices remain to be defined and are important considerations in the wider use of these techniques in a broad selection of patients to understand best use and practice moving forward. Expanding DCD donation entails substantial resource allocation, coordination efforts, and training initiatives. Moving forward, standardization is imperative, particularly in aspects such as "stand-off" time, warm ischemic time (WIT), and perfusate composition.Item Circumstances Surrounding End-of-Life in Pediatric Patients Pre- and Post-Heart Transplant: A Report from the Pediatric Heart Transplant Society(Wiley, 2022) Cousino, Melissa K.; Yu, Sunkyung; Blume, Elizabeth D.; Henderson, Heather T.; Hollander, Seth A.; Khan, Sairah; Parent, John Jerry; Schumacher, Kurt R.; Pediatrics, School of MedicineBackground: Although mortality has decreased considerably in pediatric heart transplantation, waitlist and post-transplant death rates remain notable. End-of-life focused research in this population, however, is very limited. This Pediatric Heart Transplant Society study aimed to describe the circumstances surrounding death of pediatric heart transplant patients. Methods: A retrospective analysis of the multi-institutional, international, Pediatric Heart Transplant Society registry was conducted. Descriptive statistics and univariate analyses were performed to 1) describe end-of-life in pediatric pre- and post-heart transplant patients and 2) examine associations between location of death and technological interventions at end-of-life with demographic and disease factors. Results: Of 9217 patients (0-18 years) enrolled in the registry between 1993 and 2018, 2804 (30%) deaths occurred; 1310 while awaiting heart transplant and 1494 post-heart transplant. The majority of waitlist deaths (89%) occurred in the hospital, primarily in ICU (74%) with most receiving mechanical ventilation (77%). Fewer post-transplant deaths occurred in the hospital (22%). Out-of-hospital death was associated with older patient age (p < .01). Conclusions: ICU deaths with high use of technological interventions at end-of-life were common, particularly in patients awaiting heart transplant. In this high mortality population, findings raise challenging considerations for clinicians, families, and policy makers on how to balance quality of life amidst high risk for hospital-based death.Item Donor heart selection: Evidence-based guidelines for providers(Elsevier, 2023) Copeland, Hannah; Knezevic, Ivan; Baran, David A.; Rao, Vivek; Pham, Michael; Gustafsson, Finn; Pinney, Sean; Lima, Brian; Masetti, Marco; Ciarka, Agnieszka; Rajagopalan, Navin; Torres, Adriana; Hsich, Eileen; Patel, Jignesh K.; Adams Goldraich, Livia; Colvin, Monica; Segovia, Javier; Ross, Heather; Ginwalla, Mahazarin; Sharif-Kashani, Babak; Farr, MaryJane A.; Potena, Luciano; Kobashigawa, Jon; Crespo-Leiro, Maria G.; Altman, Natasha; Wagner, Florian; Cook, Jennifer; Stosor, Valentina; Grossi, Paolo A.; Khush, Kiran; Yagdi, Tahir; Restaino, Susan; Tsui, Steven; Absi, Daniel; Sokos, George; Zuckermann, Andreas; Wayda, Brian; Felius, Joost; Hall, Shelley A.; Medicine, School of MedicineThe proposed donor heart selection guidelines provide evidence-based and expert-consensus recommendations for the selection of donor hearts following brain death. These recommendations were compiled by an international panel of experts based on an extensive literature review.Item Epidemiology and risk factors for varicella zoster virus reactivation in heart transplant recipients(Wiley, 2021) La Hoz, Ricardo M.; Wallace, Ashley; Barros, Nicolas; Xie, Donglu; Hynan, Linda S.; Liu, Terrence; Yek, Christina; Schexnayder, Scott; Grodin, Justin L.; Garg, Sonia; Drazner, Mark H.; Peltz, Matthias; Haley, Robert W.; Greenberg, David E.; Medicine, School of MedicineHeart transplant (HT) recipients are at higher risk of varicella zoster virus (VZV) reactivation. Risk factors for VZV reactivation are currently not well defined, impeding the ability to design and implement strategies to minimize the burden of this illness in this population. Automated data extraction tools were used to retrieve data from the electronic health record (EHR) of all adult HT recipients at our center between 2010 and 2016. Information from the Organ Procurement and Transplantation Network Standard Analysis and Research Files was merged with the extracted data. Potential cases were manually reviewed and adjudicated using consensus definitions. Cumulative incidence and risk factors for VZV reactivation in HT recipients were assessed by the Kaplan-Meier method and Cox modeling, respectively. In 203 HT recipients, the cumulative incidence of VZV reactivation at 8-years post-transplantation was 26.4% (95% CI: 17.8-38.0). The median time to VZV reactivation was 2.1 years (IQR, 1.5-4.1). Half (14/28) of the cases experienced post-herpetic neuralgia (PHN). Post-transplant CMV infection (HR 9.05 [95% CI: 3.76-21.77) and post-transplant pulse-dose steroids (HR 3.19 [95% CI: 1.05-9.68]) were independently associated with a higher risk of VZV reactivation in multivariable modeling. Identification of risk factors will aid in the development of targeted preventive strategies.Item Equity in Heart Transplant Allocation: Intended Progress Up the Hill or an Impossibility?(American Heart Association, 2021) Lewsey, Sabra C.; Breathett, Khadijah; Medicine, School of MedicineItem Modeling the Potential of Treg-Based Therapies for Transplant Rejection: Effect of Dose, Timing, and Accumulation Site(Frontiers Media, 2022-04-11) Lapp, Maya M.; Lin, Guang; Komin, Alexander; Andrews, Leah; Knudson, Mei; Mossman, Lauren; Raimondi, Giorgio; Arciero, Julia C.; Mathematical Sciences, School of ScienceIntroduction: The adoptive transfer of regulatory T cells (Tregs) has emerged as a method to promote graft tolerance. Clinical trials have demonstrated the safety of adoptive transfer and are now assessing their therapeutic efficacy. Strategies that generate large numbers of antigen specific Tregs are even more efficacious. However, the combinations of factors that influence the outcome of adoptive transfer are too numerous to be tested experimentally. Here, mathematical modeling is used to predict the most impactful treatment scenarios. Methods: We adapted our mathematical model of murine heart transplant rejection to simulate Treg adoptive transfer and to correlate therapeutic efficacy with Treg dose and timing, frequency of administration, and distribution of injected cells. Results: The model predicts that Tregs directly accumulating to the graft are more protective than Tregs localizing to draining lymph nodes. Inhibiting antigen-presenting cell maturation and effector functions at the graft site was more effective at modulating rejection than inhibition of T cell activation in lymphoid tissues. These complex dynamics define non-intuitive relationships between graft survival and timing and frequency of adoptive transfer. Conclusion: This work provides the framework for better understanding the impact of Treg adoptive transfer and will guide experimental design to improve interventions.Item Relationships Between 2018 UNOS Heart Policy and Transplant Outcomes In Metropolitan, Micropolitan, and Rural Settings(Elsevier, 2022) Breathett, Khadijah; Knapp, Shannon M.; Addison, Daniel; Johnson, Amber; Shah, Rashmee U.; Flint, Kelsey; Van Spall, Harriette G. C.; Sweitzer, Nancy K.; Mazimba, Sula; Medicine, School of MedicineBackground: In 2018, United Network for Organ Sharing (UNOS) extended the radius for which a heart transplant candidate can match with a donor, and outcomes across population densities are unknown. We sought to determine whether the policy change was associated with differences in heart transplant waitlist time or death post-transplant for patients from rural, micropolitan, and metropolitan settings. Methods: Using the Scientific Registry of Transplant Recipients, we evaluated U.S. adult patients listed for heart transplant from Janurary 2017 to September 2019 with follow-up through March 2020. Patients were stratified by home zip-codes to either metropolitan, micropolitan, or rural settings. Fine and Gray and Cox models were respectively used to estimate Sub-distribution hazard ratios (SHR) of heart transplant with death or removal from transplant list as a competing event, and HR of death post-transplant within population densities after versus before the UNOS policy change date, October 18, 2018. Analyses were adjusted for demographics, comorbidities, and labs. Results: Among 8,747 patients listed for heart transplant, 84.7% were from metropolitan, 8.6% micropolitan, and 6.6% rural settings. The 2018 UNOS policy was associated with earlier receipt of heart transplant for metropolitan [SHR 1.56 (95% CI: 1.46-1.66)] and micropolitan [SHR 1.48 (95% CI: 1.21-1.82)] populations, but not significantly for rural [SHR 1.20 (95% CI: 0.93-1.54)]; however, the interaction between policy and densities was not significant (p = .14). Policy changes were not associated with risk of death post-transplant [metropolitan: HR 1.04 (95% CI: 0.80-1.34); micropolitan: HR 1.10 (95% CI: 0.55-2.23); rural: HR 1.04 (95% CI: 0.52-2.08); interaction p = .99]. Conclusions: The 2018 UNOS heart transplant policy was associated with earlier receipt of heart transplant and no difference in post-transplant survival within population densities. Additional follow-up is needed to determine whether improvements are sustained.Item SARS-CoV-2 infection in heart transplant recipients: a systematic literature review of clinical outcomes and immunosuppression strategies(Springer, 2021-10-20) Ilonze, Onyedika J.; Ballut, Kareem; Rao, Roopa S.; Jones, Mark A.; Guglin, Maya; Medicine, School of MedicineThe impact of SARS-CoV-2 infection on heart transplant recipients is unknown. Literature is limited to case reports and series. The purpose of this study is to identify the clinical features, outcomes, and immunosuppression strategies of heart transplant recipients with COVID-19 infection. A systematic review was conducted using the search term “Coronavirus” or COVID,” “SARS-CoV-2,” “cardiac transplantation,” and “heart transplant.” Case reports and retrospective studies were gathered by searching Medline/PubMed, Google Scholar, CINAHL, Cochrane CENTRAL, and Web of Science. Thirty-three articles were selected for review. We identified 74 cases of SARS-CoV-2 infection in heart transplant and heart-kidney transplant recipients. The mean age was 60.5 ± 15.8 years, and 82.4% were males with median time from transplant of 6.5 years. Commonest symptoms were fever, cough, and dyspnea, but new left ventricular (LV) dysfunction was rare. Leukocytosis, lymphopenia, elevated inflammatory markers, and bilateral ground-glass opacities were common. Mortality was high, with particularly poor survival in patients who required intensive care unit (ICU) admission and older patients. Immunosuppression involved discontinuation of antimetabolites and steroids. COVID-19 infection in heart transplant (HT) recipients presents similarly to the general population, but new onset of LV dysfunction is uncommon. Immunosuppression strategies include increase in corticosteroids and discontinuation of antimetabolites.Item Special Considerations in the Care of Women With Advanced Heart Failure(Frontiers Media, 2022-07-11) Ebong, Imo A.; DeFilippis, Ersilia M.; Hamad, Eman A.; Hsich, Eileen M.; Randhawa, Varinder K.; Billia, Filio; Kassi, Mahwash; Bhardwaj, Anju; Byku, Mirnela; Munagala, Mrudala R.; Rao, Roopa A.; Hackmann, Amy E.; Gidea, Claudia G.; DeMarco, Teresa; Hall, Shelley A.; Medicine, School of MedicineAdvanced heart failure (AHF) is associated with increased morbidity and mortality, and greater healthcare utilization. Recognition requires a thorough clinical assessment and appropriate risk stratification. There are persisting inequities in the allocation of AHF therapies. Women are less likely to be referred for evaluation of candidacy for heart transplantation or left ventricular assist device despite facing a higher risk of AHF-related mortality. Sex-specific risk factors influence progression to advanced disease and should be considered when evaluating women for advanced therapies. The purpose of this review is to discuss the role of sex hormones on the pathophysiology of AHF, describe the clinical presentation, diagnostic evaluation and definitive therapies of AHF in women with special attention to pregnancy, lactation, contraception and menopause. Future studies are needed to address areas of equipoise in the care of women with AHF.Item Veno-venous ECLS rescue for a heart transplant recipient with COVID-19, a case report(Sage, 2023) Copeland, Hannah; Baran, David A.; Morton, John; Rodriguez, Vicente; Fernandes, Eustace; Mohammed, Asim; Surgery, School of MedicineThe potential for increased rates of morbidity of SARS-CoV-2 within immunocompromised populations has been of concern since the pandemic’s onset. Transplant providers and patients can face particularly challenging situations, in the current settings as data continues to emerge for the prevention and treatment of the immunocompromised subpopulation. This case report details a patient 9-months post orthotopic heart transplant that developed SARS-CoV-2 infection despite two prior doses of the Pfizer-BioNtech COVID-19 vaccine, and had successful rescue from refractory hypoxemia with veno-venous extracorporeal membrane oxygenation (VV ECLS).