Cardiac retransplantation is an efficacious therapy for primary cardiac allograft failure

Atluri, Pavan; Hiesinger, William; Gorman, Robert C.; Pochettino, Alberto; Jessup, Mariell; Acker, Michael A.; Morris, Rohinton J.; Woo, Y. Joseph

doi:10.1186/1749-8090-3-26

Cited by 33 publications

(21 citation statements)

References 22 publications

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“…[5][6][7][8][9][10][11][12][13] Most reports suggest caution about retransplantation because its outcomes are inferior to those of primary transplantation, and conclude that retransplantation should thus be considered only for select patients. On the other hand, Atluri and colleagues 12 found that meticulous perioperative care improved the results of retransplantation and concluded that it was an efficacious procedure with potentially wider application. A recent report on 23 patients who had retransplantations over a RESEARCH 25-year period at an experienced heart transplant centre suggested improved late survival results when repeat transplantation was performed for graft vascular disease or chronic graft failure.…”

Section: Discussionmentioning

confidence: 99%

Early and late outcomes after cardiac retransplantation

Saito¹,

Novick²,

Kiaii³

et al. 2013

Can J Surg

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Background: Cardiac retransplantation remains the most viable option for patients with allograft heart failure; however, careful patient selection is paramount considering limited allograft resources. We analyzed clinical outcomes following retransplantation in an academic, tertiary care institution. Methods:Between 1981 and 2011, 593 heart transplantations, including 22 retransplantations were performed at our institution. We analyzed the preoperative demographic characteristics, cause of allograft loss, short-and long-term surgical outcomes and cause of death among patients who had cardiac retransplantations.Results: Twenty-two patients underwent retransplantation: 10 for graft vascular disease, 7 for acute rejection and 5 for primary graft failure. Mean age at retransplantation was 43 (standard deviation [SD] 15) years; 6 patients were women. Thirteen patients were critically ill preoperatively, requiring inotropes and/or mechanical support. The median interval between primary and retransplantation was 2.2 (range 0-16) years. Thirty-day mortality was 31.8%, and conditional (> 30 d) 1-, 5-and 10-year survival after retransplantation were 93%, 79% and 59%, respectively. A diagnosis of allograft vasculopathy (p = 0.008) and an interval between primary and retransplantation greater than 1 year (p = 0.016) had a significantly favourable impact on 30-day mortality. The median and mean survival after retransplantation were 3.3 and 5 (SD 6, range 0-18) years, respectively; graft vascular disease and multiorgan failure were the most common causes of death. Conclusion:Long-term outcomes for primary and retransplantation are similar if patients survive the 30-day postoperative period. Retransplantation within 1 year of the primary transplantation resulted in a high perioperative mortality and thus may be a contraindication to retransplantation. Contexte :Une nouvelle transplantation cardiaque demeure l'option la plus viable pour les patients qui présentent une insuffisance de leur coeur transplanté. Il est toutefois crucial de bien sélectionner les patients, compte tenu du nombre limité d'organes disponibles. Nous avons analysé les résultats cliniques des secondes transplantations cardiaques dans un établissement universitaire de soins tertiaires. Méthodes :Entre 1981 et 2011, on a procédé dans notre établissement à 593 transplantations cardiaques, dont 22 secondes transplantations. Nous avons analysé les carac téristiques démographiques préopératoires, la cause de la perte du coeur transplanté, les résultats chirurgicaux à court et à long terme et la cause de mortalité chez les patients soumis à une seconde transplantation.

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Section: Discussionmentioning

confidence: 99%

Early and late outcomes after cardiac retransplantation

Saito¹,

Novick²,

Kiaii³

et al. 2013

Can J Surg

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“…Previous studies have demonstrated that outcomes of cardiac re-transplantation are worse compared with those of the first transplant (1-3), while cardiac re-transplantation is thought to be a sole definitive treatment strategy for cardiac allograft failure (4).…”

Section: Introductionmentioning

confidence: 99%

Inhibition of C‑X‑C motif chemokine 10 reduces graft loss mediated by memory CD8+ T cells in a rat cardiac re‑transplant model

Deng

et al. 2017

Exp Ther Med

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Abstract. The interaction of chemokine (C-X-C motif) ligand 10 (CXCL10) with its receptor (CXCR3) is a critical process in recruiting donor reactive T cells to a graft and alloantigen-specific memory T (Tm) cells exert a principal function in promoting graft dysfunction during accelerated cardiac rejection. However, whether CXCL10 chemokine exerts any effects on acute accelerated rejection mediated by CD8 + Tm cells in a re-transplant model has remained elusive. The present study established a cardiac transplant model by advanced microsurgery technology and improved organ storage. A novel rat model of cardiac re-transplantation was established at 40 days following primary heart transplant. The experiment included two parts, and when models were established, the rats were divided into two groups: Primary cardiac transplant (HTx) and re-transplantation without treatment (HRTx). In part 1, recipients from part 2, including re-transplantation without treatment (HRTx+NS) and re-transplantation treated with anti-CXCL10 antibodies (500 µg every other day by intraperitoneal injection; HRTx+CXCL10 Abs group). The graft survival time was observed and graft infiltration by inflammatory cells was assessed via histology of cardiac graft sections; in addition, the gene expression and the serum concentration of CXCL10 in each group was assessed. Indexes such as rejection-associated cytokines were assayed by reverse-transcription quantitative PCR and ELISA kits, and flow cytometry of splenocytes was used to detect Tm cells in the re-transplantation groups. The results demonstrated that level of CXCL10 was significantly increased and the graft mean survival time was shortened accompanied with aggravated lymphocyte cell infiltration in the HRTx group when compared that in the HTx group; in addition, the serum levels and mRNA expression of interleukin (IL)-2 and interferon (IFN)-γ were increased, while transforming growth factor (TGF)-β was decreased in the HRTx group. Furthermore, neutralization of CXCL10 prolonged the graft mean survival time and delayed accelerated rejection. Compared with that in the HRTx+NS group, serum levels and graft tissue mRNA expression of IFN-γ and IL-2 were decreased in the HRTx+CXCL10 Abs group, while TGF-β mRNA was significantly increased but the serum concentration was not significantly affected. In addition, there was no difference in IL-10 between the two groups, while delayed accelerated rejection paralleled with inflammatory cell infiltration decreased and the proliferation and differentiation of CD8 + Tm cells in secondary lymphoid organs were reduced in the HRTx+CXCL10 Abs group vs. those in the HRTx+NS group. The present study demonstrated that CXCL10 had a crucial role in cardiac transplantation and re-transplantation, and that treatment with CXCL10 antibodies delays accelerated acute rejection mediated by Tm cells in a rat model of cardiac re-transplantation. IntroductionA multidisciplinary program has been initiated to better establish transplantation for prolonging survival time of cardi...

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“…Популяция реципиентов с трансплантирован-ным сердцем непрерывно увеличивается [2], что ведет к возрастанию числа пациентов с недоста-точностью сердечного трансплантата (НСТ). НСТ чаще всего обусловлена одной из трех причин: острое отторжение, первичная НСТ, васкулопатия трансплантированного сердца (ВТС).…”

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“…Несомненно, возможность и клинический успех выполнения РеТС определяются клиническим опы-том и объемом выполняемых операций в конкрет-ном клиническом центре. В течение двух последних десятилетий был накоплен значительный опыт в пред-, интра-и постоперационном ведении паци-ентов с трансплантированным сердцем [2], пред-ложены критерии подбора донора и реципиента, изучены различные интра-и периоперационные технологические аспекты, достигнут значительный успех в иммуносупрессивной терапии.…”

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“…Atluri и соавт. оценивали выживаемость и основ-ные характеристики постоперационного периода у 15 реципиентов, перенесших ретрансплантацию сердца (всего за данный промежуток времени в центре было выполнено 709 трансплантаций сер-дца) [2]. Средний возраст пациента на момент ре-трансплантации составлял 45,5 ± 9,7 года.…”

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Heart Retransplantation

Саитгареев

Захаревич

Гольц

et al. 2016

RJTAO

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1 ФГБУ «ФНЦ трансплантологии и искусственных органов им. академика В.И. Шумакова» Минздрава России, Москва, Российская Федерация 2 Кафедра трансплантологии и искусственных органов ГБОУ ВПО «Первый МГМУ им. Сеченова» Минздрава России, Москва, Российская Федерация Популяция пациентов с трансплантированным сердцем непрерывно увеличивается. Как следствие, возрастает количество пациентов, нуждающихся в ретрансплантации сердца (РеТС). В данном обзоре литературы представлен анализ результатов опубликованных исследований, посвященных изучению и безопасности РеТС и факторов риска нежелательных событий в периоперационном и отдаленном перио-дах. Результаты опубликованных исследований свидетельствуют о том, что РеТC, являющаяся основным радикальным методом лечения дисфункции сердечного трансплантата, несколько уступает первичной трансплантации сердца (ТС), однако может иметь благоприятный отдаленный прогноз, если будет вы-полняться по показаниям у отдельных групп пациентов. The number of patients with transplanted heart is continuously increasing; therefore, the number of patients requiring heart retransplantation grows. Analysis of the results of published studies focused on safety of cardiac retransplantation and risk factors for adverse events in perioperative, early and late postoperative periods is presented in our review. The results of published studies suggest that heart retransplantation is the main radical treatment option for cardiac allograft dysfunction, but the results of heart retransplantation are slightly worse than those of primary cardiac transplantation. On the other hand, the favorable long-term prognosis after heart retransplantation should be expected in carefully selected recipients.

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Cardiac retransplantation is an efficacious therapy for primary cardiac allograft failure

Cited by 33 publications

References 22 publications

Early and late outcomes after cardiac retransplantation

Early and late outcomes after cardiac retransplantation

Inhibition of C‑X‑C motif chemokine 10 reduces graft loss mediated by memory CD8+ T cells in a rat cardiac re‑transplant model

Heart Retransplantation

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