Conditional Survival in Heart Transplantation: An Organ Procurement and Transplantation Network Database Analysis

Suarez‐Pierre, Alejandro; Lui, Cecillia; Zhou, Xun; Fraser, Charles D.; Ferrigno, Ana S.; Etchill, Eric W.; Giuliano, Katherine; Higgins, Robert S.D.; Choi, Chun Woo; Kilic, Ahmet

doi:10.1016/j.athoracsur.2020.02.014

Cited by 12 publications

(7 citation statements)

References 23 publications

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“…Our institutional conditional survival rates were comparable to the rates reported for de novo or post long-term circulatory support transplant recipients in large American databases or European transplant centers within the Eurotransplant or Scandiatransplant region [19][20][21][22].…”

Section: Discussionsupporting

confidence: 73%

Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation

Just

Guelfirat

Leser

et al. 2021

Life

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Background: Despite the risk for complications, allograft surveillance after orthotopic heart transplantation (OHT) is performed by cardiac catheterization and biopsies. We investigated the diagnostic and prognostic value of a TDI-derived systolic wall motion analysis of the posterobasal wall of the left ventricle (Sm) as a screening modality in OHT aftercare. Methods: We examined data of 210 eligible patients who underwent OHT between 2010 and 2020. Forty-four patients who had died within the initial hospital stay were excluded. For 166 patients, baseline and follow-up data were analyzed. The mean age at OHT was 46.2 (±11.4) years; 76.5% were male. Results: Within the observational period, 22 (13.3%) patients died. In total, 170 episodes of acute cellular or humoral rejections occurred (84 ISHLT1R; 13 ISHLT2R; 8 ISHLT3R; 65 AMR), and 29 catheterizations revealed cardiac allograft vasculopathy (5 CAV1; 4 CAV2; 20 CAV3). Individual Sm radial/longitudinal remained stable within the follow-up period (11.5 ± 2.2 cm/s; 10.9 ± 2.1 cm/s). Patients with acute rejections and CAV3 showed significant Sm radial/longitudinal reductions (AMR1: 1.6 ± 1.9 cm/s, confidence interval (CI) 0.77–0.243, p < 0.001; 1.8 ± 2.0 cm/s, CI 0.92–0.267, p < 0.001. ISHLT1R: 1.7 ± 1.8 cm/s, CI 1.32–2.08, p < 0.001; 2.0 ± 1.6 cm/s, CI 1.66–2.34, p < 0.001. CAV3: 1.3 ± 2.5 cm/s, CI 0.23–2.43, p < 0.017; 1.4 ± 2.8 cm/s, CI 0.21–2.66, p < 0.021). Lower Sm was associated with a threefold increase in all-cause mortality (hazard ratio (HR) 3.24, CI 1.2–8.76, p = 0.020; HR 2.92, CI 1.19–7.18, p = 0.019). Overall, Sm-triggered surveillance led to 0.75 invasive diagnostics per patient post-OHT year. Conclusions: Sm remained stable in the post-OHT course. Reductions indicated ISHLT1R, AMR1 and CAV3 and were associated with higher all-cause mortality. Sm-triggered surveillance may be referred to as a safe, high-yield screening modality in OHT aftercare.

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Section: Discussionsupporting

confidence: 73%

Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation

Just

Guelfirat

Leser

et al. 2021

Life

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“…Currently, the survival of patients receiving organ transplantation remains unsatisfactory, with a five-year survival of 89.6% ( 75 ), 86.6% ( 76 ), and 77% ( 77 ) in the liver, kidney, and heart transplantation, respectively. Although immunosuppression has been widely used to inhibit acute graft- vs -host disease after organ transplantation ( 78 ), many complications (like heart failure or acute kidney injury) increase morbidity and mortality ( 79 ).…”

Section: Discussionmentioning

confidence: 99%

Placental Immune Tolerance and Organ Transplantation: Underlying Interconnections and Clinical Implications

Sun

Jiang

et al. 2021

Front. Immunol.

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The immune system recognizes and attacks non-self antigens, making up the cornerstone of immunity activity against infection. However, during organ transplantation, the immune system also attacks transplanted organs and leads to immune rejection and transplantation failure. Interestingly, although the embryo and placenta are semi-allografts, like transplanted organs, they can induce maternal tolerance and be free of a vigorous immune response. Also, embryo or placenta-related antibodies might adversely affect subsequent organ transplantation despite the immune tolerance during pregnancy. Therefore, the balance between the immune tolerance in maternal-fetal interface and normal infection defense provides a possible desensitization and tolerance strategy to improve transplantation outcomes. A few studies on mechanisms and clinical applications have been performed to explore the relationship between maternal-fetal immune tolerance and organ transplantation. However, up to now, the mechanisms underlying maternal-fetal immune tolerance remain vague. In this review, we provide an overview on the current understanding of immune tolerance mechanisms underlying the maternal-fetal interface, summarize the interconnection between immune tolerance and organ transplantation, and describe the adverse effect of pregnancy alloimmunization on organ transplantation.

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“…For this analysis, the risk set population was restricted only to recipients who survived the first year after transplant, as previously described. 19 Univariate and multivariable Cox regressions were used to compare survival by bridging strategy as previously mentioned.…”

Section: Methodsmentioning

confidence: 99%

“…Compared to no-BTT recipients, MV-only BTT recipients were more likely to be intubated at 72 hours posttransplant (67.4% vs. 23.4%, adjusted odds ratio [aOR] = 4.60 [95% CI: 2.86-7.38], p < 0.001; Table 3) and had longer median hospital lengths of stay (27 [18][19][20][21][22][23][24] vs. 16 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]…”

Section: Perioperative Outcomesmentioning

confidence: 99%

Outcomes of Recipients Aged 65 Years and Older Bridged to Lung Transplant With Extracorporeal Membrane Oxygenation

Zhou,

Jenkins,

Ruck

et al. 2023

ASAIO Journal

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Extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplant (BTT) has been used for critically ill candidates with excellent outcomes, but data on this strategy in older recipients remain limited. We compared outcomes of no BTT, mechanical ventilation (MV)-only BTT, and ECMO BTT in recipients of greater than or equal to 65 years. Lung-only recipients of greater than or equal to 65 years in the United Network for Organ Sharing database between 2008 and 2022 were included and stratified by bridging strategy. Of the 9,936 transplants included, 226 (2.3%) were MV-only BTT and 159 (1.6%) were ECMO BTT. Extracorporeal membrane oxygenation BTT recipients were more likely to have restrictive disease pathology, had higher median lung allocation score, and spent fewer days on the waitlist (all p < 0.001). Compared to no-BTT recipients, ECMO BTT recipients were more likely to be intubated or on ECMO at 72 hours posttransplant and had longer hospital lengths of stay (all p < 0.001). Extracorporeal membrane oxygenation BTT recipients had increased risk of 3 years mortality compared to both no-BTT (adjusted hazard ratio [aHR] = 1.48 [95% confidence interval {CI}: 1.14–1.91], p = 0.003) and MV-only recipients (aHR = 1.50 [95% CI: 1.08–2.07], p = 0.02). Overall, we found that ECMO BTT in older recipients is associated with inferior posttransplant outcomes compared to MV-only or no BTT, but over half of recipients remained alive at 3 years posttransplant.

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Conditional Survival in Heart Transplantation: An Organ Procurement and Transplantation Network Database Analysis

Cited by 12 publications

References 23 publications

Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation

Diagnostic and Prognostic Value of a TDI-Derived Systolic Wall Motion Analysis as a Screening Modality for Allograft Rejection after Heart Transplantation

Placental Immune Tolerance and Organ Transplantation: Underlying Interconnections and Clinical Implications

Outcomes of Recipients Aged 65 Years and Older Bridged to Lung Transplant With Extracorporeal Membrane Oxygenation

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