Levosimendan: A New Therapeutic Option in the Treatment of Primary Graft Dysfunction After Heart Transplantation

Weis, Florian; Beiras-Fernández, Andrés; Kaczmarek, Ingo; Sodian, Ralf; Kur, F.; Weis, Marion; Schmoeckel, Michael; Reichart, Bruno

doi:10.1016/j.healun.2009.01.017

Cited by 25 publications

(11 citation statements)

References 24 publications

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“…In addition, LS may possess anti-inflammatory and anti-apoptotic properties that could protect against renal ischemia-reperfusion injury (13-15, 18, 29). In accordance with our findings, several studies also support the reno-protective effects of LS in different cardiac surgery settings (14,17,(19)(20)(21)(30)(31)(32).…”

Section: Discussionsupporting

confidence: 92%

“…In this pilot randomized trial, our objective was to evaluate the effects of a levosimendan (LS)based strategy on renal function in the early postoperative period following heart transplantation. The rationale of the study was based on the previous trials and mechanistic studies showing that LS, an inodilator, may have reno-protective properties (13)(14)(15)(16)(17)(18). The protective effects may be related to a decrease in renal congestion or a modulation of inflammatory or apoptotic renal pathways (13)(14)(15).…”

mentioning

confidence: 99%

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The effects of levosimendan on renal function early after heart transplantation: results from a pilot randomized trial

Kneževič

Poglajen

Hrovat

et al. 2014

Clinical Transplantation

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

The effects of levosimendan on renal function early after heart transplantation: results from a pilot randomized trial

Kneževič

Poglajen

Hrovat

et al. 2014

Clinical Transplantation

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“…In milder cases of primary allograft dysfunction, high-dose inotropic agents may be sufficient to restore myocardial contractility and haemodynamic stability. A variety of inotropic agents have been used to treat PGF include catecholamines, phosphodiesterase inhibitors, and more recently levosimendan [41–43]. …”

Section: Managementmentioning

confidence: 99%

Primary Graft Failure after Heart Transplantation

Iyer

Kumarasinghe

Hicks

et al. 2011

Journal of Transplantation

116

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Primary graft failure (PGF) is a devastating complication that occurs in the immediate postoperative period following heart transplantation. It manifests as severe ventricular dysfunction of the donor graft and carries significant mortality and morbidity. In the last decade, advances in pharmacological treatment and mechanical circulatory support have improved the outlook for heart transplant recipients who develop this complication. Despite these advances in treatment, PGF is still the leading cause of death in the first 30 days after transplantation. In today's climate of significant organ shortages and growing waiting lists, transplant units worldwide have increasingly utilised “marginal donors” to try and bridge the gap between “supply and demand.” One of the costs of this strategy has been an increased incidence of PGF. As the threat of PGF increases, the challenges of predicting and preventing its occurrence, as well as the identification of more effective treatment modalities, are vital areas of active research and development.

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“…In one small uncontrolled study, levosimendan (0.1 μg/kg/min) was given to 12 patients with PGD, defined as an LV ejection fraction of less than 30 %. Following a 24-hour infusion, levosimendan improved ejection fraction and cardiac output, and patients showed a rapid reduction of the required dose of inotropic medications [42]. No patient required mechanical support, and 30-day survival in this series was 93 %.…”

Section: Managementmentioning

confidence: 66%

Primary Graft Dysfunction After Heart Transplantation

et al. 2014

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Primary graft dysfunction (PGD) is a lifethreatening complication of heart transplantation that presents as left, right, or biventricular dysfunction occurring within the first 24 hours of transplant surgery for which there is no identifiable secondary cause. Myocardial injury caused by acute catecholamine toxicity and the release of multiple proinflammatory mediators in the donor, followed by ischaemiareperfusion injury sustained during retrieval, have been considered the predominant pathogenetic processes leading to PGD. Donor, recipient, and procedural factors contribute to the development and severity of the clinical syndrome. The changing donor and recipient characteristics over the last two decades, particularly the increasing donor and recipient age, have led to heightened risk of PGD. PGD is graded from mild to severe depending on the extent of circulatory support that is required to maintain haemodynamic stability and vital organ function. While advances in acute mechanical support devices have improved the outlook for patients with PGD, the rate of mortality remains high for those with severe PGD, reaching 40 %. Potential approaches to preventing or minimising the severity of PGD include optimising donor management, donor heart preservation, and donor/recipient matching.

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Levosimendan: A New Therapeutic Option in the Treatment of Primary Graft Dysfunction After Heart Transplantation

Cited by 25 publications

References 24 publications

The effects of levosimendan on renal function early after heart transplantation: results from a pilot randomized trial

The effects of levosimendan on renal function early after heart transplantation: results from a pilot randomized trial

Primary Graft Failure after Heart Transplantation

Primary Graft Dysfunction After Heart Transplantation

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