Outcomes of Adult Orthotopic Heart Transplantation With Extended Allograft Ischemic Time

Yeen, Wing; Polgar, A. A.; Guglin, Maya; Downes, Katheryne; Faber, Cristiano; Roy, Anurag; Caldeira, Christiano

doi:10.1016/j.transproceed.2013.04.003

Cited by 30 publications

(28 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…All rights reserved. Ann Cardiothorac Surg 2018;7(1):106-117 www.annalscts.com of the donor heart is performed by our own surgeons, the direct communication between the procurement and the implanting team might help to significantly reduce ischemic times (15)(16)(17)(18). Also, most donors come from Belgian hospitals which results in short transportation times.…”

Section: Discussionmentioning

confidence: 99%

“…This has not only resulted in scientific output, but has also likely lowered the threshold for patients to contact the transplant nurses and physicians in case of questions or problems. It may have also assisted in creating a culture where patients and their families form a team together with Primary graft failure [16] Acute rejection [7] Late graft failure (HFrEF) [6] [Non] STEMI [4] Post-PCI/CABG [3] Technical problems during HTx [3] Stroke/intracranial bleeding [12] Aortic rupture [4] Intestinal ischemia [3] Malignancy 78 [32] Lung [35] GI tract [10] PTLD [9] Kidney-bladder [6] Pancreas [4] Blood [4] Prostate [3] Skin [3] Primary tumor unknown [3] Brain [1] Infection 43 [18] Pneumonia [22] Sepsis [15] Other [6] Other 27 [11] Old age [8] Dementia [5] Suicide [4] Therapy withdrawal [3] Trauma [3] Respiratory failure [1] Bleeding [1] ALS [1] Euthanasia [1] Finally, we pay a lot of attention to cardiovascular prevention and screening for malignancies. The significant and consistent decreases in age-adjusted cardiovascular mortality shown in European and US registries was attributed to better prevention and better treatment of cardiac disease (29).…”

Section: Discussionmentioning

confidence: 99%

“…Until the end of 2015, 648 transplantations were performed in 615 patients, resulting in an average annual transplantation rate of 23 (range, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Thirty recipients received a second donor heart and one patient was transplanted three times.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

How to obtain and maintain favorable results after heart transplantation: keys to success?

Cleemput

Verbelen²,

Aelst

et al. 2018

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

We compared survival in our heart recipients with survival rates reported by the International Society of Heart and Lung Transplantation (ISHLT) Registry. As recipient and donor characteristics are changing over time, we studied four different eras. In order to differentiate between short-and long-term survival, we analyzed both overall survival and survival at one year. Obviously, this exercise is only relevant when baseline donor and recipient characteristics are comparable, as these differences may affect the outcome in opposite directions. To overcome this potential bias as much as possible, we calculated the Index for Mortality Prediction After Cardiac Transplantation (IMPACT)-scores and the Donor Risk Index (DRI). Looking to our results, we found that our DRIs in the different eras are almost equal to those obtained from the United Network for Organ Sharing database in the very same eras. Our IMPACT-scores, on the other hand, seem higher than those reported by ISHLT. Survival after transplantation and conditional on 1-year survival was higher than the outcome reported by the ISHLT Registry. As our operation technique and post-transplant immunosuppressive schedule did not differ from most centers, we speculated on potential factors that might contribute to our positive results. Patient selection and a relatively short waiting time are important contributors to the overall survival benefit. Our centralized follow-up may also have played an important role. Finally, the indefinite compulsory health insurance coverage in our country and easy access to different screening programs might also have influenced our outcome in a positive way. We are well aware that with challenges like donor organ shortage, more and more patients on mechanical circulatory support (MCS) will affect outcomes in the future.Keywords: Heart transplantation; predictors; survival Submitted Sep 11, 2017. Accepted for publication Nov 25, 2017Nov 25, . doi: 10.21037/acs.2017 View this article at: http://dx.doi.org/10. 21037/acs.2017.12.03 Perspective IntroductionComparing the results of hip surgery performed by one surgeon with the results of his colleague working in the hospital next door, is asking for trouble. Comparing results of one heart transplant center with those of another or, even more challenging, those of a registry, is at least as daunting.Nevertheless, it is worthwhile to critically review one's results and compare them with those of peers. In case they differ manifestly, one has to speculate on why this is the case considering the importance our society currently attributes to cost effectiveness and transparency. Of course, this exercise only makes sense when you are comparing apples with apples. You should first examine that you are transplanting the same types of patients and that you are using the same types of donors.We compared our short-and long-term survival data with those of the ISHLT registry. To do so, we also compared our recipient and donor risk profiles with those of the UNOS database. Finally, we speculated...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

How to obtain and maintain favorable results after heart transplantation: keys to success?

Cleemput

Verbelen²,

Aelst

et al. 2018

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

show abstract

“…Our finding that increased IT (>3.1 hours) is independently associated with rejection prior to hospital discharge is novel. Of the aforementioned studies regarding IT and overall outcomes, only one study compared the incidence of rejection between long and short IT groups. These investigators found no difference in rejection episodes in the first year after transplant between groups; however, rejection prior to discharge was not specifically evaluated in that study.…”

Section: Discussionmentioning

confidence: 99%

The impact of ischemic time on early rejection after pediatric heart transplant

Magdo

Friedland‐Little

et al. 2017

Pediatric Transplantation

View full text Add to dashboard Cite

Prolonged graft ischemia may be a risk factor for early rejection post-HTx, but this has not been well studied in children. Furthermore, factors moderating the association between IT and early rejection have not been investigated. From 2004 to 2012, pediatric HTx recipients (n = 2381) were identified from the UNOS database. A ROC curve determined the optimal IT discriminating patients by the presence of early rejection. Separate univariate analyses identified factors associated with: (i) early (prior to hospital discharge) rejection, and (ii) IT. A multivariable logistic regression assessed independent risk factors for early rejection. We included interaction terms to evaluate whether IT's independent risk effect on early rejection is moderated via interaction with associated factors found in univariate analysis. Longer IT was associated with an increased risk of early rejection. In multivariable analysis, IT > 3.1 hours was an independent risk factor for early rejection (AOR 1.44, P = .01). No interaction terms between IT and any associated factors were significant. Longer IT is an independent risk for early rejection in pediatric HTx recipients. Better understanding the association between IT and early rejection may identify interventions to mitigate this risk.

show abstract

“…This was also confirmed in patients initially listed at UNOS status 1A of the medically treated and the Delayed-LVAD groups. LVAD recipients were in an unfavorable condition because of long ischemic times during HTx and a higher prevalence of infections at the time of HTx (21-22). In addition, albumin levels in LVAD recipients at HTx were lower than those in medically-treated patients which might reflect a poor overall status and associate infections.…”

Section: Discussionmentioning

confidence: 99%

Comparison of early versus delayed timing of left ventricular assist device implantation as a bridge-to-transplantation: An analysis of the UNOS dataset

Kitada

Schulze

Jin

et al. 2016

International Journal of Cardiology

View full text Add to dashboard Cite

Background Placement of left ventricular assist devices (LVAD) as a bridge-to-heart transplantation (HTx) has rapidly expanded due to organ donor shortage. However, the timing of LVAD implantation is variable and it remains unclear if earlier implantation improves survival. Methods We analyzed 14,187 adult candidates from the United Network of Organ Sharing database. Patients were classified by 3 treatment strategies including patients medically treated alone (MED, n=11,009), patients on LVAD support at listing (Early-LVAD, n=1588) and patients undergoing LVAD placement while awaiting HTx (Delayed-LVAD, n=1590). Likelihood of HTx and event-free survival were assessed in patients subcategorized by clinical strategies and UNOS status at listing. Results The device support strategy, despite the timing of placement, was not associated with increased likelihood of HTx compared to MED group. However, both LVAD implantation strategies showed better survival compared to MED group (Early-LVAD: HR 0.811 and 0.633, 95% CI 0.668-0.984 and 0.507-0.789, for 1A and 1B; p=0.034 and p<0.001, Delayed-LVAD: HR 0.553 and 0.696, 95% CI 0.415-0.736 and 0.571-0.847, for 1A and 1B; both p<0.001, respectively). Furthermore, there was no significant difference in survival between these LVAD implantation strategies in patients listed as 1B (p=0.500), although Early-LVAD implantation showed worse survival in patients listed as 1A (HR 1.467, 95% CI 1.076-2.000; p=0.015). Conclusion LVAD support strategies offer a safe bridge-to-HTx. Those candidates who receive urgent upfront LVAD implantation for HTx, and improve to 1B status, would achieve competitive survival with those who receive elective LVAD implantation.

show abstract

Outcomes of Adult Orthotopic Heart Transplantation With Extended Allograft Ischemic Time

Cited by 30 publications

References 12 publications

How to obtain and maintain favorable results after heart transplantation: keys to success?

How to obtain and maintain favorable results after heart transplantation: keys to success?

The impact of ischemic time on early rejection after pediatric heart transplant

Comparison of early versus delayed timing of left ventricular assist device implantation as a bridge-to-transplantation: An analysis of the UNOS dataset

Contact Info

Product

Resources

About