The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Heart Transplantation Report—2017; Focus Theme: Allograft ischemic time

Abstract

This year marks the 50th anniversary of the first heart transplant, performed in 1967. Since then, and in particular since the introduction of cyclosporine immunosuppression in the 1970s, heart transplantation has grown worldwide. This 34th adult heart transplant report is based on data submitted to the International Society for Heart and Lung Transplantation (ISHLT) Registry on 135,387 heart transplants in recipients of all ages (including 120,991 adult heart transplants) through June 30, 2016. With each year's report we now also provide more detailed analyses on a particular focus theme. Since 2013, these have been donor and recipient age, retransplantation, early graft failure, indication for transplant, and in 2017, allograft ischemic time. Statistical methods Data collection, conventions and statistical methods National and multinational organ/data exchange organizations and individual centers submit data to the ISHLT

Outcomes and survival following heart retransplantation for cardiac allograft failure: a systematic review and meta-analysis

“…Several therapeutic interventions including aggressive immunosuppressive therapy, percutaneous transluminal coronary angioplasty, laser myocardial therapy, coronary artery bypass grafting, valvular repair and temporary and long term mechanical circulatory assist devices have been proposed; however, heart retransplantation (RTx) remains the only viable long-term treatment for end-stage cardiac allograft failure (4)(5)(6)(7)(8). Despite annual RTx rates of as high as 6% as reported by the 2017 ISHLT data (9), the literature on RTx is ambiguous with several studies reporting conflicting findings in regards to the survival and viability of this therapy (10,11).…”

A Peripheral Blood Transcriptome Biomarker Test to Diagnose Functional Recovery Potential in Advanced Heart Failure

“…Current graft survival rates with advances in immunosuppressive therapy are 85-90%, 75-80% and 70-75% in adults at 1-, 3-, 5-year, respectively, and a median survival of 11-13 years. Internationally, contemporary median survival after adult HTx is 10.7 years [27] (Table 1).…”

Myocardial perfusion imaging for cardiac allograft vasculopathy assessment: Evidence grows, but questions remain

“…CAV develops in one-third of heart transplant survivors at 5 years and in one-half at 10 years post-transplant, and is responsible for at least 12.8% of deaths at 10 years. 1 Risk factor modification and early therapy with mammalian target of rapamycin (mTOR) inhibitors such as sirolimus may attenuate CAV progression. 2,3 Percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) are useful for focal lesions but suboptimal in advanced disease because of diffuse disease, poor targets, and high restenosis rates.…”

“…Approximately 50% of heart transplant recipients develop renal dysfunction at 5 years post-transplant, and routine use of surveillance angiography becomes challenging. 1 Patients with reportedly normal CAGs who died from graft failure have a high prevalence of significant CAV on autopsy. 4 As a result, several other anatomic and functional, invasive and non-invasive modalities, including dobutamine stress echocardiography (DSE), myocardial perfusion imaging (MPI), positron emission tomography (PET), computed tomography (CT), Magnetic Resonance Imaging (MRI), intravascular ultrasound (IVUS), and optical coherence tomography (OCT), have been evaluated in CAV.…”