High-dose calcineurin inhibitor-free everolimus as a maintenance regimen for heart transplantation may be a risk factor for Pneumocystis pneumonia

2017 ◽  
Vol 19 (4) ◽  
pp. e12709 ◽  
Author(s):  
Yu-Ning Hu ◽  
Nan-Yao Lee ◽  
Jun-Neng Roan ◽  
Chi-Hsin Hsu ◽  
Chwan-Yau Luo
Keyword(s):  
Risk Factor ◽  
Heart Transplantation ◽  
Calcineurin Inhibitor ◽  
Pneumocystis Pneumonia ◽  
High Dose

High-dose mizoribine combined with calcineurin inhibitor (cyclosporine or tacrolimus), basiliximab and corticosteroids for renal transplantation: A Japanese multicenter study

2017 ◽  
Vol 25 (2) ◽  
pp. 141-145 ◽  
Author(s):  
Tsukasa Nishioka ◽  
Norio Yoshimura ◽  
Hidetaka Ushigome ◽  
Yoshihiko Watarai ◽  
Kenji Nishimura ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Multicenter Study ◽  
Calcineurin Inhibitor ◽  
High Dose

scholarly journals Clinical prognosis analysis of extracorporeal membrane oxygenation in patients with heart transplantation

2019 ◽  
Author(s):  
Xiaozu Liao ◽  
Zhou Cheng ◽  
Liqiang Wang ◽  
Binfei Li ◽  
Weizhao Huang ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Heart Transplantation ◽  
Independent Risk Factor ◽  
Life Support ◽  
Univariate Analysis ◽  
Clinical Prognosis ◽  
Ischemia Time ◽  
Membrane Oxygenation

Abstract Purpose Extracorporeal membrane oxygenation (ECMO) is the primary indication for transplanted right heart failure in transition and postoperative period for heart transplantation patients. This study explored risk factors affecting the clinical prognosis of ECMO through analyzing the clinical data of heart transplantation patients with such condition. Methods Data on 28 heart transplantation patients with ECMO obtained from January 2012 to January 2018 in the People’s Hospital of Zhongshan City were retrospectively analyzed. Results A total of 25 patients (20 male and 5 female) were included in this study. Heart transplantation among patients was performed mainly due to cardiomyopathy (77.8%). Eighteen patients survived and were discharged 18 (72%). Four patients were treated with cardiopulmonary resuscitation before ECMO, and three patients died in the hospital. No differences existed among the surviving and death group donors (N-terminal pro b-type natriuretic peptide（NT-proBNP）, creatine kinase-muscle/brain（CK-MB）, warm ischemia time of donated heart, cold ischemia time of donated heart, total ischemia time of donated heart, and donator type). Univariate analysis showed that body mass index(BMI), length of stay in intensive care unit(ICU), and cardiopulmonary resuscitation are relevant prognosis factors in applying ECMO for patients with heart transplantation. Multi-factor logistic regression results show that cardiopulmonary resuscitation before ECMO (OR: 49.45, 95% CI[1.37, 1781.6]; P=0.033) is an independent risk factor influencing prognosis. Conclusion ECMO is an important life support method for patients with heart transplantation before and after the operation. Patients with obesity, poor preoperative cardiac function, and considerable red blood cell transfusions during surgery may influence the prognosis of patients. Extracardiac compression before ECMO of patients is an independent risk factor for their prognosis.

Decreased Levels of Serum Immunoglobulins as a Risk Factor for Infection After Heart Transplantation

2005 ◽  
Vol 37 (9) ◽  
pp. 4046-4049 ◽  
Author(s):  
E. Sarmiento ◽  
J. Rodrı́guez-Molina ◽  
P. Muñoz ◽  
J. Fernández-Yánez ◽  
J. Palomo ◽  
...  
Keyword(s):  
Risk Factor ◽  
Heart Transplantation ◽  
Serum Immunoglobulins

Abstract 13933: High Urgency Candidates for Heart Transplantation Does Not Correlate to the Development of Primary Graft Dysfunction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rafael Skorka ◽  
Keith Nishihara ◽  
Adriana Shen ◽  
Evan P Kransdorf ◽  
Lillian Benck ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Heart Transplant ◽  
Survival Rates ◽  
Control Group ◽  
High Dose ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Assist Device ◽  
Transplant Patients ◽  
High Urgency

Introduction: Primary Graft Dysfunction (PGD) after Heart Transplantation (HTx) is seen in approximately 7-30% of heart transplant patients as described by the literature. Many of these patients have severe PGD which requires support with ECMO. It has been reported that patients who are severely ill on high dose inotropes or on assists devices have greater propensity to develop severe PGD. Many of these patients have borderline blood pressure due to poor cardiac function which may contribute to PGD with its associated vasoplegia. In order to asses risk for the development of PGD we evaluated our patients in terms of their status at the time of transplant to assess risk. Methods: Between 2010 and 2019 we assessed 44 Heart Transplant patients who developed severe PGD immediately after HTx. The UNOS Status at the time of Transplant was recorded along with the presence of a durable assist device, temporary assist device, or no Inotropes or assist device. 30 Day and 1 Year survival were assessed for all status groups including a control group (no PGD, n=799). Results: High urgency status at the time of transplant was not the overwhelming majority of patients that developed severe PGD. Approximately 32% of these patients were patients who were waiting for transplant at home, who were not on Intravenous Inotropes and not on assist devices. 1 Year survival was compromised in all patients who developed severe PGD with survival rates that were significantly lower than patients without PGD in our program (47.7% vs 93.6%, p<0.001) (see Table). Conclusions: High urgency status is not solely associated with the development of severe PGD. Further assessment into these non-urgent patients who develop severe PGD is warranted and is under investigation. Inflammatory markers should be assessed in all patients who develop severe PGD.

IgG2 Insufficiency before Heart Transplantation as a Risk Factor of Early Deadly Infections

2019 ◽  
Vol 38 (4) ◽  
pp. S221
Author(s):  
J. Carbone ◽  
J. Navarro ◽  
I. Sousa ◽  
E. Zatarain ◽  
J. Fernandez-Yañez ◽  
...  
Keyword(s):  
Risk Factor ◽  
Heart Transplantation

scholarly journals SEVERE HYPERTRIGLYCERIDEMIA ASSOCIATED WITH EVEROLIMUS TREATMENT AFTER HEART TRANSPLANTATION

2020 ◽  
Vol 6 (5) ◽  
pp. e269-e272
Author(s):  
Phillip Lo ◽  
Katherine Kearney ◽  
Christopher A. Muir ◽  
Ning Song ◽  
John A. Eisman ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Heart Transplant ◽  
Serum Triglyceride ◽  
Adverse Outcomes ◽  
Lipid Lowering ◽  
High Dose ◽  
Serum Triglyceride Level ◽  
Post Transplantation ◽  
Partial Lipodystrophy ◽  
Severe Hypertriglyceridemia

Objective: Everolimus, a mammalian target-ofrapamycin (mTOR) inhibitor, is increasingly used post-transplantation due to favorable effects on renal function and malignancy risk when compared to other immunosuppressive treatments such as calcineurin inhibitors. However, it can confer adverse effects such as dyslipidemia, which is not underpinned by any long-term screening and management of dyslipidemia in heart transplant recipients treated with everolimus. Methods: We report a case of severe hypertriglyceridemia which developed after commencement of everolimus in a heart transplant recipient with a background of Dunnigan-type familial partial lipodystrophy. Results: The patient is a 36-year-old woman who underwent heart transplantation for dilated cardiomyopathy. About 11 weeks following commencement of everolimus as part of her antirejection medication regime, serum triglyceride level concentration peaked at 5,093 mg/dL (normal, 0.0 to 177.2 mg/dL). There were no clinical complications with triglycerides at this elevated level and it improved substantially following cessation of everolimus and initiation of a high dose intravenous insulin-dextrose infusion. Conclusion: This case highlights dyslipidemia as a potential complication of everolimus treatment and that appropriate screening is important as lipid lowering medication can effectively control levels and minimize adverse outcomes.

scholarly journals Antibody-mediated rejection with detection of de novo donor-specific anti-human leucocyte antigen Class II antibodies 3 years after heart transplantation: a case report

2020 ◽  
Vol 4 (1) ◽  
pp. 1-4
Author(s):  
Bernd Ludwig ◽  
Johanna Schneider ◽  
Daniela Föll ◽  
Qian Zhou
Keyword(s):  
Heart Transplantation ◽  
De Novo ◽  
Survival Rates ◽  
Graft Function ◽  
Left Ventricular ◽  
Cardiac Allograft ◽  
Left Ventricular Ejection ◽  
High Dose ◽  
Ventricular Ejection Fraction ◽  
Antibody Mediated Rejection

Abstract Background Antibody-mediated rejection (AMR) in cardiac transplantation may manifest early within the first weeks after transplantation but also late after months to years following transplantation resulting in mild heart failure to cardiogenic shock. While patients with early cardiac AMR are less affected and seem to have survival rates comparable to transplant recipients without AMR, late cardiac AMR is frequently associated with graft dysfunction, fulminant forms of cardiac allograft vasculopathy, and a high mortality rate. Nevertheless, AMR of cardiac allografts remains difficult to diagnose and to treat. Case summary We report the case of a 47-year-old male patient with late AMR of the cardiac allograft 3 years after heart transplantation. Antibody-mediated rejection was confirmed by endomyocardial biopsy and the presence of donor-specific antibodies (DSA). The patient was treated with high dose of prednisolone, plasmapheresis, intravenous Gamma Globulin, rituximab, immunoadsorption, and bortezomib. Under this treatment regimen left ventricular ejection fraction and pro B-type natriuretic peptide recovered, and the patient improved to New York Heart Association Class I. Currently, 3 years after the diagnosis of cardiac AMR, graft function continues to be nearly normal, and there is no evidence for transplant vasculopathy. Discussion This case illustrates that AMR can occur at any time after transplantation. Although graft function fully recovered after treatment in our patient, the level of DSA remained high, suggesting that DSA may not be a reliable parameter to determine the intensity and duration of the therapy.

scholarly journals Bone marrow transplantation for children with severe aplastic anemia: use of donors other than HLA-identical siblings

Blood ◽  
1989 ◽  
Vol 74 (5) ◽  
pp. 1852-1857 ◽  
Author(s):  
B Camitta ◽  
R Ash ◽  
J Menitove ◽  
K Murray ◽  
C Lawton ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Aplastic Anemia ◽  
Marrow Transplantation ◽  
Chronic Gvhd ◽  
Conditioning Regimen ◽  
Pneumocystis Pneumonia ◽  
Severe Aplastic Anemia ◽  
High Dose ◽  
Gvhd Prophylaxis

Abstract Eighty-five percent of untransfused and 70% of transfused patients with severe aplastic anemia (SAA) are cured with bone marrow transplants from histocompatible sibling donors. Use of partially matched family donors or unrelated donors has been relatively unsuccessful because of high incidences of graft rejection and graft-versus-host disease (GVHD). Thirteen children with SAA received marrow grafts from alternative donors (sibling 4, parent 5, unrelated 4). The first three patients were pretreated with cyclophosphamide (CYCLO) +/- irradiation and received methotrexate for GVHD prophylaxis. Subsequent children were pretreated with CYCLO + high-dose cytosine arabinoside + methylprednisolone + total body irradiation, had monoclonal antibody T- cell depletion of the donor marrow, and received cyclosporine for GVHD prophylaxis. Three heavily transfused patients with haploidentical- related donors failed to engraft and died. All 10 patients with more closely matched donors engrafted. Acute GVHD was grade II in only one patient (non-T-depleted); this patient is the only one with severe chronic GVHD. Three engrafted patients died (Pneumocystis pneumonia, systemic parainfluenza, venocclusive disease). Seven children are alive 33+ to 2,692+ days. Donors for the survivors were siblings 3, parent 1, unrelated 3. These data suggest that bone marrow transplantation from closely matched donors other than histocompatible siblings can be effective therapy for SAA if an intensive conditioning regimen is used. These results must be confirmed with larger numbers and longer follow- up.

scholarly journals Calcineurin inhibitor therapy-associated esophageal polyps 12 years after heart transplantation

Endoscopy ◽  
2011 ◽  
Vol 43 (S 02) ◽  
pp. E120-E121
Author(s):  
C. Langner ◽  
A. Eherer ◽  
M. Vieth
Keyword(s):  
Heart Transplantation ◽  
Calcineurin Inhibitor ◽  
Inhibitor Therapy
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