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1دورية أكاديمية
المؤلفون: Shuktika Nandkeolyar, Tripti Gupta, D. Marshall Brinkley, Sophoclis Alexopoulos, Emily Firsich, Sally Anne Fossey, Rachel Fowler, Benjamin Frischhertz, Kimberly Harrison, JoAnn Lindenfeld, Martin Montenovo, Dawn Pedrotty, Lynn Punnoose, Aniket Rali, Alexandra Shingina, Kelly Schlendorf, Hasan Siddiqi, Ashish Shah, Sandip Zalawadiya, Mark Wigger, Jonathan N. Menachem
المصدر: International Journal of Cardiology Congenital Heart Disease, Vol 15, Iss , Pp 100504- (2024)
مصطلحات موضوعية: ACHD, Heart, Liver, Transplantation, Rejection, Diseases of the circulatory (Cardiovascular) system, RC666-701
الوصف: Introduction: Each year the number of combined heart-liver transplants (HLT) increases, with two distinct patient populations proceeding down this pathway. The first are patients with congenital heart disease (CHD), most commonly single ventricle patients palliated with Fontan. The second group are those with long standing congestive hepatopathy, amyloidosis, hemochromatosis, or alcohol induced myopathies and liver disease.One argument for HLT has been the low rate of rejection even among sensitized patients, with reported rejection rates ranging from 0% to 31%. Historically, those with CHD have been highly sensitized which in some cases may prevent or at least delay transplantation. As such, a recent consensus statement by Emamaulee et al. suggest that “there may be an immunological benefit to proceed with HLT with significantly fewer acute cellular and humoral rejection episodes”. The aim of this study is to demonstrate that HLT patients remain at risk for rejection and have required treatment for it. Results: There were 15 patients who underwent HLT from January 2017 to February 2022. Of the four patients who did not have CHD, none were considered sensitized, and all underwent induction with basiliximab per our institutional protocol. One of these had rejection. Rejection episodes were identified in four of the 11 CHD patients (36%) patients. Conclusions: In our study of 15 HLT, including 11 CHD patients (73% denied transplant at ≥ 1 center) demonstrated a higher rate of rejection than previously reported. While theoretically, HLT may mitigate the likelihood of rejection, the risk still exists, and patients benefit from close monitoring commensurate with single organ transplant.
وصف الملف: electronic resource
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2دورية أكاديمية
المؤلفون: Anupam A Kumar, Lena E Tran, Aniket S Rali, Alexander Perez, Robert Hoffman, Kelly Schlendorf
المصدر: Cardiac Failure Review, Vol 8, Iss , Pp - (2022)
مصطلحات موضوعية: Diseases of the circulatory (Cardiovascular) system, RC666-701
الوصف: A 46-year-old man with systolic heart failure, end-stage renal disease on dialysis, ventricular tachycardia and pulmonary sarcoidosis presented with decompensated heart failure and cardiogenic shock of unknown aetiology. The hospital course was complicated by worsening shock requiring inotropic and mechanical circulatory support, as well as eventual dual heart and kidney transplantation. Cardiac imaging was used to assess the aetiology of the patient’s non-ischaemic cardiomyopathy, including a PET scan and cardiac MRI. Imaging demonstrated findings consistent with left ventricular non-compaction, but was inconclusive for cardiac sarcoidosis. After eventual heart transplantation, histopathology of the patient’s explanted heart showed evidence of both non-compaction and cardiac sarcoidosis. In this case report, the authors review the pathophysiology of both cardiac sarcoidosis and left ventricular non-compaction, and highlight a multimodality approach to the diagnosis of non-ischaemic cardiomyopathy.
وصف الملف: electronic resource
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3دورية أكاديمية
المؤلفون: Vineet Agrawal, Kelly A Costopoulos, Mohammed Chowdhary, Keki Balsara, Kelly Schlendorf, JoAnn Lindenfeld, Jonathan N Menachem
المصدر: Cardiac Failure Review, Vol 8, Iss , Pp - (2022)
مصطلحات موضوعية: Diseases of the circulatory (Cardiovascular) system, RC666-701
وصف الملف: electronic resource
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4دورية أكاديمية
المؤلفون: Travis D. Richardson, Leslie Hale, Christopher Arteaga, Meng Xu, Mary Keebler, Kelly Schlendorf, Matthew Danter, Ashish Shah, JoAnn Lindenfeld, Christopher R. Ellis
المصدر: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 7, Iss 5 (2018)
مصطلحات موضوعية: cardiac resynchronization therapy, implantable cardioverter defibrillator, left ventricular assist device, Diseases of the circulatory (Cardiovascular) system, RC666-701
الوصف: BackgroundVentricular arrhythmias are common in patients with left ventricular assist devices (LVADs) but are often hemodynamically tolerated. Optimal implantable cardioverter defibrillator (ICD) tachy‐programming strategies in patients with LVAD have not been determined. We sought to determine if an ultra‐conservative ICD programming strategy in patients with LVAD affects ICD shocks. Methods and ResultsAdult patients with an existing ICD undergoing continuous flow LVAD implantation were randomized to standard ICD programming by their treating physician or an ultra‐conservative ICD programming strategy utilizing maximal allowable intervals to detection in the ventricular fibrillation and ventricular tachycardia zones with use of ATP. Patients with cardiac resynchronization therapy (CRT) devices were also randomized to CRT ON or OFF. Patients were followed a minimum of 6 months. The primary outcome was time to first ICD shock. Among the 83 patients studied, we found no statistically significant difference in time to first ICD shock or total ICD shocks between groups. In the ultra‐conservative group 16% of patients experienced at least one shock compared with 21% in the control group (P=0.66). There was no difference in mortality, arrhythmic hospitalization, or hospitalization for heart failure. In the 41 patients with CRT ICDs fewer shocks were observed with CRT‐ON but this was not statistically significant: 10% of patients with CRT‐ON (n=21) versus 38% with CRT‐OFF (n=20) received shocks (P=0.08). ConclusionsAn ultra‐conservative programming strategy did not reduce ICD shocks. Programming restrictions on ventricular tachycardia and ventricular fibrillation zone therapy should be reconsidered for the LVAD population. The role of CRT in patients with LVAD warrants further investigation. Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT01977703.
وصف الملف: electronic resource
Relation: https://doaj.org/toc/2047-9980
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5دورية أكاديمية
المؤلفون: Sebastian Kelle, Kelly Schlendorf, Glenn A. Hirsch, Gary Gerstenblith, Eckart Fleck, Robert G. Weiss, Matthias Stuber
المصدر: Cardiology Research and Practice, Vol 2010 (2010)
مصطلحات موضوعية: Diseases of the circulatory (Cardiovascular) system, RC666-701
الوصف: Purpose. We evaluated the influence of the time between low-dose gadolinium (Gd) contrast administration and coronary vessel wall enhancement (LGE) detected by 3T magnetic resonance imaging (MRI) in healthy subjects and patients with coronary artery disease (CAD). Materials and Methods. Four healthy subjects (4 men, mean age 29 ± 3 years and eleven CAD patients (6 women, mean age 61±10 years) were studied on a commercial 3.0 Tesla (T) whole-body MR imaging system (Achieva 3.0 T; Philips, Best, The Netherlands). T1-weighted inversion-recovery coronary magnetic resonance imaging (MRI) was repeated up to 75 minutes after administration of low-dose Gadolinium (Gd) (0.1 mmol/kg Gd-DTPA). Results. LGE was seen in none of the healthy subjects, however in all of the CAD patients. In CAD patients, fifty-six of 62 (90.3%) segments showed LGE of the coronary artery vessel wall at time-interval 1 after contrast. At time-interval 2, 34 of 42 (81.0%) and at time-interval 3, 29 of 39 evaluable segments (74.4%) were enhanced. Conclusion. In this work, we demonstrate LGE of the coronary artery vessel wall using 3.0 T MRI after a single, low-dose Gd contrast injection in CAD patients but not in healthy subjects. In the majority of the evaluated coronary segments in CAD patients, LGE of the coronary vessel wall was already detectable 30–45 minutes after administration of the contrast agent.
وصف الملف: electronic resource
Relation: https://doaj.org/toc/2090-0597
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المؤلفون: Savine Hernandez, Christina Aquilante, Kimberly Deininger, Joann Lindenfeld, Kelly Schlendorf, Sara Van Driest, Michelle Liu
الوصف: CYP3A5 genetic variants are associated with tacrolimus metabolism. Controversy remains on whether CYP3A4 increased [*1B (rs2740574), *1G (rs2242480)] and decreased function [*22 (rs35599367)] genetic variants provide additional information. This study aims to address whether tacrolimus dose-adjusted trough concentrations differ between combined CYP3A (CYP3A5 and CYP3A4) phenotype groups. Significant differences between CYP3A phenotype groups in tacrolimus dose-adjusted trough concentrations were found in the early postoperative period and continued to 6 months post-transplant. In CYP3A5 nonexpressers, carriers of CYP3A4*1B or *1G variants (Group 3) compared to CYP3A4*1/*1 (Group 2) patients were found to have lower tacrolimus dose-adjusted trough concentrations at 2 months. In addition, significant differences were found among CYP3A phenotype groups in the dose at discharge and time to therapeutic range while time in therapeutic range was not significantly different. A combined CYP3A phenotype interpretation may provide more nuanced genotype-guided TAC dosing in heart transplant recipients.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_________::509fe0cff4f9b991b76f9119d48d87d4
https://doi.org/10.21203/rs.3.rs-2921796/v1 -
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المؤلفون: Alicia Carver, Rachel C. Forbes, Roman E. Perri, Cori Edmonds, Leena Choi, Josh DeClercq, Kelly Schlendorf, Megan E. Peter, Beatrice P. Concepcion
المصدر: The American Journal of Surgery. 223:975-982
مصطلحات موضوعية: medicine.medical_specialty, medicine.medical_treatment, Hepatitis C virus, Hepacivirus, Liver transplantation, medicine.disease_cause, Antiviral Agents, medicine, Humans, Lung transplantation, Kidney transplantation, Retrospective Studies, business.industry, Retrospective cohort study, Organ Transplantation, General Medicine, Hepatitis C, Hepatitis C, Chronic, medicine.disease, Tissue Donors, Transplantation, Specialty pharmacy, Emergency medicine, Surgery, business
الوصف: Background Emerging data supports expanding the solid organ donor pool with transplantation from hepatitis C virus (HCV)-positive donors into HCV-negative recipients. However, concerns exist regarding the ability to access direct-acting antivirals (DAAs) post-transplant in a real-world setting. Methods This single-center, retrospective study evaluated DAA access rates, time to first dose, and patient cost in donor-derived HCV solid-organ transplant recipients utilizing an integrated specialty pharmacy process. Results Among 91 patients, all accessed DAAs through prescription insurance (97%) or patient assistance programs (3%). Of those who received DAAs through insurance, only 65% received approval on initial insurance submission. Median time from transplant to first dose was 45d [IQR 34–66]. The on-site specialty pharmacy was used by 69% of patients. Copay assistance programs reduced the median monthly patient cost from $1914 [range $7-7536] to $0 [range $0–5]. Conclusion Our findings indicate that access to DAAs in donor-derived HCV post-transplant is achievable and affordable; however, significant added administrative efforts may be required for insurance approval as well as obtaining copay assistance, which is a limited resource.
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المؤلفون: Michelle M. Kittleson, Kelly Schlendorf, Chetan B. Patel, Amanda C. Coniglio, Adam D. DeVore, Jacob N. Schroder
المصدر: Journal of Cardiac Failure. 28:467-476
مصطلحات موضوعية: Heart Failure, Heart transplantation, Hepatitis, medicine.medical_specialty, Tissue and Organ Procurement, business.industry, medicine.medical_treatment, Hepatitis C, Hepatitis C, Chronic, medicine.disease, Antiviral Agents, Tissue Donors, United States, Transplantation, Donation, Heart failure, medicine, Heart Transplantation, Humans, Cardiology and Cardiovascular Medicine, Intensive care medicine, business, Donor pool, Antibody detection
الوصف: Advanced heart failure affects tens of thousands of people in the United States alone with high morbidity and mortality. Cardiac transplantation offers the best treatment strategy, but has been limited historically by donor availability. Recently, there have been significant advances in organ allocation, donor-recipient matching, organ preservation, and expansion of the donor pool. The current heart allocation system prioritizes the sickest patients to minimize waitlist mortality. Advances in donor organ selection, including predicted heart mass calculations and more sophisticated antibody detection methods for allosensitized patients, offer more effective matching of donors and recipients. Innovations in organ preservation such as with organ preservation systems have widened the donor pool geographically. The use of donors with hepatitis C is possible with the advent of effective direct-acting antiviral agents to cure donor-transmitted hepatitis C. Finally, further expansion of the donor pool is occurring with the use of higher risk donors with advanced age, medical comorbidities, and left ventricular dysfunction and advances in donation after circulatory death. This review provides an update on the new technologies and transplantation strategies that serve to widen the donor pool and more effectively match donors and recipients so that heart transplant candidates may derive the best outcomes from heart transplantation.
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المؤلفون: Hasan K. Siddiqi, Kelly Schlendorf
المصدر: Current Transplantation Reports
مصطلحات موضوعية: Heart transplantation, Transplantation, medicine.medical_specialty, Donor pool, Hepatology, business.industry, Hepatitis C virus, medicine.medical_treatment, Immunology, Hepatitis C, medicine.disease, medicine.disease_cause, HCV Positive, Direct-acting antiviral therapies, Thoracic Transplantation (J Patel and AM Holm, Section Editors), Nephrology, Medicine, Surgery, Registry data, Organ donation, business, Intensive care medicine
الوصف: Purpose of Review To summarize outcomes to date, as well as important considerations and unanswered questions related to the use of hepatitis C virus (HCV) positive donors for heart transplantation. Recent Findings Outcomes from single-center studies and registry data to date suggest that among patients who develop donor-transmitted HCV after heart transplantation, direct-acting antiviral therapies (DAAT) are effective and well-tolerated, and that short-term survival is similar to that of patients transplanted with HCV - donors. Summary In an era marked by increasing numbers of HCV positive deceased donors and a growing imbalance between the demand and supply of donor hearts, utilization of HCV + donors is a feasible strategy to expand the donor pool and reduce waitlist times. Ongoing work is needed to clarify longer-term outcomes with the use of this strategy.
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المؤلفون: Keki R. Balsara, Mark Wigger, Lynne W. Stevenson, L. Punnoose, Tarek S. Absi, Jordan R.H. Hoffman, Ashish S. Shah, Melissa Levack, Jonathan N. Menachem, William G. McMaster, Aniket S Rali, Zakiur Rahaman, JoAnn Lindenfeld, Kelly Schlendorf, M. Brinkley, Sandip Zalawadiya, Suzanne Brown Sacks
المصدر: The Journal of Heart and Lung Transplantation. 40:1408-1418
مصطلحات موضوعية: Adult, Graft Rejection, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Time Factors, Tissue and Organ Procurement, Adolescent, medicine.medical_treatment, Primary Graft Dysfunction, Young Adult, Internal medicine, medicine, Humans, Lung transplantation, Child, Retrospective Studies, Heart Failure, Transplantation, Ejection fraction, business.industry, Cold Ischemia, Graft Survival, Organ Preservation, medicine.disease, Perfusion, medicine.anatomical_structure, Ventricle, Ventricular assist device, Heart failure, Cardiology, Heart Transplantation, Female, Surgery, Transthoracic echocardiogram, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
الوصف: Background Given the shortage of suitable donor hearts for cardiac transplantation and the growing interest in donation after circulatory death (DCD), our institution recently began procuring cardiac allografts from DCD donors. Methods Between October 2020 and March 2021, 15 patients with heart failure underwent cardiac transplantation using DCD allografts. Allografts were procured using a modified extracorporeal membrane oxygenation circuit for thoracic normothermic regional perfusion (TA-NRP) and were subsequently transported using cold static storage. Data collection and analysis were performed with institutional review board approval. Results The mean age of the DCD donors was 23 ± 7 years and average time on TA-NRP was 56 ± 8 minutes. Total ischemic time was 183 ± 31 minutes and distance from transplant center was 373 ± 203 nautical miles. Recipient age was 55 ± 14 years, with 8 (55.3%) recipients on durable left ventricular assist device support. Post-transplant, 6 (40%) recipients experienced mild left ventricle primary graft dysfunction (PGD-LV), 3 (20%) recipients experienced moderate PGD-LV, and no recipients experienced severe PGD-LV. Postoperative transthoracic echocardiogram demonstrated left ventricular ejection fraction >55% in all recipients. One recipient (6.6%) developed International Society for Heart and Lung Transplantation 2R acute cellular rejection on first biopsy. At last follow-up, all 15 recipients were alive past 30-days. Conclusions Cardiac DCD provides an opportunity to increase the availability of donor hearts for transplantation. Utilizing TA-NRP with cold static storage, we have extended the cold ischemic time of DCD allografts to almost 3 hours, allowing for inter-hospital organ transport.
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