Pulmonale Hypertonie bei Linksherzerkrankungen

The 2009 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension have been adopted for Germany. While the guidelines contain detailed recommendations regarding pulmonary arterial hypertension (PAH), they contain only a relatively short paragraph on other, much more frequent forms of PH such as PH due to left heart disease. Despite the lack of data, targeted PAH treatments are increasingly being used for PH associated with left heart disease. This development is of concern. On the other hand, PH is a frequent problem that is highly relevant for morbidity and mortality in patients with left heart disease, so that it may be speculated whether selected patients may benefit from…

The clinical impact of donor-specific antibodies in heart transplantation.

Donor-specific antibodies (DSA) are integral to the development of antibody-mediated rejection (AMR). Chronic AMR is associated with high mortality and an increased risk for cardiac allograft vasculopathy (CAV). Anti-donor HLA antibodies are present in 3-11% of patients at the time of heart transplantation (HTx), with de novo DSA (predominantly anti-HLA class II) developing post-transplant in 10-30% of patients. DSA are associated with lower graft and patient survival after HTx, with one study suggesting a three-fold increase in mortality in patients who develop de novo DSA (dnDSA). DSA against anti-HLA class II, notably DQ, are at particularly high risk for graft loss. Although detection o…

Prognosis of Patients Listed for a Heart Transplant During the Pretransplant Period: Does Diabetes Matter?

Whether patients with advanced heart failure and diabetes mellitus (DM) should be listed for heart transplantation (HTx) remains controversial due to conflicting findings regarding their post-HTx survival (1–3). We studied HTx candidates with and without DM during the pre-HTx period, examining multiple waiting list outcomes. Patients were enrolled in the Waiting for a New Heart Study, a multisite observational study of 318 adult (≥18 years of age) patients (aged 53 ± 11 years; 18% female) who were newly listed for HTx with Eurotransplant between April 2005 and December 2006 (4). Informed consent and ethics approval were obtained (4). Characteristics at the time of listing included age, DM, …

469: Prospective, randomized, multicenter trial comparing conversion to a CNI-free regimen (MMF & sirolimus) vs. a CNI-reduced, MMF-based immunosuppression to improve renal function in late cardiac transplant recipients