Search results for "Heart transplantation"
showing 10 items of 59 documents
Organ Recovery Procedure in Donation After Controlled Circulatory Death with Normothermic Regional Perfusion: State of the Art
2020
The global shortage of organ donors will not be resolved solely by relying on donation after brain death. Expansion to use of donation after controlled circulatory death will be needed to address the shortfall of organs for transplantation. The processes of warm ischemia threaten the viability of organs obtained after controlled circulatory death, but these can be minimized by well-organized donation pathways and new techniques of in situ organ preservation, such as normothermic regional perfusion. The use of extracorporeal membrane oxygenation (ECMO) devices for normothermic regional perfusion in liver transplantation can help reduce rates of biliary complications, ischemic type biliary le…
Shedding light on the elusive role of endothelial cells in cytomegalovirus dissemination.
2011
Cytomegalovirus (CMV) is frequently transmitted by solid organ transplantation and is associated with graft failure. By forming the boundary between circulation and organ parenchyma, endothelial cells (EC) are suited for bidirectional virus spread from and to the transplant. We applied Cre/loxP-mediated green-fluorescence-tagging of EC-derived murine CMV (MCMV) to quantify the role of infected EC in transplantation-associated CMV dissemination in the mouse model. Both EC- and non-EC-derived virus originating from infected Tie2-cre + heart and kidney transplants were readily transmitted to MCMV-naïve recipients by primary viremia. In contrast, when a Tie2-cre + transplant was infected by pri…
Old and New Drugs for Treatment of Advanced Heart Failure.
2020
Background: Advanced heart failure (HF) is a progressive disease with high mortality and limited medical therapeutic options. Long-term mechanical circulatory support and heart transplantation remain goldstandard treatments for these patients; however, access to these therapies is limited by the advanced age and multiple comorbidities of affected patients, as well as by the limited number of organs available. Methods: Traditional and new drugs available for the treatment of advanced HF have been researched. Results: To date, the cornerstone for the treatment of patients with advanced HF remains water restriction, intravenous loop diuretic therapy and inotropic support. However, many patien…
Pharmacogenetic Study of ABCB1 and CYP3A5 Genes During the First Year Following Heart Transplantation Regarding Tacrolimus or Cyclosporine Levels
2011
Pharmacogenetics explains part of the interindividual variability in drug responses. Many published works about the effects of single nucleotide polymorphisms (SNPs) on immunosuppressive drug blood levels present contradictory results. We evaluated the SNPs in ABCB1 (glycoprotein P) and CYP3A5 (metabolic enzyme) genes, seeking correlate them with tacrolimus or cyclosporine levels during the first year after heart transplantation. One blood sample was obtained from each of 41 patients: 26 treated with cyclosporine and 15 with tacrolimus. We characterize the SNPs rs1045642, 1128503, 2032582, 2235013, 2235033, 2229109, 3213619, 9282564 in ABCB1 and rs10264272, 776746 in CYP3A5 genes using the …
Compartmentalized production of CCL17 in vivo: strong inducibility in peripheral dendritic cells contrasts selective absence from the spleen.
2003
Dendritic cells (DCs)(*) fulfill an important regulatory function at the interface of the innate and adaptive immune system. The thymus and activation-regulated chemokine (TARC/CCL17) is produced by DCs and facilitates the attraction of activated T cells. Using a fluorescence-based in vivo reporter system, we show that CCL17 expression in mice is found in activated Langerhans cells and mature DCs located in various lymphoid and nonlymphoid organs, and is up-regulated after stimulation with Toll-like receptor ligands. DCs expressing CCL17 belong to the CD11b(+)CD8(-)Dec205(+) DC subset, including the myeloid-related DCs located in the subepithelial dome of Peyer's patches. CCL17-deficient mi…
Pulmonary vascular resistance as a potential marker of reactive pulmonary hypertension reduction following sildenafil therapy in patients disqualifie…
2019
Purpose:We sought to determine the predictors of restoration of heart transplantation (HTx) candidacy in pa-tients with systolic heart failure (HF) and reactive fixed pulmonary hypertension (RFPH) defined as pulmonaryvascular resistance (PVR) > 2.5 Wood units (WU), transpulmonary gradient (TPG) > 12 mmHg or ≤2.5 WUwith systolic arterial pressure ≤85 mmHg during vasoreactivity test, following sildenafil therapy.Material and methods:Between2007and20181136patientswereevaluatedatourdepartmentascandidatesforHTx. Thirty-five of them, who presented with systolic HF and were not eligible for HTx due to RFPH, wereincluded in the study (31 men aged 55.1 ± 7.4 years). In all the patients sildenafil wa…
Hypoxia and myocardial remodeling in human cardiac allografts: a time-course study.
2009
Background: Cardiac allografts are known to develop myocardial fibrosis, which may be a cause of progressive cardiac dysfunction. Apart from the renin‐angiotensin and transforming growth factor- system, hypoxia has been proposed as an important player in the pathogenesis of fibrosis, but its significance remains unclear. This study examines the degree of myocardial fibrosis, cellular remodeling and hypoxic signaling over a time-course of 10 years after human cardiac allograft transplantation. Methods: Serial right ventricular biopsies of 57 patients were collected in 6-month intervals after cardiac transplant surgery for a total of 10 years to allow a retrospective longitudinal analysis. Ov…
Medical and psychosocial predictors of mechanical circulatory support device implantation and competing outcomes in the Waiting for a New Heart Study
2011
Background Medical and psychosocial factors are related to 1-year outcomes in the Waiting for a New Heart Study. With increased use of mechanical circulatory support devices (MCSD) over the course of the study, we can now evaluate these variables as predictors of MCSD in an extended follow-up. Methods Analyses focused on 313 MCSD-free patients (82% men; aged 53 ± 11 years) newly listed for heart transplantation (HTx). Variables assessed at time of listing included psychosocial risk (depression, social isolation), quality of life, waiting list stress, and medical risk (Heart Failure Survival Score, pulmonary capillary wedge pressure). Cumulative incidence functions and cause-specific Cox mod…
The role of the Heart Failure Survival Score and psychosocial stress in predicting event-free survival in patients referred for heart transplantation
2012
We read with interest the article “Selecting patients for heart transplantation: Comparison of the Heart Failure Survival Score (HFSS) and the Seattle Heart Failure Model (SHFM)” by Goda et al. Their study showed that the HFSS and the SHFM are similarly predictive of event-free survival in heart transplant (HTx) candidates enrolled at a single center in the USA. We also found that a HFSS denoting high medical risk predicts time until death, urgent transplantation, and implantation of ventricular assist devices (VAD) in patients newly listed for an HTx with Eurotransplant; in that same study, we have also shown that low HFSS risk predicts de-listing due to clinical improvement. The article b…
Carotid endarterectomy in heart transplant patients
2005
AIM: The aim of this study was to determine the clinical outcome of carotid endarterectomy in heart transplant recipients and morphologic features of atherosclerotic plaques removed during operation. METHODS: Between April 1993 and October 2001 5 heart transplant patients with symptomatic carotid stenosis >70% underwent carotid endarterectomy with regional anesthesia, including a staged bilateral procedure in one patient. Cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol were evaluated in each patient. The plaques ( n=6) underwent histologic analysis after carotid endarterectomy. Carotid artery duplex imaging was added to the routine postoperative evaluation. RESULTS: Carotid pla…