The Journal of heart transplantation最新文献

{"title":"A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Heart Rejection Study Group. The International Society for Heart Transplantation.","authors":"M E Billingham, N R Cary, M E Hammond, J Kemnitz, C Marboe, H A McCallister, D C Snovar, G L Winters, A Zerbe","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 6","pages":"587-93"},"PeriodicalIF":0.0,"publicationDate":"1990-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13428266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart transplantation in patients with malignant disease.","authors":"J M Armitage,&nbsp;R L Kormos,&nbsp;B P Griffith,&nbsp;F J Fricker,&nbsp;R L Hardesty","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We have traditionally pushed the limits of conservative candidate criteria for heart transplantation. We have been gratified by our results in the aged, the diabetic, and the mortally ill. Our inclusion of patients with malignant disease underscores our philosophy to include patients as candidates for transplantation for whom the procedure has reasonable expectation of success. We report here our early results of heart transplantation in 11 patients with malignant disease. Our survival rate in this group is 100%, and all patients are leading active lives with no evidence of recurrent or metastatic tumor. Immunosuppression protocols were adjusted on an individual basis determined by the chemotherapy dosage, duration, and relation to transplantation. Whenever possible a 1-year disease-free interval after completion of adequate cancer therapy is desired before transplantation.</p>","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 6","pages":"627-9; discussion 630"},"PeriodicalIF":0.0,"publicationDate":"1990-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13427397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver and kidney function in patients undergoing mechanical circulatory support with Jarvik-7 artificial heart as a bridge to transplantation.","authors":"A T Kawaguchi,&nbsp;I Gandjbahch,&nbsp;A Pavie,&nbsp;C Muneretto,&nbsp;E Solis,&nbsp;P Leger,&nbsp;V Bors,&nbsp;J Szefner,&nbsp;E Vaissier,&nbsp;J P Levasseur","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Changes in liver and kidney function were reviewed in 32 patients who received a Jarvik-7 total artificial heart (TAH) as a bridge to transplantation. Preoperatively, seven (22%) had significant isolated kidney dysfunction, five (15%) had isolated liver impairment, and 13 (41%) had combined disorder, affecting 25 (78%) of the 32 recipients. Immediately after TAH implantation, vigorous diuresis occurred, and biochemical indices improved in 17 patients: 71% of isolated kidney, 60% of isolated liver, and 38% of combined organ disorder were reversed irrespective of severity in preoperative dysfunction. In contrast, urine output remained poor, and biochemical indices continued to deteriorate in 15 patients regardless of preoperative status; as a result, kidney (28%), liver (17%), and combined organ failure (33%) accounted for a total of 78% of failure in this series. Although preoperative liver and kidney dysfunction were frequent and severe, they did not correlate with postoperative functional recovery and later transplantation. Recipient body size and initial postoperative urine output were found to be the variables discriminating patients with or without subsequent transplantation. Because liver/kidney failure remained as the leading cause of death, knowledge of the underlying cause of the organ failure would increase the success of TAH as a bridge to transplantation.</p>","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 6","pages":"631-7"},"PeriodicalIF":0.0,"publicationDate":"1990-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13427398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low incidence of neoplasia in heart and heart-lung transplant recipients receiving triple-drug immunosuppression.","authors":"M T Olivari,&nbsp;R A Diekmann,&nbsp;S H Kubo,&nbsp;E Braunlin,&nbsp;S W Jamieson,&nbsp;W S Ring","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The risk of neoplasias developing after solid organ transplantation is markedly increased by immunosuppressive therapy. Lymphoma has been reported to develop in 13% of heart and in 33% of heart-lung transplant recipients treated with cyclosporine, and the incidence of skin carcinoma ranges between 6% and 16%. The incidence of posttransplant neoplasias with the use of lower loading and maintenance doses of cyclosporine as used in triple-drug immunosuppression is unknown. From December 1983 through August 1988, 134 heart and seven heart-lung transplants were performed at the University of Minnesota. All patients received a combination of cyclosporine, azathioprine, and prednisone. Survival was 94% at 1 and 90% at 3 years in heart recipients. Probability of acute rejection was 9% at 3 months and 12% at 1 and 3 years. B-cell lymphoma developed after heart transplant in only two patients for an incidence of 1.5%. Episodes of acute rejection and mean cyclosporine blood level did not predict the occurrence of posttransplant lymphoma. The incidence of skin carcinoma was 6.4%. No neoplasia occurred in heart-lung transplant recipients. All neoplasias were observed in patients older than 50 years. Our data indicate that the risk for developing lymphoproliferative disorders, but not for basal cell carcinoma, is reduced in heart and heart-lung transplant recipients receiving triple-drug immunosuppression. Older recipients may be at increased risk, suggesting that lower doses of immunosuppressive therapy should be considered in this group.</p>","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 6","pages":"618-21"},"PeriodicalIF":0.0,"publicationDate":"1990-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13427401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left ventricular systolic function and diastolic filling at rest and during upright exercise after orthotopic heart transplantation: comparison with young and aged normal subjects.","authors":"L T Younis,&nbsp;J A Melin,&nbsp;J C Schoevaerdts,&nbsp;M Van Dyck,&nbsp;J M Detry,&nbsp;A Robert,&nbsp;C Chalant,&nbsp;M Goenen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>To evaluate the hemodynamic response to upright exercise of heart transplant recipients, we had 10 patients aged 46 +/- 14 years undergo rest and exercise radionuclide ventriculography 6 to 26 (mean, 14) month after orthotopic heart transplantation. Results were compared with those obtained in 18 young subjects, aged 22 +/- 3 years, and 17 older subjects, aged 56 +/- 5 years. Radionuclide ventriculography was performed at rest and at three levels of exercise, representing 50%, 70%, and 90% of the maximal physical workload. At rest, heart rate was higher in transplant patients than in normal subjects, but during exercise, heart rate increased only 33% compared with a 142% increase in the young subjects and a 111% increase in the older group. During exercise, left ventricular ejection fraction increased in the three groups, but, as compared with the transplant group, the increase of ejection fraction was higher in the young group. End-diastolic volume increased both in transplant patients (+16%) and in older subjects (+13%), whereas it decreased (-20%) in the young subjects during exercise. End-systolic volume decreased in the young group and in the transplant group with exercise, and it did not change in the older group. Cardiac index increased throughout the three levels of exercise in the three groups of subjects, but cardiac index was higher during exercise in young and older normal subjects. With exercise, all three groups showed increases in peak filling rates, but young subjects had a significantly higher value compared with the transplant group. Filling fraction in the first third of diastole did not change with exercise in the transplant and the older group but increased in the young group. We conclude that in transplant patients, increase in cardiac index during upright exercise is mediated by an increase in end-diastolic index during submaximal exercise and by increased heart rate and augmented contractility at peak exercise. Early diastolic filling is altered in these patients, and this alteration is independent from the changes in heart rate and cardiac volumes. When compared with normal persons, this pattern of hemodynamic response to exercise is similar to older subjects but differs from young subjects in whom the increase in heart rate and reduction in end-systolic volume are the chief mechanisms of enhancing cardiac index during exercise.</p>","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 6","pages":"683-92"},"PeriodicalIF":0.0,"publicationDate":"1990-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13428099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prostacyclin in the management of pulmonary hypertension after heart transplantation.","authors":"J M Pascual,&nbsp;A I Fiorelli,&nbsp;G M Bellotti,&nbsp;N A Stolf,&nbsp;A D Jatene","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Right ventricular failure after heart transplantation has been well documented as a major determinant of patient outcome. In 50 patients undergoing orthotopic heart transplantation, nine male patients with an average age of 41 years had in the immediate postoperative period a syndrome that consisted of low cardiac index, high right atrial and pulmonary artery pressures, and high pulmonary vascular resistance. The preoperative data showed: right atrial pressure, 9 +/- 6 mm Hg; pulmonary pressure, 38 +/- 10 mm Hg; cardiac index, 1.6 +/- 0.4 L/min/m2; pulmonary vascular resistance, 466 +/- 91 dynes/sec/cm-5; pulmonary wedge pressure, 15 +/- 6 mm Hg; and systemic vascular resistance, 2089 +/- 290 dynes/sec/cm-5. The immediate postoperative data revealed: right atrial pressure, 17 +/- 5; pulmonary artery pressure, 32 +/- 8; cardiac index, 2.2 +/- 0.7; pulmonary vascular resistance, 421 +/- 368; pulmonary wedge pressure, 15 +/- 6; systemic vascular resistance 1318 +/- 263. All of these patients were receiving inotropic and vasodilator drugs with no improvement after volume challenge. Prostacyclin was started, and the dose increased from 0.5 to 5.0 ng/kg/min, until an increase in cardiac index and a reduction in pulmonary resistance were achieved. The final profile was right atrial pressure, 12 +/- 5; pulmonary artery pressure, 24 +/- 6; cardiac index, 3.7 +/- 1.2; pulmonary vascular resistance, 122 +/- 42; pulmonary wedge pressure, 14 +/- 4; systemic vascular resistance, 870 +/- 263. The use of prostacyclin enabled the weaning of other drugs within a 48-hour period with no side effects and no worsening of the hemodynamic conditions after discontinuation of prostacyclin.</p>","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 6","pages":"644-51"},"PeriodicalIF":0.0,"publicationDate":"1990-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13427400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heterotopic heart transplantation: mid-term hemodynamic and echocardiographic analysis--the concern of arteriovenous-valve incompetence.","authors":"A Hildebrandt,&nbsp;H Reichenspurner,&nbsp;G D Gordon,&nbsp;A R Horak,&nbsp;J A Odell,&nbsp;B Reichart","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>To assess the hemodynamic contribution of both hearts after heterotopic heart transplantation, we examined recipients by cardiac catheterization and Doppler echocardiography. Since September 1984, immunosuppression consisted of cyclosporine, azathioprine, methylprednisolone, and antithymocyte globulin. In this time interval, 55 orthotopic and 14 heterotopic transplants have been performed. The indications for heterotopic transplant were elevated pulmonary vascular resistance (greater than 4 Wood units), in 10 patients, or gross (greater than 20%) donor-recipient weight mismatch, in six patients. Two patients belonged to both groups. The 1-year survival rate was 63%; currently seven of the 14 patients are alive. Cardiac output (as measured by dye dilution curves and by the Fick method) increased from 4.2 L/min preoperatively to 6.1 L/min in both groups postoperatively (mean follow up, 5.3 months; p less than 0.0005); the transpulmonary gradient fell from 18.5 to 12.3 mm Hg, the pulmonary vascular resistance from 4.4 to 2.4 Wood units (p less than 0.01). The echocardiographic findings were as follows: left ventricular end-diastolic diameter (mm) in the recipient heart was 67.4 +/- 12 and in the donor heart, 42.6 +/- 8.7. Fractional shortening (%) in the recipient heart was 7.1 +/- 2.9 and in the donor heart, 30.4 +/- 10.4. The Doppler technique revealed a cardiac output contribution-ratio (CO donor/CO recipient) of 3.0 +/- 0.61 on average. In all recipient hearts mild and moderate mitral and tricuspid regurgitation was discovered. In the donor heart all mitral and tricuspid valves were found to be incompetent; this was severe in 66% and 11% of the mitral and tricuspid valves, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)</p>","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 6","pages":"675-81; discussion 682"},"PeriodicalIF":0.0,"publicationDate":"1990-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13428101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"15-Deoxyspergualin and primate heart transplantation.","authors":"D P Kapelanski,&nbsp;M J Perelman,&nbsp;L A Faber,&nbsp;D E Paez,&nbsp;E F Rose,&nbsp;D M Behrendt","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>15-Deoxyspergualin is a synthetic polyamine that exhibits a novel spectrum of immunosuppressive activity in lower mammals. To define the clinical potential of this drug, we performed 25 abdominal heterotopic heart transplants in Macaca fasicularis. Donor and recipient pairs were selected from ABO-identical animals with negative erythrocyte crossmatches. All recipients received one dose of methylprednisolone sodium succinate at graft reperfusion. Five control recipients received no subsequent immunosuppression. Five recipients received high-dose 15-deoxyspergualin (7.5 mg/kg IM). Five recipients received low-dose 15-deoxyspergualin (2.0 mg/kg IM). Five recipients received cyclosporine (1.0 mg/kg IM). Five recipients received both 15-deoxyspergualin (2.0 mg/kg IM) and cyclosporine (1.0 mg/kg IM). Immunosuppressive agents were administered daily, beginning with the morning of operation, and were continued until the animal was killed or 30 days had elapsed. Graft function was assessed by daily palpation. Median graft survival among control recipients was 9 days (range, 6 to 34 days). At the dose used, cyclosporine alone did not influence either graft survival time (median survival, 13 days; range, 7 to 23 days) or rejection grade. Graft survival and rejection grade among recipients treated with low-dose 15-deoxyspergualin were not different from control recipients or those treated with cyclosporine alone (median survival, 10 days; range, 8 to 39 days). One recipient, killed on postoperative day 8, had an intraadominal abscess. In each of the recipients treated with high-dose 15-deoxyspergualin systemic toxicity developed, and the animal was killed when death appeared imminent, although graft contraction remained vigorous (median survival, 28 days; range 25 to 30 days).(ABSTRACT TRUNCATED AT 250 WORDS)</p>","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 6","pages":"668-73; discussion 673-4"},"PeriodicalIF":0.0,"publicationDate":"1990-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13428098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smooth muscle cells and macrophages in rabbit cardiac allograft atherosclerosis.","authors":"J T Beranek,&nbsp;N C Cavarocchi","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 6","pages":"732"},"PeriodicalIF":0.0,"publicationDate":"1990-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13428103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-year experience with human cytomegalovirus infections in heart transplant recipients.","authors":"P Grossi,&nbsp;M G Revello,&nbsp;L Minoli,&nbsp;E Percivalle,&nbsp;M Zavattoni,&nbsp;G Poma,&nbsp;L Martinelli,&nbsp;G Gerna","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>One hundred twenty-four patients underwent heart transplantation over a 3-year period. All patients were monitored for human cytomegalovirus (CMV) infection if at risk for primary CMV infection or in the presence of CMV-related symptoms. Rapid diagnosis of CMV infection relied on virus isolation and identification or viral antigen detection by using monoclonal antibodies to CMV immediate early or early antigens. In addition, \"in situ\" hybridization was used to detect viral DNA in tissue samples. Specimens examined included peripheral blood polymorphonuclear cells for CMV viremia and antigenemia determination, together with the most appropriate clinical samples when organ involvement was suspected. There was a 100% (6/6 patients) incidence of primary CMV infection in seronegative recipients of hearts from seropositive donors, whereas no CMV infection occurred in the three seronegative recipients receiving a transplant heart from CMV-negative donors. CMV hyperimmunoglobulin prophylaxis did not prevent primary CMV infection. Five of the six patients with primary CMV infection were symptomatic. In addition, 15 patients (13%) had symptomatic recurrent CMV infection. The most frequent symptoms associated with CMV infection (either primary or recurrent) were fever (19 patients) and pneumonia (eight patients). CMV viremia was detected in 17 patients either before or concomitantly with the appearance of fever. CMV was isolated from bronchoalveolar lavage in all cases with pneumonia; however, another pathogen was associated with CMV and appeared to be the major cause of pneumonia in 75% of these patients (6/8). Twelve patients (five with primary and seven with recurrent CMV infections) were treated with ganciclovir.(ABSTRACT TRUNCATED AT 250 WORDS)</p>","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 6","pages":"712-9"},"PeriodicalIF":0.0,"publicationDate":"1990-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13330460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}