The Journal of heart transplantation最新文献_第6页

Low-dose aspirin and accelerated coronary disease in heart transplant recipients. 低剂量阿司匹林与心脏移植受者冠心病加速

The Journal of heart transplantation Pub Date : 1990-07-01

M de Lorgeril, P Boissonnat, G Dureau, S Renaud

引用次数: 0

Results of heart transplantation for active lymphocytic myocarditis. 活动性淋巴细胞性心肌炎心脏移植疗效观察。

The Journal of heart transplantation Pub Date : 1990-07-01

J B O'Connell, G W Dec, I F Goldenberg, R C Starling, G H Mudge, S M Augustine, M R Costanzo-Nordin, M L Hess, J D Hosenpud, T B Icenogle

{"title":"Results of heart transplantation for active lymphocytic myocarditis.","authors":"J B O'Connell, G W Dec, I F Goldenberg, R C Starling, G H Mudge, S M Augustine, M R Costanzo-Nordin, M L Hess, J D Hosenpud, T B Icenogle","doi":"","DOIUrl":"","url":null,"abstract":"To determine whether the heart-specific immunoreactivity associated with active myocarditis affects outcome after heart transplantation, we retrospectively analyzed the outcome of 12 patients with active lymphocytic myocarditis in their explanted native hearts identified by the Registry of the International Society for Heart Transplantation. The patients were 38 +/- 10 years of age and predominantly female (75%). In nine patients (75%), endomyocardial biopsy showed active myocarditis before transplant; eight of these patients also received immunosuppression before transplant. Recipient hemodynamic study before transplantation demonstrated an ejection fraction of 0.18 +/- 0.06, cardiac index of 1.7 +/- 0.4 L/min/m2, pulmonary artery pressure of 41 +/- 6/23 +/- 6 mm Hg, and mean pulmonary capillary wedge pressure of 30 +/- 5 mm Hg. Left ventricular end-diastolic dimension by echocardiography was 6.0 +/- 1.4 cm. Four of the patients were dependent on intravenous inotropes, and six required mechanical assistance. Over a 36-month follow-up period, 2.9 +/- 2.4 episodes of rejection occurred per patient. Sixty percent of the first episodes occurred within 2 weeks of transplantation. These patients experienced a 2.2 +/- 1.1-fold increase in rejection compared with institutional average rejection rates. Survival was significantly shorter than that of age-matched or female control subjects. This study is limited by its retrospective nature and the unusual pretransplant characteristics of the subjects. It indicates that active myocarditis may predispose patients to early severe rejection and a high mortality rate after heart transplantation.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 4","pages":"351-5; discussion 355-6"},"PeriodicalIF":0.0,"publicationDate":"1990-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13546270","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}

引用次数: 0

Pathologic features in long-term cardiac allografts. 长期同种异体心脏移植的病理特征。

The Journal of heart transplantation Pub Date : 1990-07-01

A M Pucci, R D Forbes, M E Billingham

引用次数: 0

Nontuberculous mycobacterial infections in heart transplant recipients: a seventeen-year experience. 心脏移植受者的非结核分枝杆菌感染:一个17年的经验。

The Journal of heart transplantation Pub Date : 1990-07-01

R J Novick, C E Moreno-Cabral, E B Stinson, P E Oyer, V A Starnes, S A Hunt, N E Shumway

{"title":"Nontuberculous mycobacterial infections in heart transplant recipients: a seventeen-year experience.","authors":"R J Novick, C E Moreno-Cabral, E B Stinson, P E Oyer, V A Starnes, S A Hunt, N E Shumway","doi":"","DOIUrl":"","url":null,"abstract":"A retrospective review was undertaken to determine the clinical features, outcome, and impact on survival of nontuberculous mycobacterial infections in 14 (of 502) heart transplant recipients. The prevalence of these infections was significantly higher (p less than 0.05) during the precyclosporine than during the cyclosporine era. The mean interval from transplantation to diagnosis was 3.5 +/- 0.7 years (+/- SEM). The 14 patients had a higher (p less than 0.05) linearized rejection rate than did other transplant patients during postoperative years 1, 2, and 4 to 6, and had received 7.3 +/- 2 gm of methylprednisolone as bolus treatment of rejection before diagnosis. Eight patients were initially seen with disseminated disease, four had localized pulmonary infection, one had subcutaneous infection in the previous site of a left ventricular assist device, and in one the organism was cultured from a fluid collection adjacent to a hip prosthesis. Twelve patients were first given 3 +/- 1 antimycobacterial drugs; the infections were usually controlled, but in 75% of patients the therapeutic regimen was prematurely stopped or altered because of drug toxicity. Mycobacterial infection was a contributory cause of death in only one patient. Actuarial survival in the 14 patients was not significantly different from the entire transplant population at 4 to 7 years. We conclude that nontuberculous mycobacterial infections occur late after heart transplantation, that drug treatment is usually successful (although difficult), and that long-term survival is not adversely affected if the infection is successfully controlled.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 4","pages":"357-63"},"PeriodicalIF":0.0,"publicationDate":"1990-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13546269","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}

引用次数: 0

Successful intermediate-term outcome for patients with cardiac amyloidosis undergoing heart transplantation: results of a multicenter survey. 接受心脏移植的心脏淀粉样变性患者成功的中期结果:一项多中心调查的结果。

The Journal of heart transplantation Pub Date : 1990-07-01

J D Hosenpud, B F Uretsky, B P Griffith, J B O'Connell, M T Olivari, H A Valantine

{"title":"Successful intermediate-term outcome for patients with cardiac amyloidosis undergoing heart transplantation: results of a multicenter survey.","authors":"J D Hosenpud, B F Uretsky, B P Griffith, J B O'Connell, M T Olivari, H A Valantine","doi":"","DOIUrl":"","url":null,"abstract":"Amyloid heart disease has been considered a contraindication for heart transplant on the basis of the hypothesis that it is a systemic disease and that amyloid deposition would occur in the cardiac allograft. Despite these concerns, several centers have performed heart transplantation for amyloidosis in a limited number of cases. A survey was sent to all of the U.S. centers and a limited number of European centers listed with the Registry of the International Society for Heart Transplantation. Nineteen centers responded, and data were provided for a total of seven patients (three men and four women, with a mean age of 46 years, range, 30 to 60 years) who had transplants for cardiac amyloid. The diagnosis of cardiac amyloidosis was made histologically on endomyocardial biopsy and/or examination of the explanted heart. Additional organ involvement included liver (two cases), rectal (two cases), renal (one case), gingiva (one case), and tongue (one case). A specific amyloid protein was identified in five patients (four lambda, one kappa Ig light chain). Two patients developed recurrent amyloid in their allograft seen by electron microscopy at 3 1/2 and 4 months, respectively. One patient developed progressive diastolic dysfunction, but systolic function was preserved. This patient died 13 months after transplantation as a result of progressive liver infiltration with amyloid. One patient died immediately after operation. Five patients are alive and fully rehabilitated 32 +/- 12 months after transplant. On the basis of this small series, some patients with cardiac amyloidosis can undergo heart transplantation with good intermediate-term results.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 4","pages":"346-50"},"PeriodicalIF":0.0,"publicationDate":"1990-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13546121","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}

引用次数: 0

Posttransplant obesity and hyperlipidemia: major predictors of severity of coronary arteriopathy in failed human heart allografts. 移植后肥胖和高脂血症:心脏移植失败患者冠状动脉病变严重程度的主要预测因素。

The Journal of heart transplantation Pub Date : 1990-07-01

G L Winters, T J Kendall, S J Radio, J E Wilson, M R Costanzo-Nordin, B L Switzer, J A Remmenga, B M McManus

{"title":"Posttransplant obesity and hyperlipidemia: major predictors of severity of coronary arteriopathy in failed human heart allografts.","authors":"G L Winters, T J Kendall, S J Radio, J E Wilson, M R Costanzo-Nordin, B L Switzer, J A Remmenga, B M McManus","doi":"","DOIUrl":"","url":null,"abstract":"The contribution of specific risk factors to the development of coronary arteriopathy in human heart allografts remains unclear. Allografts from 15 patients, 11 males and 4 females, aged 15 to 58 years (mean, 40 years), with patient survival from 0.5 to 24 months (mean, 8.6 months) with \"triple drug therapy,\" had the entire coronary artery trees removed, with 184 4-mm arterial segments studied. Luminal narrowing was measured by means of digitization on a video image analysis system, and extent of luminal narrowing (cross-sectional area reduction: [Intimal area/Intimal area + Luminal area] X 100 = %) was related to 40 individual risk factors, including demographic, hemodynamic, immune, environmental, and therapeutic factors. Mean luminal narrowing, considering all coronary segments, was significantly greater in patients with higher versus lower mean cholesterol levels (246 vs 163 mg/dl), triglyceride levels (328 vs 145 mg/dl), and body mass indices (31 vs 22 kg/m2) at 62% versus 38%, 59% versus 42% and 61% versus 44% luminal narrowing, respectively. Considering all coronary segments from all heart allografts, mean luminal narrowing steadily progressed with duration of implant, reaching greater than 60% within 6 months. Mean luminal narrowing was identical in proximal and distal halves of coronary trees at 51% and 50%, respectively. Rejection episodes, considering all degrees of rejection, were strongly related to percent luminal narrowing (p = 0.01). Multivariate analysis indicated the single most predictive risk factor to be posttransplant body mass index (r = 0.77; p = 0.0009).(ABSTRACT TRUNCATED AT 250 WORDS)","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 4","pages":"364-71"},"PeriodicalIF":0.0,"publicationDate":"1990-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13546119","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}

引用次数: 0

Analysis of risk factors for acute allograft rejection after heart transplantation. 心脏移植术后急性同种异体排斥反应的危险因素分析。

The Journal of heart transplantation Pub Date : 1990-07-01

M Carrier, D H Russell, R C Cork, J Wild, R W Emery, J G Copeland

{"title":"Analysis of risk factors for acute allograft rejection after heart transplantation.","authors":"M Carrier, D H Russell, R C Cork, J Wild, R W Emery, J G Copeland","doi":"","DOIUrl":"","url":null,"abstract":"The diagnosis of cardiac allograft rejection is currently based on endomyocardial biopsy and histologic evaluation. Since the introduction of cyclosporine, cardiac biopsy has been recognized as the only reliable method of diagnosis. From July 1985 to June 1986, 22 transplant patients were studied during the early posttransplant period to evaluate other characteristics of allograft rejection. The immunosuppressive protocol included cyclosporine, azathioprine, prednisone, and prophylactic rabbit antithymocyte globulin. Acute rejection was established by standard histologic criteria. Twenty-four positive and 123 negative biopsy findings were obtained. Clinical variables (age, sex, immunosuppressive regimen, cyclosporine dosage, ECG voltage), biologic variables (level of cyclosporine, white blood cells, blood urea nitrogen, creatinine, bilirubin, prolactin, urinary polyamines, blood type, HLA typing), and immunologic variables (T-cell subsets) were analyzed in regard to the histologic diagnosis of acute rejection. Four variables (WBC, prolactin, total urinary polyamines, N-acetyl putrescine) were found to have a significant univariate association with acute rejection. These variables were studied by multivariate discriminant analysis. The only factors found to have independent predictive value for acute rejection were prolactin and N-acetyl putrescine peaks occurring before acute rejection. When we used these factors, a discriminant function correctly predicted acute rejection episodes, as well as negative biopsy results, in 74% of the cases in this group of patients.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 4","pages":"372-5"},"PeriodicalIF":0.0,"publicationDate":"1990-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13546122","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}

引用次数: 0

Increased incidence of cholelithiasis in heart transplant recipients receiving cyclosporine therapy. 接受环孢素治疗的心脏移植受者胆石症发生率增高。

The Journal of heart transplantation Pub Date : 1990-07-01

C H Spes, C E Angermann, R W Beyer, J Schreiner, P Lehnert, B M Kemkes, K Theisen

{"title":"Increased incidence of cholelithiasis in heart transplant recipients receiving cyclosporine therapy.","authors":"C H Spes, C E Angermann, R W Beyer, J Schreiner, P Lehnert, B M Kemkes, K Theisen","doi":"","DOIUrl":"","url":null,"abstract":"The introduction of cyclosporine to immunosuppressive therapy greatly improved the results of organ transplantation. The clinical use of cyclosporine, however, is associated with several serious side effects. Because the drug is primarily eliminated via biliary secretion and thus probably alters bile composition, we investigated the incidence of gallstones in 29 heart transplant recipients receiving immunosuppressive therapy with cyclosporine. Two of three female patients and none of the male patients had gallstones before heart transplantation. After operation, in nine of the 26 male patients cholelithiasis developed during cyclosporine therapy; seven cases of gallstones occurred within the first postoperative year. High cyclosporine blood levels, obesity, and diabetes mellitus in the early postoperative period appeared to be predisposing factors for formation of gallstones. Prevention of biliary calculous disease in heart transplant recipients is especially important because immunosuppressive therapy poses an additional risk on potential complications of cholelithiasis. An immunosuppressive regimen aimed at lower cyclosporine blood levels may help to avoid hepatobiliary complications.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 4","pages":"404-7"},"PeriodicalIF":0.0,"publicationDate":"1990-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13546125","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}

引用次数: 0

Neonatal autoperfused working heart-lung preparation: assessment of factors determining survival. 新生儿自体灌注工作心肺准备:决定生存因素的评估。

The Journal of heart transplantation Pub Date : 1990-07-01

J Caspi, S L Herman, G J Wilson, J Villamater, J Augustine, F Hamilton, S Castellarin, R Kumar, L N Benson, J G Coles

{"title":"Neonatal autoperfused working heart-lung preparation: assessment of factors determining survival.","authors":"J Caspi, S L Herman, G J Wilson, J Villamater, J Augustine, F Hamilton, S Castellarin, R Kumar, L N Benson, J G Coles","doi":"","DOIUrl":"","url":null,"abstract":"The function and survival of the autoperfused working heart-lung preparation in the newborn period was studied in six newborn pigs (3 to 5 days old). Normothermic autoperfusion was maintained by a closed blood-primed circuit. Left ventricular afterload was determined by positioning the blood reservoir, and the venous return was adjusted to maintain a right atrial pressure of 6 to 8 mm Hg. Left ventricular function was assessed by a conductance catheter in the left ventricle and was determined by the slope of the end-systolic pressure-volume relationship. Left ventricular diastolic compliance was measured from the end-diastolic pressure-volume relationship. Serial measurements at 60, 120, 180, and 240 minutes showed no change in the end-systolic pressure-volume relationship, whereas there was a significant leftward shift of the end-diastolic pressure-volume relationship after 240 minutes (0.42 +/- 0.02 ml-1 to 0.66 +/- 0.04 ml-1, p less than 0.05). Cessation of effective cardiac function occurred at 268 +/- 10 minutes (+/- SEM). This followed progressive deterioration in pulmonary function based on measurement of arterial blood gases and peak airway resistance. This study shows the feasibility of maintaining systolic cardiac function in a newborn autoperfused working heart-lung preparation. Extended survival beyond 4 hours will require improved methods to preserve left ventricular diastolic function and especially pulmonary function.","PeriodicalId":77638,"journal":{"name":"The Journal of heart transplantation","volume":"9 4","pages":"435-40"},"PeriodicalIF":0.0,"publicationDate":"1990-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13548217","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}

引用次数: 0

Amelioration of weight gain after heart transplantation by corticosteroid-free maintenance immunosuppression. UTAH Cardiac Transplant Program. 无皮质类固醇维持免疫抑制改善心脏移植术后体重增加。犹他州心脏移植项目。

The Journal of heart transplantation Pub Date : 1990-07-01

M E Hagan, C S Holland, C M Herrick, L G Rasmussen

引用次数: 0