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Yoshifumi Naka - One of the best experts on this subject based on the ideXlab platform.
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characteristics and outcomes of recipients of Heart Transplant with coronavirus disease 2019
JAMA Cardiology, 2020Co-Authors: F Latif, Susan Restaino, Maryjane Farr, Yoshifumi Naka, Kevin J Clerkin, Marlena V Habal, K Takeda, G Sayer, Nir UrielAbstract:Importance Recipients of Heart Transplant (HT) may be at increased risk of adverse outcomes attributable to infection with coronavirus disease 2019 (COVID-19) because of multiple comorbidities and clinically significant immunosuppression. Objective To describe the characteristics, treatment, and outcomes of recipients of HT with COVID-19. Design, Setting, and Participants This case series from a single large academic Heart Transplant program in New York, New York, incorporates data from between March 1, 2020, and April 24, 2020. All recipients of HT followed up by this center who were infected with COVID-19 were included. Interventions Heart Transplant and a confirmed diagnosis of COVID-19. Main Outcomes and Measures The primary measure was vital status at end of study follow-up. Secondary measures included patient characteristics, laboratory analyses, changes to immunosuppression, and treatment administered for COVID-19. Results Twenty-eight patients with HT received a confirmed diagnosis of COVID-19. The median age was 64.0 (interquartile range [IQR], 53.5-70.5) years, 22 (79%) were men, and the median time from HT was 8.6 (IQR, 4.2-14.5) years. Comorbid conditions included hypertension in 20 patients (71%), diabetes in 17 patients (61%), and cardiac allograft vasculopathy in 16 patients (57%). Twenty-two participants (79%) were admitted for treatment, and 7 (25%) required mechanical ventilation. Most (13 of 17 [76%]) had evidence of myocardial injury (median high-sensitivity troponin T, 0.055 [IQR, 0.0205-0.1345] ng/mL) and elevated inflammatory biomarkers (median peak high-sensitivity C-reactive protein, 11.83 [IQR, 7.44-19.26] mg/dL; median peak interleukin 6, 105 [IQR, 38-296] pg/mL). Among patients managed at the study institution, mycophenolate mofetil was discontinued in 16 patients (70%), and 6 (26%) had a reduction in the dose of their calcineurin inhibitor. Treatment of COVID-19 included hydroxychloroquine (18 patients [78%]), high-dose corticosteroids (8 patients [47%]), and interleukin 6 receptor antagonists (6 patients [26%]). Overall, 7 patients (25%) died. Among 22 patients (79%) who were admitted, 11 (50%) were discharged home, 4 (18%) remain hospitalized at the end of the study, and 7 (32%) died during hospitalization. Conclusions and Relevance In this single-center case series, COVID-19 infection was associated with a case fatality rate of 25% in recipients of HT. Immunosuppression was reduced in most of this group of patients. Further study is required to evaluate the optimal approach to management of COVID-19 infection in the HT population.
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Extracorporeal membrane oxygenation for primary graft dysfunction after Heart Transplant.
The Journal of Thoracic and Cardiovascular Surgery, 2019Co-Authors: Scott Deroo, Hiroo Takayama, Samantha Nemeth, A. Reshad Garan, Paul Kurlansky, Susan Restaino, Paolo C. Colombo, Maryjane Farr, Yoshifumi Naka, Koji TakedaAbstract:Abstract Objective Venoarterial extracorporeal membrane oxygenation is a useful treatment for severe primary graft dysfunction after Heart Transplant. The ideal timing of initiation is unknown. Methods We retrospectively reviewed 362 adult Heart Transplant recipients at our center between January 2011 and December 2017. Thirty-eight patients (10.5%) experienced severe primary graft dysfunction treated with venoarterial extracorporeal membrane oxygenation. As our institution adopted a prompt venoarterial extracorporeal membrane oxygenation policy in 2015, patients were stratified into pre-2015 (conservative extracorporeal membrane oxygenation: n = 18) and post-2015 (prompt extracorporeal membrane oxygenation: n = 20) cohorts. Clinical outcomes were compared. Results Baseline characteristics were similar (conservative vs prompt) except for age (51.82 vs 59.96 years, P = .036), aspartate transaminase (32 vs 21.5 U/L, P = .038), male donor (44.4 vs 80%, P = .042), and donor ejection fraction (60 vs 65%, P = .047). Median ischemic time was significantly longer in the conservative extracorporeal membrane oxygenation cohort (210 vs 148 minutes, P = .005). Median time to initiation of extracorporeal membrane oxygenation was significantly shorter in the prompt extracorporeal membrane oxygenation cohort (7.26 vs 1.95 hours, P Conclusions Prompt venoarterial extracorporeal membrane oxygenation use for primary graft dysfunction after Heart Transplant results in excellent myocardial recovery and a possible decrease in mortality without increased risk of complications.
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post Heart Transplant survival is inferior at low volume centers across all risk strata
Circulation, 2010Co-Authors: Mark J Russo, Alexander Iribarne, Rachel Easterwood, Ali Ibrahimiye, Ryan R Davies, Kimberly N Hong, Deborah D Ascheim, Annetine C Gelijns, Yoshifumi NakaAbstract:Background—Previous studies have demonstrated a relationship between increasing center volume and cardiac Transplant outcomes. The purpose of this study was to confirm a relationship between post–Heart Transplant outcomes and center experience and to determine whether this relationship persists among low- and high-risk Heart Transplant recipient–donor pairs. Methods and Results—The United Network for Organ Sharing (UNOS) provided deidentified patient-level data. Analysis included 8029 Heart Transplant recipients aged ≥18 years and Transplanted between January 1, 2001 and December 31, 2006 with follow-up available through February 3, 2009. The primary outcome was observed 1-year postTransplant graft survival. Multivariable logistic regression was used to calculate expected 1-year survival for recipients. Threshold analysis identified 3 discrete risk groups of Transplant recipients: high-risk, moderate-risk, and low-risk. Three discrete risk strata for center volume: low (<10.5 recipients/yr), intermediate ...
Mark S. Slaughter - One of the best experts on this subject based on the ideXlab platform.
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Heart Transplant vs Left Ventricular Assist Device in Heart Transplant-Eligible Patients
The Annals of thoracic surgery, 2011Co-Authors: Matthew L. Williams, Jaimin R. Trivedi, Kelly C. Mccants, Sumanth D. Prabhu, Emma J. Birks, Laurie Oliver, Mark S. SlaughterAbstract:Background Patients listed for Heart Transplant have a prolonged wait time, with continued deterioration, poor quality of life, and 10% mortality. Although recent bridge to Transplant (BTT) studies demonstrated 1-year survival similar to Heart Transplantation, doubt remains about overall effectiveness as a treatment strategy compared with waiting and implanting a left ventricular device (LVAD) only as a last resort. We evaluated 1-year outcome and effectiveness of LVAD vs Heart Transplantation. Methods Patients on the Heart Transplantation list, either receiving an allograft or LVAD for BTT from January 2009 to December 2009 were evaluated. Of 43 patients treated, 1 received both LVAD and an allograft during same admission was removed from the analysis. All patients but one who received an allograft had prior LVAD. Descriptive and univariate ( t test) statistics and Kaplan-Meier survival curve were used for analyses. Results LVAD for BTT was used in 29 patients (51.4 ± 12.8 years, 6.9% women), and 13 (51.1 ± 11.6 years, 15.38% women) underwent Heart Transplantation. Initial hospital length of stay was 17.5 ± 14.4 days in BTT group and 14.3 ± 4.6 days in Heart Transplant group ( p = 0.44) At 1 year, the total number of days spent in the hospital (operation and related complications), including index hospitalization was 11.6 ± 14.3 days/100 days in BTT and 7.9 ± 9.0 days/100 days in Heart Transplantation ( p = 0.38). A total of 41% BTT and 46% Heart Transplant patients had one readmission within 3 months of the index hospitalization. Infection was the most common cause of readmission in both groups. The 1-year survival was similar for both groups (no hospital death in either group; 3 late deaths in the BTT group). Conclusions One-year outcomes for patients eligible for Heart Transplantation were similar whether they received an allograft or LVAD for BTT. Heart Transplant outcome for patients with LVAD were not adversely affected. Improving outcomes for patients treated with LVAD suggest that current decision models for patients eligible for Heart Transplantation may need to be reevaluated.
Jon A. Kobashigawa - One of the best experts on this subject based on the ideXlab platform.
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Omission of Heart Transplant Recipients From the Appropriate Use Criteria for Revascularization and the Ramifications on Heart Transplant Centers.
JAMA cardiology, 2020Co-Authors: Joe X. Xie, Jon A. Kobashigawa, Kevin F. Kennedy, Timothy D. Henry, Steven W. Tabak, Robert Krebbs, Leslee J. Shaw, J. Dawn Abbott, Wendy Book, S. Tanveer RabAbstract:Importance Guidelines endorse routine coronary angiography and percutaneous coronary intervention (PCI) to screen for and treat cardiac allograft vasculopathy in Heart Transplant recipients. However, the current Appropriate Use Criteria for Revascularization (AUC-R) do not recognize prior Heart Transplant as a unique PCI indication. Whether this affects rates of rarely appropriate (RA) PCIs is unknown. Objective To assess the rate of RA PCI procedures in Heart Transplant recipients and how it pertains to hospital PCI appropriateness metrics and pay-for-performance scorecards. Design, Setting, and Participants This observational study used National Cardiovascular Data Registry CathPCI Registry data on all patients undergoing elective PCIs from 96 Medicare-approved Heart Transplant centers from quarter 3 of 2009 to quarter 2 of 2017. The data were analyzed in July 2018. Exposures Prior Heart Transplant. Main Outcomes and Measures Rates of RA elective PCIs in Heart Transplant recipients compared with nonrecipients and hospital rates of RA PCI before vs after exclusion of Heart Transplant recipients using pairedttests. In a subset of Heart Transplant centers participating in the Anthem Blue Cross and Blue Shield’s Quality-In-Sights Hospital Incentive Program (Q-HIP), we compared the change in Q-HIP scorecards before vs after excluding Heart Transplant recipients. Results Of 168 802 participants, 123 124 (72.9%) were men, 137 457 were white, and the mean (SD) age was 66.3 (11.4) years. Of 168 802 elective PCIs performed in Heart Transplant centers, 1854 (1.1%) were for Heart Transplant recipients. Heart Transplant recipients were less likely to have ischemic symptoms (14.6% vs 61.4%,P Conclusions and Relevance Two-thirds of PCIs in Heart Transplant recipients were deemed RA by the AUC-R. The failure of the AUC-R to consider prior Heart Transplant as a unique PCI indication may lead to inflated RA PCI rates with the potential for affecting quality reporting and pay-for-performance metrics in Heart Transplant centers.
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ANTI-THYMOCYTE GLOBULIN PROTECTS AGAINST ISCHEMIA REPERFUSION INJURY IN THE IMMEDIATE POST Heart Transplant PERIOD
Journal of the American College of Cardiology, 2016Co-Authors: Parham Zarrini, Tamar Aintablian, Dael Geft, Michelle M. Kittleson, Lawrence S.c. Czer, David Chang, Jon A. KobashigawaAbstract:Ischemia reperfusion injury after Heart Transplant (Htx) is not uncommon. This may lead to rejection and endothelial cells dysfunction with subsequent development of cardiac allograft vasculopathy (CAV). It has been reported that the use of anti-thymocyte globulin (ATG) as induction therapy post-tx
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Marijuana and Listing for Heart Transplant: A Survey of Transplant Providers.
Circulation: Heart Failure, 2016Co-Authors: Jonathan Neyer, Abhimanyu Uberoi, Michele A. Hamilton, Jon A. KobashigawaAbstract:Background There is no consensus within the Heart Transplant community about whether patients who use marijuana should be eligible for Transplant listing, but several states have passed legislation prohibiting marijuana-using patients from being denied Transplant listing based on their use of the substance. Methods and results We conducted an independent, voluntary, web-based survey of Heart and lung Transplant providers to assess current practice patterns and attitudes toward marijuana use in patients with advanced Heart failure being considered for Transplant. A total of 360 Heart Transplant providers responded from 26 countries. Nearly two thirds of respondents (n=222, 64.4%) supported listing patients with advanced, end-stage Heart failure for Transplant who use legal medical marijuana. Significantly, fewer respondents (n=96, 27.5%) supported Transplant listing for patients using legal recreational marijuana. The majority of providers currently make patients eligible for Transplantation after a period of abstinence from marijuana (n=241, 68.3%). There were no differences between the proportion of respondents supporting Transplant listing after stratification by profession or country/region. Most (78.4%) survey respondents from states with laws prohibiting marijuana-using patients from being denied Transplant listing reported denying all marijuana-using patients or mandating abstinence before Transplant listing. Conclusions The majority of Heart and lung Transplant providers in our study sample supports the listing of patients who use medical marijuana for Transplant after a period of abstinence. Communication and collaboration between the medical community and legislative groups about marijuana use in Transplant candidates is needed to ensure the best patient outcomes with the use of scarce donor organs.
Jeanpaul Duong Van Huyen - One of the best experts on this subject based on the ideXlab platform.
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micrornas as non invasive biomarkers of Heart Transplant rejection
European Heart Journal, 2014Co-Authors: Jeanpaul Duong Van Huyen, Marion Tible, R Guillemain, Olivier Aubert, Shaida Varnous, Franck Iserin, Philippe Rouvier, Arnaud FrancoisAbstract:Aim Rejection is one of the major causes of late cardiac allograft failure and at present can only be diagnosed by invasive endomyocardial biopsies. We sought to determine whether microRNA profiling could serve as a non-invasive biomarker of cardiac allograft rejection. Methods We included 113 Heart Transplant recipients from four referral French institutions (test cohort, n = 60, validation cohort, n = 53). In the test cohort, we compared patients with acute biopsy-proven allograft rejection ( n = 30) to matched control patients without rejection ( n = 30), by assessing microRNAs expression in the Heart allograft tissue and patients concomitant serum using RNA extraction and qPCR analysis. Fourteen miRNAs were selected on the basis of their implication in allograft rejection, endothelial activation, and inflammation and tissue specificity. Results We identified seven miRNAs that were differentially expressed between normal and rejecting Heart allografts: miR-10a, miR-21, miR-31, miR-92a, miR-142-3p miR-155, and miR-451 ( P < 0.0001 for all comparisons). Four out of seven miRNAs also showed differential serological expression (miR-10a, miR-31, miR-92a, and miR-155) with strong correlation with their tissular expression. The receiver-operating characteristic analysis showed that these four circulating miRNAs strongly discriminated patients with allograft rejection from patients without rejection: miR-10a (AUC = 0.975), miR-31 (AUC = 0.932), miR-92a (AUC = 0.989), and miR-155 (AUC = 0.998, P < 0.0001 for all comparisons). We confirmed in the external validation set that these four miRNAs highly discriminated patients with rejection from those without. The discrimination capability of the four miRNAs remained significant when stratified by rejection diagnosis (T-cell-mediated rejection or antibody-mediated rejection) and time post-Transplant. Conclusion This study demonstrates that a differential expression of miRNA occurs in rejecting allograft patients, not only at the tissue level but also in the serum, suggesting their potential relevance as non-invasive biomarkers in Heart Transplant rejection.
Lori Bourassa - One of the best experts on this subject based on the ideXlab platform.
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diaporthe soft tissue infection in a Heart Transplant patient
Transplant Infectious Disease, 2017Co-Authors: Robert M Rakita, Kevin D Obrien, Lori BourassaAbstract:Infections caused by Diaporthe species are very uncommon. We describe a Heart Transplant recipient 14 years post Transplant who developed a soft tissue fungal infection due to a Diaporthe species that responded well to surgical excision and posaconazole therapy. The Aspergillus galactomannan index was markedly elevated, and returned to normal following treatment. Solid organ Transplant patients remain at risk of infection long after Transplant and should be counseled about risk avoidance. This article is protected by copyright. All rights reserved.
