Transplant RSS : Gourt

Newest frontier for social media: transplants - Baltimore Sun

Baltimore SunNewest frontier for social media: transplantsBaltimore SunToday, Imes, who is 54 and lives in Baltimore, remains at Hopkins; he's still not feeling well enough to talk about the transplant surgery that provided ...and more »

Soldier's gift saves boy's life - Atlanta Journal Constitution

Soldier's gift saves boy's lifeAtlanta Journal Constitution... had compatible blood types, but doctors recommended that Rebecca not donate, figuring a 10-year-old boy would need his mother after transplant surgery. ...and more »

Jim Salisbury: Jim Salisbury: Rodrigo Lopez's long road back - Philadelphia Inquirer

Jim Salisbury: Jim Salisbury: Rodrigo Lopez's long road backPhiladelphia InquirerHundreds of pitchers have had their elbows surgically rebuilt since Frank Jobe performed the first ligament-transplant surgery on Tommy John in 1974. ...and more »

Steve Jobs Back To Work At Apple >AAPL - Wall Street Journal

Los Angeles TimesSteve Jobs Back To Work At Apple >AAPLWall Street JournalHowever, Jobs's return undoubtedly will revive controversy over the Apple board's failure to disclose his liver transplant surgery - and his post-surgical ...Jobs Travel to Transplant Mecca Shows System FlawsBloombergSteve Jobs is officially back, says AppleSan Francisco ChronicleApple Shares: Still Worth a BiteBarron'sComputerWeekly.com -InjuryBoard.com -CNET News -The Ageall 875 news articles »

Bauman Medical Group Hosts World's First NeoGraft Hair Transplant ... - PR Web (press release)

Bauman Medical Group Hosts World's First NeoGraft Hair Transplant ...PR Web (press release)Dr. Alan Bauman instructs other doctors how to use the new machine-assisted minimally-invasive hair transplant surgery with NeoGraft. ...and more »

Test Before Corneal Transplant May Improve Outcome - Forbes

Test Before Corneal Transplant May Improve OutcomeForbes"It is also possible that treating inflammation intensively before corneal transplant surgery would reduce the risk of rejection," study lead author Dr. ...'Stealth' Herpes Simplex Inflammation Impacts Corneal TransplantsScience Daily (press release)Inflammation May Predict Corneal RejectionMedPage Todayall 27 news articles »

A Transplant That Is Raising Many Questions - New York Times

ABC NewsA Transplant That Is Raising Many QuestionsNew York Times“It's controversial whether transplant is a helpful approach,” he said. Dr. Lewis Teperman, the director of transplant surgery and vice chairman of surgery ...Surgery News: Steve Jobs Has Liver Transplant Surgery--Myths About ...Surgery.about.comSteve Jobs transplant uncommon for rare tumorSan Francisco ChronicleWhat I need to know about Liver TransplantationFood ConsumerChristian Science Monitor -Ars Technicaall 3,333 news articles »

Diva's 3-Ring Circus Starts Small - Washington Post

Diva's 3-Ring Circus Starts SmallWashington PostMontgomery, now 49 and the chief of transplant surgery at Johns Hopkins, has gained acclaim for his work with "kidney paired donations," in which a donor ...and more »

GETTING PERSONAL: Wealthy Have Advantage In Organ Transplants - Wall Street Journal

GETTING PERSONAL: Wealthy Have Advantage In Organ TransplantsWall Street JournalAll US transplant centers accept health insurance, but coverage varies. The cost of transplant surgery varies by procedure, but they can easily total ...Organ Transplant Waiting Lists Not Limited to In-State Residents ...PR Newswire (press release)all 11 news articles »

Stunning Surgery For Man Fighting Kidney Disease - WJZ

Stunning Surgery For Man Fighting Kidney DiseaseWJZDr. Sarcar agreed to do the surgery to prepare Don for a future transplant. Never did he imagine that the kidney that hadn't worked in six months would ...and more »

0041-1345; +246 new citations

246 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results: 0041-1345 These pubmed results were generated on 2009/06/24PubMed, a service of the National Library of Medicine, includes over 15 million citations for biomedical articles back to the 1950's. These citations are from MEDLINE and additional life science journals. PubMed includes links to many sites providing full text articles and other related resources.

Re: Lung transplantation in older patients with cystic fibrosis: analysis of UNOS data.

Related Articles Re: Lung transplantation in older patients with cystic fibrosis: analysis of UNOS data. J Heart Lung Transplant. 2009 Jul;28(7):751-2 Authors: Elidemir O, Schecter MG, Mallory GB PMID: 19560710 [PubMed - in process]

Recovery from anthracycline cardiomyopathy--how can it be explained?

Related Articles Recovery from anthracycline cardiomyopathy--how can it be explained? J Heart Lung Transplant. 2009 Jul;28(7):751 Authors: Christiansen S PMID: 19560709 [PubMed - in process]

Pancytopenia with hypercellular bone marrow secondary to cytomegalovirus after cardiac transplant.

Related Articles Pancytopenia with hypercellular bone marrow secondary to cytomegalovirus after cardiac transplant. J Heart Lung Transplant. 2009 Jul;28(7):749-50 Authors: Elkhateeb O, Jackson S, Schlech WF, Storm K, Howlett J We describe a case of cytomegalovirus-induced pancytopenia in a heart transplant patient. The interesting finding of a hypercellular bone marrow indicates the possibility of a different mechanism for the pancytopenia other than bone marrow suppression. The patient was treated with ganciclovir, which resulted in the complete resolution of the viremia and pancytopenia. Cytomegalovirus infection should be suspected in heart transplant patients with pancytopenia, regardless of bone marrow results. The pathogenesis of cytomegalovirus-induced pancytopenia is likely multifactorial, with both a central and peripheral effect. PMID: 19560708 [PubMed - in process]

Regression of cardiac amyloid after autologous stem-cell transplantation.

Related Articles Regression of cardiac amyloid after autologous stem-cell transplantation. J Heart Lung Transplant. 2009 Jul;28(7):746-8 Authors: Blair JE, Zeigler SM, Mehta J, Singhal S, Cotts W Primary cardiac amyloid has a dismal prognosis and most treatments are experimental with highly variable results. Although autologous stem-cell transplant in conjunction with high-dose chemotherapy has yielded regression of amyloid in other body tissues, the presence of cardiac involvement contraindicates stem-cell transfer due to high treatment mortality. We describe the successful treatment of cardiac amyloid using autologous stem-cell transplantation and the resultant regression of the cardiac amyloid. PMID: 19560707 [PubMed - in process]

Immune tolerance after total lymphoid irradiation for heart transplantation: immunosuppressant-free survival for 8 years.

Related Articles Immune tolerance after total lymphoid irradiation for heart transplantation: immunosuppressant-free survival for 8 years. J Heart Lung Transplant. 2009 Jul;28(7):743-5 Authors: Comerci GD, Williams TM, Kellie S A 51-year-old African American man underwent orthotopic heart transplantation in 1995 for post-viral cardiomyopathy. Refractory rejection occurred, and he subsequently required total lymphoid irradiation to prevent further rejection. Disseminated Mycobacterium avium complex developed in 2000, and the patient decided to discontinue all drugs after the antibiotics caused intolerable medication side effects. The patient did not subsequently die of rejection, and he was discovered to have profound suppression of several lymphocytes subsets, presumably from the previous total lymphoid irradiation. This induced immunotolerance appears to have enabled his prolonged immunosuppressant-free survival. PMID: 19560706 [PubMed - in process]

Ventricular assist device application with the intermediate use of a membrane oxygenator as a bridge to pediatric heart transplantation.

Related Articles Ventricular assist device application with the intermediate use of a membrane oxygenator as a bridge to pediatric heart transplantation. J Heart Lung Transplant. 2009 Jul;28(7):740-2 Authors: Garcia-Guereta L, Cabo J, de la Oliva P, Villar MA, Bronte LD, Goldman L, Hübler M Extracorporeal membrane oxygenation and ventricular assist devices are currently used for the treatment of severe heart failure as a bridge to transplantation. The use of ventricular assist devices is limited by respiratory failure. We report a patient with severe heart failure and respiratory failure who was successfully bridged to transplantation, initially with extracorporeal membrane oxygenation and afterwards with an EXCOR biventricular assist device (Berlin Heart AG, Berlin, Germany) and a membrane oxygenator (Jostra Quadrox D, Maquet Cardiopulmonary, AG Hirrlingen, Germany) intercalated in the outflow cannula of the left pump. PMID: 19560705 [PubMed - in process]

Disseminated infection with Bartonella henselae in a lung transplant recipient.

Related Articles Disseminated infection with Bartonella henselae in a lung transplant recipient. J Heart Lung Transplant. 2009 Jul;28(7):736-9 Authors: Lienhardt B, Irani S, Gaspert A, Weishaupt D, Boehler A We present the case of a lung transplant recipient with disseminated infection with Bartonella henselae. In non-immunosuppressed humans, the organism typically causes a local infection that manifests itself as regional lymphadenopathy. The role of the host immune response to B henselae is critical in preventing progression to systemic disease. Only rare cases of bartonellosis in transplant recipients have been reported. We discuss aspects and difficulties of diagnosis and treatment of bartonellosis in a lung transplant recipient who suffered from a severe multisystem involvement of this disease. In our case, the initial response to therapy was unsatisfying and necessitated an extended anti-infective combination therapy, which eventually was successful. PMID: 19560704 [PubMed - in process]

Incidence of ventricular arrhythmias in patients on long-term support with a continuous-flow assist device (HeartMate II).

Related Articles Incidence of ventricular arrhythmias in patients on long-term support with a continuous-flow assist device (HeartMate II). J Heart Lung Transplant. 2009 Jul;28(7):733-5 Authors: Andersen M, Videbaek R, Boesgaard S, Sander K, Hansen PB, Gustafsson F The incidence of ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients supported with a continuous-flow left ventricular assist device (LVAD) has not been investigated in detail. In 23 consecutive recipients of a HeartMate II, we analyzed the incidence of VT/VF during a total of 266 months of follow-up. Sustained VT or VF occurred in 52% of the patients, with the majority of arrhythmias occurring in the first 4 weeks after LVAD implantation. VT/VF requiring implantable cardioverter-defibrillator (ICD) shock or external defibrillation occurred in 8 patients and significant hemodynamic instability ensued in 3 patients. There were no clear predictors of VT/VF, and it is argued that prophylactic ICD implantation should be considered in patients supported with a continuous-flow LVAD. PMID: 19560703 [PubMed - in process]

Alteration of neuropeptides in the lung tissue correlates brain death-induced neurogenic edema.

Related Articles Alteration of neuropeptides in the lung tissue correlates brain death-induced neurogenic edema. J Heart Lung Transplant. 2009 Jul;28(7):725-32 Authors: Barklin A, Theodorsson E, Tyvold SS, Larsson A, Granfeldt A, Sloth E, Tonnesen E BACKGROUND: Increased intracranial pressure induces neurogenic pulmonary edema (NPE), potentially explaining why only lungs from less than 20% of brain dead organ donors can be used for transplantation. This study investigated the underlying mechanisms of NPE, focusing on neuropeptides, which potently induce vasoconstriction, vasodilatation, and neurogenic inflammation. METHODS: Brain death was induced in 10 pigs by increasing the intracranial pressure. Eight additional pigs served as controls. Neuropeptide Y (NPY), calcitonin gene-related peptide (CGRP), and substance P were analyzed in plasma, bronchoalveolar lavage (BAL) fluid, and homogenized lung tissue 6 hours after brain death. Pulmonary oxygen exchange was estimated using partial pressure of arterial oxygen (Pao2)/fraction of inspired oxygen (Fio2), and pulmonary edema by wet/dry weight ratio. RESULTS: Brain death induced a decrease in Pao(2)/Fio2 (p < 0.001) and increased the wet/dry weight of both apical (p = 0.01) and basal lobes (p = 0.03). NPY and CGRP concentrations were higher in the BAL fluid of brain-dead animals compared with controls (p = 0.02 and p = 0.02) and were positively correlated with the wet/dry weight ratio. NPY content in lung tissue was lower in brain-dead animals compared with controls (p = 0.04) and was negatively correlated with the wet/dry weight ratio. There were no differences in substance P concentrations between the groups. CONCLUSION: NPY was released from the lung tissue of brain-dead pigs, and its concentration was related to the extent of pulmonary edema. NPY may be one of several crucial mediators of neurogenic pulmonary edema, raising the possibility of treatment with NPY-antagonists to increase the number of available lung donors. PMID: 19560702 [PubMed - in process]

Methylprednisolone and tacrolimus prevent hypothermia-induced endothelial dysfunction.

Related Articles Methylprednisolone and tacrolimus prevent hypothermia-induced endothelial dysfunction. J Heart Lung Transplant. 2009 Jul;28(7):718-24 Authors: Diestel A, Billecke N, Roessler J, Schmitt B, Troeller S, Schwartlander R, Berger F, Sauer IM, Schmitt KR BACKGROUND: Hypothermia is used to preserve organs for transplantation and is the oldest method to protect organs during complex pediatric cardiac surgery. Loss of tissue function and tissue edema are common complications in children undergoing corrective cardiac surgery and heart transplantation. The present study was designed to examine the effects of methylprednisolone and tacrolimus on endothelial cell function and morphology after deep hypothermia and rewarming. METHODS: Human umbilical vein endothelial cells were pre-treated with methylprednisolone or tacrolimus, or both, incubated within a specially designed bioreactor or in monolayers, and then exposed to a dynamic cooling and rewarming protocol. Immunocytochemistry, time-lapse video microscopy, cell permeability and adherence assays, and Western blot analysis were performed. RESULTS: Confluent endothelial cells exposed to hypothermia displayed elongated cell shapes with intercellular gap formation, increased endothelial cell-layer permeability, and loss in adherence. Upon rewarming, however, endothelial cell integrity was restored. Opening and closing of intercellular gaps was dependent on extracellular signal-regulated kinase 1 and 2 (ERK 1/2) activation and connexin 43 expression. The combined treatment with methylprednisolone and tacrolimus inhibited these hypothermia-induced changes. CONCLUSIONS: These results suggest that methylprednisolone and tacrolimus inhibit hypothermia-induced endothelial gap formation by phosphorylated ERK 1/2 inhibition and connexin 43 stabilization. Application of combined drugs that affect multiple targets may therefore be considered as a possible new therapeutic strategy to prevent endothelial dysfunction after hypothermia and rewarming. PMID: 19560701 [PubMed - in process]

Increased number of circulating progenitor cells after implantation of ventricular assist devices.

Related Articles Increased number of circulating progenitor cells after implantation of ventricular assist devices. J Heart Lung Transplant. 2009 Jul;28(7):710-7 Authors: Manginas A, Tsiavou A, Sfyrakis P, Giamouzis G, Tsourelis L, Leontiadis E, Degiannis D, Cokkinos DV, Alivizatos PA BACKGROUND: Bone marrow-derived circulating progenitor cells possess tissue repair potential, improving perfusion, left ventricular remodeling, and contractility in experimental models. We quantified and investigated the kinetics of 4 circulating progenitor cell sub-populations on the basis of CD34, CD133, and vascular endothelial growth factor receptor-2 (VEGFR-2) antigen expression. METHODS: CD34+, CD34+/CD133+/VEGFR-2-, CD34+/CD133+/VEGFR-2+, and CD34+/CD133-/VEGFR-2+ cells were counted in 10 male patients with end-stage congestive heart failure. Five underwent left ventricular/biventricular assist device (LVAD/BiVAD) implantation (VAD group), and 5 were ineligible for VAD implantation (no-VAD group). Peripheral blood was collected at 3 time points for each patient: before, 15, and 60 days after VAD placement in the VAD group and at the same time points in the no-VAD group. Purified CD34+ cells were stained with anti-CD34, anti-CD133, and anti-VEGFR-2 monoclonal antibodies and analyzed by flow cytometry. Serum levels of granulocyte-colony stimulating factor (G-CSF), interleukin-8, vascular endothelial growth factor-alpha (VEGF-alpha), and B-type natriuretic peptide (BNP) were also measured. RESULTS: In the VAD group the number of CD34+ cells/ml of blood tended to increase, from 159.6 +/- 137.0 at baseline to 428.9 +/- 224.3 at 15 days, and decreased to 343.8 +/- 165.7 at 60 days (p = 0.05 vs no-VAD group). In the other 3 cell populations, no significant differences occurred over time or between groups. A significant interaction between BNP levels and VAD status was observed (p = 0.005): BNP levels decreased over time in VAD patients vs no-VAD patients. G-CSF levels tended to decrease over time in both groups, but without a significant difference (p = 0.3). Serum levels of interleukin-8 and VEGF-alpha over time or between VAD and no-VAD patients were not significantly different. CONCLUSIONS: After VAD implantation, a transient increase occurs in the number of circulating CD34+ cells, in parallel to a reduction in BNP levels. Release of these cells from the bone marrow may contribute to the improvement of tissue perfusion and cardiac recovery occasionally seen after VAD placement. PMID: 19560700 [PubMed - in process]

The change in B-type natriuretic peptide levels over time predicts significant rejection in cardiac transplant recipients.

Related Articles The change in B-type natriuretic peptide levels over time predicts significant rejection in cardiac transplant recipients. J Heart Lung Transplant. 2009 Jul;28(7):704-9 Authors: Kittleson MM, Skojec DV, Wittstein IS, Champion HC, Judge DP, Barouch LA, Halushka M, Hare JM, Kasper EK, Russell SD BACKGROUND: B-type natriuretic peptide (BNP) correlates with cardiac filling pressures and outcomes in patients with heart failure. In heart transplant recipients, we hypothesize that a within-individual change in BNP over time would be more helpful than absolute BNP in detecting International Society of Heart and Lung Transplantation (ISHLT) grade 2R or greater rejection. METHODS: N-terminal pro-BNP (NT-proBNP) levels were measured in 146 consecutive transplant recipients undergoing routine endomyocardial biopsies. In the cross-sectional analysis, multiple observations per individual were accounted for using generalized estimation equations. RESULTS: A cross-sectional analysis demonstrated a weak association between NT-proBNP levels and rejection, with an odds ratio (OR) of 1.01 for every 100-pg/mL increase in NT-proBNP (p = 0.02). However, with a doubling of an individual's NT-proBNP level, the OR for significant rejection was 2.9 (95% confidence interval [CI] 1.2-7.0), the OR with a 5-fold increase was 9.1 (95% CI, 2.7-31.5), and the OR with a 10-fold increase was 27.7 (95% CI, 5.9-129). A 10-fold increase in NT-proBNP offered a negative predictive value of 95% for the diagnosis of rejection. The relationship between within-individual increases in NT-proBNP and rejection persisted after adjusting for a fall in ejection fraction and a rise pulmonary capillary wedge pressure, and was a stronger predictor than changes in these parameters. CONCLUSIONS: There is a strong, graded relationship between the within-individual increase in NT-proBNP and the odds of significant rejection independent of hemodynamic parameters. These results suggest that the change in NT-proBNP rather than absolute BNP levels may offer a non-invasive approach to detect rejection. PMID: 19560699 [PubMed - in process]

Tacrolimus and azathioprine versus cyclosporine and mycophenolate mofetil after lung transplantation: a retrospective cohort study.

Related Articles Tacrolimus and azathioprine versus cyclosporine and mycophenolate mofetil after lung transplantation: a retrospective cohort study. J Heart Lung Transplant. 2009 Jul;28(7):697-703 Authors: Celik MR, Lederer DJ, Wilt J, Eser D, Bacchetta M, D'Ovidio F, Sonett JR, Arcasoy SM BACKGROUND: The efficacy and safety of different combinations of immunosuppressive regimens after lung transplantation are unknown. METHODS: We examined 120 consecutive transplant recipients between July 2001 and July 2005, of whom 37 received cyclosporine and mycophenolate mofetil (Cyc/MMF) and 83 received tacrolimus and azathioprine (Tac/Aza) as the initial immunosuppressive regimen along with an interleukin-2 antagonist induction therapy. The primary outcome was the rate of histologically confirmed acute rejection. RESULTS: The rate of acute rejection did not vary by treatment regimen (0.42 vs 0.34 episodes per 100 person-days in Cyc/MMF and Tac/Aza groups, respectively, p = 0.22). The mean cumulative lymphocytic bronchiolitis score was greater in the Cyc/MMF group (1.8 +/- 1.9) compared with the Tac/Aza group (1.2 +/- 2.0; p = 0.03). Pulmonary function at 1 year was better in the Tac/Aza group, even when adjusted for recipient age, gender, and transplant procedure. Survival and the rate of bronchiolitis obliterans syndrome did not vary by group. CONCLUSIONS: Outcomes after lung transplantation did not meaningfully vary between those assigned to Cyc/MMF compared with Tac/Aza combined with IL-2 inhibitor induction therapy. PMID: 19560698 [PubMed - in process]

Microvolt T-wave alternans, peak oxygen consumption, and outcome in patients with severely impaired left ventricular systolic function.

Related Articles Microvolt T-wave alternans, peak oxygen consumption, and outcome in patients with severely impaired left ventricular systolic function. J Heart Lung Transplant. 2009 Jul;28(7):689-96 Authors: Gorodeski EZ, Cantillon DJ, Goel SS, Kaufman ES, Martin DO, Hsich EM, Blackstone EH, Lauer MS BACKGROUND: Abnormal microvolt T-wave alternans (MTWA) and low peak oxygen consumption (VO2) both predict poor outcome in heart failure. However, their independent predictive properties have not been assessed in large-scale cohorts. METHODS: This was an observational prospective cohort study of 303 consecutive patients referred for metabolic stress testing. All had an ejection fraction < or = 40% and were considered candidates for transplantation. The exercise laboratory did not collect MTWA data from patients with implanted pacemakers or defibrillators. The primary end point was a composite of all-cause death or United Network for Organ Sharing status 1 transplantation. RESULTS: During a 2.8-year period, there were 34 deaths and 17 transplantations. Patients with abnormal MTWA had a higher event rate of 23% (31 of 136) vs 12% (20 of 167), with an unadjusted hazard ratio (HR) of 1.90 (95% confidence interval [CI], 1.90-3.33; p = 0.03). The association remained significant after adjustment for 3 clinical variables (HR, 1.89; 95% CI, 1.05-3.39; p = 0.03). After adding peak VO2 to the model, the association was no longer significant (adjusted HR, 1.18; 95% CI, 0.64-2.17, p = 0.60). After accounting for peak VO2 and 28 other confounders in a matched propensity analysis, MTWA was not predictive (propensity-matched HR, 0.79; 95% CI, 0.37-1.66; p = 0.53). CONCLUSIONS: These results confirm the association of abnormal MTWA with poor outcome amongst patients with impaired left ventricular systolic function. However, this association is markedly attenuated after accounting for peak VO2. PMID: 19560697 [PubMed - in process]

Clinical experience with a new removable tracheobronchial stent in the management of airway complications after lung transplantation.

Related Articles Clinical experience with a new removable tracheobronchial stent in the management of airway complications after lung transplantation. J Heart Lung Transplant. 2009 Jul;28(7):683-8 Authors: Fernandez-Bussy S, Akindipe O, Kulkarni V, Swafford W, Baz M, Jantz MA BACKGROUND: Airway complications are among the most challenging problems after lung transplantation. This article describes the use of a new tracheobronchial stent that can be placed and removed easily by flexible bronchoscopy. METHODS: A retrospective review was done of 24 consecutive patients requiring tracheobronchial stent placement after lung transplantation. A new self-expanding hybrid nitinol stent was used, and changes in airway diameter and spirometry were assessed. Stent related complications were recorded. RESULTS: Between February 2007 and April 2008, 24 patients underwent stent placement, and 49 stents were placed for 36 anastomoses at risk. Indications included bronchial stenosis in 12, bronchomalacia in 12, bronchial stenosis plus bronchomalacia in 20, and partial bronchial dehiscence in 5. Adjunctive procedures included electrocautery in 1, balloon dilatation in 7, and electrocautery plus balloon dilatation in 4. The average degree of stenosis decreased from 80% to 20%. After stent placement, the average increase was 0.28 liters in forced vital capacity and 0.44 liters in forced expiratory volume in 1 second. Complications included granulation tissue formation in 10 stents, migration in 9, thick mucus formation in 2, and fracture in 3. CONCLUSION: Airway complications in lung transplant patients were effectively palliated. Our complication rate with this new stent is comparable with other airway stents. This stent has the advantage of easy removability during flexible bronchoscopy if complications from the stent outweigh the benefits of palliation. PMID: 19560696 [PubMed - in process]

Acute hemodynamic effects of intravenous sildenafil citrate in congestive heart failure: comparison of phosphodiesterase type-3 and -5 inhibition.

Related Articles Acute hemodynamic effects of intravenous sildenafil citrate in congestive heart failure: comparison of phosphodiesterase type-3 and -5 inhibition. J Heart Lung Transplant. 2009 Jul;28(7):676-82 Authors: Botha P, Parry G, Dark JH, Macgowan GA BACKGROUND: The reversibility of elevated pulmonary vascular resistance in heart failure bears an important relation to outcome after cardiac transplantation. The phosphodiesterase 3 (PDE3) and PDE5 inhibitors both increase levels of cyclic nucleotides in the vascular smooth muscle, causing vasodilatation. PDE3 inhibitors also have direct inotropic effects. We contrasted the acute hemodynamic responses to intravenous PDE3 and PDE5 inhibitors in patients with congestive cardiac failure to assess their relative suitability for reversibility testing in this setting. METHODS: Thirty patients undergoing assessment for cardiac transplantation underwent right heart catheterization. Patients were randomized to receive an intravenous bolus of milrinone (0.05 mg/kg) or sildenafil citrate at a high (0.43 mg/kg) or low dose (0.05 mg/kg). RESULTS: Differences between low- and high-dose sildenafil were not significant. Both agents caused similar reductions in systemic and pulmonary vascular resistance. Milrinone caused significantly greater reductions in pulmonary artery wedge and mean pulmonary artery pressure, and increases in heart rate. In all study groups, greater increases in cardiac index (>25%) were seen in patients with a higher pulmonary artery wedge pressure at baseline (29 +/- 1 vs 20 +/- 2 mm Hg; p < 0.001). CONCLUSIONS: In end-stage congestive cardiac failure, intravenous milrinone and sildenafil both cause similar reductions in systemic and pulmonary vascular resistance; however, milrinone has more cardiac selective effects on left ventricular filling and heart rate. Both agents appear to have a suitable hemodynamic profile for testing of reversibility of secondary pulmonary hypertension in congestive cardiac failure. Larger studies are needed to confirm these results. PMID: 19560695 [PubMed - in process]

Cytomegalovirus prevention in high-risk lung transplant recipients: comparison of 3- vs 12-month valganciclovir therapy.

Related Articles Cytomegalovirus prevention in high-risk lung transplant recipients: comparison of 3- vs 12-month valganciclovir therapy. J Heart Lung Transplant. 2009 Jul;28(7):670-5 Authors: Jaksch P, Zweytick B, Kerschner H, Hoda AM, Keplinger M, Lang G, Aigner C, Klepetko W BACKGROUND: Cytomegalovirus (CMV) infections are common after lung transplantation (LuTx) and have an influence on acute rejection rates and chronic organ dysfunction. The objective of this study was to determine the incidence of CMV infections by comparing a prolonged valganciclovir prophylaxis with a standard regimen in high-risk LuTx recipients. METHODS: A retrospective, single-center study was performed comparing two different CMV prophylactic regimens in high-risk LuTx recipients (D(+)/R(-)). The study population received either 3 months (Group A, 15 patients) or 12 months (Group B, 17 patients) of oral valganciclovir 900 mg/day in combination with CMV hyperimmune globulin in four doses (Days 1, 7, 14 and 21 post-transplant). RESULTS: CMV viremia was noted in 11 of 15 patients in Group A (75%) and 5 of 17 in Group B (33%) (p < 0.05) at 6 months after valganciclovir cessation. The incidence of symptomatic CMV disease/syndrome was 6 of 15 (44%) in Group A and 2 of 17 in Group B (13%) (p < 0.05). Histologically proven acute rejection episodes of ISHLT Grade > or =A2 were found in 4 patients in Group A and in 1 patient in Group B within the first year (p = 0.14). CONCLUSIONS: A 12-month CMV prophylaxis with oral valganciclovir is effective in significantly reducing CMV viremia and CMV disease/syndrome in high-risk lung transplant recipients. In addition, a reduction in acute and recurrent rejection episodes was observed, possibly due to less CMV viremia and subsequent immunomodulatory effects. PMID: 19560694 [PubMed - in process]

Heart transplantation in human immunodeficiency virus-positive patients.

Related Articles Heart transplantation in human immunodeficiency virus-positive patients. J Heart Lung Transplant. 2009 Jul;28(7):667-9 Authors: Uriel N, Jorde UP, Cotarlan V, Colombo PC, Farr M, Restaino SW, Lietz K, Naka Y, Deng MC, Mancini D BACKGROUND: Human immunodeficiency virus (HIV) infection is widely considered a contraindication for cardiac transplantation. However, with the newer anti-retroviral drugs, the estimated 10-year survival after seroconversion is exceeds 90%. This case series describes the intermediate range outcome of HIV-positive cardiac transplant recipients. METHODS: A retrospective analysis of 1679 cardiac transplant patients was undertaken to identify HIV-positive recipients. RESULTS: Seven patients were identified. Five (4 men) were diagnosed with HIV before transplantation and 2 patients seroconverted after transplantation. Dilated cardiomyopathy was the indication for transplant in all patients. The 5 HIV recipients were aged 42 +/- 8 years, and time after HIV seroconversion averaged 9.5 years. All underwent cardiac transplantation as high-risk candidates. The CD4 count was 554 +/- 169 cells/microl, and viral load was undetectable in all patients at the time of transplantation. Two patients seroconverted to HIV-positive status at 1 and 7 years after transplant. No AIDS-defining illness was observed in any patient before or after transplant. Six patients received highly active anti-retroviral therapy. Viral load remained low in the presence of immunosuppression. All patients are alive with a follow-up from transplant of 57 +/- 78.9 months. CONCLUSION: Excellent intermediate term outcome is noted in carefully selected HIV-positive patients. No significant AIDS-related infections or complications occurred. PMID: 19560693 [PubMed - in process]

Quality of life in adult survivors greater than 10 years after pediatric heart transplantation.

Related Articles Quality of life in adult survivors greater than 10 years after pediatric heart transplantation. J Heart Lung Transplant. 2009 Jul;28(7):661-6 Authors: Petroski RA, Grady KL, Rodgers S, Backer CL, Kulikowska A, Canter C, Pahl E BACKGROUND: This study assessed quality of life (QOL) in adult survivors of pediatric heart transplantation who survived > or = 10 years after transplantation. METHODS: Prospective data were collected from heart transplant recipients who were aged > or = 18 years and had survived > or = 10 years after transplantation (transplantation between July 3, 1986, and April 4, 1997). QOL data were collected from patients using the Medical Outcomes Study 36-Item Short Form (SF-36) Health Survey. Clinical data were collected from medical records. Statistical analyses included frequencies and measures of central tendency. RESULTS: Twenty-three patients (65% men, 91% white) completed the study. At the study initiation, they were a mean age of 9.0 +/- 7.1 years at transplantation, and were a mean age of 25.2 +/- 5.5 years (range, 18-34 years) and a mean of 16.2 +/- 3.0 years (range, 11-22 years) post-transplantation. Most were in school or working. Mean patient QOL scores from the SF-36v2 survey were 50.56 +/- 0.5 (range, 27.3-68.9) for physical health and 49.88 +/- 11.72 (range, 23.56-62.84) for mental health, similar to the general United States population. Late complications were frequent, including transplant coronary artery disease, 3; repeat heart transplantation, 2; post-transplantation lymphoproliferative disorder, 6; kidney transplantation, 5; acute late rejection, 5; and arrhythmias, 4. CONCLUSION: This report of QOL in adult survivors of pediatric heart transplantation shows patient perception of physical and mental health is similar to the general population despite serious late complications. A multicenter study is planned to further evaluate QOL in this unique cohort. PMID: 19560692 [PubMed - in process]

Generic drug immunosuppression in thoracic transplantation: an ISHLT educational advisory.

Related Articles Generic drug immunosuppression in thoracic transplantation: an ISHLT educational advisory. J Heart Lung Transplant. 2009 Jul;28(7):655-60 Authors: Uber PA, Ross HJ, Zuckermann AO, Sweet SC, Corris PA, McNeil K, Mehra MR PMID: 19560691 [PubMed - in process]