Experience Of Heart Transplantation Research Articles

Transplantologia a ontologia – Intruz Jeana-Luka Nancy’ego

This article presents an analysis of Jean-Luc Nancy’s essay L’Intrus (2002), a personal reflection on illness and the experience of heart transplantation. The analysis combines two approaches (though the first of them is given more prominence). Firstly, L’Intrus is treated as philosophical-literary pathography, where the reader’s attention is engrossed by the lived experience of illness and its linguistic representation – a sophisticated, elliptical, metaphorical style which exposes the altering intrusiveness of both the med-ical condition and the treatment (implanting an ‘alien’ organ). Secondly, L’Intrus is read in the context of Jean-Luc Nancy’s philosophical reflection proper. The essay’s linguistic manipulation of singular and plural are interpreted as an echo of his philosophical position put forth in Être singulier pluriel. The totally individual experience of illness and suffering exposes the underlying ontological validity of ‘being-with’ others. The in-sight that there is no being (Dasein) without ‘being-with’ (Mitsein) leads in effect to a revision of a number of key philosophical concepts like the Self / the Other, the subject, identity, nature and technology (ecotechnology).

(1247) - A Single Institutional Experience of Heart Transplantation in Children with Functional Single Ventricle

(1247) - A Single Institutional Experience of Heart Transplantation in Children with Functional Single Ventricle

Heart transplant experience after circulatory death. Are there differences with brain death?

Heart transplant experience after circulatory death. Are there differences with brain death?

Our First Experience with Transplantation – A Case Report

Goal: Transplantation is the medical procedure of transplanting an organ from a living or deceased person into the body of a recipient whose organ is severely and irreversibly damaged. In this way, the recipient's survival rate and quality of life are improved. Heart transplantation is a revolutionary procedure that provides a new chance for life to patients with serious heart diseases. It represents a great challenge both for the patient and for the entire healthcare system. We aim to provide a comprehensive account of our first heart transplant experience. Through a detailed analysis of the case report, we will present the challenges we encountered, the successes we achieved, and provide a deeper insight into the entire process of heart transplantation from the perspective of nurses.

An in vitro comparison of intra-operative isohemagglutinin and human leukocyte antigen removal techniques in pediatric heart transplantation

Background: Highly sensitized pediatric patients awaiting heart transplantation experience longer wait times and thus higher waitlist mortality. Similarly, children less than 2 years of age have increased waitlist times and mortality when compared to their older peers. To improve the likelihood of successful transplantation in these patients, various strategies have been utilized, including peri-operative plasmapheresis. However, limited data exists comparing plasmapheresis techniques for antibody reduction. This study’s aim was to compare the in vitro magnitude of isohemagglutinin titers (IT) and human leukocyte antigen (HLA) antibody removal and the time required between membrane-based plasmapheresis (MP) and centrifuge-based plasmapheresis (CP) incorporated into the extracorporeal (EC) circuit. Methods: Two MP (Prismaflex) and two CP (Spectra Optia, Terumo BCT) circuits were incorporated into four separate EC circuits primed with high titer, highly sensitized type O donor whole blood. Assays were performed to determine baseline IT and anti-HLA antibodies and then at 30-minute increments until completion of the run (two plasma volume exchanges) at two hours. Results: There was a decrease in anti-A and anti-B IgM and IgG titers with both MP and CP. Mean anti-A and anti-B titer reduction was by 4.625 titers (93.7% change) and 4.375 titers (93.8% change) using MP and CP, respectively. At 2 h of apheresis, CP reduced 62.5% of all ITs to ≤ 1:4, while MP reduced 50% of ITs to ≤ 1:4. Additionally, reduction of anti-HLA class II antibody to mean fluorescence intensity (MFI) <3000 was achieved with both MP and CP. At 2 h of apheresis, CP reduced MFI by 2–3.5 fold and MP reduced MFI by 1.7–2.5 fold. Both demonstrated similar hemolytic and thrombotic profiles. Conclusions: In this in vitro plasmapheresis model of IT and anti-HLA antibody reduction, both MP and CP incorporated into the EC circuit can be used quickly and effectively to reduce circulating antibodies. While CP may have some greater efficiency, further study is necessary to verify this in vivo.

A 5-year single-center experience in heart transplantation in Rostov oblast

Objective: to evaluate the outcomes of heart transplants performed at Rostov Regional Clinical Hospital within five years.Materials and methods. Between 2017 and 2022, 29 orthotopic heart transplants (HT) were performed in our clinic. Heart failure was caused by postinfarction cardiosclerosis (21 cases, 72.4%) and dilated cardiomyopathy (8 cases, 27.6%). Among the recipients, 27 (93.1%) were men and 2 (6.9%) were women. Mean age was 53.14 ± 8.7 years (34 to 67 years). All patients received quadruple-drug immunosuppressive therapy, including induction with monoclonal antibodies; calcineurin inhibitor, mycophenolic acid, and corticosteroid were used after HT.Results. In-hospital mortality was 10.34% (n = 3). The causes of death were multiple organ failure and infectious and septic complications. After discharge, 4 (13.8%) recipients died over 5 years. Rejection reaction with the development of graft dysfunction (3 recipients, 75%), infectious and septic complications (1 recipient, 25%) were the causes of death in the long-term period. The survival rate was analyzed according to the Kaplan–Meier estimate. One-year survival was 80.9%. Three-year survival rate corresponded to the 5-year survival rate – 70.56%. Five-year survival of patients surviving the first year after HT was 86.1%. Maximum follow-up period was 64 months.Conclusion. HT continues to be the gold standard for patients with end-stage heart failure. Five-year HT experience in our center has shown a survival rate that is comparable to that of the International Society for Heart and Lung Transplantation (ISHLT).

Long term results of pediatric heart transplantations - single center experiences.

Heart failure (HF) is characterized by significant mortality in both adults and children. Characteristic of paediatric HF are feeding problems, poor weight gain, exercise intolerance or dyspnoea. These changes are often accompanied by endocrine disorders. The main causes of HF are congenital heart defects (CHD) cardiomyopathies, arrhythmias, myocarditis or heart failure secondary to oncological treatment. Heart transplantation (HTx) is the method of choice for treatment of end-stage HF in paediatric patients. The aim is to summarize single center experience in heart transplantation in children. Between 1988 and 2021 in the Silesian Center for Heart Diseases in Zabrze 122 pediatric cardiac transplantations were performed. In the group of recipients with falling Fontan circulation HTx was performed in 5 children. The study group was evaluated for postoperative course: rejection episodes depending on the medical treatment scheme, coinfections and mortality. 1-, 5- and 10-year survival rate between 1988 and 2001 were 53%, 53% and 50%, respectively. 1-, 5- and 10-year survival rate between 2002 and 2011 was 97%, 90% and 87%; between 2012 and 2021 1-year observation with survival rate 92%. The main cause of mortality both in early and in late period after transplantation was graft failure. Cardiac transplantation in children remains the main method of treatment of end-stage heart failure. Our results at both early and long-term posttransplant period, are comparable to those obtained in the most experienced foreign centers.

Infants Who Require Total Parenteral Nutrition and Paralytics at Time of Heart Transplant Experience Inferior Post-Transplant Mortality.

Background: Infants experience the worst one-year post-heart transplant (HTx) survival of any other pediatric group. Although mechanical ventilatory (MV) requirement at the time of transplant is an established predictor of post-transplant mortality, the impacts of commonly co-utilized support modalities such as total parenteral nutrition (TPN)-dependence and paralytics are understudied. Methods: All infant HTx recipients from 2003 to 2020 in both the United Network for Organ Sharing and Pediatric Health Information System databases were identified (n = 1344) and categorized depending upon support requirement at the time of transplant-none (59%), MV-only (10%), MV + Paralytics (2%), TPN-dependence-only (15%), MV + TPN (10%), and MV + Paralytics + TPN (4%). The primary study aim was to characterize the impact of TPN-dependence and paralytics on one-year post-transplant survival (PTS). Results: Compared to no-support, supported infants were generally at higher risk and more ill at transplant, with greater rates of congenital heart disease, renal and hepatic dysfunctions, and inotrope requirements. Post-transplant hospital outcomes were inferior among supported patients; all support groups experienced longer post-transplant MV, intensive care unit, and hospital lengths of stay (all P < .05 vs no-support). Upon multivariable analysis, each support modality independently predicted 1-year mortality (MV vs no-MV: 1.54 [1.10-2.14]; MV + Paralytics vs neither: 2.02 [1.25-3.27]; TPN vs no-TPN: 1.53 [1.10-2.13]; P < .01 for all), whereas no-support was protective (HR 0.66 [95% CI 0.48-0.91]). Conclusions: Infants who require paralytics and/or who are TPN-dependent at the time of HTx experience worse one-year PTS. Such knowledge can assist in risk-stratification, and the identification of patients who would benefit from pretransplant optimization.

Early Single Center Experience of Heart Transplantation from Donation After Circulatory Death Donors in the United States

<h3>Purpose</h3> Heart transplantation (HT) from donation after circulatory death (DCD) donors has been proposed as a means of addressing the scarcity of available donor grafts. International experience has suggested that DCD HT is safe, with outcomes comparable to donation after brain death (DBD) HT. Herein we describe our center's early experience using 2 DCD heart procurement strategies: 1) A direct procurement and perfusion (DPP) protocol, and 2) A thoracoabdominal normothermic regional perfusion (TA-NRP) protocol. <h3>Methods</h3> In September 2020, we launched a DCD HT program as part of a randomized trial using DPP and the OCS Transmedics platform. We subsequently launched a TA-NRP program. The TA-NRP protocol uses mobile cardiopulmonary bypass (CPB) to assess hearts in situ following declaration of death. Functional warm ischemic time (FWIT) was defined as the time from onset of mean pressure <50mm Hg or oxygen saturation <70%, to cold flush (DPP) or initiation of CPB (TA-NRP). FWIT was ≤30 minutes for DPP, while there was no pre-defined limit for TA-NRP. Data was prospectively collected. Donor and recipient characteristics were analyzed. We report 30-day survival as the primary endpoint. Secondary endpoints include incidence of primary graft dysfunction requiring mechanical support, immediate cardiac performance, ventilator days, need for renal replacement therapy, and intensive care and hospital length of stay. <h3>Results</h3> From September 2020 to October 2021, our center attended 50 candidate DCD donors, and performed 33 DCD HTs (66.0%), comprised of 13 DPP and 20 TA-NRP protocol donors. Among candidate DPP donors, 13 of 23 (56.5%) hearts were transplanted, whereas among candidate TA-NRP donors, 20 of 27 (74.1%) were transplanted. Year-to-date, DCD as a proportion of all HTs at our center has been 43.1%. Comparing similar time periods before and after implementing our DCD heart transplant program revealed a 20.3% increase in transplant activity. Donor and recipient characteristics are described in tabular format. 30-day survival is 100% among all DCD heart recipients. The incidence of primary graft dysfunction and other secondary endpoints are comparable with standard DBD HT. <h3>Conclusion</h3> DCD HT using both the DPP and TA-NRP procurement protocols is feasible and safe. Outcomes in our early single center experience are comparable with standard DBD HT.

Heart transplantation at the Peruvian National Heart Institute: One-decade single-center experience.

Heart transplantations are ideal for most patients with end-stage heart failure refractory to medical treatment. The transplantation program at the Peruvian National Heart Institute started with a 10-year continuity in 2010. To compare our 10-year heart transplantation experience results with international standards and reflect on our Transplant Program. We studied 83 patients who underwent orthotopic heart transplantation at a single center between January 2010 and December 2019. The recipients' profiles and survival rates were analyzed according to sex and age group, ensuring the information's confidentiality. The recipients' mean age was 41.2 ± 17 years, 88% were adults, and 68.7% were male. The main indications for transplantation were idiopathic dilated cardiomyopathy. 85.5% of recipients were clinically categorized as INTERMACS profiles 1-3 before transplantation. There was a significant difference between sexes regarding the preoperative left ventricular ejection fraction and between age groups regarding the waiting time. The average ischemia time was 3.1 h, operating time was 6.1 h, cardiopulmonary bypass time was 3 h, and aortic cross-clamp time was 1.7 h. The principal early postoperative complications were hematological disorders and acute kidney failure. The principal late ones were kidney failure and severe anemia. The postoperative mortality was 15.9%, and the principal causes were infection and then acute rejection. The survival at 1, 5, and 10 years was 87.5%, 79.8%, and 79.8%, respectively. The survival results were not influenced by sex or age group. Our patients' postoperative complications, mortality, and survival rates coincided with those reported by the ISHLT registry.

Normothermic regional perfusion surgical technique for the procurement of cardiac donors after circulatory death.

Normothermic regional perfusion surgical technique for the procurement of cardiac donors after circulatory death.

Prognosis of chronic Chagas heart disease and other pending clinical challenges.

In this chapter, the main prognostic markers of Chagas heart disease are addressed, with an emphasis on the most recent findings and questions, establishing the basis for a broad discussion of recommendations and new approaches to managing Chagas cardiopathy. The main biological and genetic markers and the contribution of the electrocardiogram, echocardiogram and cardiac magnetic resonance are presented. We also discuss the most recent therapeutic proposals for heart failure, thromboembolism and arrhythmias, as well as current experience in heart transplantation in patients suffering from severe Chagas cardiomyopathy. The clinical and epidemiological challenges introduced by acute Chagas disease due to oral contamination are discussed. In addition, we highlight the importance of ageing and comorbidities in influencing the outcome of chronic Chagas heart disease. Finally, we discuss the importance of public policies, the vital role of funding agencies, universities, the scientific community and health professionals, and the application of new technologies in finding solutions for better management of Chagas heart disease.

Heart Transplant System of Korea

The Korean Ministry of Drug and Food Safety approved the clinical use of durable left ventricular assist devices (LVADs) in 2014. However, Korean Health Insurance and Assessment service had not covered durable LVADs until October 2018[1]. Implantation of durable LVADS has increased from 31 for 7 years before insurance coverable to 230 for 40 months after insurance coverage. The criteria for insurance coverage are quite distinct which requires both institutional heart transplantation experience and approval for each case before surgery. The popularization of durable LVADs resulted in changing main bridge therapy from extracorporeal membrane oxygenation (ECMO) to durable LVADs in most centers. However, a few hospitals which do not meet institutional approval criteria still use ECMO as a bridge therapy. Waiting list mortality, post-transplant survival, and cost-effectiveness of durable LVADs in Korea are under evaluation by academic society. The Korean Ministry of Drug and Food Safety approved the clinical use of durable left ventricular assist devices (LVADs) in 2014. However, Korean Health Insurance and Assessment service had not covered durable LVADs until October 2018[1]. Implantation of durable LVADS has increased from 31 for 7 years before insurance coverable to 230 for 40 months after insurance coverage. The criteria for insurance coverage are quite distinct which requires both institutional heart transplantation experience and approval for each case before surgery. The popularization of durable LVADs resulted in changing main bridge therapy from extracorporeal membrane oxygenation (ECMO) to durable LVADs in most centers. However, a few hospitals which do not meet institutional approval criteria still use ECMO as a bridge therapy. Waiting list mortality, post-transplant survival, and cost-effectiveness of durable LVADs in Korea are under evaluation by academic society.

Outcomes of diabetic patients with end-stage heart failure listed for heart transplantation: a propensity-matched analysis

Abstract Background There are on-going concerns about offering heart transplants to patients with diabetes due to the risk of poor outcomes. We investigated the current trends and outcomes of patients listed for heart transplants in the U.S. and provided a method for risk-stratification. Methods Using data from the United Network for Organ Sharing (UNOS), we identified heart failure patients listed for heart transplants between 2010 and 2019. Diabetic patients were propensity-matched with non-diabetes, and waitlist mortality as well as post-transplant graft survival were compared between the two matched groups. Further risk-stratification of the diabetic cohort was done based on the risk factors that independently predict the risk of graft failure. Results 28,928 adult patients (30% diabetic) with end-stage heart failure were added to the waitlist over the study period. In the propensity-matched cohort, waitlist mortality was higher with diabetics compared to non-diabetics: 19.3 vs 17.1 deaths per 100 person-years, respectively, (HR=1.13 (95% CI=1.04–1.22, p=0.002). Over the study period, 5739 diabetics (mean age 57.6 years, 21.9% female) were transplanted. A total of 1308 (23.3%) and 1143 (20.4%) graft failures occurred in diabetic and non-diabetic recipients, respectively. Compared to non-diabetics, diabetics experienced worse graft survival (HR=1.17, 95% CI=1.08–1.26, p&amp;lt;0.001). We developed a risk score based on the 12 risk factors/markers that independently predict worse graft survival and a risk score of 4 reasonably differentiates between low and high-risk diabetics. Low risk diabetics (score≤4) had similar graft survival as non-diabetics with 1- and 5-year survival of 92.7% and 80.5%, respectively, (HR=0.91, 95% CI=0.82–1.01, p=0.06). On the other hand, high-risk diabetics had worse graft survival compared to non-diabetics (HR=1.52, 95% CI=1.38–1.67, P&amp;lt;0.001) with 1- and 5-year graft survival of 86.8% and 69.8%, respectively. Conclusion Diabetic patients with end-stage heart failure listed for heart transplantation experience higher waitlist mortality and worse post-transplant graft survival compared to non-diabetics. However, a simple risk score can be used for further risk-stratification in these patients to maximize survival benefit. Funding Acknowledgement Type of funding sources: None.

The Stanford experience of heart transplantation over five decades.

Since 1968, heart transplantation has become the definitive treatment for patients with end-stage heart failure. We aimed to summarize our experience in heart transplantation at Stanford University since the first transplantation performed over 50 years ago. From 6 January 1968 to 30 November 2020, 2671 patients presented to Stanford University for heart transplantation, of which 1958 were adult heart transplantations. Descriptive analyses were performed for patients in 1968-95 (n = 639). Stabilized inverse probability weighting was applied to compare patients in 1996-2006 (n = 356) vs. 2007-19 (n = 515). Follow-up data were updated through 2020. The primary endpoint was all-cause mortality. Prior to weighting, recipients in 2007-19 vs. those in 1996-2006 were older and had heavier burden of chronic diseases. After the application of stabilized inverse probability weighting, the distance organ travelled increased from 84.2 ± 111.1 miles to 159.3 ± 169.9 miles from 1996-2006 to 2007-19. Total allograft ischaemia time also increased over time (199.6 ± 52.7 vs. 225.3 ± 50.0 min). Patients in 2007-19 showed superior survival than those in 1996-2006 with a median survival of 12.1 vs. 11.1 years. In this half-century retrospective descriptive study from one of the largest heart transplant programmes in the USA, long-term survival after heart transplantation has improved over time despite increased recipient and donor age, worsening comorbidities, increased technical complexity, and prolonged total allograft ischaemia time. Further investigation is warranted to delineate factors associated with the excellent outcomes observed in this study.

Back on the Road to Life: Iranian Patients’ Experience of Heart Transplantation

Introduction: Heart transplantation is a standard treatment for end-stage cardiac disease. In addition to inducing physical changes and improving the quality of life, it causes unique mental and psychological changes in transplant recipients. Therefore, this study sought to explain and interpret the experience of heart transplant recipients in Iran. Methods: Using a qualitative content analysis approach, this study was performed on 13 heart transplant recipients in Tehran. The data were collected through observation and semi-structured interviews. The participants were selected using purposive sampling, and the interviews continued until data saturation. After obtaining informed consent, interviews were recorded, transcribed, and analyzed using conventional and concurrent content analysis. Results: The analysis of the data revealed two stages experienced by heart transplant recipients. The transition stage was categorized into two concepts of and of duality. The emotional turmoil was subcategorized into feeling guilty, alienation with the new heart, and gratitude. Besides, the of duality was subdivided into personality change and lifestyle changes. The stabilization stage was conceptualized into “self-acceptance” which was subcategorized into three concepts of the acceptance of the new heart, feeling of unity with the donor, and normalization. Conclusion: Adaptation to the new heart is a multistage process in heart transplant recipients. Based on the insights from this study, it can be concluded that healthcare professionals need to improve their knowledge of post-transplant changes, recipients’ feelings, and their adaptation strategies. They are also advised to address the physical needs and mental concerns of transplant recipients.

Heart transplant in a patient with persistent left superior vena cava

Objective: to present our own experience of heart transplantation in a patient with persistent left superior vena cava (PLSVC). A clinical case of successful orthotopic heart transplantation using the biatrial technique in a patient with PLSVC drainage into the right atrium is presented. The clinical effect achieved as a result of the treatment fully justifies the chosen surgical tactics and allows us to recommend the proposed tactics for treatment of such a rare anomaly. Conclusion. The clinical effect achieved as a result of the treatment fully justifies the chosen surgical tactics and allows us to recommend the proposed tactics for treatment of such a rare anomaly.

Can Patients Be Transplanted or Undergo Ventricular Assist Device Placement During the COVID-19 Pandemic? Padova Perspective.

The SARS-CoV-2 pandemic is nowadays an international emergency and the North-Italian regions have faced a high rate of infection and case fatality. A logistic and structural rearrangement has been required to ensure COVID-19-free areas, to save human and economic resources, and to solve all incoming urgencies. Herein, we report the Padova experience in heart transplantation and mechanical circulatory support implantation for severe INTERMACS class patients with satisfactory results during COVID-19 pandemic.

Initial clinical experience of heart transplantation in health care system of the Moscow region

<h3></h3> Трансплантация сердца является «золотым стандартом» лечения терминальной сердечной недостаточности при неэффективности оптимальной медикаментозной терапии и невозможности реконструктивной хирургии. Трансплантация сердца увеличивает выживаемость пациентов с рефрактерной стадией сердечной недостаточности, улучшает качество жизни больных и позволяет большинству из них вернуться к активной жизни. По последним опубликованным данным Международного регистра, за 2017 г. было выполнено более 5000 трансплантаций сердца. Годовая, 5- и 10-летняя выживаемость после трансплантации сердца составляет 88, 74 и 55%, соответственно. В системе здравоохранения Московской области программа трансплантации сердца стартовала в МОНИКИ им. М.Ф. Владимирского в 2019 г. После завершения всех организационных и логистических процедур был начат подбор реципиентов с целью формирования листа ожидания. В статье представлен первый клинический опыт трансплантации сердца в системе здравоохранения Московской области.

A 5-year single-center early experience of heart transplantation from donation after circulatory-determined death donors

In an effort to address the increasing demand for heart transplantation within the United Kingdom (UK), we established a clinical program of heart transplantation from donation after circulatory-determined death (DCD) donors in 2015. After 5 years, we report the clinical early outcomes and impact of the program. This is a single-center, retrospective, matched, observational cohort study comparing outcomes of hearts transplanted from DCD donors from March 1, 2015 to February 29, 2020 with those from matched donation after brain death (DBD) donors at Royal Papworth Hospital (RPH) (Cambridge, UK). DCD hearts were either retrieved using thoracoabdominal normothermic regional perfusion or the direct procurement and perfusion technique. All DBD hearts were procured using standard cold static storage. The primary outcomes were recipient 30-day and 1-year survival. During the 5-year study, DCD heart donation increased overall heart transplant activity by 48% (79 for DCD and 164 for DBD). There was no difference in survival at 30days (97% for DCD vs 99% for DBD, p = 1.00) or 1 year (91% for DCD vs 89% for DBD, p = 0.72). There was no difference in the length of stay in the intensive care unit (7 for DCD vs 6 for DBD days, p = 0.24) or in the hospital (24 for DCD vs 25 for DBD days, p = 0.84). DCD heart donation increased overall heart transplant activity at RPH by 48%, with no difference in 30-day or 1-year survival in comparison with conventional DBD heart transplantations. DCD heart donation is set to make a dramatic difference in the number of patients who can benefit from heart transplantation.