Our results demonstrate that PGF is associated with poor outcomes that extend beyond the 1st month and the 1st year after heart transplantation. We found female donor, total ischaemic time and preoperative mechanical extracorporeal circulatory support to be risk factors for PGF.

SummaryWe intended to evaluate the influence of sex mismatch between donor and recipient, which is still under much debate, on survival and comorbidities after cardiac transplantation. From November 2003 to December 2013, a total of 258 patients were transplanted in our center. From these, 200 receptors were male (77.5%) and constituted our study population, further divided into those who received the heart from a female donor (Group A) -44 patients (22%) and those who received it from a male donor (Group B) -156 (78%). Median follow-up was 4.2 AE 3.0 years (1-10 years). The two groups were quite comparable with each other, except for body mass index, systolic pulmonary artery pressure, and transpulmonary gradient, which were significantly lower in Group A. A low donor/ recipient weigh ratio (<0.8) was avoided whenever possible. Hospital mortality was not different in the two groups. During follow-up, global survival was similar, as was survival free from acute cellular rejection and cardiac allograft vasculopathy. However, patients in Group A had decreased survival free from serious infections and malignant tumors. Allocation of female donors to male receptors can be done safely, at least in receptors without pulmonary hypertension and when an adequate donor/recipient weigh ratio is ensured.

Background Patients older than 65 years have traditionally not been considered candidates for heart transplantation. However, recent studies have shown similar survival. We evaluated immediate and medium-term results in patients older than 65 years compared with younger patients. Methods From November 2003 to December 2013, 258 patients underwent transplantation. Children and patients with other organ transplantations were excluded from this study. Recipients were divided into two groups: 45 patients (18%) aged 65 years and older (Group A) and 203 patients (81%) younger than 65 years (Group B). Results Patients differed in age (67.0 AE 2.2 vs. 51.5 AE 9.7 years), but gender (male 77.8 vs. 77.3%; p ¼ 0.949) was similar. Patients in Group A had more cardiovascular risk factors and ischemic cardiomyopathy (60 vs. 33.5%; p < 0.001). Donors to Group A were older (38.5 AE 11.3 vs. 34.0 AE 11.0 years; p ¼ 0.014). Hospital mortality was 0 vs. 5.9% (p ¼ 0.095) and 1-and 5-year survival were 88.8 AE 4.7 versus 86.8 AE 2.4% and 81.5 AE 5.9 versus 77.2 AE 3.2%, respectively. Mean follow-up was 3.8 AE 2.7 versus 4.5 AE 3.1 years. Incidence of cellular/humoral rejection was similar, but incidence of cardiac allograft vasculopathy was higher (15.6 vs. 7.4%; p ¼ 0.081). Incidence of diabetes de novo was similar (p ¼ 0.632), but older patients had more serious infections in the 1st year (p ¼ 0.018). Conclusion Heart transplantation in selected older patients can be performed with survival similar to younger patients, hence should not be restricted arbitrarily. Incidence of infections, graft vascular disease, and malignancies can be reduced with a more personalized approach to immunosuppression. Allocation of donors to these patients does not appear to reduce the possibility of transplanting younger patients.

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PALAVRAS-CHAVE53,0 ± 12,7 anos (limites 3-72 anos) e predominância do sexo masculino (78%) foram transplantados. Mais de um terço dos doentes tinha miocardiopatia isquémica (37,2%) e 36,4% idiopática. A idade média dos dadores era 34,4 ± 11,3 anos e 195 eram do sexo masculino (76%), com disparidade de sexo entre dador e recetor (F:M) em 32% dos casos e disparidade AB0 (grupos não idênticos mas compatíveis) em 18%. A colheita foi feita à distância em 59% dos casos. Em todos os casos foi utilizada a técnica de transplantação total, com anastomose bicava, modificada neste centro. O tempo médio de isquemia foi 89,7 ± 35,4 minutos. Todos os doentes receberam terapêutica de indução. Resultados: A mortalidade precoce foi 4,7% (12 doentes), por falência do enxerto e acidente vascular cerebral em cinco cada, e por rejeição hiperaguda em dois. Treze doentes (5%) necessitaram de ventilação prolongada e 25 (11,8%) requereram suporte inotrópico por mais de 48 horas, sete necessitaram de implantação de pacemaker. O tempo médio de internamento foi de 15,8 ± 15,3 dias (mediana, 12 dias). Noventa por cento dos doentes foram mantidos com terapêutica imunossupressora tripla, incluindo ciclosporina. Os restantes receberam tacrolimus. Em 23 doentes foi necessário alterar o esquema de imunossupressão devido a complicações renais e/ou neoplásicas e rejeição humoral. Todos os doentes, exceto dois, são seguidos no centro cirúrgico. Cinquenta doentes (19,4%) faleceram tardiamente por infeção (18 doentes), neoplasia (dez doentes), causa vascular (oito doentes), neuropsiquiátrica (quatro doentes), cardíaca (dois doentes) ou outras (oito doentes). Quarente e seis doentes (17,8%) tiveram episódios de rejeição celular (≥ 2 R da ISHLT) e oito tiveram rejeição humoral (3,1%), e em 22 há evidência de doença vascular enxerto (8,5%). A sobrevivência atuarial a um, cinco, e oito anos foi de 87 ± 2%, 78 ± 3% e 69 ± 4%, respetivamente. * Autor para correspondência.

A morfeia, ou esclerodermia localizada, é uma doença do tecido conjuntivo na qual o excesso de deposição de colagénio leva ao desenvolvimento de lesões escleróticas. Inicialmente distinguida da esclerose sistémica pela ausência de manifestações sistémicas, envolvimento limitado à pele e curso relativamente benigno, sabe-se actualmente que a esclerose localizada pode estar associada a múltiplas manifestações extracutâneas. No presente artigo faz-se uma revisão da literatura das manifestações extracutâneas associadas a esta doença, nomeadamente musculoesqueléticas, neurológicas, oftalmológicas, gastrointestinais, respiratórias, cardíacas e renais.

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ObjectiveTo evaluate immediate and long-term results of cardiac transplantation at two different levels of urgency.MethodsFrom November 2003 to December 2012, 228 patients underwent cardiac transplantation. Children and patients in cardiogenic shock were excluded from the study. From the final group (n=212), 58 patients (27%) were hospitalized under inotropic support (Group A), while 154 (73%) were awaiting transplantation at home (Group B). Patients in Group A were younger (52.0±11.3 vs. 55.2±10.4 years, P=0.050) and had shorter waiting times (29.4±43.8 vs. 48.8±45.2 days; P=0.006). No difference was found for sex or other comorbidities. Haemoglobin was lower and creatinine higher in Group A. The characteristics of the donors were similar. Follow-up was 4.5±2.7 years.ResultsNo differences were found in time of ischemia (89.1±37.0 vs. 91.5±34.5 min, P=0.660) or inotropic support (13.8% vs. 11.0%, P=0.579), neither in the incidence of cellular or humoral rejection and of cardiac allograft vasculopathy. De novo diabetes de novo in the first year was slightly higher in Group A (15.5% vs. 11.7%, P=0.456), and these patients were at increased risk of serious infection (22.4% vs. 12.3%, P=0.068). Hospital mortality was similar (3.4% vs. 4.5%, P=0.724), as well as long-term survival (7.8±0.5 vs. 7.4±0.3 years).ConclusionsThe results obtained in patients hospitalized under inotropic support were similar to those of patients awaiting transplantation at home. Allocation of donors to the first group does not seem to compromise the benefit of transplantation. These results may not be extensible to more critical patients.