Donor and Recipient Characteristics in Heart Transplantation Are                     Associated with Altered Myocardial Tissue Structure and Cardiac                     Function

Dolan, Ryan S.; Rahsepar, Amir Ali; Blaisdell, Julie; Sarnari, Roberto; Ghafourian, Kambiz; Wilcox, Jane E.; Khan, Sadiya S.; Vorovich, Esther; Rich, Jonathan D.; Yancy, Clyde W.; Anderson, Allen S.; Carr, James C.; Markl, Michael

doi:10.1148/ryct.2019190009

Cited by 2 publications

(1 citation statement)

References 37 publications

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“…Current donor-recipient matching includes size, weight, blood group, HLA antibodies, and variable centerspecific criteria. Donor demographics, including size, sex, and age, as well as comorbidities such as hypertension, diabetes mellitus, and smoking all are associated with an increase in post transplantation mortality (17,18). Size matching is a useful adjunct to blood group and HLA antibodies, as significant undersizing of greater than 30% increases the risk of all cause one-year mortality by approximately 30%, while conversely, insignificant risk was seen with over-sizing (19).…”

Section: Relative Shortage Of Donor Organs Limit Heart Failure Potentialmentioning

confidence: 99%

The current and future role of artificial intelligence in optimizing donor organ utilization and recipient outcomes in heart transplantation

Carlson¹,

Kamalia²,

Zimmerman³

et al. 2022

HVT

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Heart failure (HF) is a leading cause of morbidity and mortality in the United States. While medical management and mechanical circulatory support have undergone significant advancement in recent years, orthotopic heart transplantation (OHT) remains the most definitive therapy for refractory HF. OHT has seen steady improvement in patient survival and quality of life (QoL) since its inception, with one-year mortality now under 8%. However, a significant number of HF patients are unable to receive OHT due to scarcity of donor hearts. The United Network for Organ Sharing has recently revised its organ allocation criteria in an effort to provide more equitable access to OHT. Despite these changes, there are many potential donor hearts that are inevitably rejected. Arbitrary regulations from the centers for Medicare and Medicaid services and fear of repercussions if one-year mortality falls below established values has led to a current state of excessive risk aversion for which organs are accepted for OHT. Furthermore, non-standardized utilization of extended criteria donors and donation after circulatory death, exacerbate the organ shortage. Data-driven systems can improve donor-recipient matching, better predict patient QoL post-OHT, and decrease needless organ waste through more uniform application of acceptance criteria. Thus, we propose a data-driven future for OHT and a move to patient-centric and holistic transplantation care processes.

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Section: Relative Shortage Of Donor Organs Limit Heart Failure Potentialmentioning

confidence: 99%

The current and future role of artificial intelligence in optimizing donor organ utilization and recipient outcomes in heart transplantation

Carlson¹,

Kamalia²,

Zimmerman³

et al. 2022

HVT

View full text Add to dashboard Cite

show abstract

Multi-parametric cardiovascular magnetic resonance with regadenoson stress perfusion is safe following pediatric heart transplantation and identifies history of rejection and cardiac allograft vasculopathy

Husain

Watanabe

Berhane

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background The progressive risk of graft failure in pediatric heart transplantation (PHT) necessitates close surveillance for rejection and coronary allograft vasculopathy (CAV). The current gold standard of surveillance via invasive coronary angiography is costly, imperfect and associated with complications. Our goal was to assess the safety and feasibility of a comprehensive multi-parametric CMR protocol with regadenoson stress perfusion in PHT and evaluate for associations with clinical history of rejection and CAV. Methods We performed a retrospective review of 26 PHT recipients who underwent stress CMR with tissue characterization and compared with 18 age-matched healthy controls. CMR protocol included myocardial T2, T1 and extracellular volume (ECV) mapping, late gadolinium enhancement (LGE), qualitative and semi-quantitative stress perfusion (myocardial perfusion reserve index; MPRI) and strain imaging. Clinical, demographics, rejection score and CAV history were recorded and correlated with CMR parameters. Results Mean age at transplant was 9.3 ± 5.5 years and median duration since transplant was 5.1 years (IQR 7.5 years). One patient had active rejection at the time of CMR, 11/26 (42%) had CAV 1 and 1/26 (4%) had CAV 2. Biventricular volumes were smaller and cardiac output higher in PHT vs. healthy controls. Global T1 (1053 ± 42 ms vs 986 ± 42 ms; p < 0.001) and ECV (26.5 ± 4.0% vs 24.0 ± 2.7%; p = 0.017) were higher in PHT compared to helathy controls. Significant relationships between changes in myocardial tissue structure and function were noted in PHT: increased T2 correlated with reduced LVEF (r = − 0.57, p = 0.005), reduced global circumferential strain (r = − 0.73, p < 0.001) and reduced global longitudinal strain (r = − 0.49, p = 0.03). In addition, significant relationships were noted between higher rejection score and global T1 (r = 0.38, p = 0.05), T2 (r = 0.39, p = 0.058) and ECV (r = 0.68, p < 0.001). The presence of even low-grade CAV was associated with higher global T1, global ECV and maximum segmental T2. No major side effects were noted with stress testing. MPRI was analyzed with good interobserver reliability and was lower in PHT compared to healthy controls (0.69 ± − 0.21 vs 0.94 ± 0.22; p < 0.001). Conclusion In a PHT population with low incidence of rejection or high-grade CAV, CMR demonstrates important differences in myocardial structure, function and perfusion compared to age-matched healthy controls. Regadenoson stress perfusion CMR could be safely and reliably performed. Increasing T2 values were associated with worsening left ventricular function and increasing T1/ECV values were associated with rejection history and low-grade CAV. These findings warrant larger prospective studies to further define the role of CMR in PHT graft surveillance.

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Donor and Recipient Characteristics in Heart Transplantation Are Associated with Altered Myocardial Tissue Structure and Cardiac Function

Cited by 2 publications

References 37 publications

The current and future role of artificial intelligence in optimizing donor organ utilization and recipient outcomes in heart transplantation

The current and future role of artificial intelligence in optimizing donor organ utilization and recipient outcomes in heart transplantation

Multi-parametric cardiovascular magnetic resonance with regadenoson stress perfusion is safe following pediatric heart transplantation and identifies history of rejection and cardiac allograft vasculopathy

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