Factors predicting 10-year survival after heart transplantation

Radovančević, Branislav; Konuralp, Cüneyt; Vrtovec, Bojan; Radovancevic, Rajko; Thomas, Cynthia D.; Zaqqa, Munir; Vaughn, William K.; Frazier, O.H.

doi:10.1016/j.healun.2003.11.399

Cited by 62 publications

(47 citation statements)

References 11 publications

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“…Also the opinions regarding the impact of pre-transplantation diabetes are controversial as are the opinions on its effect on long-term survival. According to Czerny, Badovancevic and Meyer [15][16][17] , pretransplantation diabetes decreases long-term survival (10-year) of patients, while according to Russo, Inkedy and Morgan 18-20 DM does not increase mortality of patients after transplantation and the survival of patients with non-complicated DM is comparable to patients without diabetes. In his work, Marelli 21 describes decreased 1-year survival of patients with DM, however, the 5-year survival is identical to non-diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of Diabetes Mellitus on Survival Rates After Heart Transplantation

Bedáňová¹,

Ondrášek²,

Černý³

et al. 2009

BIOMED PAP

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Aims: Heart transplantation (HTx) is the most effective therapy in patients with end-stage heart failure. Diabetesrelated complications are relative contraindications for heart transplantation. The aim of our study was to analyse the impact of DM (diabetes mellitus) at the time of heart transplantation and new-onset post-transplantation DM on long-term survival.Methods: A retrospective database analysis was performed on all patients who had undergone HTx at our institution between 4/1997 and 9/2007. Patients were divided into three groups: Group A -patients without DM; Group B -patients with new onset of DM after HTx; Group C -patients with DM prior to HTx.Results: Patients with DM before the surgery were more obese, their BMI was 27.7 ± 2.90, compared to groups A and B with BMI of 24.7 ± 3.37 and 25.3 ± 3.64 respectively (p = 0.0003). Patients in group B had statistically significantly higher risk of developing acute rejection (G 1B and more according to International Society of Heart and Lung Transplantation -ISHLT -classification) (p = 0.0350). The incidence of infections between individual groups showed no statistically significant differences (p = 0.5839). Five-year survival in group A was 82%, 10-year survival was 73%. Corresponding numbers for group B were 86% and 78%, for group C 86% and 83%. Differences between groups were not statistically significant (p = 0.2560).Conclusions: DM in patients after heart transplantation in our study had no effect on long-term survival of patients. Post-transplantation DM increases risk of acute rejections. Pre-transplantation DM was associated with excessive bodyweight or obesity.

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Section: Discussionmentioning

confidence: 99%

Impact of Diabetes Mellitus on Survival Rates After Heart Transplantation

Bedáňová¹,

Ondrášek²,

Černý³

et al. 2009

BIOMED PAP

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“…has been related to acute rejection. 7,8 The onset and severity of acute biopsy-proven rejection (BPR), as indicated by the time from transplantation to the development of the first rejection episode (regardless of rejection severity) and the incidence of a rejection episode rated as Grade Ն3A, were secondary endpoints. Finally, the composite end-point of death, the incidence of rejection Grade Ն3A, or early rejection was used to examine the risk of unfavorable outcomes after HTx.…”

Section: Outcomes Measuresmentioning

confidence: 99%

“…Female-to-male mismatch, donor and recipient age, allograft ischemia time, cause of brain death, cytomegalovirus (CMV) status, HLA sensitization and HLA mismatch have all been implied as risk factors for acute rejection. [5][6][7][8] Behavioral factors such as noncompliance with therapy and depression have also been related to acute rejections and poor prognosis post-HTx. 9 -11 Persistent symptoms of psychologic distress are prevalent among HTx patients 11,12 and have a negative impact on compliance.…”

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confidence: 99%

Unfavorable Outcome of Heart Transplantation in Recipients With Type D Personality

Denollet

Vrints

et al. 2007

The Journal of Heart and Lung Transplantation

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Unfavorable outcome of heart transplantation in recipients with type D personalityDenollet, Johan; Holmes, R.V.F.H.; Vrints, C.J.; Conraads, V. Published in:The Journal of Heart and Lung Transplantation Document version:Publisher's PDF, also known as Version of record General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.-Users may download and print one copy of any publication from the public portal for the purpose of private study or research -You may not further distribute the material or use it for any profit-making activity or commercial gain -You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright, please contact us providing details, and we will remove access to the work immediately and investigate your claim. Background: The role of personality in heart transplantation (HTx) remains largely unknown. We examined the distressed personality (Type D) as a predictor of outcomes in patients suffering from end-stage heart disease who underwent HTx. Methods:Using the DS14 scale, 51 patients (75% men; 54.1 Ϯ 9.7 years of age) were diagnosed as Type D or non-Type D in the pre-transplant period. End-points of this prospective follow-up study (mean 5.4 years) were mortality and allograft rejection (Grade Ն3A rejection, rejection-free days after HTx). Results:At baseline, 15 patients were diagnosed as Type D and 36 as non-Type D; they did not differ in recipient or donor characteristics. At follow-up, there were 8 deaths; the mortality rate of Type D recipients was 33% vs 8% for non-Type Ds ( p ϭ 0.036). Two deaths were due to early post-operative complications and were excluded from further analyses. Type D recipients had a 10-fold higher mortality rate after hospital discharge (5 of 15, or 33%) as compared with non-Type D recipients (1 of 34, or 3%) ( p ϭ 0.013, adjusting for age and gender). Among surviving recipients, the rate of Grade Ն3A rejection for both groups was 40% vs 27%, respectively (p ϭ 0.45). The first episode of rejection was diagnosed, on average, after 14 days in Type D recipients vs after 50 days in the other patients (p ϭ 0.032). The risk of unfavorable outcomes (death, Grade Ն3A rejection, or number rejection-free days Յ14) was greater in Type D recipients (12 of 15, or 80%) than in non-Type Ds (13 of 34, or 38%), adjusting for other risk factors (odds ratio: 6.75; 95% confidence interval: 1.47 to 30.97) ( p ϭ 0.014). Conclusions: Type D personality independently predicted mortality and early allograft rejection, and should be accounted for when planning interventions to achieve optimal outcomes after HTx. J Heart Lung Transplant 2007;26:152-8.

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“…15,16 In our study, no relationship was seen between systemic endothelial function and donor or recipient CMV status, the traditional markers of risk of CMV disease. CMV prophylaxis has reduced the risk of coronary disease in this group.…”

Section: Discussionmentioning

confidence: 44%

Endothelial Dysfunction and Cytomegalovirus Replication in Pediatric Heart Transplantation

et al. 2008

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Background-Cardiac allograft vasculopathy is the major limiting factor to the long-term success of pediatric heart transplantation. Cytomegalovirus (CMV) has been shown to be a significant risk factor for the development of cardiac allograft vasculopathy. Recent work has demonstrated CMV DNA in leukocytes in the absence of direct allograft infection, suggesting that vascular changes may not be limited to the allograft. Method and Results-Systemic arterial endothelial function was assessed with high-resolution ultrasound to determine brachial artery flow-mediated dilation in 50 pediatric heart transplant recipients (8 to 17 years of age; 27 male). Patients were separated into 2 groups according to CMV status: those without evidence of CMV replication after transplantation (nϭ38; 19 male) and patients with evidence of viremia after transplantation (nϭ12; 8 male). No patient had detectable viremia at the time of study. Flow-mediated dilation was significantly impaired in patients with evidence of CMV replication after transplantation (6.64Ϯ1.12%, meanϮSE) compared with those without (9.48Ϯ0.56%; Pϭ0.02). This difference remained after adjustment for age, time since transplantation, and medication. Pretransplantation recipient and donor CMV status and traditional CMV risk were not associated with flow-mediated dilation. Conclusions-CMV replication after cardiac transplantation is associated with chronic endothelial dysfunction in the systemic circulation in children. The implication for both systemic and coronary vascular health requires prospective evaluation.

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Factors predicting 10-year survival after heart transplantation

Cited by 62 publications

References 11 publications

Impact of Diabetes Mellitus on Survival Rates After Heart Transplantation

Impact of Diabetes Mellitus on Survival Rates After Heart Transplantation

Unfavorable Outcome of Heart Transplantation in Recipients With Type D Personality

Endothelial Dysfunction and Cytomegalovirus Replication in Pediatric Heart Transplantation

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