Have risk factors for mortality after heart transplantation changed over time? Insights from 19 years of Cardiac Transplant Research Database study

Tallaj, José; Pamboukian, Salpy V.; George, James F.; Kirklin, James K.; Brown, Robert N.; McGiffin, David C.; Acharya, Deepak; Loyaga‐Rendon, Renzo Y.; Melby, Spencer J.; Bourge, Robert C.; Naftel, David C.

doi:10.1016/j.healun.2014.08.014

Cited by 28 publications

(19 citation statements)

References 15 publications

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“…Karamlou and colleagues 5 reported similar results, with their study showing 665 of 8496 patients dying from acute graft rejection and 271 dying from infection. In turn, Tallaj and associates 24 reported that, over a 19-year period, infections caused 24% of deaths, with 14% from graft failure (within 30 days) and 12.5% from acute rejection Although, the numbers of patients in both studies differed from ours, we managed to corroborate that these are the most common causes of death in patients after heart transplant.…”

Section: Discussionmentioning

confidence: 51%

“…23 Survival after heart transplant has improved over time. 24 However, there are inconsistencies in the results of various institutions. For example, 1 study evidenced a 90% survival at 1 year.…”

Section: Discussionmentioning

confidence: 99%

“…However, a recent study stated that, over time, this has ceased to be, as long as the donor obtains a suitable heart. 24 For example, Patel and colleagues 9 mentioned that recipients with elevated pulmonary resistance who received a heart with an unappropriated measure had lower survival. In our experience, 71% of all patients had pulmonary hypertension; however, our univariate analysis showed that this condition was not significant for mortality.…”

Section: Discussionmentioning

confidence: 99%

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Rojas¹,

Cruz-Ku²,

Yassen³

et al. 2018

Exp Clin Transplant

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Objectives: The identification of variables related to the survival of heart transplant patients is vital for a good medical practice. Few studies have examined this issue in a Latin American population. Therefore, the aim of this study was to analyze, retrospectively, the survival and mortality characteristics of patients after heart transplant. Materials and Methods: Information on patients was obtained through review of medical records; we collected information on all patients who underwent this procedure from 2010 to 2015. Sociodemographic, clinical, and surgical characteristics associated with posttransplant mortality were analyzed. Survival over 5 years was determined with the Kaplan-Meier method. Results: The overall survival rate of the 35 patients who underwent heart transplant was 85%. Those with low total cholesterol values (< 160 mg/dL) had a lower survival at 5 years than patients with higher values (74% vs 100%; P = .044). The overall mortality was 14.3%, and the main cause of death was acute graft rejection (40%). Lower total cholesterol level (< 160 mg/dL; P = .036), presence of chronic kidney disease stage 1 (P = .049), intraoperative bleeding (> 600 mL; P = .013), and number of sepsis incidents (P = .03) were more frequent in patients who died. Conclusions: The survival in our institute at 5 years is higher than shown in the reported literature, and the mortality is lower. In addition, a low total cholesterol value negatively affects survival of heart transplant patients at 5 years. Key words: Cardiac surgery, Cholesterol, Graft rejection, Sepsis IntroductionCompared with past decades, the International Society for Heart and Lung Transplantation and other institutions have recorded improved survival after heart transplant at 1, 5, and 10 years. 1,2 This is relevant because this surgical procedure remains the treatment of choice in patients with severe heart failure from different causes. 3 Data have also demonstrated survival greater than 20 years after heart transplant. 4 However, survival continues to be below 80% at 5 years in various institutions. 2,5 Survival after heart transplant is affected by several mortality factors from both the recipient and the donor. 6 For the recipient, age, body mass index, high preoperative creatinine level, ischemic time, cardiovascular diseases or hematologic-associated causes, and the patient's psychological state can affect survival. 2,7-10 For the donor, higher age, donor diabetes mellitus history, and sex mismatch or race mismatch can increase the recipients' mortality after heart transplant. 9,11 The principal causes of death after this procedure include cardiac graft vasculopathy, primary graft failure, graft rejection, infection, and neoplasia. 12,13 In recent years, new developments to minimize the causes of death have been implemented, thus raising survival rates. 14 These include the implementation of more protocols, strict sanitary policies, and the combination and use of better immunosuppressive therapy. 6 Most studies have been done on p...

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Rojas¹,

Cruz-Ku²,

Yassen³

et al. 2018

Exp Clin Transplant

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“…In the first early phase of acute risk, acute rejection was a cause of death in 12.5% of cases. 32 Acute rejection is not a significant contributor to death beyond this acute phase. The implications of our results are thus important, and suggest that patients who receive G-CSF should undergo increased surveillance for rejection during the 3 months after its administration, especially in the first year post-transplant.…”

Section: Discussionmentioning

confidence: 99%

Increase in short-term risk of rejection in heart transplant patients receiving granulocyte colony-stimulating factor

Nguyen

Lourenço

Chung

et al. 2018

The Journal of Heart and Lung Transplantation

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BACKGROUND: Neutropenia is a significant adverse event after heart transplantation (HT) and increases infection risk. Granulocyte colony-stimulating factor (G-CSF) is commonly used in patients with neutropenia. In this work, we assessed the adverse effects of G-CSF treatment in the setting of a university hospital. METHODS: Data on HT patients from January 2008 to July 2016 were reviewed. Patients who received G-CSF were identified and compared with patients without a history of therapy. Baseline characteristics, rejection episodes, and outcomes were collected. Data were analyzed by incidence rates, time to rejection and survival were analyzed using Kaplan–Meier curves, and odds ratios were generated using logistic regression analysis. RESULTS: Two hundred twenty-two HT patients were studied and 40 (18%) received G-CSF for a total of 85 total neutropenic events (0.79 event/patient year). There were no differences in baseline characteristics between the groups. In the 3 months after G-CSF, the incidence rate of rejection was 0.067 event/month. In all other time periods considered free of G-CSF effect, the incidence rate was 0.011 event/month. This rate was similar to the overall incidence rate in the non-GCSF group, which was 0.010 event/month. There was a significant difference between the incidence rates in the G-CSF group at 0 to 3 months after G-CSF administration and the non-GCSF group (p = 0.04), but not for the other time periods (p = 0.5). Freedom from rejection in the 3 months after G-CSF administration was 87.5% compared with 97.5% in the non-GCSF group (p = 0.006). CONCLUSIONS: G-CSF administration was found to be associated with significant short-term risk of rejection. This suggests the need for increased surveillance during this time period.

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“…For heart and renal grafts, 5–9% are lost in the first year and the average graft survival at 5 years remains only about 80% (1–4). The high frequency of recipient T cells expressing receptors that are cross-reactive with donor allogeneic MHC molecules generates two pools of donor-reactive T cells that undermine successful allogeneic organ transplantation (5, 6).…”

Section: Introductionmentioning

confidence: 99%

IL-1 Receptor Signaling on Graft Parenchymal Cells Regulates Memory and De Novo Donor-Reactive CD8 T Cell Responses to Cardiac Allografts

Iida

Tsuda

Tanaka

et al. 2016

The Journal of Immunology

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Reperfusion of organ allografts induces a potent inflammatory response that directs rapid memory T cell, neutrophil and macrophage graft infiltration and their activation to express functions mediating graft tissue injury. The role of cardiac allograft IL-1 receptor signaling in this early inflammation and the downstream primary alloimmune response was investigated. When compared to complete MHC-mismatched wild type cardiac allografts, IL-1R−/− allografts had marked decreases in endogenous memory CD8 T cell and neutrophil infiltration and expression of proinflammatory mediators at early times after transplant whereas endogenous memory CD4 T cell and macrophage infiltration was not decreased. IL-1R−/− allograft recipients also had marked decreases in de novo donor-reactive CD8, but not CD4, T cell development to IFN-γ-producing cells. CD8 T cell-mediated rejection of IL-1R−/− cardiac allografts took 3 weeks longer than wild type allografts. Cardiac allografts from reciprocal bone marrow reconstituted IL-1R−/−/wild type chimeric donors indicated that IL-1R signaling on graft non-hematopoietic-derived, but not bone marrow-derived, cells is required for the potent donor-reactive memory and primary CD8 T cell alloimmune responses observed in response to wild type allografts. These studies implicate IL-1R-mediated signals by allograft parenchymal cells in generating the stimuli provoking development and elicitation of optimal alloimmune responses to the grafts.

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Have risk factors for mortality after heart transplantation changed over time? Insights from 19 years of Cardiac Transplant Research Database study

Cited by 28 publications

References 15 publications

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Increase in short-term risk of rejection in heart transplant patients receiving granulocyte colony-stimulating factor

IL-1 Receptor Signaling on Graft Parenchymal Cells Regulates Memory and De Novo Donor-Reactive CD8 T Cell Responses to Cardiac Allografts

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