The future of cardiac transplantation

Koomalsingh, Kevin J.; Kobashigawa, Jon A.

doi:10.21037/acs.2017.12.02

Cited by 15 publications

(8 citation statements)

References 44 publications

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“…An extension of the allograft preservation time will make it possible to schedule transplantation during the day, when the highest competence will be available for these complex, highrisk cases. Furthermore, NIHP may make it possible to increase the donor pool by utilizing more marginal donors and enabling organ sharing across long distances (perhaps even between continents) 25 . Finally, a preservation system that can decrease the activation of innate and adaptive immune responses resulting in a downregulation of the immune system, might provide further benefits for organ transplantation 7,9,24 .…”

Section: Discussionmentioning

confidence: 99%

“…Baseline characteristics, except for body size, were similar for those in the two groups. The donor size was similar in the two groups but the NIHP recipients were larger and had a median body mass index (BMI) of 30 kg/m 2 (IQR, 29-32) compared with the SCS group, who had a median BMI of 26 kg/m 2 (IQR, [23][24][25][26][27][28]. This resulted in a larger and Fig.…”

Section: Recruitmentmentioning

confidence: 99%

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A nonrandomized open-label phase 2 trial of nonischemic heart preservation for human heart transplantation

et al. 2020

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Pre-clinical heart transplantation studies have shown that ex vivo non-ischemic heart preservation (NIHP) can be safely used for 24 h. Here we perform a prospective, open-label, non-randomized phase II study comparing NIHP to static cold preservation (SCS), the current standard for adult heart transplantation. All adult recipients on waiting lists for heart transplantation were included in the study, unless they met any exclusion criteria. The same standard acceptance criteria for donor hearts were used in both study arms. NIHP was scheduled in advance based on availability of device and trained team members. The primary endpoint was a composite of survival free of severe primary graft dysfunction, free of ECMO use within 7 days, and free of acute cellular rejection ≥2R within 180 days. Secondary endpoints were I/R-tissue injury, immediate graft function, and adverse events. Of the 31 eligible patients, six were assigned to NIHP and 25 to SCS. The median preservation time was 223 min (IQR, 202-263) for NIHP and 194 min (IQR, 164-223) for SCS. Over the first six months, all of the patients assigned to NIHP achieved event-free survival, compared with 18 of those assigned to SCS (Kaplan-Meier estimate of event free survival 72.0% [95% CI 50.0-86.0%]). CK-MB assessed 6 ± 2 h after ending perfusion was 76 (IQR, 50-101) ng/mL for NIHP compared with 138 (IQR, 72-198) ng/mL for SCS. Four deaths within six months after transplantation and three cardiac-related adverse events were reported in the SCS group compared with no deaths or cardiac-related adverse events in the NIHP group. This first-inhuman study shows the feasibility and safety of NIHP for clinical use in heart transplantation. ClinicalTrial.gov, number NCT03150147

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Section: Discussionmentioning

confidence: 99%

Section: Recruitmentmentioning

confidence: 99%

A nonrandomized open-label phase 2 trial of nonischemic heart preservation for human heart transplantation

et al. 2020

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“…As acknowledged in recent reflections on the 50th anniversary of the first heart transplant, [4][5][6] rejection remains an ongoing challenge. Additionally, we have become increasingly aware of the importance of parenchymal injury 7 : brain death, organ donation-preservation-implantation, and rejection are major "wounds" to the cardiac parenchyma, and wounds have long-term consequences.…”

Section: Introductionmentioning

confidence: 99%

The Molecular Microscope Diagnostic System: Assessment of Rejection and Injury in Heart Transplant Biopsies

Halloran

Madill‐Thomsen

2022

Transplantation

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This review describes the development of the Molecular Microscope Diagnostic System (MMDx) for heart transplant endomyocardial biopsies (EMBs). MMDx-Heart uses microarrays to measure biopsy-based gene expression and ensembles of machine learning algorithms to interpret the results and compare each new biopsy to a large reference set of earlier biopsies. MMDx assesses T cell–mediated rejection (TCMR), antibody-mediated rejection (AMR), recent parenchymal injury, and atrophy-fibrosis, continually “learning” from new biopsies. Rejection-associated transcripts mapped in kidney transplants and experimental systems were used to identify TCMR, AMR, and recent injury-induced inflammation. Rejection and injury emerged as gradients of intensity, rather than binary classes. AMR was one-third donor-specific antibody (DSA)-negative, and many EMBs first considered to have no rejection displayed minor AMR-like changes, with increased probability of DSA positivity and subtle inflammation. Rejection-associated transcript–based algorithms now classify EMBs as “Normal,” “Minor AMR changes,” “AMR,” “possible AMR,” “TCMR,” “possible TCMR,” and “recent injury.” Additionally, MMDx uses injury-associated transcript sets to assess the degree of parenchymal injury and atrophy-fibrosis in every biopsy and study the effect of rejection on the parenchyma. TCMR directly injures the parenchyma whereas AMR usually induces microcirculation stress but relatively little initial parenchymal damage, although slowly inducing parenchymal atrophy-fibrosis. Function (left ventricular ejection fraction) and short-term risk of failure are strongly determined by parenchymal injury. These discoveries can guide molecular diagnostic applications, either as a central MMDx system or adapted to other platforms. MMDx can also help calibrate noninvasive blood-based biomarkers to avoid unnecessary biopsies and monitor response to therapy.

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“…Importantly, dyspnea and fatigue may limit exercise tolerance and fluid retention. On the other hand, Anticipating challenges after transplant such as debilitating side effects, variable pharmacokinetics, rejection, malignancy and infection risk are valid concerns and may affect patients pre-transplant psychological status [10].…”

Section: Introductionmentioning

confidence: 99%

Exploring the Experiences of Chinese Patients Waiting for Heart Transplantation

Song¹,

Qiao²,

Li³

et al. 2021

WJCD

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Background: Patients waiting for heart transplantation (HT) have complex physiological and psychosocial problems. Factors such as psychological state, behavior, social relationships, and cultural background of patients influence the HT process, such as causing psychotic disorder, difficult decision and close dependence. Care during the waiting period needs to be aimed at not only treating the symptoms but also the specific status. Purpose: To describe the physical and psychosocial experiences of the patients waiting for HT in one general hospital in the northern part of China. Methods: A qualitative approach was used in this study. Fifteen patients waiting for HT were selected based on purposive sampling, and semi-structured interviews were carried out. Results: In the analysis process, reported experiences of the participants were categorized into five main themes as follows: 1) feeling the impact; 2) uncertainty about the future; 3) difficult to make decisions; 4) negative emotions and 5) request support. Conclusion: This study provides an in-depth description of patients waiting for HT who have experienced many physical, psychosocial, and familial problems due to disease and their cultural background. It found that Chinese patients have some special experiences due to their psychosocial background. This study suggests that nurses should focus on not only physical but also psychosocial problems of these patients, and provide understandings to develop more effective strategies to solve their problems. Relevance to Clinical Practice: This study focused on the special patients who are waiting for heart transplantation, and got the special results about the feelings and experiences. The results can help the doctors and nurses to help the patients pass the special period smoothly.

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The future of cardiac transplantation

Cited by 15 publications

References 44 publications

A nonrandomized open-label phase 2 trial of nonischemic heart preservation for human heart transplantation

A nonrandomized open-label phase 2 trial of nonischemic heart preservation for human heart transplantation

The Molecular Microscope Diagnostic System: Assessment of Rejection and Injury in Heart Transplant Biopsies

Exploring the Experiences of Chinese Patients Waiting for Heart Transplantation

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