Heart transplantation(HT),the treatment choice of advanced heart failure pa-tients,is proven effective in increasing the survival and functional status of the recipients.However,compared to normal controls,functional ...Heart transplantation(HT),the treatment choice of advanced heart failure pa-tients,is proven effective in increasing the survival and functional status of the recipients.However,compared to normal controls,functional status is lower in HT recipients.Exercise given in cardiac rehabilitation has been shown to improve exercise capacity as measured with peak oxygen uptake(VO2 peak)and muscle strength after completion of the program and cessation of exercise results in loss of exercise benefits.Several factors related to cardiac denervation and the use of immunosuppressive agents in HT recipients result in functional impairments including cardiovascular,pulmonary,exercise capacity,psychological,and qua-lity of life(QoL)problems.High-intensity interval training(HIIT)is the most common type of exercise used in HT recipients and given as a hospital-based program.Improvement of functional impairments was found to have occurred due to primarily musculoskeletal adaptations through improvement of muscle structure and aerobic capacity and cardiovascular adaptations.In general,exercise given after transplantation improved VO2 peak significantly and improvement was better in the HIIT group compared to moderate intensity continuous training or no-exercise groups.Improvement of QoL was ascribed to improve-ment of exercise capacity,symptoms,pulmonary function,physical capacity improve-ment,anxiety,and depression.展开更多
BACKGROUND Transplant recipients commonly harbor multidrug-resistant organisms(MDROs),as a result of frequent hospital admissions and increased exposure to antimi-crobials and invasive procedures.AIM To investigate th...BACKGROUND Transplant recipients commonly harbor multidrug-resistant organisms(MDROs),as a result of frequent hospital admissions and increased exposure to antimi-crobials and invasive procedures.AIM To investigate the impact of patient demographic and clinical characteristics on MDRO acquisition,as well as the impact of MDRO acquisition on intensive care unit(ICU)and hospital length of stay,and on ICU mortality and 1-year mortality post heart transplantation.METHODS This retrospective cohort study analyzed 98 consecutive heart transplant patients over a ten-year period(2013-2022)in a single transplantation center.Data was collected regarding MDROs commonly encountered in critical care.RESULTS Among the 98 transplanted patients(70%male),about a third(32%)acquired or already harbored MDROs upon transplantation(MDRO group),while two thirds did not(MDRO-free group).The prevalent MDROs were Acinetobacter baumannii(14%),Pseudomonas aeruginosa(12%)and Klebsiella pneumoniae(11%).Compared to MDRO-free patients,the MDRO group was characterized by higher body mass index(P=0.002),higher rates of renal failure(P=0.017),primary graft dysfunction(10%vs 4.5%,P=0.001),surgical re-exploration(34%vs 14%,P=0.017),mechanical circulatory support(47%vs 26%P=0.037)and renal replacement therapy(28%vs 9%,P=0.014),as well as longer extracorporeal circulation time(median 210 vs 161 min,P=0.003).The median length of stay was longer in the MDRO group,namely ICU stay was 16 vs 9 d in the MDRO-free group(P=0.001),and hospital stay was 38 vs 28 d(P=0.006),while 1-year mortality was higher(28%vs 7.6%,log-rank-χ2:7.34).CONCLUSION Following heart transplantation,a predominance of Gram-negative MDROs was noted.MDRO acquisition was associated with higher complication rates,prolonged ICU and total hospital stay,and higher post-transplantation mortality.展开更多
To investigate the effect of TGF-β1 on the expressions of IL-12, IL-15, IL-18, IL-4 and IL-10 in heart transplantation rejection in rats, a model of rat cervical heterotopic heart transplantation was set up and the m...To investigate the effect of TGF-β1 on the expressions of IL-12, IL-15, IL-18, IL-4 and IL-10 in heart transplantation rejection in rats, a model of rat cervical heterotopic heart transplantation was set up and the model rats were randomly divided into three groups： control group, transplant group and TGF-β1 group. The mRNA expression levels of IL-12, IL-15, IL-18, IL-4 and IL-10 were determined by RT-PCR at the 5th day after the transplantation. The mRNA expression levels of IL- 12, IL-15, IL-18 were increased obviously and those of IL-4, IL-10 were significantly decreased in the transplant group as compared with the control group （P〈0.01）. In the TGF-β1 group, the mRNA ex- pression levels of IL- 12, IL- 15, IL- 18 were significantly decreased and those of IL-4, IL- 10 were significantly increased as compared with the transplant group （P〈0.01）. The immunosuppressive effect of TGF-β1 on heart transplantation rejection was related to its inhibition of the expressions of Th1-type cytokines （IL-12, IL-15, IL-18 etc） and its promotion of the expressions of Th2-tpye cyto- kines （IL-4, IL-10）.展开更多
Heart transplantation remains the gold standard in the treatment of end-stage heart failure(HF).Heart transplantation patients present lower exercise capacity due to cardiovascular and musculoskeletal alterations lead...Heart transplantation remains the gold standard in the treatment of end-stage heart failure(HF).Heart transplantation patients present lower exercise capacity due to cardiovascular and musculoskeletal alterations leading thus to poor quality of life and reduction in the ability of daily self-service.Impaired vascular function and diastolic dysfunction cause lower cardiac output while decreased skeletal muscle oxidative fibers,enzymes and capillarity cause arteriovenous oxygen difference,leading thus to decreased peak oxygen uptake in heart transplant recipients.Exercise training improves exercise capacity,cardiac and vascular endothelial function in heart transplant recipients.Pre-rehabilitation regular aerobic or combined exercise is beneficial for patients with end-stage HF awaiting heart transplantation in order to maintain a higher fitness level and reduce complications afterwards like intensive care unit acquired weakness or cardiac cachexia.All hospitalized patients after heart transplantation should be referred to early mobilization of skeletal muscles through kinesiotherapy of the upper and lower limbs and respiratory physiotherapy in order to prevent infections of the respiratory system prior to hospital discharge.Moreover,all heart transplant recipients after hospital discharge who have not already participated in an early cardiac rehabilitation program should be referred to a rehabilitation center by their health care provider.Although high intensity interval training seems to have more benefits than moderate intensity continuous training,especially in stable transplant patients,individualized training based on the abilities and needs of each patient still remains the most appropriate approach.Cardiac rehabilitation appears to be safe in heart transplant patients.However,long-term follow-up data is incomplete and,therefore,further high quality and adequately-powered studies are needed to demonstrate the long-term benefits of exercise training in this population.展开更多
Objective： To investigate the protective effects of ecdysterone（EDS） on the allograft heart transplant model of rats. Methods： Fifty healthy Sprayue-Dawley（SD） rats were divided into donors and recipients random...Objective： To investigate the protective effects of ecdysterone（EDS） on the allograft heart transplant model of rats. Methods： Fifty healthy Sprayue-Dawley（SD） rats were divided into donors and recipients randomly. Hearts were harvested and placed heterotopically into allogenic recipients. All animals were divided into three groups： sham-operation group（only opening and closing the abdomen, n=l 0）, EDS group（injected intraperitoneally with 20 mg/（kg · day） of EDS, n = 10）, and control group （injected intraperitoneally with normal saline, n = 10）. The pathological changes of myocardial tissue were analyzed by light microscopy and transmission electron microscopy and the levels of myocardial enzymes（GOT, LDH, CPK）, SOD, ET-1, NO, MDA in serum were measured. Tissue samples underwent the detection ofapoptotic cell death by in situ terminal deoxyribonucleotide transferase-mediated dUTP nick end labeling for apoptotic index（M） and also by immunohistochemistry method to study the expressions of Bcl-2 and Bax. Results： Pathological examination and transmission electron microscope observation showed greater myocardium damage in the control group. EDS group showed a decrease in the amount of myocardial enzymes, MDA, ET-1 and an increase in the levels of SOD, NO, compared to the control group. The A1 of EDS group became lower than that of control group, meanwhile the EDS group increased the expression of Bcl-2 and decreased the expression of Bax. Conclusion： EDS has protective effects on heteroptopic heart transplantation, which provides a new idea for myocardial protection in heart transplantation. However, the mechanism of its protective effect needs further research.展开更多
The function of the transplanted heart will be affected by acute allograft rejection, chronic rejection, high blood pressure and so on, which may induce the reconstruction of the left ventricle and the increase of lef...The function of the transplanted heart will be affected by acute allograft rejection, chronic rejection, high blood pressure and so on, which may induce the reconstruction of the left ventricle and the increase of left ventricular mass （LVM）, and eventually lead to left ventricular hypertrophy that will significantly affect the prognosis of heart transplantation （HT）. The purpose of this study was to dy- namically monitor the changes of left ventricular geometric patterns after HT using two-dimensional echocardiography and to understand the remodeling process and its possible influencing factors. The left ventricular internal diameter, interventricular septal wall thickness, posterior wall thickness at end dias- tole were measured and the relative wall thickness （RWT）, left ventricular mass, left ventricular mass index were calculated respectively in 34 HT patients and 34 healthy volunteers by two-dimensional echocardiography. The type of left ventricular geometry was identified based on the echocardiographic determination of LVM index （LVMI） and RWT. The HT patients were divided into three groups ac- cording to the time length after surgery： A （3 months postoperatively）, B （6 months postoperatively） and C （12 months postoperatively）. We compared the parameters of left ventricle between HT group and normal control group, and explored the risk factors causing the increase of LVM. The results showed that 4 patients （16%） in group A had concentric remodeling. Nine patients （34.62%） in group B had re- construction, including 5 cases of concentric remodeling, 2 cases of concentric hypertrophy and 2 cases of eccentric hypertrophy. The hypertrophy incidence rate was 15.4% in group B. 15 patients （62.5%） had reconstruction in group C, including 9 cases of concentric remodeling, 5 cases of concentric hyper- trophy, and 1 case of eccentric hypertrophy. The prevalence of hypertrophy was 25%. Multivariate analysis showed that hypertension and acute rejection history were the risk factors that resulted in left ventricular hypertrophy. It is concluded that the left ventricular remodeling occurs following cardiac transplantation at an early stage and the incidence of left ventricular hypertrophy increases with survival time. In this study, the one-year prevalence of left ventricular hypertrophy was 25% after surgery. Hy- pertension and acute rejection history are risk factors that can predict the left ventricular hypertrophy.展开更多
Objective:To determine whether long-term survival(>10 years) after heart transplantation is possible and identify complications influencing long-term survival.Methods:We analyzed clinical outcomes in the group of 2...Objective:To determine whether long-term survival(>10 years) after heart transplantation is possible and identify complications influencing long-term survival.Methods:We analyzed clinical outcomes in the group of 21 patients who had undergone heart transplantation at the Second Affiliated Hospital of Harbin Medical University since 1992 and 4 of them survived more than 10 years.Results:Nine patients are still alive with normal left ventricular function,and 4 of them have survived more than 10 years.The longest survival patient has lived more than 18 years after transplantation,whose survival is the longest in China and in Asia.We have also found that there has been a high incidence of complications,such as rejection episodes during the first 6 months,and transplant vasculopathy in the long-term survival patients.Conclusion:Long-term survivors maintain normal hemodynamic function of their allografts,and long-term survival following cardiac transplantation is possible.Aggressive preventive and therapeutic measures are essential to limit the risk factors for development of complications such as rejection episodes and transplant vasculopathy,and enable long-term survival after cardiac transplantation.展开更多
Heart transplantation has become an effective therapy for patients with end stage heart failure. The preservation of the donor heart is an important factor that affects the results of the operation. We performed 3 cas...Heart transplantation has become an effective therapy for patients with end stage heart failure. The preservation of the donor heart is an important factor that affects the results of the operation. We performed 3 cases of orthotopic heart transplantation and obtained some experience in the preservation of the donor heart. Methods： Three male patients with end stage heart failure received the operation in our department successfully. Doppler echocardiography showed left ventrieular end diameter （LVED） of the patients were 91, 87, and 83 mm, and ejection fraction （EF） were 24%, 20%, 12.9%, respectively. Once the declaration of brain death had been made, the median stemotomy was performed with a sternal saw. Haparin at a dose of 300 U/kg of body weight was administered. After at least 2-min heparin circulation, the procurement proceeded. The superior vena cava and the inferior vena cava were nearly completely divided. When the heart was empty, the ascending aorta was cross-clamped and the St. Thomas solution was infused by gravity. The heart was excised by transection of the inferior vena cava, the superior vena cava and all pulmonary veins. After donor heart was removed, it was infused with University of Wisconsin （UW） solution by gravity at a temperature of 4-6℃, then placed in UW solution for storage during transportation. The temperature of solution was maintained at about 4-6℃. The ischemic times of donor heart were 9, 8 and 6 h, respectively. The bicaval anastomotic heart transplantation was adopted. The left atrial anastomoses were constructed using 3.0 polypropylene. The inferior vene cava anastomosis was constructed, the donor and native aorta were cut to an appropriate length. Then the aorta and main pulmonary artery anastomosis were performed respectively. The superior vene cava anastomosis was usually constructed during the rewarming phase. The intraoperative course with a cardiopulmonary bypass of the 3 patients was 96, 44 and 49 min, respectively. Standard triple immunosuppression therapy was commenced in the immediate post-operative period. Results： The operation procedure was smooth and no perioperative death occurred. The follow-up was carried out carefully. The patient＇s condition was fine in 25, 30 and 32 months after operation. The blood pressure was 130/90, 140/95 and 120/80 mmHg, respectively, and LVED was 51, 49 and 53 mm; EF was 50%, 54% and 60%, respectively. Cardiothoracic ratio was 0.63, 0.55, and 0.64, respectively. Conclusion： Preservation time of donor heart with St. Thomas solution infusion and UW solution storage at 0-4℃ may exceed 6 h, and receive comparable middle-term outcomes.展开更多
BACKGROUND Cardiac transplantation is considered the standard treatment for refractory endstage heart failure.Worldwide,5074 heart transplantations were performed in 2015.About 100 heart transplants are performed at t...BACKGROUND Cardiac transplantation is considered the standard treatment for refractory endstage heart failure.Worldwide,5074 heart transplantations were performed in 2015.About 100 heart transplants are performed at the authors’center each year.The usual complications of heart transplantation include graft rejection,infection,and graft dysfunction.Aortic dissection after heart transplantation is very rare and is a serious complication that requires a hybrid procedure.CASE SUMMARY A 58-year-old female patient was admitted to Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in July 2020 because of unprovoked low back pain without precipitating causes.Magnetic resonance imaging and computed tomography angiography showed type A aortic dissection with an aberrant right subclavian artery.After admission,urapidil was used to control blood pressure.Ten days later,the patient underwent ascending aortic and aortic arch replacement,subclavian artery reconstruction,and endovascular repair of abdominal and thoracic aortic aneurysms.A cardiopulmonary bypass was established through the right femoral artery and femoral vein.The aberrant right subclavian artery,innominate artery,left common carotid artery,and left subclavian artery were blocked,and the left and right common carotid arteries were cannulated for bilateral cerebral perfusion.CONCLUSION The right axillary artery could not be selected for cardiopulmonary bypass intubation because of aberrant right subclavian artery.展开更多
BACKGROUND Insertion of a left ventricular assist device(LVAD)and heart transplantation(HT)improve the survival of patients with heart failure.In addition,cardiac rehabilitation(CR)further increases the functional cap...BACKGROUND Insertion of a left ventricular assist device(LVAD)and heart transplantation(HT)improve the survival of patients with heart failure.In addition,cardiac rehabilitation(CR)further increases the functional capacity.This case report describes a successful case of CR after LVAD insertion and subsequent HT.CASE SUMMARY In the present case,during the LVAD insertion period,peak oxygen consumption(VO2)increased by 12.16%after CR.HT was performed 7 mo after the LVAD insertion,and the patient participated in phases I and II CR.The peak VO2 increased from 17.24 to 22.29 m L/kg/min.This improvement was more significant than that reported in previous studies on CR after LVAD insertion or HT.The patient’s quality of life also improved.The total average score of the short form-36 questionnaire increased from 29.5 points at admission to 53.3 points 9 mo after HT.CONCLUSION A tailored CR program after LVAD insertion or HT may improve the patients’quality of life and increase survival.展开更多
<div style="text-align:justify;"> <strong>Background:</strong> Patients waiting for heart transplantation (HT) have complex physiological and psychosocial problems. Factors such as psycholo...<div style="text-align:justify;"> <strong>Background:</strong> 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<span "="">. <b>Purpose: </b>To describe the </span>physical and psychosocial experiences of the patients waiting for HT in one general hospital in the northern <span "="">part of China. <b>Methods: </b></span>A qualitative approach was used in this <span "="">study. Fifteen patients waiting for HT were selected based on purposive sampling, and semi-structured interviews were carried out. <b>Results: </b></span>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. <b>Conclusion: </b>This study provides an in-depth description of patients waiting for HT who have<span "=""></span>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. <b>Relevance to Clinical Practice: </b>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. </div>展开更多
Heart transplantation is considered the best treatment modality for advanced heart disease. While old age has conventionally been considered a contraindication for heart transplantation due to the reported adverse eff...Heart transplantation is considered the best treatment modality for advanced heart disease. While old age has conventionally been considered a contraindication for heart transplantation due to the reported adverse effect of advanced age, however donor hearts＇ shortage continues to stimulate the discussion about the recipient＇s upper age limit. Our study was based on a retrospective analysis for the results of 52（18%） patients aged 60 years and older undergoing heart transplantation between May 2008 and December 2015, and these patients were compared with 236（82%） adult recipients who were younger than 60 years at the time of transplantation and during the same period. In older group, 71% were males with the mean age of 63.38±3.55 years, and in younger group, 83.4% were males with a mean age of 43.72±11.41 years（P=0.27）. Dilated cardiomyopathy was the most common indication for transplantation among patients in both groups（P=0.147）. In older group, the 3-month survival rate was higher than that in younger group（P=0.587）, however the 6-month survival rate showed no significant difference（P=0.225）. Although the 1-year survival rate was higher in older group（P=0.56）, yet the 3-year survival rate between the two groups showed no statistically significant difference（P=0.48）. According to our experience among older heart transplant candidates who were 60 years and older, we believe that advanced age should not be an excluding criterion to cardiac transplantation.展开更多
Objectives To analyze the six-minute walk test （6MWT） and gas exchange of 5 heart transplantation patients and to approach the variation tendency of exercise tolerance, oxygen uptake （ VO2 ） and heart rate chronot...Objectives To analyze the six-minute walk test （6MWT） and gas exchange of 5 heart transplantation patients and to approach the variation tendency of exercise tolerance, oxygen uptake （ VO2 ） and heart rate chronotropic response. Methods 5 cases of heart transplantation patients （ age 25 - 52 years） were undertaken 6MWT 6 - 30 months after operation, synchronizing gas exchanging parameters were measured by wireless portable remote sensing K4B^2 gas analyzer, 51 normal controls were compared. Results The six-minute walk distance （6MWD） of 5 patients were （592.6 ± 26.7 ） m （558 - 625 ） m, the ascending tendency during exercise was slower, the maximum heart rates were 80% ± 6% of age-predicting maximal heart rate, lower than normal control （86%） ; the end point VO2/kg were （21.8 ± 1.4 ） mL/min · kg （ 19. 94 - 23.60） mL/min · kg. Conclusions The 6WMD and VO2 of 5 patients reached normal range, but the heart rate chronotropic response and VO2 ascending tendency were slower than those of normal controls.展开更多
OBJECTIVES: In recent years, the percentage of heart transplantation (HT) with short/medium-term assistance devices has increased. This study aims at analyzing primary graft failure and in-hospital mortality according...OBJECTIVES: In recent years, the percentage of heart transplantation (HT) with short/medium-term assistance devices has increased. This study aims at analyzing primary graft failure and in-hospital mortality according to the type of care. MATERIAL AND METHODS: From January 2013 to December?2017 all patients undergoing urgent HT with circulatory/ventricular assistance?were retrospectively and consecutively recruited. Combined transplants, retransplantations and pediatric transplants were excluded. The sample was divided in 10 groups according to the type of shot/medium term assistance devices. RESULTS: A total of 53 patients were recruited, 79% men, average age 49 ± 13 years. 26 patients (51%) had mechanical ventilation at the time of the HT. Primary graft failure occurred in 20 patients (38.5%), whilst it was more frequent in patients assisted with ECMO (8 patients in group 1 (45%) and 7 in group 2 (54%), p 0.5). 14 deaths (27%) were registered, whereas a higher mortality was observed in the group assisted with ECMO (6 patients in group 1 (34%) and 4 in group 2 (31%), p 0.6). Mortality was 17% in the group of non-urgent Levitronix. CONCLUSIONS: Despite not showing statistical significance due to the low number of patients in some subgroups, hospital?mortality was high in HT patients with circulatory assistance. A trend towards a higher incidence of primary graft failure and mortality in patients assisted with ECMO was observed. The direct implantation of a centrifugal pump as a bridge to urgent transplantation could identify a subgroup with a better prognosis.展开更多
The purpose of this review is to provide a comprehensive update on recent advances in heart transplantation in China.Despite advances in pharmacologic and device treatment of chronic heart failure,long-term morbidity ...The purpose of this review is to provide a comprehensive update on recent advances in heart transplantation in China.Despite advances in pharmacologic and device treatment of chronic heart failure,long-term morbidity and mortality remain high,and many patients progress to end-stage heart failure.Heart transplantation has become standard treatment for selected patients with end-stage heart failure,though challenges still exist.However,multiple advances over the past few years will improve the survival and quality-of-life of heart transplant recipients.This article elaborates on the specific characteristics of heart transplantation in China,the current issues,development trends,and related experiences with heart transplantation in Wuhan Union Hospital.展开更多
AIM To investigate the impact of timing of same-admission orthotopic heart transplant(OHT) after left ventricular assist device(LVAD) implantation on in-hospital mortality and post-transplant length of stay.METHODS Us...AIM To investigate the impact of timing of same-admission orthotopic heart transplant(OHT) after left ventricular assist device(LVAD) implantation on in-hospital mortality and post-transplant length of stay.METHODS Using data from the Nationwide Inpatient Sample from 1998 to 2011, we identified patients 18 years of age or older who underwent implantation of a LVAD and for whom the procedure date was available. We calculated in-hospital mortality for those patients who underwent OHT during the same admission as a function of time from LVAD to OHT, adjusting for age, sex, race, household income, and number of comorbid diagnoses. Finally, we analyzed the effect of time to OHT after LVAD implantation on the length of hospital stay post-transplant.RESULTS Two thousand and two hundred patients underwent implantation of a LVAD in this cohort. One hundred and sixty-four(7.5%) patients also underwent OHT duringthe same admission, which occurred on average 32 d(IQR 7.75-66 d) after LVAD implantation. Of patients who underwent OHT, patients who underwent transplantation within 7 d of LVAD implantation("early") experienced increased in-hospital mortality(26.8% vs 12.2%, P = 0.0483) compared to patients who underwent transplant after 8 d("late"). There was no statistically significant difference in age, sex, race, household income, or number of comorbid diagnoses between the early and late groups. Post-transplant length of stay after LVAD implantation was also not significantly different between patients who underwent early vs late OHT. CONCLUSION In this cohort of patients who received LVADs, the rate of in-hospital mortality after OHT was lower for patients who underwent late OHT(at least 8 d after LVAD implantation) compared to patients who underwent early OHT. Delayed timing of OHT after LVAD implantation did not correlate with longer hospital stays post-transplant.展开更多
Significant scarcity of a donor pool exists for heart transplantation(HT)as the prevalence of patients with end-stage refractory heart failure is increasing exceptionally.With the discovery of effective direct-acting ...Significant scarcity of a donor pool exists for heart transplantation(HT)as the prevalence of patients with end-stage refractory heart failure is increasing exceptionally.With the discovery of effective direct-acting antiviral and favorable short-term outcomes following HT,the hearts from hepatitis C virus(HCV)patient are being utilized to increase the donor pool.Short-term outcomes with regards to graft function,coronary artery vasculopathy,and kidney and liver disease is comparable in HCV-negative recipients undergoing HT from HCVpositive donors compared to HCV-negative donors.A significant high incidence of donor-derived HCV transmission was observed with great success of achieving sustained viral response with the use of direct-acting antivirals.By accepting HCV-positive organs,the donor pool has expanded with younger donors,a shorter waitlist time,and a reduction in waitlist mortality.However,the longterm outcomes and impact of specific HCV genotypes remains to be seen.We reviewed the current literature on HT from HCV-positive donors.展开更多
Despite a record setting number of heart transplants performed annually,the national donor shortage continues to plague transplant teams across the United States.Here we describe the barriers to adaptation of numerous...Despite a record setting number of heart transplants performed annually,the national donor shortage continues to plague transplant teams across the United States.Here we describe the barriers to adaptation of numerous“non-traditional”orthotopic heart transplant donor characteristics including donors with hepatitis C virus,those meeting criteria for donation after cardiac death,donors with coronavirus disease 19 infection,donors with the human immunodeficiency virus,and grafts with left ventricular systolic dysfunction.Our center’s objective was to increase our transplant volume by expanding our donor pool from“traditional”donors to these“non-traditional”donors.We detail how medical advances such as certain laboratory studies,pharmacologic interventions,and organ care systems have allowed our center to expand the donor pool thereby increasing transplantation volume without adverse effects on outcomes.展开更多
Background Alveolar echinococcosis （AE） is caused by the metacestode stage of Echinococcus multilocularis （E. multilocularis） and is a rare but life-threatening disease. This disease commonly is characterized by a...Background Alveolar echinococcosis （AE） is caused by the metacestode stage of Echinococcus multilocularis （E. multilocularis） and is a rare but life-threatening disease. This disease commonly is characterized by an infiltrative, tumor-like growth of the E. multilocularis metacestode in the liver of human. Liver transplantation is an effective therapy for end-stage of hepatic AE, but the characteristics of host immunity associated with E. multilocularis infection with organ transplantation are poorly defined. We hereby aimed to study the immunological status and allograft heart survival in inbred rats with E. multilocularis infection. Methods Rat models of AE were established by injecting the E. multilocularis suspension made from E. multilocularis infected tissues into the abdomen of Lewis （LEW） rats. Three months later, in the experimental group, allograft heart transplantation was performed from Brown-Norway （BN） rats to the E. multilocularis infected LEW rats. In the control group, we transplanted hearts from BN rats to healthy LEW rats. The influence of the disturbed immune system in E. multilocularis infected rats on the heart transplantation was assessed, including observation of allograft heart survival time, histopathological examination of grafts and immunohistochemical examination of infiltrating cells （CD4＋ T cells, CD8＋ T cells and eosinophile granulocytes）, measurement of interleukin （IL）-4 and interferon （IFN）-γ in the serum by enzyme-linked immunosorbent assay （ELISA） and analysis of CD4＋CD25＋ regulatory T cells in peripheral blood by fluorescence activated cell sorting （FACS） flow cytometric analysis. Results The survival time of recipients in the experimental group was prolonged compared with those in the control group. The numbers of graft infiltrating CD8＋ T cells were decreased whereas the graft infiltrating eosinophil granulocytes （CD15＋） were increased in grafts in the experimental group （P 〈0.05）. Furthermore, the proportion of CD4＋CD25＋regulatory T cells in the peripheral blood was 10.8% on average in the experimental group, which was significantly higher than that in the control group （6.1%）. In addition, the level of serum IL-4 in E. multilocularis infected rats was higher than that in the control group rats, whereas the level of serum IFN-γ in experimental group was lower than that in the control group when graft rejection occurred （P 〈0.05）. Conclusions This study suggests that E. multilocularis infection could prolong the allograft survival time through the polarization of Th1/Th2-type cells and induction of CD4＋CD25＋ regulatory T cells. This strategy may provide a new idea for establishing transplantation tolerance.展开更多
文摘Heart transplantation(HT),the treatment choice of advanced heart failure pa-tients,is proven effective in increasing the survival and functional status of the recipients.However,compared to normal controls,functional status is lower in HT recipients.Exercise given in cardiac rehabilitation has been shown to improve exercise capacity as measured with peak oxygen uptake(VO2 peak)and muscle strength after completion of the program and cessation of exercise results in loss of exercise benefits.Several factors related to cardiac denervation and the use of immunosuppressive agents in HT recipients result in functional impairments including cardiovascular,pulmonary,exercise capacity,psychological,and qua-lity of life(QoL)problems.High-intensity interval training(HIIT)is the most common type of exercise used in HT recipients and given as a hospital-based program.Improvement of functional impairments was found to have occurred due to primarily musculoskeletal adaptations through improvement of muscle structure and aerobic capacity and cardiovascular adaptations.In general,exercise given after transplantation improved VO2 peak significantly and improvement was better in the HIIT group compared to moderate intensity continuous training or no-exercise groups.Improvement of QoL was ascribed to improve-ment of exercise capacity,symptoms,pulmonary function,physical capacity improve-ment,anxiety,and depression.
文摘BACKGROUND Transplant recipients commonly harbor multidrug-resistant organisms(MDROs),as a result of frequent hospital admissions and increased exposure to antimi-crobials and invasive procedures.AIM To investigate the impact of patient demographic and clinical characteristics on MDRO acquisition,as well as the impact of MDRO acquisition on intensive care unit(ICU)and hospital length of stay,and on ICU mortality and 1-year mortality post heart transplantation.METHODS This retrospective cohort study analyzed 98 consecutive heart transplant patients over a ten-year period(2013-2022)in a single transplantation center.Data was collected regarding MDROs commonly encountered in critical care.RESULTS Among the 98 transplanted patients(70%male),about a third(32%)acquired or already harbored MDROs upon transplantation(MDRO group),while two thirds did not(MDRO-free group).The prevalent MDROs were Acinetobacter baumannii(14%),Pseudomonas aeruginosa(12%)and Klebsiella pneumoniae(11%).Compared to MDRO-free patients,the MDRO group was characterized by higher body mass index(P=0.002),higher rates of renal failure(P=0.017),primary graft dysfunction(10%vs 4.5%,P=0.001),surgical re-exploration(34%vs 14%,P=0.017),mechanical circulatory support(47%vs 26%P=0.037)and renal replacement therapy(28%vs 9%,P=0.014),as well as longer extracorporeal circulation time(median 210 vs 161 min,P=0.003).The median length of stay was longer in the MDRO group,namely ICU stay was 16 vs 9 d in the MDRO-free group(P=0.001),and hospital stay was 38 vs 28 d(P=0.006),while 1-year mortality was higher(28%vs 7.6%,log-rank-χ2:7.34).CONCLUSION Following heart transplantation,a predominance of Gram-negative MDROs was noted.MDRO acquisition was associated with higher complication rates,prolonged ICU and total hospital stay,and higher post-transplantation mortality.
文摘To investigate the effect of TGF-β1 on the expressions of IL-12, IL-15, IL-18, IL-4 and IL-10 in heart transplantation rejection in rats, a model of rat cervical heterotopic heart transplantation was set up and the model rats were randomly divided into three groups： control group, transplant group and TGF-β1 group. The mRNA expression levels of IL-12, IL-15, IL-18, IL-4 and IL-10 were determined by RT-PCR at the 5th day after the transplantation. The mRNA expression levels of IL- 12, IL-15, IL-18 were increased obviously and those of IL-4, IL-10 were significantly decreased in the transplant group as compared with the control group （P〈0.01）. In the TGF-β1 group, the mRNA ex- pression levels of IL- 12, IL- 15, IL- 18 were significantly decreased and those of IL-4, IL- 10 were significantly increased as compared with the transplant group （P〈0.01）. The immunosuppressive effect of TGF-β1 on heart transplantation rejection was related to its inhibition of the expressions of Th1-type cytokines （IL-12, IL-15, IL-18 etc） and its promotion of the expressions of Th2-tpye cyto- kines （IL-4, IL-10）.
文摘Heart transplantation remains the gold standard in the treatment of end-stage heart failure(HF).Heart transplantation patients present lower exercise capacity due to cardiovascular and musculoskeletal alterations leading thus to poor quality of life and reduction in the ability of daily self-service.Impaired vascular function and diastolic dysfunction cause lower cardiac output while decreased skeletal muscle oxidative fibers,enzymes and capillarity cause arteriovenous oxygen difference,leading thus to decreased peak oxygen uptake in heart transplant recipients.Exercise training improves exercise capacity,cardiac and vascular endothelial function in heart transplant recipients.Pre-rehabilitation regular aerobic or combined exercise is beneficial for patients with end-stage HF awaiting heart transplantation in order to maintain a higher fitness level and reduce complications afterwards like intensive care unit acquired weakness or cardiac cachexia.All hospitalized patients after heart transplantation should be referred to early mobilization of skeletal muscles through kinesiotherapy of the upper and lower limbs and respiratory physiotherapy in order to prevent infections of the respiratory system prior to hospital discharge.Moreover,all heart transplant recipients after hospital discharge who have not already participated in an early cardiac rehabilitation program should be referred to a rehabilitation center by their health care provider.Although high intensity interval training seems to have more benefits than moderate intensity continuous training,especially in stable transplant patients,individualized training based on the abilities and needs of each patient still remains the most appropriate approach.Cardiac rehabilitation appears to be safe in heart transplant patients.However,long-term follow-up data is incomplete and,therefore,further high quality and adequately-powered studies are needed to demonstrate the long-term benefits of exercise training in this population.
文摘Objective： To investigate the protective effects of ecdysterone（EDS） on the allograft heart transplant model of rats. Methods： Fifty healthy Sprayue-Dawley（SD） rats were divided into donors and recipients randomly. Hearts were harvested and placed heterotopically into allogenic recipients. All animals were divided into three groups： sham-operation group（only opening and closing the abdomen, n=l 0）, EDS group（injected intraperitoneally with 20 mg/（kg · day） of EDS, n = 10）, and control group （injected intraperitoneally with normal saline, n = 10）. The pathological changes of myocardial tissue were analyzed by light microscopy and transmission electron microscopy and the levels of myocardial enzymes（GOT, LDH, CPK）, SOD, ET-1, NO, MDA in serum were measured. Tissue samples underwent the detection ofapoptotic cell death by in situ terminal deoxyribonucleotide transferase-mediated dUTP nick end labeling for apoptotic index（M） and also by immunohistochemistry method to study the expressions of Bcl-2 and Bax. Results： Pathological examination and transmission electron microscope observation showed greater myocardium damage in the control group. EDS group showed a decrease in the amount of myocardial enzymes, MDA, ET-1 and an increase in the levels of SOD, NO, compared to the control group. The A1 of EDS group became lower than that of control group, meanwhile the EDS group increased the expression of Bcl-2 and decreased the expression of Bax. Conclusion： EDS has protective effects on heteroptopic heart transplantation, which provides a new idea for myocardial protection in heart transplantation. However, the mechanism of its protective effect needs further research.
基金supported by a grant from the National Natural Science Foundation of China(No.30901478)
文摘The function of the transplanted heart will be affected by acute allograft rejection, chronic rejection, high blood pressure and so on, which may induce the reconstruction of the left ventricle and the increase of left ventricular mass （LVM）, and eventually lead to left ventricular hypertrophy that will significantly affect the prognosis of heart transplantation （HT）. The purpose of this study was to dy- namically monitor the changes of left ventricular geometric patterns after HT using two-dimensional echocardiography and to understand the remodeling process and its possible influencing factors. The left ventricular internal diameter, interventricular septal wall thickness, posterior wall thickness at end dias- tole were measured and the relative wall thickness （RWT）, left ventricular mass, left ventricular mass index were calculated respectively in 34 HT patients and 34 healthy volunteers by two-dimensional echocardiography. The type of left ventricular geometry was identified based on the echocardiographic determination of LVM index （LVMI） and RWT. The HT patients were divided into three groups ac- cording to the time length after surgery： A （3 months postoperatively）, B （6 months postoperatively） and C （12 months postoperatively）. We compared the parameters of left ventricle between HT group and normal control group, and explored the risk factors causing the increase of LVM. The results showed that 4 patients （16%） in group A had concentric remodeling. Nine patients （34.62%） in group B had re- construction, including 5 cases of concentric remodeling, 2 cases of concentric hypertrophy and 2 cases of eccentric hypertrophy. The hypertrophy incidence rate was 15.4% in group B. 15 patients （62.5%） had reconstruction in group C, including 9 cases of concentric remodeling, 5 cases of concentric hyper- trophy, and 1 case of eccentric hypertrophy. The prevalence of hypertrophy was 25%. Multivariate analysis showed that hypertension and acute rejection history were the risk factors that resulted in left ventricular hypertrophy. It is concluded that the left ventricular remodeling occurs following cardiac transplantation at an early stage and the incidence of left ventricular hypertrophy increases with survival time. In this study, the one-year prevalence of left ventricular hypertrophy was 25% after surgery. Hy- pertension and acute rejection history are risk factors that can predict the left ventricular hypertrophy.
文摘Objective:To determine whether long-term survival(>10 years) after heart transplantation is possible and identify complications influencing long-term survival.Methods:We analyzed clinical outcomes in the group of 21 patients who had undergone heart transplantation at the Second Affiliated Hospital of Harbin Medical University since 1992 and 4 of them survived more than 10 years.Results:Nine patients are still alive with normal left ventricular function,and 4 of them have survived more than 10 years.The longest survival patient has lived more than 18 years after transplantation,whose survival is the longest in China and in Asia.We have also found that there has been a high incidence of complications,such as rejection episodes during the first 6 months,and transplant vasculopathy in the long-term survival patients.Conclusion:Long-term survivors maintain normal hemodynamic function of their allografts,and long-term survival following cardiac transplantation is possible.Aggressive preventive and therapeutic measures are essential to limit the risk factors for development of complications such as rejection episodes and transplant vasculopathy,and enable long-term survival after cardiac transplantation.
文摘Heart transplantation has become an effective therapy for patients with end stage heart failure. The preservation of the donor heart is an important factor that affects the results of the operation. We performed 3 cases of orthotopic heart transplantation and obtained some experience in the preservation of the donor heart. Methods： Three male patients with end stage heart failure received the operation in our department successfully. Doppler echocardiography showed left ventrieular end diameter （LVED） of the patients were 91, 87, and 83 mm, and ejection fraction （EF） were 24%, 20%, 12.9%, respectively. Once the declaration of brain death had been made, the median stemotomy was performed with a sternal saw. Haparin at a dose of 300 U/kg of body weight was administered. After at least 2-min heparin circulation, the procurement proceeded. The superior vena cava and the inferior vena cava were nearly completely divided. When the heart was empty, the ascending aorta was cross-clamped and the St. Thomas solution was infused by gravity. The heart was excised by transection of the inferior vena cava, the superior vena cava and all pulmonary veins. After donor heart was removed, it was infused with University of Wisconsin （UW） solution by gravity at a temperature of 4-6℃, then placed in UW solution for storage during transportation. The temperature of solution was maintained at about 4-6℃. The ischemic times of donor heart were 9, 8 and 6 h, respectively. The bicaval anastomotic heart transplantation was adopted. The left atrial anastomoses were constructed using 3.0 polypropylene. The inferior vene cava anastomosis was constructed, the donor and native aorta were cut to an appropriate length. Then the aorta and main pulmonary artery anastomosis were performed respectively. The superior vene cava anastomosis was usually constructed during the rewarming phase. The intraoperative course with a cardiopulmonary bypass of the 3 patients was 96, 44 and 49 min, respectively. Standard triple immunosuppression therapy was commenced in the immediate post-operative period. Results： The operation procedure was smooth and no perioperative death occurred. The follow-up was carried out carefully. The patient＇s condition was fine in 25, 30 and 32 months after operation. The blood pressure was 130/90, 140/95 and 120/80 mmHg, respectively, and LVED was 51, 49 and 53 mm; EF was 50%, 54% and 60%, respectively. Cardiothoracic ratio was 0.63, 0.55, and 0.64, respectively. Conclusion： Preservation time of donor heart with St. Thomas solution infusion and UW solution storage at 0-4℃ may exceed 6 h, and receive comparable middle-term outcomes.
基金Supported by Natural Science Foundation of Hubei Province in 2016,No.2016CFB644.
文摘BACKGROUND Cardiac transplantation is considered the standard treatment for refractory endstage heart failure.Worldwide,5074 heart transplantations were performed in 2015.About 100 heart transplants are performed at the authors’center each year.The usual complications of heart transplantation include graft rejection,infection,and graft dysfunction.Aortic dissection after heart transplantation is very rare and is a serious complication that requires a hybrid procedure.CASE SUMMARY A 58-year-old female patient was admitted to Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in July 2020 because of unprovoked low back pain without precipitating causes.Magnetic resonance imaging and computed tomography angiography showed type A aortic dissection with an aberrant right subclavian artery.After admission,urapidil was used to control blood pressure.Ten days later,the patient underwent ascending aortic and aortic arch replacement,subclavian artery reconstruction,and endovascular repair of abdominal and thoracic aortic aneurysms.A cardiopulmonary bypass was established through the right femoral artery and femoral vein.The aberrant right subclavian artery,innominate artery,left common carotid artery,and left subclavian artery were blocked,and the left and right common carotid arteries were cannulated for bilateral cerebral perfusion.CONCLUSION The right axillary artery could not be selected for cardiopulmonary bypass intubation because of aberrant right subclavian artery.
文摘BACKGROUND Insertion of a left ventricular assist device(LVAD)and heart transplantation(HT)improve the survival of patients with heart failure.In addition,cardiac rehabilitation(CR)further increases the functional capacity.This case report describes a successful case of CR after LVAD insertion and subsequent HT.CASE SUMMARY In the present case,during the LVAD insertion period,peak oxygen consumption(VO2)increased by 12.16%after CR.HT was performed 7 mo after the LVAD insertion,and the patient participated in phases I and II CR.The peak VO2 increased from 17.24 to 22.29 m L/kg/min.This improvement was more significant than that reported in previous studies on CR after LVAD insertion or HT.The patient’s quality of life also improved.The total average score of the short form-36 questionnaire increased from 29.5 points at admission to 53.3 points 9 mo after HT.CONCLUSION A tailored CR program after LVAD insertion or HT may improve the patients’quality of life and increase survival.
文摘<div style="text-align:justify;"> <strong>Background:</strong> 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<span "="">. <b>Purpose: </b>To describe the </span>physical and psychosocial experiences of the patients waiting for HT in one general hospital in the northern <span "="">part of China. <b>Methods: </b></span>A qualitative approach was used in this <span "="">study. Fifteen patients waiting for HT were selected based on purposive sampling, and semi-structured interviews were carried out. <b>Results: </b></span>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. <b>Conclusion: </b>This study provides an in-depth description of patients waiting for HT who have<span "=""></span>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. <b>Relevance to Clinical Practice: </b>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. </div>
文摘Heart transplantation is considered the best treatment modality for advanced heart disease. While old age has conventionally been considered a contraindication for heart transplantation due to the reported adverse effect of advanced age, however donor hearts＇ shortage continues to stimulate the discussion about the recipient＇s upper age limit. Our study was based on a retrospective analysis for the results of 52（18%） patients aged 60 years and older undergoing heart transplantation between May 2008 and December 2015, and these patients were compared with 236（82%） adult recipients who were younger than 60 years at the time of transplantation and during the same period. In older group, 71% were males with the mean age of 63.38±3.55 years, and in younger group, 83.4% were males with a mean age of 43.72±11.41 years（P=0.27）. Dilated cardiomyopathy was the most common indication for transplantation among patients in both groups（P=0.147）. In older group, the 3-month survival rate was higher than that in younger group（P=0.587）, however the 6-month survival rate showed no significant difference（P=0.225）. Although the 1-year survival rate was higher in older group（P=0.56）, yet the 3-year survival rate between the two groups showed no statistically significant difference（P=0.48）. According to our experience among older heart transplant candidates who were 60 years and older, we believe that advanced age should not be an excluding criterion to cardiac transplantation.
文摘Objectives To analyze the six-minute walk test （6MWT） and gas exchange of 5 heart transplantation patients and to approach the variation tendency of exercise tolerance, oxygen uptake （ VO2 ） and heart rate chronotropic response. Methods 5 cases of heart transplantation patients （ age 25 - 52 years） were undertaken 6MWT 6 - 30 months after operation, synchronizing gas exchanging parameters were measured by wireless portable remote sensing K4B^2 gas analyzer, 51 normal controls were compared. Results The six-minute walk distance （6MWD） of 5 patients were （592.6 ± 26.7 ） m （558 - 625 ） m, the ascending tendency during exercise was slower, the maximum heart rates were 80% ± 6% of age-predicting maximal heart rate, lower than normal control （86%） ; the end point VO2/kg were （21.8 ± 1.4 ） mL/min · kg （ 19. 94 - 23.60） mL/min · kg. Conclusions The 6WMD and VO2 of 5 patients reached normal range, but the heart rate chronotropic response and VO2 ascending tendency were slower than those of normal controls.
文摘OBJECTIVES: In recent years, the percentage of heart transplantation (HT) with short/medium-term assistance devices has increased. This study aims at analyzing primary graft failure and in-hospital mortality according to the type of care. MATERIAL AND METHODS: From January 2013 to December?2017 all patients undergoing urgent HT with circulatory/ventricular assistance?were retrospectively and consecutively recruited. Combined transplants, retransplantations and pediatric transplants were excluded. The sample was divided in 10 groups according to the type of shot/medium term assistance devices. RESULTS: A total of 53 patients were recruited, 79% men, average age 49 ± 13 years. 26 patients (51%) had mechanical ventilation at the time of the HT. Primary graft failure occurred in 20 patients (38.5%), whilst it was more frequent in patients assisted with ECMO (8 patients in group 1 (45%) and 7 in group 2 (54%), p 0.5). 14 deaths (27%) were registered, whereas a higher mortality was observed in the group assisted with ECMO (6 patients in group 1 (34%) and 4 in group 2 (31%), p 0.6). Mortality was 17% in the group of non-urgent Levitronix. CONCLUSIONS: Despite not showing statistical significance due to the low number of patients in some subgroups, hospital?mortality was high in HT patients with circulatory assistance. A trend towards a higher incidence of primary graft failure and mortality in patients assisted with ECMO was observed. The direct implantation of a centrifugal pump as a bridge to urgent transplantation could identify a subgroup with a better prognosis.
文摘The purpose of this review is to provide a comprehensive update on recent advances in heart transplantation in China.Despite advances in pharmacologic and device treatment of chronic heart failure,long-term morbidity and mortality remain high,and many patients progress to end-stage heart failure.Heart transplantation has become standard treatment for selected patients with end-stage heart failure,though challenges still exist.However,multiple advances over the past few years will improve the survival and quality-of-life of heart transplant recipients.This article elaborates on the specific characteristics of heart transplantation in China,the current issues,development trends,and related experiences with heart transplantation in Wuhan Union Hospital.
文摘AIM To investigate the impact of timing of same-admission orthotopic heart transplant(OHT) after left ventricular assist device(LVAD) implantation on in-hospital mortality and post-transplant length of stay.METHODS Using data from the Nationwide Inpatient Sample from 1998 to 2011, we identified patients 18 years of age or older who underwent implantation of a LVAD and for whom the procedure date was available. We calculated in-hospital mortality for those patients who underwent OHT during the same admission as a function of time from LVAD to OHT, adjusting for age, sex, race, household income, and number of comorbid diagnoses. Finally, we analyzed the effect of time to OHT after LVAD implantation on the length of hospital stay post-transplant.RESULTS Two thousand and two hundred patients underwent implantation of a LVAD in this cohort. One hundred and sixty-four(7.5%) patients also underwent OHT duringthe same admission, which occurred on average 32 d(IQR 7.75-66 d) after LVAD implantation. Of patients who underwent OHT, patients who underwent transplantation within 7 d of LVAD implantation("early") experienced increased in-hospital mortality(26.8% vs 12.2%, P = 0.0483) compared to patients who underwent transplant after 8 d("late"). There was no statistically significant difference in age, sex, race, household income, or number of comorbid diagnoses between the early and late groups. Post-transplant length of stay after LVAD implantation was also not significantly different between patients who underwent early vs late OHT. CONCLUSION In this cohort of patients who received LVADs, the rate of in-hospital mortality after OHT was lower for patients who underwent late OHT(at least 8 d after LVAD implantation) compared to patients who underwent early OHT. Delayed timing of OHT after LVAD implantation did not correlate with longer hospital stays post-transplant.
文摘Significant scarcity of a donor pool exists for heart transplantation(HT)as the prevalence of patients with end-stage refractory heart failure is increasing exceptionally.With the discovery of effective direct-acting antiviral and favorable short-term outcomes following HT,the hearts from hepatitis C virus(HCV)patient are being utilized to increase the donor pool.Short-term outcomes with regards to graft function,coronary artery vasculopathy,and kidney and liver disease is comparable in HCV-negative recipients undergoing HT from HCVpositive donors compared to HCV-negative donors.A significant high incidence of donor-derived HCV transmission was observed with great success of achieving sustained viral response with the use of direct-acting antivirals.By accepting HCV-positive organs,the donor pool has expanded with younger donors,a shorter waitlist time,and a reduction in waitlist mortality.However,the longterm outcomes and impact of specific HCV genotypes remains to be seen.We reviewed the current literature on HT from HCV-positive donors.
文摘Despite a record setting number of heart transplants performed annually,the national donor shortage continues to plague transplant teams across the United States.Here we describe the barriers to adaptation of numerous“non-traditional”orthotopic heart transplant donor characteristics including donors with hepatitis C virus,those meeting criteria for donation after cardiac death,donors with coronavirus disease 19 infection,donors with the human immunodeficiency virus,and grafts with left ventricular systolic dysfunction.Our center’s objective was to increase our transplant volume by expanding our donor pool from“traditional”donors to these“non-traditional”donors.We detail how medical advances such as certain laboratory studies,pharmacologic interventions,and organ care systems have allowed our center to expand the donor pool thereby increasing transplantation volume without adverse effects on outcomes.
基金This study was supported by grants from the National Natural Science Foundation of China （No. 30760239 and No. 81160201）. Conflicts of interest： none.
文摘Background Alveolar echinococcosis （AE） is caused by the metacestode stage of Echinococcus multilocularis （E. multilocularis） and is a rare but life-threatening disease. This disease commonly is characterized by an infiltrative, tumor-like growth of the E. multilocularis metacestode in the liver of human. Liver transplantation is an effective therapy for end-stage of hepatic AE, but the characteristics of host immunity associated with E. multilocularis infection with organ transplantation are poorly defined. We hereby aimed to study the immunological status and allograft heart survival in inbred rats with E. multilocularis infection. Methods Rat models of AE were established by injecting the E. multilocularis suspension made from E. multilocularis infected tissues into the abdomen of Lewis （LEW） rats. Three months later, in the experimental group, allograft heart transplantation was performed from Brown-Norway （BN） rats to the E. multilocularis infected LEW rats. In the control group, we transplanted hearts from BN rats to healthy LEW rats. The influence of the disturbed immune system in E. multilocularis infected rats on the heart transplantation was assessed, including observation of allograft heart survival time, histopathological examination of grafts and immunohistochemical examination of infiltrating cells （CD4＋ T cells, CD8＋ T cells and eosinophile granulocytes）, measurement of interleukin （IL）-4 and interferon （IFN）-γ in the serum by enzyme-linked immunosorbent assay （ELISA） and analysis of CD4＋CD25＋ regulatory T cells in peripheral blood by fluorescence activated cell sorting （FACS） flow cytometric analysis. Results The survival time of recipients in the experimental group was prolonged compared with those in the control group. The numbers of graft infiltrating CD8＋ T cells were decreased whereas the graft infiltrating eosinophil granulocytes （CD15＋） were increased in grafts in the experimental group （P 〈0.05）. Furthermore, the proportion of CD4＋CD25＋regulatory T cells in the peripheral blood was 10.8% on average in the experimental group, which was significantly higher than that in the control group （6.1%）. In addition, the level of serum IL-4 in E. multilocularis infected rats was higher than that in the control group rats, whereas the level of serum IFN-γ in experimental group was lower than that in the control group when graft rejection occurred （P 〈0.05）. Conclusions This study suggests that E. multilocularis infection could prolong the allograft survival time through the polarization of Th1/Th2-type cells and induction of CD4＋CD25＋ regulatory T cells. This strategy may provide a new idea for establishing transplantation tolerance.
