54 research outputs found
Everolimus immunosuppression in de novo heart transplant recipients: What does the evidence tell us now?
No full textThe efficacy of everolimus with reduced cyclosporine in de novo heart transplant patients has been demonstrated convincingly in randomized studies. Moreover, everolimus-based immunosuppression in de novo heart transplant recipients has been shown in two randomized trials to reduce the increase in maximal intimal thickness based on intravascular ultrasound, indicating attenuation of cardiac allograft vasculopathy (CAV). Randomized trials of everolimus in de novo heart transplantation have also consistently shown reduced cytomegalovirus infection versus antimetabolite therapy. In maintenance heart transplantation, conversion from calcineurin inhibitors to everolimus has demonstrated a sustained improvement in renal function. In de novo patients, a renal benefit may only be achieved if there is an adequate reduction in exposure to calcineurin inhibitor therapy. Delayed introduction of everolimus may be appropriate in patients at high risk of wound healing complications, e.g. diabetic patients or patients with ventricular assist device. The current evidence base suggests that the most convincing reasons for use of everolimus from the time of heart transplantation are to slow the progression of CAV and to lower the risk of cytomegalovirus infection. A regimen of everolimus with reduced-exposure calcineurin inhibitor and steroids in de novo heart transplant patients represents a welcome addition to the therapeutic armamentarium. (C) 2013 Elsevier Inc. All rights reserved
Everolimus immunosuppression in de novo heart transplant recipients: What does the evidence tell us now?
No full textThe efficacy of everolimus with reduced cyclosporine in de novo heart transplant patients has been demonstrated convincingly in randomized studies. Moreover, everolimus-based immunosuppression in de novo heart transplant recipients has been shown in two randomized trials to reduce the increase in
maximal intimal thickness based on intravascular ultrasound, indicating attenuation of cardiac allograft vasculopathy (CAV). Randomized trials of everolimus in de novo heart transplantation have also consistently shown reduced cytomegalovirus infection versus antimetabolite therapy. In maintenance heart transplantation, conversion from calcineurin inhibitors to everolimus has demonstrated a sustained improvement in renal function. In de novo patients, a renal benefit may only be achieved if there is an adequate reduction in exposure to calcineurin inhibitor therapy. Delayed introduction of everolimus may be appropriate in patients at high risk of wound healing complications, e.g. diabetic patients or patients with ventricular assist device. The current evidence base suggests that the most convincing reasons for use of everolimus from the time of heart transplantation are to slow the progression of CAV and to lower the risk of cytomegalovirus infection. A regimen of everolimus with reduced-exposure calcineurin inhibitor and steroids in de novo heart transplant patients represents a welcome addition to the
therapeutic armamentarium
0135: Increasing severity and complexity in adults with congenital heart disease undergoing heart transplantation (ACHD): temporal trends – a collaborative study on 97 patients
No full textBackgroundResidual abnormalities in cardiac structure and function predispose ACHD to late-onset heart failure and its complications. Therefore, heart transplantation (HT) in ACHD is increasingly used.MethodsOut of a multi-institutional (3 centers) series of 2257 HT from 1988 to 2012, 100 (4.4%) were performed in 97 ACHD (65 men). They represented 45% of ACHD recipients in France at that time. We investigated the role of temporal trends on profile and outcomes of ACHD recipients. Trends were compared between 2 eras: era 1 (1988-2005, n=48) and era 2 (2006-2012, n=49).ResultsMean age at the time of HT was 29.8 years. Forty-three patients (44%) had univentricular physiology (1V). Severity of disease was categorized in terms of initial diagnosis (according to classification of 32th ACC Bethesda Conference): 74.2% had a great complexity cardiopathy while 21.7% had a moderate severity disease and 4.1% a simple CHD. In-hospital mortality was high (34%).Baseline characteristics did not differ significantly between the 2 eras. Era 2 recipients had less often right heart failure signs before HT. Their donors were older. They were more likely to be hospitalized, supported by inotropes and assist devices at the time of HT. The rate of 1V patients did not change over time: 50% in era 1 vs 39% in era 2 (p=0.27). The distribution of severity of disease changed significantly over time (p=0.048). The proportion of adult recipients with CHD of great complexity was higher in era 2 than era 1 (respectively 81.6% and 66.7%). In fact, transposition of the great arteries became the major provider of HT in adult in the recent era (30.6% in era 2 vs 8.3%, p=0.006), representing the only primary diagnosis whose proportion increased significantly. Multivariable factors associated with increased in-hospital mortality did not include transplant era.ConclusionDespite a worse baseline risk profile, and increasing complexity of ACHD recipients in recent years, mortality after HT has not increased
A single‐center long‐term experience with marginal donor utilization for heart transplantation
No full textBackground To evaluate the early and late outcome of heart transplantation (HT) using marginal (MDs) and optimal donors (ODs). Methods Clinical records of recipients transplanted between July 2004 and December 2014 were retrospectively reviewed. MDs were defined as follows: age >55 years, high-dose inotropic support, left ventricular ejection fraction <45%, left ventricular hypertrophy, donor to recipient predicted heart mass ratio <0.86, ischemic time >4 hours. Results A total of 412 (55%) recipients received an organ from a MD; recipients who received an organ from an OD had less primary graft dysfunction (PGD) (25% vs 38%;P < .001), less acute renal failure (23% vs 34%;P < .001), and higher survival rates (90.2% vs 81.8% at 30 days, 79.5% vs 71.1% at 1 year, 51.8% vs 45.4% at 12 years;P = .01) than recipients who received an organ from a MD. There was no statistically significant difference in 30-day conditional survival between the two groups (survival rates 57.4% vs 55.5% at 12 years;P = .43). PGD, perioperative hemodialysis, and sepsis were independent risk factors of mortality at multivariate analysis. Conclusions Utilization of MDs for HT is associated with a higher incidence of PGD and acute renal failure, and a reduction of 30-day survival
Changes in Heart Transplant Allocation Policy: “unintended” Consequences but Maybe Not so “unexpected…”
No full textInternational audienc
Association between cytomegalovirus infection and allograft rejection in a large contemporary cohort of heart transplant recipients
No full textInternational audienc
Heart Transplantation for Peripartum Cardiomyopathy: A Single-Center Experience
No full textAbstract Background: Peripartum cardiomyopathy is an idiopathic disorder defined by the occurrence of acute heart failure during late pregnancy or post-partum period in the absence of any other definable cause. Its clinical course is variable and severe cases might require heart transplantation. Objective: To investigate long-term outcomes after heart transplantation (HT) for peripartum cardiomyopathy (PPCM). Methods: Out of a single-center series of 1938 HT, 14 HT were performed for PPCM. We evaluated clinical characteristics, transplant-related complications, and long-term outcomes, in comparison with 28 sex-matched controls. Primary endpoint was death from any cause; secondary endpoints were transplant-related complications (rejection, infection, cardiac allograft vasculopathy). A value of p 0.05), except for a higher use of inotropes at the time of HT in PPCM group (p = 0.03). During a median follow-up of 7.7 years, 16 patients died, 3 (21.5%) in PPCM group and 13 (46.5%) in control group. Mortality was significantly lower in PPCM group (p = 0.03). No significant difference was found in terms of transplant-related complications (p > 0.05). Conclusions: Long-term outcomes following HT for PPCM are favorable. Heart transplantation is a valuable option for PPCM patients who did not recover significantly under medical treatment.</div
Cotton Cellulose Dissolution and Transformation to Bioproducts
No full textThe purpose of this study was to utilize low-quality cotton fiber to make eco-friendly cellulose films, find their suitable application, as well as appropriate environmental settings for their rapid post-use degradation. Furthermore, it emphasized plasma pretreatment of cotton fiber a promising approach to facilitate cellulose dissolution. Low-quality cotton cellulose was transformed into very flexible and transparent cellulose films by dissolving, casting, regeneration, plasticization, and hot pressing. Glycerol plasticization and hot pressing helped to make highly flexible and uniform cellulose films. Additionally, oleic acid functionalization of films reduced the sensitivity of cellulose films to moisture. The investigation on soil burial degradation of cellulose films revealed faster degradation of cellulose films. The rate of degradation was significantly influenced by the weather. Cellulose films underwent significant physicochemical, thermal, and mechanical changes and were completely degraded in 2- to 4-months, regardless of whether they were buried outside or in open fields. According to these findings, cellulose films would be suitable for landfill disposal. The findings from the potential use of cellulose films as soil cover mulch revealed the functionality of cellulose films for about 8 months. After the soil cover experiment, the leftover films were buried in soil beds with regulated moisture to monitor how long it took for complete degradation. The biodeterioration that was initiated during the cover experiment helped promote the disintegration of the films by microorganisms within 80 days after burial The structural complexity of cellulose prevents it from being used to its maximum capacity. In an effort to enhance the dissolution of cotton cellulose in the NaOH/Urea solvent system, cotton fiber was pretreated with microwave oxygen plasma. The pretreatment had an impact on the surface chemistry of cotton fiber. After 20 and 40 minutes of plasma treatment, the molecular weight of cotton cellulose decreased by 36% and 60%, respectively, as well as the crystallinity by 16% and 25%. It facilitated a 34% and 68% improvement in the dissolution of cotton fiber (1% w: v). This study indicated that microwave oxygen plasma pre-treatment could be an effective and environmentally friendly method for enhancing the dissolution of cellulose. The results of this study suggested that microwave oxygen plasma pre-treatment could be an efficient and eco-friendly strategy for improving cellulose dissolution.Embargo status: Restricted until 01/2027. To request the author grant access, click on the PDF link
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Everolimus with reduced cyclosporine versus MMF with standard cyclosporine in de novo heart transplant recipients.
No full textConcentration-controlled everolimus with reduced CsA results in similar renal function and equivalent efficacy compared with MMF with standard CsA at 12 months after cardiac transplantation
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