Incidence, risk factors and clinical outcome of multidrug-resistant organisms after heart transplantation

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.

Exercise as a modality to improve heart transplantation-related functional impairments: An article review

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.

Cardiac evaluation of renal transplant candidates with heart failure

Patients with advanced kidney disease are at elevated risk of developing heart failure and appropriate risk stratification is important to permit them to receive kidney transplantation.The American Heart Association and American College of Cardiology joint statement provides guidance on risk stratification for the major cause of heart failure for these patients in its recommendations for coronary heart disease.Herein we provide an overview of the available literature on risk strati-fication for nonischemic heart failure and functional heart disease states such as pulmonary hypertension.Many of these options for optimizing these patients be-fore transplant include optimizing their volume status,often with more agg-ressive ultrafiltration.Kidney transplantation remains the treatment of choice for patients with advanced kidney disease and cardiac disease,the correction of the azotemic substances with kidney transplantation has been associated with imp-roved survival than remaining on dialysis long-term.The findings in the studies reviewed here are expected to help clinicians refine current strategies for evalua-ting potential kidney transplant recipients.

Evolution of heart transplant donor characteristics in the 21st century: A United States single center’s experience

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.

Current Status of and Opinions on Heart Transplantation in China

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.

Effect of TGF-β1 on the Expression of IL-12, IL-15, IL-18, IL-4 and IL-10 in Heart Transplantation Rejection in Rats

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）.

Coronary microvasculopathy in heart transplantation: Consequences and therapeutic implications

Despite the progress made in the prevention and treatment of rejection of the transplanted heart, cardiac allograft vasculopathy(CAV) remains the main cause of death in late survival transplanted patients. CAV consists of a progressive diffuse intimal hyperplasia and the proliferation of vascular smooth muscle cells, ending in wall thickening of epicardial vessels, intramyocardial arteries(50-20 μm), arterioles(20-10 μm), and capillaries(< 10 μm). The etiology of CAV remains unclear; both immunologic and non-immunologic mechanisms contribute to endothelial damage with a sustained inflammatory response. The immunological factors involved are Human Leukocyte Antigen compatibility between donor and recipient, alloreactive T cells and the humoral immune system. The non-immunological factors are older donor age, ischemia-reperfusion time, hyperlipidemia and CMV infections. Diagnostic techniques that are able to assess microvascular function are lacking. Intravascular ultrasound and fractional flow reserve, when performed during coronary angiography, are able to detect epicardial coronary artery disease but are not sensitive enough to assess microvascular changes. Some authors have proposed an index of microcircula-tory resistance during maximal hyperemia, which is calculated by dividing pressure by flow(distal pressure multiplied by the hyperemic mean transit time). Non-invasive methods to assess coronary physiology are stress echocardiography, coronary flow reserve by transthoracic Doppler echocardiography, single photon emission computed tomography, and perfusion cardiac magnetic resonance. In this review, we intend to analyze the mechanisms, consequences and therapeutic implications of microvascular dysfunction, including an extended citation of relevant literature data.

Symptomatic Val122del mutated hereditary transthyretin amyloidosis: Need for early diagnosis and prioritization for heart and liver transplantation

Background: Hereditary transthyretin(ATTRv) amyloidosis is an autosomal dominant disease linked to transthyretin gene mutations which cause instability of the transthyretin tetramer. After dissociation and misfolding they reassemble as insoluble fibrils(i.e. amyloid). Apart from the common Val30 Met mutation there is a very heterogeneous group of non-Val30 Met mutations. In some cases, the clinical picture is dominated by a rapidly evolving restrictive and hypertrophic cardiomyopathy. Methods: A case series of four liver recipients with the highly clinically relevant, rare and particularly aggressive Val122 del mutation is presented. Medical and surgical therapeutic options, waiting list policy for ATTRv-amyloidosis, including the need for heart transplantation, and status of heart-liver transplantation are discussed. Results: Three patients needed a staged(1 patient) or simultaneous(2 patients) heart-liver transplant due to rapidly progressing cardiac failure and/or neurologic disability. Domino liver transplantation was impossible in two due to fibrotic hepatic transformation caused by cardiomyopathy. After a follow-up ranging from 3.5 to 9.5 years, cardiac(allograft) function was maintained in all patients, but neuropathy progressed in three patients, one of whom died after 80 months. Conclusions: This is the first report in(liver) transplant literature about the rare Val122 del ATTRv mutation. Due to its aggressiveness, symptomatic patients should be prioritized on the liver and, in cases with cardiomyopathy, heart waiting lists in order to avoid the irreversible neurological and cardiac damage that leads to a rapid lethal outcome.

Effect of ecdysterone on heteroptopic heart transplantation in rats

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.

Contemporary characteristics and outcomes of adults with familial dilated cardiomyopathy listed for heart transplantation

BACKGROUND Familial dilated cardiomyopathy(FDCM) account for 20%-30% of non-ischemic cardiomyopathies(NICM). Previous published data showed that some patients with FDCM tend to have rapidly progressive disease; however, five-year mortality was not significantly different in the familial and non-familial forms of NICM with optimal medical therapy.AIM To better define the characteristics and clinical outcomes of FDCM patients listed for heart transplantation(HT).METHODS We queried the United Network for Organ Sharing Registry to identify FDCM patients listed for HT between January 2008 and September 2015 and compared them to NICM and ischemic cardiomyopathy(ICM) patients. We included all patients ≥ 18 years old and we separated patients to three groups: FDCM, NICM and ICM. Chi-square test was used to compare between categorical variables, the t-test was used to compare between continues variables, and Cox-proportional hazards model was used to perform time-dependent survival analyses.RESULTS Of the 24809 adults listed for HT, we identified 677 patients(2.7%) with the diagnosis of FDCM. Compared to patients with NICM and ICM, FDCM patients were younger(FDCM 43.9 ± 13.5 vs NICM 50.9 ± 12.3, P < 0.001, vs ICM 58.5 ±8.1, P < 0.001), more frequently listed as status 2(FDCM 35.2% vs NICM 26.5%, P< 0.001), with significantly lower left ventricular assist device(LVAD) utilization(FDCM 18.4% vs NICM 25.1%, P < 0.001; vs ICM 25.6%, P < 0.001), but higher use of total artificial heart(FDCM 1.3% vs NICM 0.6%, P = 0.039; vs ICM 0.4%, P =0.002). Additionally, patients with FDCM were less frequently delisted for clinical deterioration or death and more likely to be transplanted compared to those with NICM [hazard ratio(HR): 0.617, 95% confidence interval(CI): 0.47-0.81; HR: 1.25,95%CI: 1.14-1.37, respectively], and ICM(HR: 0.5, 95%CI: 0.38-0.66; HR: 1.18,95%CI: 1.08-1.3, respectively). There was more frequent rejection among patients with FDCM(FDCM 11.4% vs NICM 9.8%, P = 0.28; vs ICM 8.4%, P = 0.034). One,three, and five post-transplant survival of patients with FDCM(91%, 88% and80%) was similar to those with NICM(91%, 84%, 79%, P = 0.225), but superior to those with ICM(89%, 82%, 75%, P = 0.008), respectively.CONCLUSION End-stage FDCM patients are more likely to be transplanted, more likely to have early rejection, and have similar or higher survival than patients with other cardiomyopathies.

Risk factors for myocardial injury during living donor liver transplantation in pediatric patients with biliary atresia

BACKGROUND Cold ischemia-reperfusion of the liver is an inevitable occurrence in liver trans-plantation that may also cause damage to the heart.Perioperative myocardial injury during liver transplantation can increase the incidence of post-operative mortality,but there is little research on the incidence of myocardial injury in children who undergo living donor liver transplantation(LDLT).Therefore,this study mainly explores the independent risk factors for myocardial injury in children who undergo LDLT.factors for intraoperative myocardial injury.METHODS We retrospectively analyzed the inpatient records of pediatric patients who underwent LDLT in Tianjin First Central Hospital from January 1,2020,to January 31,2022.Recipient-related data and donor-related data were collected.The patients were divided into a myocardial injury group and a nonmyocardial injury group according to the value of the serum cardiac troponin I at the end of surgery for analysis.Univariate analysis and multivariate logistic regression were used to evaluate the risk factors for myocardial injury during LDLT in pediatric patients.RESULTS A total of 302 patients met the inclusion criteria.The myocardial injury group had 142 individuals(47%),and the nonmyocardial injury group included 160 patients(53%).Age,height,and weight were significantly lower in the myocardial injury group(P<0.001).The pediatric end-stage liver disease(PELD)score,total bilirubin,and interna-tional standardized ratio were significantly higher in the myocardial injury group(P<0.001).The mean arterial pressure,lactate,hemoglobin before reperfusion,duration of the anhepatic phase,cold ischemic time,incidence of postreperfusion syndrome(PRS),and fresh frozen plasma transfusion were significantly different between the two groups(P<0.05).The postoperative intensive care unit stay and peak total bilirubin values in the first 5 d after LDLT were significantly higher in the myocardial injury group(P<0.05).The pediatric patients with biliary atresia in the nonmyocardial injury group who underwent LDLT had a considerably higher one-year survival rate than those in the myocardial injury group(P=0.015).Multivariate logistic regression revealed the following independent risk factors for myocardial injury:a high PELD score[odds ratio(OR)=1.065,95%confidence interval(CI):1.013-1.121;P=0.014],a long duration of the anhepatic phase(OR=1.021,95%CI:1.003-1.040;P=0.025),and the occurrence of intraoperative PRS(OR=1.966,95%CI:1.111-3.480;P=0.020).CONCLUSION A high PELD score,a long anhepatic phase duration,and the occurrence of intraoperative PRS were independent risk factors for myocardial injury during LDLT in pediatric patients with biliary atresia.

Left Ventricle Geometry Remolding after Heart Transplantation:A Two-dimensional Ultrasound Study

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.

Establishment and improvement of model of vascularized heart-thymus composite transplantation in rats

Objective To establish and improve the model of heart-thymus composite transplantation.Methods Vascularized both lobes of the thymus is transplanted heterotopically with the heart as a composite graft in rats.This technique was developed and assessed,and viability of the grafts was evaluated histologically.Results Donor operation costed 38.5±3.52 min,vascular anastomosis costed 25.0±3.28 min,operating successful rate was 90%,acute rejection was observed in SD-Wistar group,viable thymus with normal microarchitecture was maintained in Wistar-Wistar group.Conclusions The improved novel technique for combined heart-thymus transplantation is a valuable method for study of the role of thymus in transplantation immunity.

Non-Invasive Assessment of Coronary Microcirculation in Heart Transplantation

Heart transplantation (HT) is an accepted treatment for end-stage heart failure (HF). Heart transplantation significantly increases survival, exercise capacity, quality of life and return to work in selected patients with advanced heart failure compared with conventional treatment. The survival rates have improved with the use of new immunosuppressive drugs, with a median survival after transplantation of approximately 11 years. The shortage of donor hearts represents a major limitation in this field. In addition many are the consequences of the limited effectiveness and complications of immunosuppressive therapy (i.e. antibody-mediated rejection, infection, hypertension, renal failure, malignancy and coronary artery vasculopathy). In particular, chronic rejection may occur months to years after the transplantation and is referred to as cardiac allograft vasculopathy (CAV). CAV occurs in 32% of the patients after 5 years and ensuing allograft failure from CAV eventually accounts for 30% of recipient deaths after transplantation. Cardiac allograft vasculopathy, involving coronary macro- and microcirculation, is caused by complicated interplay between immunologic and non-immunologic factors resulting in repetitive endothelial injury and localized sustained inflammatory response. Early diagnosis of microvascular dysfunction is substantial. In this review we analyze signs and symptoms of CAV presentation and the different methodologies to achieve an early and precise diagnosis. We will discuss invasive and non-invasive diagnostic tools and their specific role in evaluating graft’s function, morphology, the presence of coronary artery disease and possible microcirculation involvement.

Optimal timing of same-admission orthotopic heart transplantation after left ventricular assist device implantation

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.

Exercise training in heart transplantation

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.

Exercise after heart transplantation: An overview

While life expectancy is greatly improved after a heart transplant, survival is still limited, and compared to the general population, the exercise capacity and healthrelated quality of life of heart transplant recipients are reduced. Increased exercise capacity is associated with a better prognosis. However, although several studies have documented positive effects of exercise after heart transplantation(HTx), little is known about the type, frequency and intensity of exercise that provides the greatest health benefits. Moreover, the long-term effects of exercise on co-morbidities and survival are also unclear. Exercise restrictions apply to patients with a denervated heart, and for decades, it was believed that the transplanted heart remained denervated. This has since been largely disproved, but despite the new knowledge, the exercise restrictions have largely remained, and up-to-date guidelines on exercise prescription after HTx do not exist. High-intensity, interval based aerobic exercise has repeatedly been documented to have superior positive effects and health benefits compared to moderate exercise. This applies to both healthy subjects as well as in several patient groups, such as patients with metabolic syndrome, coronary artery disease or heart failure. However, whether the effects of this type of exercise are also applicable to heart transplant populations has not yet been full yestablished. The purpose of this article is to give an overview of the current knowledge about the exercise capacity and effect of exercise among heart transplant recipients and to discuss future exercise strategies.

Long-term survival following heart transplantation is possible

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.

Combined Heart-kidney Transplantation: A Single Center Experience

Introduction: We report our experience with seven cases of combined heart-kidney transplantation (HKT). Patients and methods: Between January 2003 and December 2009, seven subjects underwent combined HKT, receiving both organs from a single donor. Their age ranged from 30 years to 59 years, six were male. Five patients were dialysis dependent before transplantation and two were in chronic renal failure (serum creatinine levels > 2.6 mg/dL). The heart was transplanted first in all cases. Results: Heart function rapidly re-covered in five of the patients, while two needed temporary inotropic and mechanical support. Diuresis started immediately in four patients. At discharge, all patients had well-functioning grafts (left ventricular ejection fraction 60% ± 6%;serum creatinine 1.4 ± 0.3 mg/dL). After an average follow-up period of 45 ± 24 months no deaths have occurred. Heart allografts are functioning normally in six patients and none of the patients currently require dialysis treatment. The main adverse event noted during follow-up was hypertension in five patients. Four patients were cardiac allograft rejection free and five patients were kidney rejection free. Conclusion: Our results are in line with the data which has been previously reported in the literature and suggest that HKT is a viable therapeutic choice in the treatment of advanced cardiac and renal failure in carefully selected patients.

Review of heart transplantation from hepatitis C-positive donors

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.