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Is There a Mortality “Weekend Effect” in Cardiac Transplantation - A Single Center Experience?
Abstracts
S397
1000
1001
Gender Differences in Pre-Transplant Characteristics and Short-Term Clinical Outcomes Post Heart Transplantation A. Almufleh,1 S. Fazelpour,2 A. Merdad,1 J. Marbach,1 R. Davies,1 L. Mielniczuk,1 S. Chih,1 and E. Stadnick.1 1Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada; and the 2 The Ottawa Hospital, Ottawa, ON, Canada.
Is There a Mortality “Weekend Effect” in Cardiac Transplantation - A Single Center Experience? A. Salimbangon,1 D. Vucicevic,2 C. Lum,1 A. Chang,1 T. Khuu,1 M. Moore,1 R. Chand,1 M. Cadeiras,3 M. Kwon,1 M. Deng,1 M. Kamath,1 and E. DePasquale.1 1UCLA, Los Angeles, CA; 2Newark Beth Israel, Newark, NJ; and the 3UC Davis, Sacramento, CA.
Purpose: Women comprise 1 in 4 of all heart transplant (HT) recipients. Sex/gender differences affect cardiovascular disease burden and outcomes with important potential to impact patient care. As an initial step towards developing personalized therapy, we evaluated differences in HT clinical characteristics and outcomes between men and women. Methods: A retrospective review was performed of consecutive adult patients who underwent HT at the University of Ottawa Heart Institute (Ontario, Canada) between 2012 and 2016. We determined patient characteristics in women and men at transplant and outcomes post transplant including death, graft function, rejection, infection and hospitalization. Results: A total of 121 HT patients were evaluated: 29 (24%) female, mean age 53.6§12.3 years, 39 (32%) for ischemic cardiomyopathy (Table). Compared to men, women had lower body mass index, increased donor-recipient sex mismatch, and higher sensitization. There were no differences in the use or dose of induction or maintenance immunotherapy, however, women received a higher mean dose of Valganciclovir for cytomegalovirus (CMV) prophylaxis: 12.1§4.1 vs. 9.5§4.2 mg/kg/day, p=0.05. Over a mean follow-up of 3.0§1.9 years, there were 12 (10%) deaths, and no difference in survival or graft function between men and women. Compared to men, women had significantly higher rates of infection (62% vs. 41%, p=0.05) and hospitalization for infection (31% vs. 13%, p=0.03). Leukopenia (white cell count <3.0 £ 109/L) occurred more frequently in women compared to men: 72% for women vs. 39% for men (p<0.01). There was no difference in rejection rate: 15% vs. 5% (p=0.10) for ≥2R and 3% vs. 4% (p=0.83) for pAMR ≥1 for women vs. men, respectively. Conclusion: Clinical characteristics and short-term outcomes post HT differ among women and men. Prospective evaluation and long-term followup of larger cohorts are needed to determine strategies to improve care in women following HT.
Purpose: Cardiac transplant surgeries can be complicated, prolonged, resource-heavy procedures that may be affected by the timing of the surgery. We analyzed data from Ronald Reagan UCLA Medical Center (RRUCLA MC) to evaluate for a “weekend effect” on mortality comparing transplant surgeries that occurred on a weekday versus during the weekend. Methods: We conducted a retrospective, cohort analysis of the RR UCLA MC data for all heart-only transplant patients between from 1987 to 2018 comparing mortality rates between weekday transplants (WDT) versus weekend transplants (WET). The exclusion criteria included age <18, patients lost to follow-up, multi-organ transplants, and re-do heart transplants. A multivariate Cox proportional hazard regression analysis (adjusted for age, sex, diabetes, race, ischemic time, need for dialysis, on life support, wait time, and HLA mismatch) was performed. Survival was censored at 12 years. Results: 1,548 patients received heart transplants between 1987-2018 at RR UCLA MC, of which 1129 patients received a transplant on a weekday and 419 patients received a transplant during the weekend. Overall, the mortality for WDT and WET were 53.3% and 53.5% (p=0.89), respectively. The breakdown of cardiovascular and non-cardiovascular mortality were similar for both WDT (15.0%, 38.4%, respectively) and WET (15.3%, 38.2%) (p=0.54). Furthermore, there was no significant difference in cause of death between WDT vs WET, looking specifically at graft failure, rejection, infection, cardiovascular, malignancy, multi-organ failure, and other causes. Conclusion: Based on this retrospective, cohort analysis of the RR UCLA MC data, there was no mortality “weekend effect” observed for cardiac transplantation surgeries.
1002 Post-Transplant Trends in BNP Levels among Recipients of Heart versus Heart-Kidney Transplantation S. Zalawadiya,1 K. Schlendorf,1 P. Hanna,2 M. Wigger,1 D. Brinkley,1 J. Menachem,1 A. Shah,3 M. Danter,3 K. Balsara,3 L. Punnoose,1 S. Brown Sacks,1 H. Ooi,1 and J. Lindenfeld.1 1Heart Failure and Transplantation, Vanderbilt University Medical Center, Nashville, TN; 2Internal Medicine, Vanderbilt University Medical Center, Nashville, TN; and the 3Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN.
S397
1000
1001
Gender Differences in Pre-Transplant Characteristics and Short-Term Clinical Outcomes Post Heart Transplantation A. Almufleh,1 S. Fazelpour,2 A. Merdad,1 J. Marbach,1 R. Davies,1 L. Mielniczuk,1 S. Chih,1 and E. Stadnick.1 1Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada; and the 2 The Ottawa Hospital, Ottawa, ON, Canada.
Is There a Mortality “Weekend Effect” in Cardiac Transplantation - A Single Center Experience? A. Salimbangon,1 D. Vucicevic,2 C. Lum,1 A. Chang,1 T. Khuu,1 M. Moore,1 R. Chand,1 M. Cadeiras,3 M. Kwon,1 M. Deng,1 M. Kamath,1 and E. DePasquale.1 1UCLA, Los Angeles, CA; 2Newark Beth Israel, Newark, NJ; and the 3UC Davis, Sacramento, CA.
Purpose: Women comprise 1 in 4 of all heart transplant (HT) recipients. Sex/gender differences affect cardiovascular disease burden and outcomes with important potential to impact patient care. As an initial step towards developing personalized therapy, we evaluated differences in HT clinical characteristics and outcomes between men and women. Methods: A retrospective review was performed of consecutive adult patients who underwent HT at the University of Ottawa Heart Institute (Ontario, Canada) between 2012 and 2016. We determined patient characteristics in women and men at transplant and outcomes post transplant including death, graft function, rejection, infection and hospitalization. Results: A total of 121 HT patients were evaluated: 29 (24%) female, mean age 53.6§12.3 years, 39 (32%) for ischemic cardiomyopathy (Table). Compared to men, women had lower body mass index, increased donor-recipient sex mismatch, and higher sensitization. There were no differences in the use or dose of induction or maintenance immunotherapy, however, women received a higher mean dose of Valganciclovir for cytomegalovirus (CMV) prophylaxis: 12.1§4.1 vs. 9.5§4.2 mg/kg/day, p=0.05. Over a mean follow-up of 3.0§1.9 years, there were 12 (10%) deaths, and no difference in survival or graft function between men and women. Compared to men, women had significantly higher rates of infection (62% vs. 41%, p=0.05) and hospitalization for infection (31% vs. 13%, p=0.03). Leukopenia (white cell count <3.0 £ 109/L) occurred more frequently in women compared to men: 72% for women vs. 39% for men (p<0.01). There was no difference in rejection rate: 15% vs. 5% (p=0.10) for ≥2R and 3% vs. 4% (p=0.83) for pAMR ≥1 for women vs. men, respectively. Conclusion: Clinical characteristics and short-term outcomes post HT differ among women and men. Prospective evaluation and long-term followup of larger cohorts are needed to determine strategies to improve care in women following HT.
Purpose: Cardiac transplant surgeries can be complicated, prolonged, resource-heavy procedures that may be affected by the timing of the surgery. We analyzed data from Ronald Reagan UCLA Medical Center (RRUCLA MC) to evaluate for a “weekend effect” on mortality comparing transplant surgeries that occurred on a weekday versus during the weekend. Methods: We conducted a retrospective, cohort analysis of the RR UCLA MC data for all heart-only transplant patients between from 1987 to 2018 comparing mortality rates between weekday transplants (WDT) versus weekend transplants (WET). The exclusion criteria included age <18, patients lost to follow-up, multi-organ transplants, and re-do heart transplants. A multivariate Cox proportional hazard regression analysis (adjusted for age, sex, diabetes, race, ischemic time, need for dialysis, on life support, wait time, and HLA mismatch) was performed. Survival was censored at 12 years. Results: 1,548 patients received heart transplants between 1987-2018 at RR UCLA MC, of which 1129 patients received a transplant on a weekday and 419 patients received a transplant during the weekend. Overall, the mortality for WDT and WET were 53.3% and 53.5% (p=0.89), respectively. The breakdown of cardiovascular and non-cardiovascular mortality were similar for both WDT (15.0%, 38.4%, respectively) and WET (15.3%, 38.2%) (p=0.54). Furthermore, there was no significant difference in cause of death between WDT vs WET, looking specifically at graft failure, rejection, infection, cardiovascular, malignancy, multi-organ failure, and other causes. Conclusion: Based on this retrospective, cohort analysis of the RR UCLA MC data, there was no mortality “weekend effect” observed for cardiac transplantation surgeries.
1002 Post-Transplant Trends in BNP Levels among Recipients of Heart versus Heart-Kidney Transplantation S. Zalawadiya,1 K. Schlendorf,1 P. Hanna,2 M. Wigger,1 D. Brinkley,1 J. Menachem,1 A. Shah,3 M. Danter,3 K. Balsara,3 L. Punnoose,1 S. Brown Sacks,1 H. Ooi,1 and J. Lindenfeld.1 1Heart Failure and Transplantation, Vanderbilt University Medical Center, Nashville, TN; 2Internal Medicine, Vanderbilt University Medical Center, Nashville, TN; and the 3Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN.