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147: Outcomes of Heart Transplantation for Peripartum Cardiomyopathy: Analysis of the United Network for Organ Sharing (UNOS) Database
The Journal of Heart and Lung Transplantation Volume 28, Number 2S
provides more extensive BMI data from all US heart transplanted patients. Methods and Materials: We reviewed our single institution data (T:430 total patients between 1992-2002) and UNOS data (U: 23,113 initial adult OHT recipients between 1996 and 2006). Primary stratification was by BMI at time of transplant. Demographic and clinical factors including wait list (WL) times were recorded. Primary endpoint was all cause mortality during the study period. Secondary outcomes included length of hospital stay (LOS), need for reoperation and postoperative infection. Post transplant survival was estimated by Kaplan-Meier methodology and compared using Cox proportional hazard regression. Results: Of 23,113 patients with available data, the distribution of BMI was as follows: BMI ⱕ 25; 9,983 (43.2%), 26-30; 8,480 (36.7%), 31-35; 3,556 (15.4%), 36-40; 891 (3.9%) and ⬎ 40; 203 (0.9%). BMI was not an independent risk factor for mortality in the UNOS data (Hz ratio ⫽ 0.98, p ⫽ 0.17) and no level of BMI led to significantly worse survival. Our single institute results were similar (BMI⬍30; 80%; 31-35;16.5%; and ⬎35;3.5%; p⫽0.892) and there was no significant between the groups in survival. In our data, recipient age, donor age, female gender, ischemic time, creatinine, hypertension, and diabetes emerged as independent predictors of mortality on multivariable analysis. BMI was not associated with increases in LOS (r ⫽ 0.01, p ⫽ 0.4), postoperative infections, or reoperation rate (OR ratio ⫽ 0.99, p ⫽ 0.6 for each) BMI correlated strongly with WL times (p ⫽ 0.01). Conclusions: The present study is the largest reported series focusing on obesity in OHT. We found BMI to not be a significant predictor of mortality, reoperation, or infection even to a BMI of 40. Obesity by itself should not be a contraindication to OHT. 147 Outcomes of Heart Transplantation for Peripartum Cardiomyopathy: Analysis of the United Network for Organ Sharing (UNOS) Database K.D. Rasmusson1,2, D.G. Renlund1,3, B.D. Horne1, K.D. Brunisholz1, S.A. Brush1, P.W. Fisher1, M.M. Endo1, B.C. Miller1, J.J. Connolly1, J. Stehlik4, A.G. Kfoury1 1 Intermountain Medical Center, Salt Lake City, UT; 2College of Nursing, Salt Lake City, UT; 3University of Utah, Salt Lake City, UT; 4George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT Purpose: Peripartum cardiomyopathy (PPCM) is a rare indication for heart transplantation (tx). Whether post-tx outcomes are worse than for other pre-tx diagnoses remains unsettled. We compared post-tx outcomes for PPCM to other females tx’d for other indications (OF) and to male recipients. Methods and Materials: The Organ Procurement and Transplantation Network (OPTN)/UNOS data collected from 109 centers from 1987-2008 was queried. Data included listing status, panel reactive antibody (PRA), treated rejections, hospitalizations for infection, and steroid use post-tx. Mortality was assessed using Kaplan Meier survival rates. Results: Based on OPTN data as of Aug 2008, out of 39,759 recipients ⱖ15 years; 458 had PPCM (1%), 8,408 were OF, and 30,893 were male. The Table shows characteristics and outcomes among the groups. For rejection and infection the data are dichotomized at age 40 years. Conclusions: Cardiac tx for PPCM is rare, occurs at a younger age, and is associated with worse outcomes when compared to other pre-tx diagnoses. Likely reasons include higher rates of sensitization, and increased rejection. Age and PRA may affect outcomes. Further study is necessary to determine if more aggressive treatment of rejection will impact outcomes.
Abstracts
S117
Table Mean Age (years) Peak PRA ⱖ20% (class I%/class II%) Status at tx n (%) 1A 1B 2 “Old” status 1 % Treated for rejection ⬍40 years ⱖ40 years % Hospitalized for infection 1st post tx year ⬍40 years ⱖ40 years % Steroid use at 1 year % Survival (1/3/5 year)
PPCM
OF
31 30/17
48 16/10
Males 7/4
106(23) 92(20) 106(23) 148(32)
1294(15) 1534(18) 3226(38) 2152(26)
5271(17) 5228(17) 10138(33) 9324(30)
52
p-value ⬍0.0001 0.0001 ⬍0.0001
27 31
33 37 77 83/64/56
23 22
32 37 76 87/78/70
21 16
0.01 ⬍0.0001
30 34 76 88/81/74
0.06 ⬍0.0001 0.81 0.0001
148 Serum SMARCAL1 Concentrations in Donors Predict Primary Graft Dysfunction in Cardiac Transplantation S. Aharinejad1,2, O. Andrukhova2, M. Gmeiner1,2, A. Zuckermann1, D. Zimpfer1, A. Thomas2, M. Grimm1 1Medical University of Vienna, Vienna, Austria; 2Medical University of Vienna, Vienna, Austria Purpose: Primary graft dysfunction (PGD) is a life-threatening complication in cardiac transplantation. A sensitive, specific, easily and quickly measurable serum predictor could facilitate PGD prevention and treatment. SMARCAL1 is a matrix-associated regulator of chromatin with helicase and ATPase activities, and its serum concentrations were significantly increased in a targeted protein array in cardiac transplant recipients with PGD. Methods and Materials: SMARCAL1 serum concentrations were analyzed by ELISA in 222 consecutive heart donors before and after aortic cross-clamping (ACC) and in recipients at 10, 30 and 60 minutes following reperfusion. Demographic and hemodynamic parameters of donors and recipients as well as transplant procedure characteristics were documented. PGD (n⫽46) was defined as ventricular dilation and hypocontractility associated with systolic blood pressure ⬍90 mm Hg, pulmonary capillary wedge pressure ⬎20 mm Hg and decreased mixed venous oxygen saturation. Results: SMARCAL1 serum protein concentration was significantly increased only before ACC in donors (p⫽0.001; not significant for all other time points of measurement) whose grafts developed PGD compared to those whose grafts did not. In receiver operating characteristic curve analysis SMARCAL1 serum concentration before ACC in donors predicted PGD (p⫽0.02, AUC⫽0.877). At a cut-off level of ⱖ1.7 ng/mL serum SMARCAL1 in donors before ACC had a sensitivity of 87% and a specificity of 81% to predict PGD. SMARCAL1 serum concentrations ⱕ1.2 ng/mL in donors before ACC resulted in 85% PGD-free outcome. Conclusions: These results suggest for the first time that SMARCAL1 is involved in PGD and that its serum concentrations may serve as a predictive marker in the assessment of cardiac graft quality, in particular in marginal donors, before ACC.
149 Quantitation of the Effect of Donor-Associated Characteristics on Post-Transplant Survival. ISHLT Registry Analysis
provides more extensive BMI data from all US heart transplanted patients. Methods and Materials: We reviewed our single institution data (T:430 total patients between 1992-2002) and UNOS data (U: 23,113 initial adult OHT recipients between 1996 and 2006). Primary stratification was by BMI at time of transplant. Demographic and clinical factors including wait list (WL) times were recorded. Primary endpoint was all cause mortality during the study period. Secondary outcomes included length of hospital stay (LOS), need for reoperation and postoperative infection. Post transplant survival was estimated by Kaplan-Meier methodology and compared using Cox proportional hazard regression. Results: Of 23,113 patients with available data, the distribution of BMI was as follows: BMI ⱕ 25; 9,983 (43.2%), 26-30; 8,480 (36.7%), 31-35; 3,556 (15.4%), 36-40; 891 (3.9%) and ⬎ 40; 203 (0.9%). BMI was not an independent risk factor for mortality in the UNOS data (Hz ratio ⫽ 0.98, p ⫽ 0.17) and no level of BMI led to significantly worse survival. Our single institute results were similar (BMI⬍30; 80%; 31-35;16.5%; and ⬎35;3.5%; p⫽0.892) and there was no significant between the groups in survival. In our data, recipient age, donor age, female gender, ischemic time, creatinine, hypertension, and diabetes emerged as independent predictors of mortality on multivariable analysis. BMI was not associated with increases in LOS (r ⫽ 0.01, p ⫽ 0.4), postoperative infections, or reoperation rate (OR ratio ⫽ 0.99, p ⫽ 0.6 for each) BMI correlated strongly with WL times (p ⫽ 0.01). Conclusions: The present study is the largest reported series focusing on obesity in OHT. We found BMI to not be a significant predictor of mortality, reoperation, or infection even to a BMI of 40. Obesity by itself should not be a contraindication to OHT. 147 Outcomes of Heart Transplantation for Peripartum Cardiomyopathy: Analysis of the United Network for Organ Sharing (UNOS) Database K.D. Rasmusson1,2, D.G. Renlund1,3, B.D. Horne1, K.D. Brunisholz1, S.A. Brush1, P.W. Fisher1, M.M. Endo1, B.C. Miller1, J.J. Connolly1, J. Stehlik4, A.G. Kfoury1 1 Intermountain Medical Center, Salt Lake City, UT; 2College of Nursing, Salt Lake City, UT; 3University of Utah, Salt Lake City, UT; 4George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT Purpose: Peripartum cardiomyopathy (PPCM) is a rare indication for heart transplantation (tx). Whether post-tx outcomes are worse than for other pre-tx diagnoses remains unsettled. We compared post-tx outcomes for PPCM to other females tx’d for other indications (OF) and to male recipients. Methods and Materials: The Organ Procurement and Transplantation Network (OPTN)/UNOS data collected from 109 centers from 1987-2008 was queried. Data included listing status, panel reactive antibody (PRA), treated rejections, hospitalizations for infection, and steroid use post-tx. Mortality was assessed using Kaplan Meier survival rates. Results: Based on OPTN data as of Aug 2008, out of 39,759 recipients ⱖ15 years; 458 had PPCM (1%), 8,408 were OF, and 30,893 were male. The Table shows characteristics and outcomes among the groups. For rejection and infection the data are dichotomized at age 40 years. Conclusions: Cardiac tx for PPCM is rare, occurs at a younger age, and is associated with worse outcomes when compared to other pre-tx diagnoses. Likely reasons include higher rates of sensitization, and increased rejection. Age and PRA may affect outcomes. Further study is necessary to determine if more aggressive treatment of rejection will impact outcomes.
Abstracts
S117
Table Mean Age (years) Peak PRA ⱖ20% (class I%/class II%) Status at tx n (%) 1A 1B 2 “Old” status 1 % Treated for rejection ⬍40 years ⱖ40 years % Hospitalized for infection 1st post tx year ⬍40 years ⱖ40 years % Steroid use at 1 year % Survival (1/3/5 year)
PPCM
OF
31 30/17
48 16/10
Males 7/4
106(23) 92(20) 106(23) 148(32)
1294(15) 1534(18) 3226(38) 2152(26)
5271(17) 5228(17) 10138(33) 9324(30)
52
p-value ⬍0.0001 0.0001 ⬍0.0001
27 31
33 37 77 83/64/56
23 22
32 37 76 87/78/70
21 16
0.01 ⬍0.0001
30 34 76 88/81/74
0.06 ⬍0.0001 0.81 0.0001
148 Serum SMARCAL1 Concentrations in Donors Predict Primary Graft Dysfunction in Cardiac Transplantation S. Aharinejad1,2, O. Andrukhova2, M. Gmeiner1,2, A. Zuckermann1, D. Zimpfer1, A. Thomas2, M. Grimm1 1Medical University of Vienna, Vienna, Austria; 2Medical University of Vienna, Vienna, Austria Purpose: Primary graft dysfunction (PGD) is a life-threatening complication in cardiac transplantation. A sensitive, specific, easily and quickly measurable serum predictor could facilitate PGD prevention and treatment. SMARCAL1 is a matrix-associated regulator of chromatin with helicase and ATPase activities, and its serum concentrations were significantly increased in a targeted protein array in cardiac transplant recipients with PGD. Methods and Materials: SMARCAL1 serum concentrations were analyzed by ELISA in 222 consecutive heart donors before and after aortic cross-clamping (ACC) and in recipients at 10, 30 and 60 minutes following reperfusion. Demographic and hemodynamic parameters of donors and recipients as well as transplant procedure characteristics were documented. PGD (n⫽46) was defined as ventricular dilation and hypocontractility associated with systolic blood pressure ⬍90 mm Hg, pulmonary capillary wedge pressure ⬎20 mm Hg and decreased mixed venous oxygen saturation. Results: SMARCAL1 serum protein concentration was significantly increased only before ACC in donors (p⫽0.001; not significant for all other time points of measurement) whose grafts developed PGD compared to those whose grafts did not. In receiver operating characteristic curve analysis SMARCAL1 serum concentration before ACC in donors predicted PGD (p⫽0.02, AUC⫽0.877). At a cut-off level of ⱖ1.7 ng/mL serum SMARCAL1 in donors before ACC had a sensitivity of 87% and a specificity of 81% to predict PGD. SMARCAL1 serum concentrations ⱕ1.2 ng/mL in donors before ACC resulted in 85% PGD-free outcome. Conclusions: These results suggest for the first time that SMARCAL1 is involved in PGD and that its serum concentrations may serve as a predictive marker in the assessment of cardiac graft quality, in particular in marginal donors, before ACC.
149 Quantitation of the Effect of Donor-Associated Characteristics on Post-Transplant Survival. ISHLT Registry Analysis