- Email: [email protected]
343: The Role of Pre-Existing Donor Vascular Disease on Allograft Vasculopathy
S184
Abstracts
according to the WHO criteria. All patients had a normal coronary angiography (non atherosclerotic luminal narrowing ⬎50%). Results: The median interval between the last pre-HTx angiography and the HTx was 20.3 months (range 1-118), without correlation between this period and the pathologic presence of atherosclerotic plaques (r⫽0.07 p⫽0.27). Coronary atherosclerotic plaques were found in 101 (73%) of the 138 coronary artery trees: 36(26%) had mild, non-narrowing plaques (Group1), 40(29%) had moderately stenosing plaques⬎50 to ⬍75% (Group2), and 25(18%) had critical lesions in at least one of the three coronaries (Group3). The grade of coronary lesion was directly related to age (r⫽0.45 P⬍0.001), hypertension (r⫽0.26 p⬍0.001) and inversely to the right ventricle dilatation (r⫽-0.24 p⫽0.002). Conclusions: An angio-pathological mismatch of the coronary arteries permeability was found in half of the patients with IDC who underwent HTx. The degree of coronary arteries narrowing was significantly associated with older age, hypertension and lack of right ventricle compromise. Eighteen percent of patients had critically stenosing plaques, in whom a misdiagnosis is suspected. In the subgroup of patients with moderately stenosing plaques, the potential contributory role of atherosclerotic to myocardial fibrosis and ventricular dysfunction needs further investigation. 341 Proteomic Biomarkers of Chronic Heart Allograft Rejection G.V. Cohen Freue1, D. Lin2, C. Imai3, A. Ignaszewski3, J. Mancini3, Z. Hollander4, A. Bergman5, M. Sasaki5, J. Wilson-McManus2, R. Balshaw1, R.T. Ng6, C. Borchers7, P. Keown3, B. McManus2, R. McMaster5 1University of British Columbia, Vancouver, BC, Canada; 2University of British Columbia, Vancouver, BC, Canada; 3University of British Columbia, Vancouver, BC, Canada; 4The James Hogg iCAPTURE Centre for Cardiovascular & Pulmonary Research, Vancouver, Canada; 5University of British Columbia, Vancouver, Canada; 6University of British Columbia, Vancouver, Canada; 7University of Victoria Proteomics Centre, Victoria, Canada Purpose: The goal of BiT is to discover biomarkers of acute and chronic heart, kidney and liver rejection to reduce invasive procedures and allow personalized treatment. Methods and Materials: BiT has collected over 400 plasma samples from 45 heart transplant patients. The heart chronic rejection cohort consists of 18 patients (26-70 years old; 78% male; 1-2 yrs posttransplant). Patient diagnoses were based on analysis of angiograms, intravascular ultrasound and/or chart review. Samples at one year post-transplant from 7 subjects with clear signs of chronic rejection (CR) and 6 clearly stable (S) subjects were used to identify plasma proteomic biomarkers. Twelve samples (6 CR, 6 S) were used as an internal validation test cohort. All samples were depleted, trypsindigested, the peptides labeled with isotope tags (iTRAQ) and evaluated using the Applied Biosystems 4800 MALDI TOF/TOF. Each proteomic run identified and relatively quantitated proteins in 3 patient samples versus a pooled normal control. A robust moderated t-test was used to find a panel of plasma proteomic markers with differential relative concentrations (p⬍0.025). Internal validation using a Linear Discriminant Analysis (LDA) to classify 12 new samples in the test cohort was performed. Results: Of the 124 proteins identified, 10 proteins had differential relative concentrations between CR and S samples; six were upregulated in CR. Seven markers are relatively well-characterized and have been closely linked to immune mechanisms, cell adhesion/ junction and cell communication. The internal validation demonstrated an accuracy of 83% in classifying new samples with 5 out of 6 in each group correctly classified.
The Journal of Heart and Lung Transplantation February 2009
Conclusions: Potential plasma proteomic biomarkers of chronic rejection were identified. These potential biomarkers will be used in future combinatorial analyses with BiT genomic data. Acknowledgements: Genome Canada, Novartis, IBM, Genome British Columbia, PROOF, NCE-CECR.. 342 Determining the Etiology of Quilty Lesions: A Repeat Heart Transplantation Study C. Ellis1, D.J. Carter2, W.M. Baldwin III3, M.K. Halushka1 1Johns Hopkins Medical Institutions, Baltimore, MD; 2Johns Hopkins Medical Institutions, Baltimore, MD; 3Cleveland Clinic Foundation, Cleveland, OH Purpose: Quilty lesions (QL) are endocardial lymphoid proliferations that mimic acute rejection in transplanted hearts. They have been associated with aspects of chronic rejection, particularly transplant vasculopathy. The etiology of QL was once thought to be the result of cyclosporine use, but that explanation has not borne out. We investigated the etiology of QL using a population of double heart transplant recipients. Methods and Materials: Twenty-five subjects who have had repeat heart transplantation and at least 1 year of follow up for each heart were included. The surgical pathology records were reviewed for the presence of QL, and a subset of older biopsies and explanted hearts were reexamined to determine the presence of unreported QL. All clinical parameters including HLA status, patient age, ethnicity, medication use, and rejection history were obtained. Results: Over 1,300 biopsies were evaluated with a similar average number of biopsies performed on each subject’s first (28) and second (25) hearts. At least one QL was found in 68% of 1st transplanted hearts and 64% of 2nd hearts. We ascertained the role of the recipient in Quilty formation by comparing the presence of QL in first and second hearts. This relationship approached significance (p⫽0.06, Fisher Exact Test) for the presence of a single QL, but was not significant if the criteria were two or more biopsies with QL (p⫽0.73). We then ascertained the role of HLA status in QL formation. We found donor HLA DR13 to be associated with the presence of a single QL, or the more stringent two or more biopsies with QL (pⱕ0.05). Recipient HLA A32 was increased in subjects without QL (p⫽0.04). We found no relationship between QL and sex mismatch, ethnicity mismatch, blood type, cyclosporine use, donor age, or the overall number of HLA mismatches. Conclusions: We found no relationship between cyclosporine use and QL formation. Our data suggests the possibility of donor-recipient interactions as a cause of Quilty formation, specifically the presence of donor HLA DR13 and recipient HLA A32 as modulators of this effect. 343 The Role of Pre-Existing Donor Vascular Disease on Allograft Vasculopathy A.M. Zaki1, T.D.G. Lee1,2,3, G.M. Hirsch3, B.M. Ross3 1Dalhousie University, Halifax, NS, Canada; 2Dalhousie University, Halifax, NS, Canada; 3Dalhousie University, Halifax, NS, Canada Purpose: Allograft vasculopathy (AV) is characterized by a progressive vascular lesion in the coronary arteries of transplant patients. This lesion is primarily made up of ␣-actin-positive myofibroblasts and is resistant to current immunosuppressive therapies. Previous rodent AV models have shown that this lesion is of recipient origin, however human studies suggest that it is chimeric, consisting of both donor and recipient elements. We believe that this discrepancy is due to the fact that in rodent models, the neointima is a de novo lesion that is
The Journal of Heart and Lung Transplantation Volume 28, Number 2S
Abstracts
developed by the recruitment of recipient cells. However in human AV, we believe that the lesion also contains elements of pre-existing donor vasculopathy. Methods and Materials: To confirm the recipient nature of the lesion in the presence of Cyclosporine A (CyA), we used B6 Green Fluorescent Protein (GFP) mice recipients of C3H aortic grafts. CyA was used at 50 mg/kg/d. To determine the role of pre-existing disease on AV, we used apolipoprotein-E-deficient (ApoE-/-) mice as donors since they have been shown to develop vascular lesions throughout their aortas. Aortic sections from ApoE-/- B6 mice were transplanted into C3H mice and after 10 weeks the lesions were assessed for AV and cellular infiltration. Results: 97% of the neointimal lesion in the GFP experimental group was positive for green fluorescence compared to 0% in the control group demonstrating the recipient nature of the neointima. The neointimal lesion in the recipients of ApoE-/- donor grafts was chimeric. The lesion consisted of both the pre-existing donor vascular lesion and a de novo lesion. These lesions were discrete and could be easily discriminated by the difference in morphology and ␣-actin positivity: pre-existing lesion negative and neo-intima positive. The neointimal lesion overlays the pre-existing lesion in most cases. Conclusions: Even in the presence of calcineurin inhibition, the neointimal lesion in mouse models is recipient in origin. Donor pre-existing lesions most likely contribute to graft vascular disease in the presence of standard immunosuppression. 344 Risk Factors for Early Death on the French Cardiac Waiting List C. Cantrelle, F. Pessione, D. Tixier, E. Herquelot, Transplant Teams, B. Loty Agence de la Biomedecine, Saint Denis La Plaine, France Purpose: The severity of heart failure on the waiting list is an important criterion for prioritizing heart allocation. The objective of the study was to determine the risk factors linked to the early death on the waiting list. Methods and Materials: Adult recipients registered on the national heart waiting list from 2000 to 2007 were included, except multiple organs and domino donor transplantations. After univariate analysis using Kaplan Meier curves, a cox model was used to determine the risk factors. The event measured was death or retrieval from the list for aggravation in the first 3 months after inscription on the waiting list (55% of death). The factors from the national data base (Cristal) were selected for a p-value inferior to 20 percent in the univariate analysis. The significant factors were those with a p-value⬍0.05. Results: 3374 heart transplantations and 336 events were analysed. 13 factors were involved in the study and different encodings tested. The factors excluded of the final model were ABO group, sex, medical or surgery history, VEF, peak VO2, arterial pressure. The factors which predicted the early death are represented in the table: Conclusions: After adjustment, 8 factors linked to early death on the waiting list were found. The development of a heart score now needs to assess the factors linked of the time spent on the waiting list.
S185
Variable
Hazard Ratio
P-value
intra aortic balloon mechanical ventilation missing value Systolic pulmonary arterial pressure > 50 missing value
1.4 1.8 2.6 10.5 1.4
⬍0.0001 ⬍0.0001 0.06 ⬍0.0001
345 Does Hormonal Resuscitation Increase Recovery of Thoracic Organs? A Single OPO Experience D.S. Nath1, M.H. Liu1, J. Coleman2, J. Wagner2, N. Moazami1, G.A. Ewald3 1Washington University School of Medicine, Saint Louis, MO; 2Mid-America Transplant Services, Saint Louis, MO; 3 Washington University School of Medicine, Saint Louis, MO Purpose: A newly described hormonal resuscitation protocol has been utilized by our OPO to improve donor management. We assessed the efficacy of this protocol in increasing thoracic organ recovery and examined if brain death management time led to an increase in early graft loss. Methods and Materials: The new protocol consisting of fluid, thyroxine, corticosteroid and vasopressin administration was initiated by our OPO in June 2006. Cohort A with donors from June 2004 to May 2006 was compared to Cohort B (subject to new protocol) with donors from June 2006 to May 2008. Cohort A had 273 consented organ donors from whom 70 hearts and 72 lungs were utilized by recipients. Cohort B had 301 consented organ donors from whom 93 hearts and 147 lungs were utilized by recipients. While overall donor pool increased by 10%, overall thoracic organ recovery increased by 70% (p ⬍ 0.001), with a 33% increase for hearts (p ⬍ 0.001) and 104% increase for lungs (p ⬍ 0.001). Conclusions: Aggressive donor management significantly increases thoracic organ recovery without a change in 30-day graft loss. Utilizing this protocol does not significantly prolong donor management time. Results: Both cohorts had similar donor characteristics. Table 1. Donor characteristics
Age Male gender Cause of death
Heart Lung Brain death to recovery time (min)
Head trauma motor vehicle accident Head trauma gunshot wound Non-traumatic stroke/anoxia Other Cold ischemic time (min) 30-day graft loss Cold ischemic time (min) 30-day graft loss
Cohort A; median (range)
Cohort B; median (range)
p value
20 (0.03-49) 64% 60%
22 (0.2-67) 73% 54%
0.37 0.87 0.96
18%
20%
0.20
12%
12%
1.0
10% 190 (90-321)
14% 194.5 (55-276)
0.70 0.47
1.7% 187.5 (91-336)
1.5% 199.5 (102-614)
0.70 0.55
0.7% 1136.5 (601-2537)
1.1% 1590 (577-2578)
0.8 0.93
Variable
Hazard Ratio
P-value
priority access Retrieval from the list before july 2004 Age at registration > 50 years Retransplantation NYHAⴝ4 Cardio-respiratory assistance versus none hospital without drug intensive care unit without drug intravenous inotropes ventricular assistance
1.3 1.3 1.7 1.6 2.1
0.01 0.09 ⬍0.0001 0.04 ⬍0.0001
1.7 2.9 7.4 1.0
⬍0.0001
The Impact of Donor-Recipient Gender Matching on Survival and Rejection after Cardiac Transplantation R.A. Bello, D.A. D’Alessandro, S. Maybaum, D.J. Goldstein Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
0.02
Purpose: Cardiac transplantation remains limited by donor supply. Thus, optimal donor-recipient (D-R) compatibility is critical. Several
346
Abstracts
according to the WHO criteria. All patients had a normal coronary angiography (non atherosclerotic luminal narrowing ⬎50%). Results: The median interval between the last pre-HTx angiography and the HTx was 20.3 months (range 1-118), without correlation between this period and the pathologic presence of atherosclerotic plaques (r⫽0.07 p⫽0.27). Coronary atherosclerotic plaques were found in 101 (73%) of the 138 coronary artery trees: 36(26%) had mild, non-narrowing plaques (Group1), 40(29%) had moderately stenosing plaques⬎50 to ⬍75% (Group2), and 25(18%) had critical lesions in at least one of the three coronaries (Group3). The grade of coronary lesion was directly related to age (r⫽0.45 P⬍0.001), hypertension (r⫽0.26 p⬍0.001) and inversely to the right ventricle dilatation (r⫽-0.24 p⫽0.002). Conclusions: An angio-pathological mismatch of the coronary arteries permeability was found in half of the patients with IDC who underwent HTx. The degree of coronary arteries narrowing was significantly associated with older age, hypertension and lack of right ventricle compromise. Eighteen percent of patients had critically stenosing plaques, in whom a misdiagnosis is suspected. In the subgroup of patients with moderately stenosing plaques, the potential contributory role of atherosclerotic to myocardial fibrosis and ventricular dysfunction needs further investigation. 341 Proteomic Biomarkers of Chronic Heart Allograft Rejection G.V. Cohen Freue1, D. Lin2, C. Imai3, A. Ignaszewski3, J. Mancini3, Z. Hollander4, A. Bergman5, M. Sasaki5, J. Wilson-McManus2, R. Balshaw1, R.T. Ng6, C. Borchers7, P. Keown3, B. McManus2, R. McMaster5 1University of British Columbia, Vancouver, BC, Canada; 2University of British Columbia, Vancouver, BC, Canada; 3University of British Columbia, Vancouver, BC, Canada; 4The James Hogg iCAPTURE Centre for Cardiovascular & Pulmonary Research, Vancouver, Canada; 5University of British Columbia, Vancouver, Canada; 6University of British Columbia, Vancouver, Canada; 7University of Victoria Proteomics Centre, Victoria, Canada Purpose: The goal of BiT is to discover biomarkers of acute and chronic heart, kidney and liver rejection to reduce invasive procedures and allow personalized treatment. Methods and Materials: BiT has collected over 400 plasma samples from 45 heart transplant patients. The heart chronic rejection cohort consists of 18 patients (26-70 years old; 78% male; 1-2 yrs posttransplant). Patient diagnoses were based on analysis of angiograms, intravascular ultrasound and/or chart review. Samples at one year post-transplant from 7 subjects with clear signs of chronic rejection (CR) and 6 clearly stable (S) subjects were used to identify plasma proteomic biomarkers. Twelve samples (6 CR, 6 S) were used as an internal validation test cohort. All samples were depleted, trypsindigested, the peptides labeled with isotope tags (iTRAQ) and evaluated using the Applied Biosystems 4800 MALDI TOF/TOF. Each proteomic run identified and relatively quantitated proteins in 3 patient samples versus a pooled normal control. A robust moderated t-test was used to find a panel of plasma proteomic markers with differential relative concentrations (p⬍0.025). Internal validation using a Linear Discriminant Analysis (LDA) to classify 12 new samples in the test cohort was performed. Results: Of the 124 proteins identified, 10 proteins had differential relative concentrations between CR and S samples; six were upregulated in CR. Seven markers are relatively well-characterized and have been closely linked to immune mechanisms, cell adhesion/ junction and cell communication. The internal validation demonstrated an accuracy of 83% in classifying new samples with 5 out of 6 in each group correctly classified.
The Journal of Heart and Lung Transplantation February 2009
Conclusions: Potential plasma proteomic biomarkers of chronic rejection were identified. These potential biomarkers will be used in future combinatorial analyses with BiT genomic data. Acknowledgements: Genome Canada, Novartis, IBM, Genome British Columbia, PROOF, NCE-CECR.. 342 Determining the Etiology of Quilty Lesions: A Repeat Heart Transplantation Study C. Ellis1, D.J. Carter2, W.M. Baldwin III3, M.K. Halushka1 1Johns Hopkins Medical Institutions, Baltimore, MD; 2Johns Hopkins Medical Institutions, Baltimore, MD; 3Cleveland Clinic Foundation, Cleveland, OH Purpose: Quilty lesions (QL) are endocardial lymphoid proliferations that mimic acute rejection in transplanted hearts. They have been associated with aspects of chronic rejection, particularly transplant vasculopathy. The etiology of QL was once thought to be the result of cyclosporine use, but that explanation has not borne out. We investigated the etiology of QL using a population of double heart transplant recipients. Methods and Materials: Twenty-five subjects who have had repeat heart transplantation and at least 1 year of follow up for each heart were included. The surgical pathology records were reviewed for the presence of QL, and a subset of older biopsies and explanted hearts were reexamined to determine the presence of unreported QL. All clinical parameters including HLA status, patient age, ethnicity, medication use, and rejection history were obtained. Results: Over 1,300 biopsies were evaluated with a similar average number of biopsies performed on each subject’s first (28) and second (25) hearts. At least one QL was found in 68% of 1st transplanted hearts and 64% of 2nd hearts. We ascertained the role of the recipient in Quilty formation by comparing the presence of QL in first and second hearts. This relationship approached significance (p⫽0.06, Fisher Exact Test) for the presence of a single QL, but was not significant if the criteria were two or more biopsies with QL (p⫽0.73). We then ascertained the role of HLA status in QL formation. We found donor HLA DR13 to be associated with the presence of a single QL, or the more stringent two or more biopsies with QL (pⱕ0.05). Recipient HLA A32 was increased in subjects without QL (p⫽0.04). We found no relationship between QL and sex mismatch, ethnicity mismatch, blood type, cyclosporine use, donor age, or the overall number of HLA mismatches. Conclusions: We found no relationship between cyclosporine use and QL formation. Our data suggests the possibility of donor-recipient interactions as a cause of Quilty formation, specifically the presence of donor HLA DR13 and recipient HLA A32 as modulators of this effect. 343 The Role of Pre-Existing Donor Vascular Disease on Allograft Vasculopathy A.M. Zaki1, T.D.G. Lee1,2,3, G.M. Hirsch3, B.M. Ross3 1Dalhousie University, Halifax, NS, Canada; 2Dalhousie University, Halifax, NS, Canada; 3Dalhousie University, Halifax, NS, Canada Purpose: Allograft vasculopathy (AV) is characterized by a progressive vascular lesion in the coronary arteries of transplant patients. This lesion is primarily made up of ␣-actin-positive myofibroblasts and is resistant to current immunosuppressive therapies. Previous rodent AV models have shown that this lesion is of recipient origin, however human studies suggest that it is chimeric, consisting of both donor and recipient elements. We believe that this discrepancy is due to the fact that in rodent models, the neointima is a de novo lesion that is
The Journal of Heart and Lung Transplantation Volume 28, Number 2S
Abstracts
developed by the recruitment of recipient cells. However in human AV, we believe that the lesion also contains elements of pre-existing donor vasculopathy. Methods and Materials: To confirm the recipient nature of the lesion in the presence of Cyclosporine A (CyA), we used B6 Green Fluorescent Protein (GFP) mice recipients of C3H aortic grafts. CyA was used at 50 mg/kg/d. To determine the role of pre-existing disease on AV, we used apolipoprotein-E-deficient (ApoE-/-) mice as donors since they have been shown to develop vascular lesions throughout their aortas. Aortic sections from ApoE-/- B6 mice were transplanted into C3H mice and after 10 weeks the lesions were assessed for AV and cellular infiltration. Results: 97% of the neointimal lesion in the GFP experimental group was positive for green fluorescence compared to 0% in the control group demonstrating the recipient nature of the neointima. The neointimal lesion in the recipients of ApoE-/- donor grafts was chimeric. The lesion consisted of both the pre-existing donor vascular lesion and a de novo lesion. These lesions were discrete and could be easily discriminated by the difference in morphology and ␣-actin positivity: pre-existing lesion negative and neo-intima positive. The neointimal lesion overlays the pre-existing lesion in most cases. Conclusions: Even in the presence of calcineurin inhibition, the neointimal lesion in mouse models is recipient in origin. Donor pre-existing lesions most likely contribute to graft vascular disease in the presence of standard immunosuppression. 344 Risk Factors for Early Death on the French Cardiac Waiting List C. Cantrelle, F. Pessione, D. Tixier, E. Herquelot, Transplant Teams, B. Loty Agence de la Biomedecine, Saint Denis La Plaine, France Purpose: The severity of heart failure on the waiting list is an important criterion for prioritizing heart allocation. The objective of the study was to determine the risk factors linked to the early death on the waiting list. Methods and Materials: Adult recipients registered on the national heart waiting list from 2000 to 2007 were included, except multiple organs and domino donor transplantations. After univariate analysis using Kaplan Meier curves, a cox model was used to determine the risk factors. The event measured was death or retrieval from the list for aggravation in the first 3 months after inscription on the waiting list (55% of death). The factors from the national data base (Cristal) were selected for a p-value inferior to 20 percent in the univariate analysis. The significant factors were those with a p-value⬍0.05. Results: 3374 heart transplantations and 336 events were analysed. 13 factors were involved in the study and different encodings tested. The factors excluded of the final model were ABO group, sex, medical or surgery history, VEF, peak VO2, arterial pressure. The factors which predicted the early death are represented in the table: Conclusions: After adjustment, 8 factors linked to early death on the waiting list were found. The development of a heart score now needs to assess the factors linked of the time spent on the waiting list.
S185
Variable
Hazard Ratio
P-value
intra aortic balloon mechanical ventilation missing value Systolic pulmonary arterial pressure > 50 missing value
1.4 1.8 2.6 10.5 1.4
⬍0.0001 ⬍0.0001 0.06 ⬍0.0001
345 Does Hormonal Resuscitation Increase Recovery of Thoracic Organs? A Single OPO Experience D.S. Nath1, M.H. Liu1, J. Coleman2, J. Wagner2, N. Moazami1, G.A. Ewald3 1Washington University School of Medicine, Saint Louis, MO; 2Mid-America Transplant Services, Saint Louis, MO; 3 Washington University School of Medicine, Saint Louis, MO Purpose: A newly described hormonal resuscitation protocol has been utilized by our OPO to improve donor management. We assessed the efficacy of this protocol in increasing thoracic organ recovery and examined if brain death management time led to an increase in early graft loss. Methods and Materials: The new protocol consisting of fluid, thyroxine, corticosteroid and vasopressin administration was initiated by our OPO in June 2006. Cohort A with donors from June 2004 to May 2006 was compared to Cohort B (subject to new protocol) with donors from June 2006 to May 2008. Cohort A had 273 consented organ donors from whom 70 hearts and 72 lungs were utilized by recipients. Cohort B had 301 consented organ donors from whom 93 hearts and 147 lungs were utilized by recipients. While overall donor pool increased by 10%, overall thoracic organ recovery increased by 70% (p ⬍ 0.001), with a 33% increase for hearts (p ⬍ 0.001) and 104% increase for lungs (p ⬍ 0.001). Conclusions: Aggressive donor management significantly increases thoracic organ recovery without a change in 30-day graft loss. Utilizing this protocol does not significantly prolong donor management time. Results: Both cohorts had similar donor characteristics. Table 1. Donor characteristics
Age Male gender Cause of death
Heart Lung Brain death to recovery time (min)
Head trauma motor vehicle accident Head trauma gunshot wound Non-traumatic stroke/anoxia Other Cold ischemic time (min) 30-day graft loss Cold ischemic time (min) 30-day graft loss
Cohort A; median (range)
Cohort B; median (range)
p value
20 (0.03-49) 64% 60%
22 (0.2-67) 73% 54%
0.37 0.87 0.96
18%
20%
0.20
12%
12%
1.0
10% 190 (90-321)
14% 194.5 (55-276)
0.70 0.47
1.7% 187.5 (91-336)
1.5% 199.5 (102-614)
0.70 0.55
0.7% 1136.5 (601-2537)
1.1% 1590 (577-2578)
0.8 0.93
Variable
Hazard Ratio
P-value
priority access Retrieval from the list before july 2004 Age at registration > 50 years Retransplantation NYHAⴝ4 Cardio-respiratory assistance versus none hospital without drug intensive care unit without drug intravenous inotropes ventricular assistance
1.3 1.3 1.7 1.6 2.1
0.01 0.09 ⬍0.0001 0.04 ⬍0.0001
1.7 2.9 7.4 1.0
⬍0.0001
The Impact of Donor-Recipient Gender Matching on Survival and Rejection after Cardiac Transplantation R.A. Bello, D.A. D’Alessandro, S. Maybaum, D.J. Goldstein Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
0.02
Purpose: Cardiac transplantation remains limited by donor supply. Thus, optimal donor-recipient (D-R) compatibility is critical. Several
346