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534 A Comparison of Post Heart Transplant Outcomes of Patients with and without Pre-Transplant Assist Device Support
S180
The Journal of Heart and Lung Transplantation, Vol 30, No 4S, April 2011
Conclusions: More than half of cardiac sarcoidosis patients were initially diagnosed after CT based on tissue analysis of the explanted heart. Posttransplant outcomes of cardiac sarcoidosis patients were acceptable with only one out of 15 cases with recurrence of cardiac sarcoidosis. Our results support CT as an appropriate treatment option for advanced cardiac sarcoidosis heart failure but the long-term outcome of these patients needs further analysis in larger cohorts. 534 A Comparison of Post Heart Transplant Outcomes of Patients with and without Pre-Transplant Assist Device Support E.C. McGee, Jr, U. Ahmad, W. Cotts, R. Gordon, L. Klein, K. Grady, B. Lapin, G. Ferguson, R. Lee, C. Malaisrie, H. Russell, P. McCarthy. Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL. Purpose: Advances in ventricular assist device (VAD) technology have led to increased utilization of VADs for bridging patients (pts) to heart transplantation(Htx). Despite improvements in VAD morbidity and mortality rates, evidence exists that pts bridged with VADs have decreased short and long-term survival post Htx compared to those not receiving VADS. We compared outcomes of pts at our institution who were bridged with assist devices (BTT) to those going directly to heart transplantation (OHTx). Methods and Materials: 114 pts underwent HTx at Northwestern Memorial Hospital (NMH) from 6/2005- 9/2010. 56 pts (49.1%) were bridged to HTx with a VAD (BTT)(50 [LVADs]:6 [ BiVADs]. 58 pts (50.8%) went directly to HTx (OHTx). The BTT and OHTx groups were analyzed for rates of survival, donor ischemic time, and complications (renal failure, stroke, bleeding, blood product utilization, infection, episodes of ⱖ2R rejection), length of stay, and readmission rates. Level of significance was p⬍0.05. Results: Survival at 30 days (BTT⫽96.4% vs OHTx⫽94.8%), one year (BTT⫽94.2% vs OHTx⫽91.2%), and three years (BTT⫽88.2% vs OHTx⫽81.8%) was not significantly different p⫽.604.
Purpose: Presensitization to human leukocyte antigen (HLA) is the major cause of allograft rejection and hamper the long term graft survival. The recent advance in solid phase assay allows identifying anti-HLA antibodies with high sensitivity and specificity. This permits accurate predicting of crossmatch results and increases the transplantation of sensitized patients as well as the use of allografts from distant regions. Methods and Materials: A total of 313 patients transplanted from January 2006 to July 2009 were analyzed retrospectively. 158 heart recipients were transplanted based on flow cytometry crossmatches (FCXM, previrtual). Results: Since the implementation of virtual crossmatch (vXM) in June 2008, 80 patients were transplanted according to vXM. There were significantly more sensitized patients transplanted by vXM 24/80 (30%) than previrtual period 28/158 (18%, p ⫽ 0.01). The transplant rate was 62% in previrtual period compared to 75% in vXM period by one year. In addition, 71/158(45%) donors were imported from outside OPO in previtrual period compared to 40/80 (50%) in vXM period. However, there was no significant difference in wait time mortality in previtual versus virtual period. The comparison between actual FCXM with vXM showed that vXM accurately predicted all crossmatch results. There were 20 patients with positive FCXM. Among them, 12 patients were completely negative for HLA antibodies. The remaining 6 patients were presensitized to HLA but did not display any donor specific antibodies to HLA. Comparison between actual FCXM with virtual crossmatch Virtual XM/DSA
Actual XM
Pos Neg
Pos
Neg
4 0
20 58
Conclusions: In conclusion, the comprehensive evaluation of HLA antibodies and the application of vXM increased the transplantability of sensitized patients and the geographic distance of the donor pool. 536 NGAL Lacks Specificity for Acute Kidney Injury in Acute Heart Failure Syndrome M. Rai,1,2 C. Statz,1 A. Ras,1 J. Rahn,1 L. O’Bara,1 F. Zaeem,1 R. Mulamalla,1 J. Hammond,1 D. Wencker.1,2 1Heart Failure and Transplant Center, Hartford Hospital, Hartford, CT; 2University of Connecticut, Farmington, CT.
BTT pts had a longer median wait time and required more blood products than OHTx p⬍0.001). Incidence of other complications and length of stay were not significantly different. Conclusions: VADS are an effective therapy for safely bridging pts to cardiac transplant. In this single center study complication rates are comparable to those of pts going directly to heart transplant and intermediate term survival is not statistically different. 535 Virtual Crossmatch Significantly Increases Sensitized Patients to Heart Transplantation Q. Zhang,1 C.J. Michael,1 D.W. Gjertson,1 J. Kobashigawa,2 A. Abbas,3 A. Hickey,3 A.S. Baas,3 D. Cruz,3 E.F. Reed.1 1Immunogenetics Center, Department of Pathology and Lab Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA; 2Cedars-Sinai Heart Institute, David Geffen School of Medicine, UCLA, Los Angeles, CA; 3Division of Cardiology, David Geffen School of Medicine, UCLA, Los Angeles, CA.
Purpose: Neutrophil gelatinase-associated lipocalin (NGAL), a recently identified cytokine, is proposed as a novel marker of kidney injury in heart failure (HF). However, current studies have shown that an increased level of NGAL in the serum is a predictive marker of mortality in HF even in the absence of renal dysfunction, questioning its specificity for the kidney. Recently, a cardiac signaling pathway between interleukin 1 beta (IL-1) and NGAL expression has been identified in rat myocytes. IL-1 is known to be activated by its inflammasome, caspase 1 (C1), which is involved in the progression of cardiomyopathy. We seek to elicit the surge of NGAL in relation to C1 activity and define its role in end stage HF independent of its action in acute kidney injury. Methods and Materials: NGAL and C1 were assessed in different subsets of patients: decompensated HF (n⫽37), cardiogenic shock (n⫽25), and normal healthy controls (n⫽4). Serum NGAL and C1 were measured in solid phase enzyme-linked immunosorbant assays (ELISA). Other variables including NYHA class, serum creatinine and serum BNP were also documented. Results: 62 patients (mean age 62 ⫾ 14.4) with acute decompensated HF (ADHF) were studied. Twenty five patients were in cardiogenic shock and underwent ventricular assist device implant or heart transplant (VAD/TX). NGAL and C1 were markedly upregulated in ADHF patients compared to normal controls (p⫽0.001 and ⬍0.0001, respectively) and were significantly correlated to each other(R⫽0.47, p⫽0.003, n⫽37). After VAD/TX, serum levels of C1 (p⫽0.003) and NGAL (p⫽0.04) decreased significantly. Of note, the rise of BNP in ADHF patients was inversely related with NGAL (R⫽ ⫺0.48, p⫽0.003) and C1 (R⫽ ⫺0.19, p⫽NS) suggesting
The Journal of Heart and Lung Transplantation, Vol 30, No 4S, April 2011
Conclusions: More than half of cardiac sarcoidosis patients were initially diagnosed after CT based on tissue analysis of the explanted heart. Posttransplant outcomes of cardiac sarcoidosis patients were acceptable with only one out of 15 cases with recurrence of cardiac sarcoidosis. Our results support CT as an appropriate treatment option for advanced cardiac sarcoidosis heart failure but the long-term outcome of these patients needs further analysis in larger cohorts. 534 A Comparison of Post Heart Transplant Outcomes of Patients with and without Pre-Transplant Assist Device Support E.C. McGee, Jr, U. Ahmad, W. Cotts, R. Gordon, L. Klein, K. Grady, B. Lapin, G. Ferguson, R. Lee, C. Malaisrie, H. Russell, P. McCarthy. Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL. Purpose: Advances in ventricular assist device (VAD) technology have led to increased utilization of VADs for bridging patients (pts) to heart transplantation(Htx). Despite improvements in VAD morbidity and mortality rates, evidence exists that pts bridged with VADs have decreased short and long-term survival post Htx compared to those not receiving VADS. We compared outcomes of pts at our institution who were bridged with assist devices (BTT) to those going directly to heart transplantation (OHTx). Methods and Materials: 114 pts underwent HTx at Northwestern Memorial Hospital (NMH) from 6/2005- 9/2010. 56 pts (49.1%) were bridged to HTx with a VAD (BTT)(50 [LVADs]:6 [ BiVADs]. 58 pts (50.8%) went directly to HTx (OHTx). The BTT and OHTx groups were analyzed for rates of survival, donor ischemic time, and complications (renal failure, stroke, bleeding, blood product utilization, infection, episodes of ⱖ2R rejection), length of stay, and readmission rates. Level of significance was p⬍0.05. Results: Survival at 30 days (BTT⫽96.4% vs OHTx⫽94.8%), one year (BTT⫽94.2% vs OHTx⫽91.2%), and three years (BTT⫽88.2% vs OHTx⫽81.8%) was not significantly different p⫽.604.
Purpose: Presensitization to human leukocyte antigen (HLA) is the major cause of allograft rejection and hamper the long term graft survival. The recent advance in solid phase assay allows identifying anti-HLA antibodies with high sensitivity and specificity. This permits accurate predicting of crossmatch results and increases the transplantation of sensitized patients as well as the use of allografts from distant regions. Methods and Materials: A total of 313 patients transplanted from January 2006 to July 2009 were analyzed retrospectively. 158 heart recipients were transplanted based on flow cytometry crossmatches (FCXM, previrtual). Results: Since the implementation of virtual crossmatch (vXM) in June 2008, 80 patients were transplanted according to vXM. There were significantly more sensitized patients transplanted by vXM 24/80 (30%) than previrtual period 28/158 (18%, p ⫽ 0.01). The transplant rate was 62% in previrtual period compared to 75% in vXM period by one year. In addition, 71/158(45%) donors were imported from outside OPO in previtrual period compared to 40/80 (50%) in vXM period. However, there was no significant difference in wait time mortality in previtual versus virtual period. The comparison between actual FCXM with vXM showed that vXM accurately predicted all crossmatch results. There were 20 patients with positive FCXM. Among them, 12 patients were completely negative for HLA antibodies. The remaining 6 patients were presensitized to HLA but did not display any donor specific antibodies to HLA. Comparison between actual FCXM with virtual crossmatch Virtual XM/DSA
Actual XM
Pos Neg
Pos
Neg
4 0
20 58
Conclusions: In conclusion, the comprehensive evaluation of HLA antibodies and the application of vXM increased the transplantability of sensitized patients and the geographic distance of the donor pool. 536 NGAL Lacks Specificity for Acute Kidney Injury in Acute Heart Failure Syndrome M. Rai,1,2 C. Statz,1 A. Ras,1 J. Rahn,1 L. O’Bara,1 F. Zaeem,1 R. Mulamalla,1 J. Hammond,1 D. Wencker.1,2 1Heart Failure and Transplant Center, Hartford Hospital, Hartford, CT; 2University of Connecticut, Farmington, CT.
BTT pts had a longer median wait time and required more blood products than OHTx p⬍0.001). Incidence of other complications and length of stay were not significantly different. Conclusions: VADS are an effective therapy for safely bridging pts to cardiac transplant. In this single center study complication rates are comparable to those of pts going directly to heart transplant and intermediate term survival is not statistically different. 535 Virtual Crossmatch Significantly Increases Sensitized Patients to Heart Transplantation Q. Zhang,1 C.J. Michael,1 D.W. Gjertson,1 J. Kobashigawa,2 A. Abbas,3 A. Hickey,3 A.S. Baas,3 D. Cruz,3 E.F. Reed.1 1Immunogenetics Center, Department of Pathology and Lab Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA; 2Cedars-Sinai Heart Institute, David Geffen School of Medicine, UCLA, Los Angeles, CA; 3Division of Cardiology, David Geffen School of Medicine, UCLA, Los Angeles, CA.
Purpose: Neutrophil gelatinase-associated lipocalin (NGAL), a recently identified cytokine, is proposed as a novel marker of kidney injury in heart failure (HF). However, current studies have shown that an increased level of NGAL in the serum is a predictive marker of mortality in HF even in the absence of renal dysfunction, questioning its specificity for the kidney. Recently, a cardiac signaling pathway between interleukin 1 beta (IL-1) and NGAL expression has been identified in rat myocytes. IL-1 is known to be activated by its inflammasome, caspase 1 (C1), which is involved in the progression of cardiomyopathy. We seek to elicit the surge of NGAL in relation to C1 activity and define its role in end stage HF independent of its action in acute kidney injury. Methods and Materials: NGAL and C1 were assessed in different subsets of patients: decompensated HF (n⫽37), cardiogenic shock (n⫽25), and normal healthy controls (n⫽4). Serum NGAL and C1 were measured in solid phase enzyme-linked immunosorbant assays (ELISA). Other variables including NYHA class, serum creatinine and serum BNP were also documented. Results: 62 patients (mean age 62 ⫾ 14.4) with acute decompensated HF (ADHF) were studied. Twenty five patients were in cardiogenic shock and underwent ventricular assist device implant or heart transplant (VAD/TX). NGAL and C1 were markedly upregulated in ADHF patients compared to normal controls (p⫽0.001 and ⬍0.0001, respectively) and were significantly correlated to each other(R⫽0.47, p⫽0.003, n⫽37). After VAD/TX, serum levels of C1 (p⫽0.003) and NGAL (p⫽0.04) decreased significantly. Of note, the rise of BNP in ADHF patients was inversely related with NGAL (R⫽ ⫺0.48, p⫽0.003) and C1 (R⫽ ⫺0.19, p⫽NS) suggesting