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Recipient Match Improve Outcome after Heart Transplantation?
Abstracts significantly less with EVR (0.030⫾0.052) vs MMF (0.070⫾0.110), p⫽0.0003. For all lipid parameters, more EVR patients were found in higher lipid categories, however showed less average MIT increase vs MMF (Table). Higher lipid values did not significantly affect slope of change of MIT (LDL-C: EVR 0.021; p⫽0.801 and MMF 0.055; p⫽0.141).
Conclusions: Across different categories of lipid parameters the increase in average MIT was smaller with EVR vs MMF. For both treatments, elevated lipids did not significantly affect increase in MIT. The antiproliferative effect of EVR on the arterial intima was maintained, irrespective of higher lipid values. 58 Sorting Out the Intricacies of Multiparity Risk on Outcomes after Heart Transplantation E. Stimpson,1,2 L. Piponniau,1 J. Patel,1 A. Velleca,1 M. Kawano,1 Z. Goldstein,1 M. Rafiei,1 N. Reinsmoen,1 L. Czer,1 F. Esmailian,1 J. Kobashigawa.1 1Cedars-Sinai Heart Institute, Los Angeles, CA; 2 University of California Los Angeles, Los Angeles, CA. Purpose: It has been demonstrated in the ISHLT registry that parous females have increased risk of rejection in the first year after heart transplant (HTx) vs. nulliparous females (JHLT 1997; 16(8):801-12). It has not been established whether the number of pregnancies incrementally increases this risk in patients (pts) on triple drug immunosuppression. Therefore we reviewed our female HTx pts for the number of pregnancies and 1st-year rejection after HTx. Methods and Materials: We reviewed 280 female pts transplanted between 1994 and 2009 for number of pregnancies. Pts were divided according to number of pregnancies, from 0 to ⱖ5. These groups were assessed for the development of circulating antibodies (Ab) prior to transplant. Post HTx, we assessed 1st-year freedom from any-treated rejection and 5-year actuarial survival, freedom from cardiac allograft vasculopathy (CAV, any stenosis ⬎ 30%), and non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, heart failure, stents, defibrillator, stroke, and new peripheral vascular disease). Results: Post Htx, pts in the 4 or ⱖ5 pregnancy groups had increased risk for antibody mediated rejection (AMR) and any-treated rejection compared to those pts with 0-3 pregnancies (p⬍0.05). Pts with 0, 1, 2 and 3 pregnancies were found to have similar 1st-year freedom from any-treated rejection, including cellular rejection and AMR. There was no significant difference in 5-year actuarial survival, freedom from CAV, and freedom from NF-MACE between all groups. The percent of pts with positive pre-transplant circulating Ab (PRA ⬎ 10%) was comparable between the 4-5 pregnancy groups and the 0-3 pregnancy groups (15% vs. 16%, p⫽0.97) Conclusions: Multiparity with ⱖ4 pregnancies appears to hold the greatest risk for AMR in the 1st year after HTx. We speculate that this may be due to increased memory B cells as pre-transplant sensitization was similar in all multiparous groups. Parous female pts with 1 to 3 pregnancies may not be at increased rejection risk compared to nulliparous female heart recipients. 59 Myth Buster: Does Homogeneous Racial Donor/Recipient Match Improve Outcome after Heart Transplantation? T. Kao, A. Velleca, M. Kittleson, L. Piponniau, J. Rush, M. Kawano, Z. Goldstein, D. Luthringer, L. Czer, F. Esmailian, J. Kobashigawa. Cedars-Sinai Heart Institute, Los Angeles, CA.
S27 Purpose: Whether donor/recipient (D/R) race mismatch impacts long term outcome following heart transplant in patients on triple-drug immunosuppression is not clear. D/R race matching may result in less rejection due lower heterogeneity of donor antigens presented to the recipient. The purpose of this study was to determine the effect of D/R race mismatch on outcomes at our center. Methods and Materials: We reviewed 1005 patients transplanted 19942010. Based upon the D/R race combination, patients were divided into race match (N⫽580) and race mismatch (N⫽425) groups. Specific race mismatches were also analyzed. Those patients who were of mixed or undetermined race were excluded. Assessed outcomes included first-year freedom from any-treated rejection and five-year survival, freedom from cardiac allograft vasculopathy (CAV, angiographic stenosis ⬎ 30%), and freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, heart failure, PCI, ICD, stroke, and new peripheral vascular disease). Results: There was no significant difference between race matched and mismatched groups in first-year freedom from any-treated rejection (90% vs. 89%, p⫽0.55), 5-year survival (76% vs. 74%, p⫽0.60), 5-year freedom from CAV (81% vs. 85%, p⫽0.14), and 5-year freedom from NF-MACE (89% vs. 89%, p⫽0.74). There was also no significant difference in outcomes according to specific race mismatch populations (see table for 1st year any treated rejection). Table 1
1st-Year Freedom from Any-Treated Rejection
Caucasian D African American D Hispanic D Asian D
Caucasian R
African American R
Hispanic R
Asian R
10% 5% 10% 13%
15% 14% 8% 13%
13% 0% 0% 0%
11% 33% 50% 17%
(N⫽557) (N⫽67) (N⫽128) (N⫽39)
(N⫽62) (N⫽14) (N⫽25) (N⫽8)
(N⫽45) (N⫽3) (N⫽5) (N⫽4)
(N⫽37) (N⫽3) (N⫽2) (N⫽6)
R⫽Recipient, D⫽Donor; P⫽NS in all groups.
Conclusions: In a large cohort of patients with uniform post transplant care, D/R race mismatch does not appear to affect outcome after heart transplantation. This result is reassuring given the limiting supply of donor hearts. 60 The Life of the Octogenarian Heart Transplant Patient D. Lockhart, L. Piponniau, A. Velleca, J. Patel, M. Kittleson, B. Kearney, T. Kao, M. Johnson, M. Kawano, Z. Goldstein, M. Rafiei, J. Kobashigawa. Cedars-Sinai Heart Institute, Los Angeles, CA. Purpose: Heart transplantation is routinely performed for patients in their 60s and on select patients over 70. As these heart transplant patients survive into their 80’s, octogenarian recipients now constitute a significant portion of the heart transplant population. The purpose of the current study was to define and characterize the medical issues facing octogenarian heart transplant recipients. Methods and Materials: Between 1998 and 2004, 711 heart transplant patients in their 60s, and 70’s were transplanted at our center. Of these, 41 patients are now 80 or older. We compared the complications of these octogenarians to those patients in their 60s and 70s (matched in a 2:1 fashion for sex, era and time from transplant). The complications assessed: infections, renal failure, malignancy, bone abnormalities (osteoporosis and fractures), diabetes, hypertension, cataracts, obesity, and transplant coronary artery disease (TCAD). Results: The average time from heart transplant was similar by design in the 60/70 year old and octogenarian groups (11 years). Octogenarian heart transplant recipients had a higher incidence of malignancy compared to the 60/70 year olds (58% vs. 33%, p⫽0.015) and demonstrated a trend toward a higher incidence of bone abnormalities (39% vs. 21%, p⫽0.06). However, there was no difference between the groups in the incidence of infections, renal failure, diabetes, hypertension, cataract surgeries, obesity, and TCAD (table).
Conclusions: Across different categories of lipid parameters the increase in average MIT was smaller with EVR vs MMF. For both treatments, elevated lipids did not significantly affect increase in MIT. The antiproliferative effect of EVR on the arterial intima was maintained, irrespective of higher lipid values. 58 Sorting Out the Intricacies of Multiparity Risk on Outcomes after Heart Transplantation E. Stimpson,1,2 L. Piponniau,1 J. Patel,1 A. Velleca,1 M. Kawano,1 Z. Goldstein,1 M. Rafiei,1 N. Reinsmoen,1 L. Czer,1 F. Esmailian,1 J. Kobashigawa.1 1Cedars-Sinai Heart Institute, Los Angeles, CA; 2 University of California Los Angeles, Los Angeles, CA. Purpose: It has been demonstrated in the ISHLT registry that parous females have increased risk of rejection in the first year after heart transplant (HTx) vs. nulliparous females (JHLT 1997; 16(8):801-12). It has not been established whether the number of pregnancies incrementally increases this risk in patients (pts) on triple drug immunosuppression. Therefore we reviewed our female HTx pts for the number of pregnancies and 1st-year rejection after HTx. Methods and Materials: We reviewed 280 female pts transplanted between 1994 and 2009 for number of pregnancies. Pts were divided according to number of pregnancies, from 0 to ⱖ5. These groups were assessed for the development of circulating antibodies (Ab) prior to transplant. Post HTx, we assessed 1st-year freedom from any-treated rejection and 5-year actuarial survival, freedom from cardiac allograft vasculopathy (CAV, any stenosis ⬎ 30%), and non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, heart failure, stents, defibrillator, stroke, and new peripheral vascular disease). Results: Post Htx, pts in the 4 or ⱖ5 pregnancy groups had increased risk for antibody mediated rejection (AMR) and any-treated rejection compared to those pts with 0-3 pregnancies (p⬍0.05). Pts with 0, 1, 2 and 3 pregnancies were found to have similar 1st-year freedom from any-treated rejection, including cellular rejection and AMR. There was no significant difference in 5-year actuarial survival, freedom from CAV, and freedom from NF-MACE between all groups. The percent of pts with positive pre-transplant circulating Ab (PRA ⬎ 10%) was comparable between the 4-5 pregnancy groups and the 0-3 pregnancy groups (15% vs. 16%, p⫽0.97) Conclusions: Multiparity with ⱖ4 pregnancies appears to hold the greatest risk for AMR in the 1st year after HTx. We speculate that this may be due to increased memory B cells as pre-transplant sensitization was similar in all multiparous groups. Parous female pts with 1 to 3 pregnancies may not be at increased rejection risk compared to nulliparous female heart recipients. 59 Myth Buster: Does Homogeneous Racial Donor/Recipient Match Improve Outcome after Heart Transplantation? T. Kao, A. Velleca, M. Kittleson, L. Piponniau, J. Rush, M. Kawano, Z. Goldstein, D. Luthringer, L. Czer, F. Esmailian, J. Kobashigawa. Cedars-Sinai Heart Institute, Los Angeles, CA.
S27 Purpose: Whether donor/recipient (D/R) race mismatch impacts long term outcome following heart transplant in patients on triple-drug immunosuppression is not clear. D/R race matching may result in less rejection due lower heterogeneity of donor antigens presented to the recipient. The purpose of this study was to determine the effect of D/R race mismatch on outcomes at our center. Methods and Materials: We reviewed 1005 patients transplanted 19942010. Based upon the D/R race combination, patients were divided into race match (N⫽580) and race mismatch (N⫽425) groups. Specific race mismatches were also analyzed. Those patients who were of mixed or undetermined race were excluded. Assessed outcomes included first-year freedom from any-treated rejection and five-year survival, freedom from cardiac allograft vasculopathy (CAV, angiographic stenosis ⬎ 30%), and freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, heart failure, PCI, ICD, stroke, and new peripheral vascular disease). Results: There was no significant difference between race matched and mismatched groups in first-year freedom from any-treated rejection (90% vs. 89%, p⫽0.55), 5-year survival (76% vs. 74%, p⫽0.60), 5-year freedom from CAV (81% vs. 85%, p⫽0.14), and 5-year freedom from NF-MACE (89% vs. 89%, p⫽0.74). There was also no significant difference in outcomes according to specific race mismatch populations (see table for 1st year any treated rejection). Table 1
1st-Year Freedom from Any-Treated Rejection
Caucasian D African American D Hispanic D Asian D
Caucasian R
African American R
Hispanic R
Asian R
10% 5% 10% 13%
15% 14% 8% 13%
13% 0% 0% 0%
11% 33% 50% 17%
(N⫽557) (N⫽67) (N⫽128) (N⫽39)
(N⫽62) (N⫽14) (N⫽25) (N⫽8)
(N⫽45) (N⫽3) (N⫽5) (N⫽4)
(N⫽37) (N⫽3) (N⫽2) (N⫽6)
R⫽Recipient, D⫽Donor; P⫽NS in all groups.
Conclusions: In a large cohort of patients with uniform post transplant care, D/R race mismatch does not appear to affect outcome after heart transplantation. This result is reassuring given the limiting supply of donor hearts. 60 The Life of the Octogenarian Heart Transplant Patient D. Lockhart, L. Piponniau, A. Velleca, J. Patel, M. Kittleson, B. Kearney, T. Kao, M. Johnson, M. Kawano, Z. Goldstein, M. Rafiei, J. Kobashigawa. Cedars-Sinai Heart Institute, Los Angeles, CA. Purpose: Heart transplantation is routinely performed for patients in their 60s and on select patients over 70. As these heart transplant patients survive into their 80’s, octogenarian recipients now constitute a significant portion of the heart transplant population. The purpose of the current study was to define and characterize the medical issues facing octogenarian heart transplant recipients. Methods and Materials: Between 1998 and 2004, 711 heart transplant patients in their 60s, and 70’s were transplanted at our center. Of these, 41 patients are now 80 or older. We compared the complications of these octogenarians to those patients in their 60s and 70s (matched in a 2:1 fashion for sex, era and time from transplant). The complications assessed: infections, renal failure, malignancy, bone abnormalities (osteoporosis and fractures), diabetes, hypertension, cataracts, obesity, and transplant coronary artery disease (TCAD). Results: The average time from heart transplant was similar by design in the 60/70 year old and octogenarian groups (11 years). Octogenarian heart transplant recipients had a higher incidence of malignancy compared to the 60/70 year olds (58% vs. 33%, p⫽0.015) and demonstrated a trend toward a higher incidence of bone abnormalities (39% vs. 21%, p⫽0.06). However, there was no difference between the groups in the incidence of infections, renal failure, diabetes, hypertension, cataract surgeries, obesity, and TCAD (table).