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72: Sinus Rhythm after Heart Transplantation Denotes Favorable Course
The Journal of Heart and Lung Transplantation Volume 27, Number 2S
Abstracts
R.L. Kormos,7 K.R. McCurry,7 1Psychiatry, Psychology and Epidemiology, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA; 2Psychiatry and Surgery, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA; 3Acute and Tertiary Care Nursing, University of Pittsburgh School of Nursing, Pittsburgh, PA; 4Cardiothoracic Transplantation Program, University of Pittsburgh Medical Center, Pittsburgh, PA; 5Institute of Nursing Science, University of Basel, Basel, Switzerland; 6Leuven Heart Transplant Program, University Hospital Leuven, Katholieke Universiteit, Leuven, Belgium; 7Surgery, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA Purpose: Despite the importance of adherence to the medical regimen for optimal health after lung transplant (txp), no prospective studies report on rates of nonadherence to each component of the post-txp regimen. We describe rates and risk factors for nonadherence in a prospectively evaluated cohort of lung recipients. A comparison group of heart recipients was also studied. Methods and Materials: 178 lung and 126 heart recipients (93% of eligible patients) were enrolled. Meta-analyses show that self-report (alone or with collateral data) yields the most evidence of nonadherence; thus adherence was assessed in separate patient and family caregiver interviews at 2, 7, 12, 18 and 24 mos. post-txp. Potential nonadherence risk factors (demographic, healthcare system access, txp-related, treatment-related, psychosocial) were assessed. Results: By 2 years post-txp, lung recipients had lower cumulative incidence rates of persistent nonadherence (ie, at 2⫹ consecutive assessments) than heart recipients for taking immunosuppressants, diet and smoking. Lung recipients had higher persistent nonadherence to blood work and monitoring blood pressure. They had high rates of spirometry nonadherence. In both groups, poor caregiver support and having only public insurance (eg, Medicaid) increased nonadherence risk in all areas. Conclusions: Lung recipients were neither uniformly better nor worse than heart recipients in adhering to their regimen. Lung recipients appear to have more difficulty in home monitoring tasks. Strategies to improve both groups’ adherence should build on caregiver support and on strengthening financial resources for patient healthcare requirements. Nonadherence--Failure to:
Cum. Incidence
Lung v. Heart
Wilcoxon 2
Take immunosuppressants Attend clinic appts. Complete blood work Monitor blood pressure Follow exercise plan Follow diet Abstain from smoking Abstain from heavy alcohol use Perform spirometry (lung only)
.13 .26 .28 .70 .41 .34 .01 .09 .62
.21 .28 .17 .59 .49 .56 .08 .05
4.5* 0.5 5.0* 9.2* 1.4 15.6* 11.4* 1.1
*p⬍.05
71 Restrictive Allograft Physiology after Heart Transplantation: Prevalence and Associated Factors I.P. Garrido,1 D.A. Pascual,1 P. Penafiel Verdu,1 F. Nicolas,2 M. Valdes Chavarri,1 1Cardiology Department, H Universitario Virgen de la Arrixaca, Murcia, Spain; 2Nuclear Medicine Department, H Universitario Virgen de la Arrixaca, Murcia, Spain Purpose: Restrictive behaviour is frequent after heart transplantation (HT). Repeated episodes of rejection or cardiac allograft vasculopathy have been related with this reduction in compliance but this point is not well established. The aim of this study in to determine the real
S85
prevalence of restrictive allograft physiology after HT nowadays and related factors. Methods and Materials: We analysed the routine echocardiographic examinations performed in 2006 to 42 consecutive patients who underwent HT between 1999-2005 (83% men, 51 ⫹/- 14 years) with more than 1 year survival. Restrictive allograft physiology was defined as early transmitral flow velocity (E) ⬎ 1 m/s, late transmitral flow velocity (A ) ⬍ 0.5 m/s and E/A ratio ⬎ 2. Other evaluated variables were age, sex, time after HT, hypertension, previous treated acute rejection, cardiac allograft vasculopathy, creatinine and BNP levels at 1 year after HT. Results: The prevalence restrictive allograft physiology in our population according previous criteria was 26% (11 patients). Using univariable analysis only BNP levels at 1 year were related with the presence of restriction 77 pg/ml [58-112] vs 48 pg/ml [34-78], (p⫽0.01). Using multivariable analysis, 2 factors were significantly associated with restrictive allograft physiology: time after HT (p⫽0.03) and BNP levels at 1 year (p⫽0.03). Conclusions: Restrictive allograft behaviour is highly prevalent in HT patients and it is associated with time after HT and BNP levels at 1 year. 72 Sinus Rhythm after Heart Transplantation Denotes Favorable Course R. Baretti,1 B. Debus,1 D. Kemper,1 C. Knosalla,1 H. Lehmkuhl,1 R. Hetzer,1 1Deutsches Herzzentrum Berlin, Berlin, Germany Purpose: Cardiac graft failure (FAILURE) is a possible complication after heart transplantation (HTx). We tested the hypothesis that the presence and continuation of sinus rhythm (SR) parallel a favorable post-HTx course and are prognostic markers for good cardiac graft function. Methods and Materials: We investigated perioperatively and for 1 year 150 consecutive patients who underwent HTx in our institution between July 1998 and December 2000. In terms of occurrence and continuation of SR after HTx, five groups were formed: I) SR after HTx and stable SR until POD 30; II) SR after HTx but intermittent loss of SR between POD 1 and 30; III) no SR after HTx but development of stable SR before POD 30; IV) SR after HTx but persistent loss of SR between POD 1 and 30; V) no SR by POD 30. Results: At the end of HTx operation SR was present in 91 patients, 43 of whom showed continuous SR until POD 30 and had no FAILURE after 1 year. Forty-three patients did not develop stable SR; 35 of these (81 %) developed FAILURE. By POD 30, 100 patients had stable SR. Three of these (3 %) developed FAILURE between POD 31 and 365. Of the 12 patients with inconspicuous hemodynamics without stable SR at POD 30, 7 (58 %) developed FAILURE between POD 31 and 365. Conclusions: Continuous SR is accompanied by favorable course after HTx. Absence of SR or its loss predicts organ failure. Category
I
II
III
IV
V
Number n GFS % FAILURE %
43 100.0 0.0
37 97.3 2.7
27 96.3 3.7
11 27.3 72.7
32 15.6 84.4
GFS denotes Graft Function Satisfactory
73 Serum Cystatin-C and beta 2-Microglobulin as Markers of Renal Dysfunction in Japanese Heart Transplant Recipients S. Nunoda,1 A. Sekikawa,1 K. Shitakura,1 K. Okajima,1 S. Oinuma,1 Y. Kubo,1 E. Takasugi,1 N. Hotta,1 Y. Watanabe,1 K. Otsuka,1 1Department of Medicine, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
Abstracts
R.L. Kormos,7 K.R. McCurry,7 1Psychiatry, Psychology and Epidemiology, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA; 2Psychiatry and Surgery, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA; 3Acute and Tertiary Care Nursing, University of Pittsburgh School of Nursing, Pittsburgh, PA; 4Cardiothoracic Transplantation Program, University of Pittsburgh Medical Center, Pittsburgh, PA; 5Institute of Nursing Science, University of Basel, Basel, Switzerland; 6Leuven Heart Transplant Program, University Hospital Leuven, Katholieke Universiteit, Leuven, Belgium; 7Surgery, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA Purpose: Despite the importance of adherence to the medical regimen for optimal health after lung transplant (txp), no prospective studies report on rates of nonadherence to each component of the post-txp regimen. We describe rates and risk factors for nonadherence in a prospectively evaluated cohort of lung recipients. A comparison group of heart recipients was also studied. Methods and Materials: 178 lung and 126 heart recipients (93% of eligible patients) were enrolled. Meta-analyses show that self-report (alone or with collateral data) yields the most evidence of nonadherence; thus adherence was assessed in separate patient and family caregiver interviews at 2, 7, 12, 18 and 24 mos. post-txp. Potential nonadherence risk factors (demographic, healthcare system access, txp-related, treatment-related, psychosocial) were assessed. Results: By 2 years post-txp, lung recipients had lower cumulative incidence rates of persistent nonadherence (ie, at 2⫹ consecutive assessments) than heart recipients for taking immunosuppressants, diet and smoking. Lung recipients had higher persistent nonadherence to blood work and monitoring blood pressure. They had high rates of spirometry nonadherence. In both groups, poor caregiver support and having only public insurance (eg, Medicaid) increased nonadherence risk in all areas. Conclusions: Lung recipients were neither uniformly better nor worse than heart recipients in adhering to their regimen. Lung recipients appear to have more difficulty in home monitoring tasks. Strategies to improve both groups’ adherence should build on caregiver support and on strengthening financial resources for patient healthcare requirements. Nonadherence--Failure to:
Cum. Incidence
Lung v. Heart
Wilcoxon 2
Take immunosuppressants Attend clinic appts. Complete blood work Monitor blood pressure Follow exercise plan Follow diet Abstain from smoking Abstain from heavy alcohol use Perform spirometry (lung only)
.13 .26 .28 .70 .41 .34 .01 .09 .62
.21 .28 .17 .59 .49 .56 .08 .05
4.5* 0.5 5.0* 9.2* 1.4 15.6* 11.4* 1.1
*p⬍.05
71 Restrictive Allograft Physiology after Heart Transplantation: Prevalence and Associated Factors I.P. Garrido,1 D.A. Pascual,1 P. Penafiel Verdu,1 F. Nicolas,2 M. Valdes Chavarri,1 1Cardiology Department, H Universitario Virgen de la Arrixaca, Murcia, Spain; 2Nuclear Medicine Department, H Universitario Virgen de la Arrixaca, Murcia, Spain Purpose: Restrictive behaviour is frequent after heart transplantation (HT). Repeated episodes of rejection or cardiac allograft vasculopathy have been related with this reduction in compliance but this point is not well established. The aim of this study in to determine the real
S85
prevalence of restrictive allograft physiology after HT nowadays and related factors. Methods and Materials: We analysed the routine echocardiographic examinations performed in 2006 to 42 consecutive patients who underwent HT between 1999-2005 (83% men, 51 ⫹/- 14 years) with more than 1 year survival. Restrictive allograft physiology was defined as early transmitral flow velocity (E) ⬎ 1 m/s, late transmitral flow velocity (A ) ⬍ 0.5 m/s and E/A ratio ⬎ 2. Other evaluated variables were age, sex, time after HT, hypertension, previous treated acute rejection, cardiac allograft vasculopathy, creatinine and BNP levels at 1 year after HT. Results: The prevalence restrictive allograft physiology in our population according previous criteria was 26% (11 patients). Using univariable analysis only BNP levels at 1 year were related with the presence of restriction 77 pg/ml [58-112] vs 48 pg/ml [34-78], (p⫽0.01). Using multivariable analysis, 2 factors were significantly associated with restrictive allograft physiology: time after HT (p⫽0.03) and BNP levels at 1 year (p⫽0.03). Conclusions: Restrictive allograft behaviour is highly prevalent in HT patients and it is associated with time after HT and BNP levels at 1 year. 72 Sinus Rhythm after Heart Transplantation Denotes Favorable Course R. Baretti,1 B. Debus,1 D. Kemper,1 C. Knosalla,1 H. Lehmkuhl,1 R. Hetzer,1 1Deutsches Herzzentrum Berlin, Berlin, Germany Purpose: Cardiac graft failure (FAILURE) is a possible complication after heart transplantation (HTx). We tested the hypothesis that the presence and continuation of sinus rhythm (SR) parallel a favorable post-HTx course and are prognostic markers for good cardiac graft function. Methods and Materials: We investigated perioperatively and for 1 year 150 consecutive patients who underwent HTx in our institution between July 1998 and December 2000. In terms of occurrence and continuation of SR after HTx, five groups were formed: I) SR after HTx and stable SR until POD 30; II) SR after HTx but intermittent loss of SR between POD 1 and 30; III) no SR after HTx but development of stable SR before POD 30; IV) SR after HTx but persistent loss of SR between POD 1 and 30; V) no SR by POD 30. Results: At the end of HTx operation SR was present in 91 patients, 43 of whom showed continuous SR until POD 30 and had no FAILURE after 1 year. Forty-three patients did not develop stable SR; 35 of these (81 %) developed FAILURE. By POD 30, 100 patients had stable SR. Three of these (3 %) developed FAILURE between POD 31 and 365. Of the 12 patients with inconspicuous hemodynamics without stable SR at POD 30, 7 (58 %) developed FAILURE between POD 31 and 365. Conclusions: Continuous SR is accompanied by favorable course after HTx. Absence of SR or its loss predicts organ failure. Category
I
II
III
IV
V
Number n GFS % FAILURE %
43 100.0 0.0
37 97.3 2.7
27 96.3 3.7
11 27.3 72.7
32 15.6 84.4
GFS denotes Graft Function Satisfactory
73 Serum Cystatin-C and beta 2-Microglobulin as Markers of Renal Dysfunction in Japanese Heart Transplant Recipients S. Nunoda,1 A. Sekikawa,1 K. Shitakura,1 K. Okajima,1 S. Oinuma,1 Y. Kubo,1 E. Takasugi,1 N. Hotta,1 Y. Watanabe,1 K. Otsuka,1 1Department of Medicine, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan