Domino heart transplantation: 10 years experience

The Journal of Heart and Lung Transplantation Volume 18, Number 1

Abstracts

CARDIAC TRANSPLANT OUTCOME BETWEEN PATIENTS SUPPORTED ON A LEFT VENTRICULAR ASSIST DEVICE VERSUS INTRAVENOUS INOTROPIC THERAPY B.E. Jaski. J. Kim, D.C. N&l, R. J. Lingle, S. C. Brazen, J. Jarcho, MR. Costanzo, H.J. Eisen. J.K. Kirklin. R.C. Bourge for the Cardiac Transplant Research Database

RESULTS: There was no significant difference in OV~tdl survival betwee LVAD and medical therapy groups. However, medical therapy arients experienced greater Preedom from infection

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Survival: Medical Therapy VS.LVAD

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INTRAOPERATIVE LIPOSOME-MEDIATED GENE TRANSFECTION OF NITRIC OXIDE SYNTHASE (ecNOS) REDUCES ISCHEMIA-REPERFUSION INIURY IN TRANSPLANTED HEARTS. A.Iwata,. S.Sai, M. Chen. R. Thomas, C. Rothnie, R. Grove*, M.D. Allen, *Megabtos Corp. Burlingame, CA, Cardiothoracic Surgery, University of Washington, Seattle, WA. The neutrophils which cause donor heart ischemiCreperfusion injury gain access to the myocardium by attachment to adhesion molecules on activated coronary endothelium. Nitric oxide inhibits endotbelial-neutrophil interaction by blocking NFkB activation and adhesion molecule expression. In this study we evaluated the eff&cy of intraoperative liposome-mediated transfection of the ecNOS gene into donor hearts as a means of inhibiting ischemia-reperfusion injury in the transfected organ post transplant. Method: Rabbit donor hearts were transfected by intracoronary perfusion of liposomes complexed to the gene encoding ecNOS immediately prior to heterotopic cervical heart transplantation. Controls included @donor hearts transfected with plasmid (PVC) without functional gene; b) donor hearts treated with diluent only (D5W), and c) recipients’ native hearts. At 24 hours post transplant, the donor (transfected) and native hearts were removed and sections of aorta and coronary sinus were analyzed fo! nitrite production by the Griess assay, with anfun;thout added calciTu~el;onophore. Ointiizlogy, manually; weIt neutrophils were ‘v immunocytochemistry and assessed by computerized image analysis. Infiltrates from 18 histologic fields/section were averaged. Results: At 24 hours, calciumdependent nitrite production in the presence of calcium ionophore was significantly incwsed in ecNOS-transfected donor hearts compared with pUCaansfected donor hearts (aorta: 414.3+ 65.9 vs. 113.9&44.1, coronary sinus: 149.1& 59.7 vs. 25.1k8.2 nM/mg, n=lO,p
TRANSFORMING GROWTH FACTOR-BETA (TGF-B) AND ALLOGRAFT VASCULOPATHY FOLLOWING HEART TRANSPLANTATION. T Aziz N Yonan. A Deiraniya. C Campbell, A Rahman, P Haselton, I Hutchinson. Wyihenshawe Hospital, Manchester University, Manchester. UK Background: Cardiac Allogratl Vasculopathy (CAV) is a frequent sequel of Cardiac Transplantation (C.Tx). but the impact cytokines on the subsequent development of CAV is still unknown. Methods: We studied 172 Heart

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transplant recipients between 1987 and 1996 to investigate the relevance of dilIerenl factors on CAV and its correlation with TGFB. We immunohistochemically examined 3G50 endomyocardial biopsy specimens using polyclonal antibodies for TGFB. CAV was diagnosed hy serial coronary angiogrsphy slarting from 20-24 months after C.Tx and rejection was graded according to ISHLT classilicatlon. TGF-B genolype was assessed from peripheral blood samples Results: Patients were aged belween 12-64(mean age 46f12 years). The incidence of CAV in our group was 31% In all CAV patients, TGF-B was immunolocalised in their EMB specimens including the cardiac muscles, endocardium, and vascular endothelium. TGF-B score was signiticantly higher in CAV patients (95% CI 6.5 to 9.9) in comparison lo patients without vaiculopalhy (CI 2.3 to 3.1) P grade 2 during the first 2 years after transplantation was associated with high TGF-B scoring and greater incidence of CAV p
DOMINO HEART TRANSPLANTATION: 10 YEARS EXPERIENCE P. Ongcharlt, H. Eiskjaer. M. Fecchia, G. Taylor, J. Dunning, K. McNeil, J. Parameshwar, J. Wallwork, S.R Large. Papworth Hospital NHS Trust, Cambridge, UK Transplanting the heart of a heart-lung block recipient (domino heart transplantation) maximises organ utilisation and has potential advantages of a short ischaemic time and avoiding the deleterious effects of brain death. Our single centre experience is reviewed. Between March 1989 and August 1998,101 domino hearts were retrieved (62 cystic fibrosis, 17 bronchiectasis, 11 emphysema, 5 primary pulmonary hypertension and 6 others). Sixty-eight hearts (66%) were utilised locally (55 males and 13 females, mean age 49 yn SD: 9.503). Preoperative diagnosis was iscbaemic heart disease in 57% (39), cardiomyopathy 35% (24) and miscellaneous 7% (5). The remaining (33) domino hearts were transplanted at other centres. In context, at our centre during this period we performed 465 heart transplants (65% with organs from cadaveric donors). Mean domino donor age was 31 .O yrs SD: 13.1 and cadaveric 33.3 yrs SD: 12.4. The actuarial survival of domino hearts was 83.5%, 78.6% and 76.7% at 1, 3 and 5 years respectively and similar for the 33 transplanted at other centres 83.636, 71.5% and 61.6%. These results compare well to survival of recipients of cadaveric organs (81 .l%, 75.6% and 70.0% respectively: pXJ.81). Early (30 day) mortality in domino recipients was half (5.8%) that of recipients of cadaveric hearts (10.3%). Perhaps this follows a significantly shorter mean organ ischaemic time (domino group 135.6 min; cadaverlc group 195.4 min, p
DEVELOPMENT OF A SIMPLE RISK MODEL FOR PREDCITING SURVIVAL AFTER ADULT ORTHOTOPIC HEART TRANSPLANTATION AC ANYANWU, CA ROGERS, AJ MURDAY and the Steering Group, UK Cardiothomcic Transplant Audit Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK Background: Knowledge of key donor and recipient factors and their relative impottance can assist in advising patients of the likely outcome of their transplant and in selecting an apprqiate recipient for a donor heart. We have previously presented a simple model for classifying adult orthotopic heart transplants based on the number of risk factors per transplant (JHLT 1998;17:82). We present a refinement of our original model thal allows fof the differential weighting of risk factors Methods: 682 transplants perlcimed over a three year period, from all 8 adult transplant units in the UK, were studied Fourteen potential risk factors for 30&y survival were