The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
-
J. Heart Lung Transplant. · May 2004
ReviewOptimizing the immunosuppressive regimen in heart transplantation.
The use of immunosuppression regimens containing a calcineurin inhibitor (CNI), an adjunct immunosuppressant (e.g., azathioprine, everolimus or mycophenolate mofetil) and corticosteroids has effectively reduced the risk of early graft loss due to acute rejection in heart transplant recipients. At present, late graft loss due to cardiac allograft vasculopathy (CAV) remains a major challenge for transplant teams. CAV is characterized by intimal hyperplasia as a result of endothelial cell injury. ⋯ However, optimal cyclosporine exposure can now be achieved through monitoring of cyclosporine levels 2 hours after dosing (C(2) monitoring). Furthermore, in a pivotal trial in heart transplantation, the new proliferation signal inhibitor, everolimus, plus full-dose cyclosporine and corticosteroids, has been shown to have improved impact on prevention of biopsy-proven acute rejection (and other efficacy end-points) and longer term on the prevention of CAV. In addition, there is evidence from studies in renal transplant recipients that everolimus plus reduced exposure cyclosporine is effective and well tolerated-with the regimen having a reduced potential for CNI-related nephrotoxicity and for other CNI-related cardiovascular side effects.
-
J. Heart Lung Transplant. · May 2004
How to predict forced vital capacity after living-donor lobar-lung transplantation.
Living-donor lobar-lung transplantation (LDLLT) has evolved from a rarely performed experimental procedure to an accepted therapy for selected patients who are unlikely to survive the long wait for cadaveric lungs. However, a convincing study has not been performed that shows the effects of small grafts and of pre-operative variables in predicting functional outcome of recipients after LDLLT. ⋯ Recipient FVC after LDLLT can be predicted by measuring donor FVC before surgery regardless of the diagnosis of the recipient.
-
J. Heart Lung Transplant. · May 2004
Clinical usefulness of bronchoalveolar lavage in heart transplant recipients with suspected lower respiratory tract infection.
Bronchoscopy with bronchoalveolar lavage (BAL) is the recommended initial invasive diagnostic procedure when lower respiratory tract infection is suspected in solid-organ transplant recipients. In this study, we evaluated the clinical impact and safety of bronchoscopy with BAL in heart transplant recipients. ⋯ Bronchoscopy with BAL is a useful diagnostic tool in heart transplant recipients, especially between 1 and 6 months after transplantation.
-
J. Heart Lung Transplant. · May 2004
Management of aortopulmonary collaterals in children following cardiac transplantation for complex congenital heart disease.
Heart transplantation (HTx) is increasingly utilized as therapy for end-stage cyanotic congenital heart disease. This study investigates the presence and impact of aortopulmonary collaterals (APCs) associated with cyanotic heart disease on the early post-operative course of patients undergoing transplantation. High output cardiac failure due to residual aortopulmonary collaterals can affect outcome following heart transplantation. ⋯ Aortopulmonary collaterals should be considered a cause of early donor heart failure in children following HTx for cyanotic congenital heart disease. Early detection and treatment of aortopulmonary collaterals by coil embolization is necessary to improve the post-transplant course in these complex patients.
-
J. Heart Lung Transplant. · May 2004
Bronchoalveolar lavage fluid characteristics in acute and chronic lung transplant rejection.
The detection of graft rejection by bronchoalveolar lavage remains controversial. ⋯ In the present study we were not able to show any difference in lymphocyte sub-types when comparing acute rejection and control subjects. Cellular and soluble parameters in bronchoalveolar lavage fluid appear useful for diagnosing bronchiolitis obliterans.