Showing papers by "Dale G. Renlund published in 1988"

Increased cardiac allograft rejection in female heart transplant recipients

Abstract: To assess differences between male and female recipients after heart transplantation, we retrospectively reviewed 140 consecutive heart transplant recipients (119 males and 21 females) with regard to sex and characteristics before and after transplantation. Before transplantation, fewer female recipients had heart failure on the basis of coronary artery disease (14% versus 56%, p = 0.001), and more females required inotropic agents (71% versus 38%, p = 0.007). Although average follow-up (for females 430 +/- 73 days, range 12 to 1097 days; for males 412 +/- 27 days, range 1 day to 1103 days, mean +/- standard error of the mean), mortality (one female and nine males), and proportion of recipients with infectious complications (48% females and 52% males) did not differ between the groups, female recipients manifested a higher incidence of rejection during the first 4 months (2.39 +/- 0.27 episodes versus 1.67 +/- 0.11 episodes, p = 0.010) and during follow-up (3.24 +/- 0.44 episodes versus 2.20 +/- 0.21 episodes, p = 0.012). Although it was possible to discontinue maintenance dosages of corticosteroids in 65% of males, corticosteroid discontinuation was possible in only 17% of females (p less than 0.001). Furthermore, in a stepwise logistic regression analysis that included age, crossmatch (no female recipients with positive results, three males with positive results), cause of heart failure, and hemodynamic status before transplantation, females were more likely to experience a rejection episode than males (p less than 0.001). Although female recipients experience rejection episodes more than their male counterparts after heart transplantation and are more likely to require maintenance corticosteroid therapy, survival and the incidence of infectious complications are not different.

Effect of preoperative hemodynamic support on survival after cardiac transplantation.

Abstract: The accessibility and success of cardiac transplantation promotes transplantation for a broad range of recipients, including those requiring intravenous inotropes or mechanical-assist devices. To determine if survival is dependent on preoperative requirements for hemodynamic support, we studied 230 patients who underwent transplant at the Loyola, Stanford, and UTAH programs from December 1, 1984 through November 30, 1986, and who were followed up for 34 months postoperatively. Group 1 (n = 132 of 230, 57%) patients required only oral medical therapy to maintain hemodynamic compensation; Group 2 (n = 69 of 230, 30%) patients were dependent on intravenous inotropic support; and Group 3 (n = 29 of 230, 13%) patients required mechanical assistance. Pretransplant characteristics showed that dilated cardiomyopathy was more common in Group 2 patients, and lower cardiac index and ejection fraction were more prevalent in Group 3 patients as expected. Although survival was lower in Group 3 only at 1 month (Group 1, 98.5%; Group 2, 92.8%; and Group 3, 86.2%; p less than 0.01), the survival advantage in Groups 1 and 2 was lost by 3 months, with 1-year survival rates of 88.6% in Group 1, 81.2% in Group 2, and 82.8% in Group 3. Allograft survival and cause of death were not different among the three groups. Acute rejection occurred at a lower monthly frequency in the first 4 months in Group 3 (Group 1, 0.47 +/- 0.03; Group 2, 0.47 +/- 0.05; and Group 3, 0.29 +/- 0.06; p less than 0.01), whereas infectious complications occurred at similar frequencies.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of cytomegalovirus pneumonia in heart transplant recipients with 9(1,3-dihydroxy-2-proproxymethyl)-guanine (DHPG)

Abstract: Cytomegalovirus (CMV) infection is a frequent cause of serious illness in heart transplant patients and may cause life-threatening pneumonia, with a reported mortality of greater than 50%. We investigated the clinical efficacy of a new antiviral agent, 9(1,3-dihydroxy-2-proproxymethyl)-guanine (DHPG) in the treatment of CMV pneumonia in heart transplant patients. Four of these patients with biopsy-proved CMV pneumonia were treated with DHPG, with resolution of pneumonia and no relapse at a mean follow-up period of 21 weeks. DHPG may be useful in the treatment of CMV pneumonia in heart transplant patients.

Acute vascular rejection involving the major coronary arteries of a cardiac allograft

Abstract: A case of acute vascular rejection occurring in a cardiac allograft is presented. The rejection was characterized by prominent lymphocytic infiltration of the major coronary arteries in a pattern similar to that observed in acute vascular rejection occurring in renal allografts. Additionally, there was electron microscopic evidence of endothelial damage of smaller vessels. In addition to routine light microscopic evaluation of heart biopsies obtained in this case, immunofluorescent staining of biopsies for IgG, IgM, C3, Clq, fibrinogen, T cells, B cells, and Ia human leukocyte antigen (HLA-DR) was also performed. These studies suggest that antibodies may have been important in the terminal rejection episode described in this case. Furthermore, immunofluorescent staining detected continuing endothelial cell damage, reflected as Ia antigen positivity of allograft blood vessels, despite apparent improvement of rejection as judged by light microscopy.

OKT3 monoclonal antibody in cardiac transplantation. Experience with 102 patients.

Abstract: OKT3 is a murine monoclonal antibody that is reactive against the CD3 surface antigen on T lymphocytes. This antigen appears to be essential for recognition of foreign antigen and for initiation of the process of cell-mediated rejection. One hundred and two patients having orthotopic cardiac transplantation in a single program during a 3-year period received prophylactic immune suppression with OKT3, along with azathioprine and low-dose steroids. Patients began receiving cyclosporine on Day 11; steroid-weaning was attempted 3 weeks after transplantation. In this group of patients, the time to the first rejection was 76 +/- 11 days (mean +/- SEM), and 85% were successfully weaned from maintenance steroids. Avoidance of the side effects of cyclosporine and/or high dose steroids during the perioperative period, combined with a long rejection-free interval and the likelihood of long-term maintenance free of steroids, make the use of OKT3 or similar agents an attractive alternative to conventional immunosuppression.