Showing papers by "Josef Stehlik published in 2013"

The registry of the international society for heart and lung transplantation: Thirtieth official adult heart transplant report - 2013; Focus theme: Age

Abstract: This 30th adult heart transplant report is based on data submitted on 110,486 heart transplants in recipients of all ages (including 99,008 adults) by 407 centers worldwide since 1982 through June 30, 2012, with follow-up until June 30, 2012. Summary data are provided for the entire cohort of patients, whereas a number of additional analyses focus on cohorts who received transplants more recently. Detailed data analyses can be viewed in the International Society for Heart and Lung Transplantation (ISHLT) Registry slide sets available online (www.ishlt.org/registries). The report is divided into several sections:

The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Adult Lung and Heart-Lung Transplant Report--2013; focus theme: age.

Abstract: This section of the 30th official Registry report of 2013 summarizes data from 43,428 adult lung and 3,703 adult heart-lung transplant recipients and their donors for transplants that occurred through June 30, 2012. This report describes donor and recipient characteristics, transplant type, and recipient outcomes data. The full Registry slide set available online (www.ishlt.org/registries) provides more detail, additional analyses, and other information not included in this printed report. For the first time, the Registry report focuses on an overall theme of recipient and donor age and incorporates new age-related analyses into its annual update.

Low-dose dopamine or low-dose nesiritide in acute heart failure with renal dysfunction: the ROSE acute heart failure randomized trial.

Abstract: RESULTS Compared with placebo, low-dose dopamine had no significant effect on 72-hour cumulative urine volume (dopamine, 8524 mL; 95% CI, 7917-9131 vs placebo, 8296 mL; 95% CI, 7762-8830 ; difference, 229 mL; 95% CI, −714 to 1171 mL; P = .59) or on the change in cystatin C level (dopamine, 0.12 mg/L; 95% CI, 0.06-0.18 vs placebo, 0.11 mg/L; 95% CI, 0.06-0.16; difference, 0.01; 95% CI, −0.08 to 0.10; P = .72). Similarly, low-dose nesiritide had no significant effect on 72-hour cumulative urine volume (nesiritide, 8574 mL; 95% CI, 8014-9134 vs placebo, 8296mL; 95% CI, 7762-8830; difference, 279 mL; 95% CI, −618 to 1176 mL; P = .49) or on the change in cystatin C level (nesiritide, 0.07 mg/L; 95% CI, 0.01-0.13 vs placebo, 0.11 mg/L; 95% CI, 0.06-0.16; difference, −0.04; 95% CI, −0.13 to 0.05; P = .36). Compared with placebo, there was no effect of low-dose dopamine or nesiritide on secondary end points reflective of decongestion, renal function, or clinical outcomes.

The Registry of the International Society for Heart and Lung Transplantation: Sixteenth Official Pediatric Heart Transplantation Report--2013; focus theme: age.

Abstract: ISHLT Registry data are provided by individual centers and national or regional Organ Procurement and Organ Exchange Organizations; these are listed in the introduction to the Annual Reports. This 16th pediatric heart transplant report from the ISHLT Registry is centered on age as the central theme, focusing on the year 2000 onwards. Key topics include geographic trends, diagnosis, survival, and the conventional post-transplant morbidities. A number of these characteristics and outcomes were analyzed for age-related differences between the newly defined age groups of 0 to o1 year, 1 to 5 years, 6 to 10 years, and 11 to 17 years. In follow-up of last year’s reported regional variation, we explored interactions among age, diagnosis, and geography and their respective effect on transplant survival. The Tables and Figures published in this report, as well as the slides describing additional analyses, are available for download

Pulsatility and the Risk of Nonsurgical Bleeding in Patients Supported With the Continuous-Flow Left Ventricular Assist Device HeartMate II

Abstract: Background—Bleeding is an important cause of morbidity and mortality in patients with continuous-flow left ventricular assist devices (LVADs). Reduced pulsatility has been implicated as a contributing cause. The aim of this study was to assess the effects of different degrees of pulsatility on the incidence of nonsurgical bleeding. Methods and Results—The Utah Transplantation Affiliated Hospitals (U.T.A.H.) heart failure and transplant program databases were queried for patients with end-stage heart failure who required support with the continuous-flow LVAD HeartMate II (Thoratec Corp, Pleasanton, CA) between 2004 and 2012. Pulsatility was evaluated by means of the LVAD parameter pulsatility index (PI) and by the echocardiographic assessment of aortic valve opening during the first 3 months of LVAD support. PI was analyzed as a continuous variable and also stratified according to tertiles of all the PI measurements during the study period (low PI: 5.2). Major ...

Morbidity and Mortality in Heart Transplant Candidates Supported With Mechanical Circulatory Support Is Reappraisal of the Current United Network for Organ Sharing Thoracic Organ Allocation Policy Justified

Abstract: Background—Survival of patients on left ventricular assist devices (LVADs) has improved. We examined the differences in risk of adverse outcomes between LVAD-supported and medically managed candidates on the heart transplant waiting list. Methods and Results—We analyzed mortality and morbidity in 33 073 heart transplant candidates registered on the United Network for Organ Sharing (UNOS) waiting list between 1999 and 2011. Five groups were selected: patients without LVADs in urgency status 1A, 1B, and 2; patients with pulsatile-flow LVADs; and patients with continuous-flow LVADs. Outcomes in patients requiring biventricular assist devices, total artificial heart, and temporary VADs were also analyzed. Two eras were defined on the basis of the approval date of the first continuous-flow LVAD for bridge to transplantation in the United States (2008). Mortality was lower in the current compared with the first era (2.1%/mo versus 2.9%/mo; P<0.0001). In the first era, mortality of pulsatile-flow LVAD patients w...

The Registry of the International Society for Heart and Lung Transplantation: Sixteenth Official Pediatric Lung and Heart-Lung Transplantation Report—2013; Focus Theme: Age

Abstract: This section of the 16th official Registry report of the International Society for Heart and Lung Transplantation (ISHLT) summarizes the pediatric lung and heart-lung transplantation activity from January 1986 through June 2012. Since 1986, 1,875 pediatric lung transplants and 667 pediatric heart-lung transplants have been reported. In 2011, the last complete year included in this year’s Registry report, 107 pediatric lung transplants were performed, which is comparable to figures in 2007 but lower than in 2010, when 125 procedures were performed. However, it is important to note, that figures included in this Registry report contain only the pediatric lung transplants that were reported to the Registry and, thus, do not necessarily reflect numbers of pediatric lung procedures performed worldwide. This Registry report includes a summary of data analyses performed by the Registry and is supplemented by further analyses, Figures, and more detailed information available on the ISHLT Web site (www.ishlt.org/registries). The 2013 Registry report on pediatric lung transplantation focuses for the first time on an overall theme together with the Registry reports on adult lung, adult heart, and pediatric heart transplantation. The selected topic for this year’s reports is age and age-related aspects of recipients and donors, along with outcome-related analyses wherever sufficient data are available. Data on pediatric heart-lung transplants are not presented in this year’s report because those were presented

ISHLT International Registry for Heart and Lung Transplantation--into the fourth decade, from strength to strength.

Abstract: This year, the ISHLT International Registry for Heart andLung Transplantation enters into its fourth decade. Withdata from more than 160,000 thoracic transplant recipients,the Registry is the largest repository of heart and lungtransplant data in the world.The Registry has had an interesting and somewhattumultuous history. One of the authors, Jeffrey Hosenpudwas directly involved in its earliest times. His first directinvolvement was in 1988 when, after performing atransplant in a patient with amyloid light-chain (AL)

The detection and role of circulating antibodies in rejection.

Abstract: Purpose of reviewIn this review, we first discuss the evolution and current controversies in antibody detection methodology for transplant candidates. Then, we summarize how immunologists and transplant clinicians integrate new evidence with their understanding of how recipient alloantibodies influe

Immune function surveillance: association with rejection, infection and cardiac allograft vasculopathy.

Abstract: Background Rejection, cardiac allograft vasculopathy (CAV), and infection are significant causes of mortality in heart transplantation recipients. Assessing the immune status of a particular patient remains challenging. Although endomyocardial biopsy (EMB) and angiography are effective for the identification of rejection and CAV, respectively, these are expensive, invasive, and may have numerous complications. The aim of this study was to evaluate the immune function and assess its utility in predicting rejection, CAV, and infection in heart transplantation recipients. Methods We prospectively obtained samples at the time of routine EMB and when clinically indicated for measurement of the ImmuKnow assay (IM), 12 cytokines and soluble CD30 (sCD30). EMB specimens were evaluated for acute cellular rejection, and antibody-mediated rejection (AMR). CAV was diagnosed by the development of angiographic coronary artery disease. Infectious episodes occurring during the next 30 days after testing were identified by the presence of positive bacterial or fungal cultures and/or viremia that prompted treatment with antimicrobials. Results We collected 162 samples from 56 cardiac transplant recipients. There were 31 infection episodes, 7 AMR, and 4 CAV cases. The average IM value was significantly lower during infection, ( P = .04). Soluble CD30 concentrations showed significantly positive correlation with infection episodes, ( P = .001). Significant positive correlation was observed between interleukin-5(IL-5) and AMR episodes ( P = .008). Tumor necrosis factor–α and IL-8 showed significant positive correlation with CAV ( P = .001). Conclusions Immune function monitoring appears promising in predicting rejection, CAV, and infection in cardiac transplantation recipients. This approach may help in more individualized immunosuppression and it may also minimize unnecessary EMBs and cardiac angiographies.

Feasibility of personalized nonparametric analytics for predictive monitoring of heart failure patients using continuous mobile telemetry

Abstract: Nonparametric model-based analytics personalized to the physiology of each patient are investigated for predictive monitoring of exacerbation in heart failure patients at home. Multivariate vital sign data are provided by means of continuous bio-signal acquisition with a mobile phone-based wearable sensor system worn by patients for several hours a day in the home ambulatory environment. Perturbation analysis demonstrates that individual patient physiological behavior is indeed effectively learned by the analytics, with high sensitivity to changes in physiological dynamics. Comparison of the analytics results with absence of unplanned medical events and self-reported wellness during regular patient follow-up demonstrate a very low false alert burden, suggesting this approach is efficient for remote clinical surveillance.

Magnitude and Time Course of Changes Induced by Continuous-Flow Left Ventricular Assist Device Unloading in Chronic Heart Failure: Insights into Cardiac Recovery

Abstract: Purpose The magnitude, timeline and sustainability of changes induced by continuous-flow left ventricular assist device (CF-LVAD) unloading on the structure and function of the failing human heart are unknown. Methods and Materials Eighty consecutive patients with chronic heart failure requiring CF-LVAD implantation were prospectively enrolled. Serial echocardiograms (1, 2, 3, 4, 6, 9 and 12 months) were performed after implant to evaluate the longitudinal effects of CF-LVADs on myocardial structure and function. Cardiac recovery was assessed on the basis of improvement in systolic and diastolic function indices that were sustained during LVAD turn-down studies. Results After 6 months of LVAD unloading, 22% of patients had an LVEF of 30-39% and 19% achieved an LVEF≥40% ( Figure ). In those with an LVEF≥40%, LV systolic function improved as early as 30 days, the greatest degree of improvement was achieved by 6 months and persisted over the 1-year follow-up ( Figure , panel C). LV diastolic function also improved as early as 30 days and this improvement persisted over time. LV end-diastolic and end-systolic volumes decreased as early as 30 days post-implant (120±39 vs. 82±36 ml/m2, p Conclusions CF-LVAD unloading induced in a subset of patients, both ischemic and nonischemics, early improvement in myocardial structure and systolic and diastolic function that was largely completed within 6 months, with no evidence of subsequent regression.

Assessment of Right Ventricle before the Implantation of Left Ventricular Assist Device by Echocardiographic Parameters (ARVADE)

Abstract: 641 Potential Application of the CircuLite Synergy Circulatory Support System in the Treatment of Pulmonary Arterial Hypertension B Meyns, F Rega, A Simon, W Kerkhoffs, E Keysselitz, O Marseille, M Martin, J Budris, D Burkhoff KULeuven Gasthuisberg University Hospital, Leuven, Belgium; Harefield Hospital, Harefield, United Kingdom; CircuLite, GmbH, Aachen, Germany; CircuLite, Inc, Saddle Brook, NJ