Influence of gender on postoperative outcome after intra-aortic balloon counter-pulsation and cardiac surgery.

INTRODUCTION: Female gender is an established risk factor for worse outcomes after cardiac surgery, and women are more likely to experience postoperative complications. Our aim was to analyze the influence of gender on outcome and postoperative complications after the use of intra-aortic balloon counter-pulsation (IABP) in cardiac surgery patients. METHODS: Fifty-seven consecutive female patients (mean age: 73 ± 9 years) requiring an IABP at our department from January 2007 to January 2010 were retrospectively analyzed and compared with 182 male patients receiving IABP support within the same period. The collected data included patient demographics, preoperative state, operative details, postoperative pharmacological treatment, IABP-associated complications, and inhospital mortality. Preoperative mortality risk was calculated by logistic EuroSCORE. RESULTS: There were no differences regarding the type of operation, preoperative renal or hepatic failure, though the prevalence of peripheral artery occlusive disease was higher in men. Furthermore, female patients receiving an IABP were significantly older (73 ± 9 vs. 67 ± 10 years), had a higher ejection fraction (EF) (45% ± 24% vs. 36% ± 14%), and had a higher EuroSCORE (25% ± 20% vs. 19% ± 17%; p < 0.05). Postoperative catecholamine support was significantly higher in the female patients. Women had a prolonged length of stay (LOS) at the ICU (10.64 ± 9.7 vs. 7.6 ± 7.6 days), higher incidence of renal replacement therapy, and a higher mortality (19 [19.4%] vs. 35 [33.9%]; p < 0.05) after the use of IABP. CONCLUSION: Women have a worse outcome after the use of IABP, including LOS at the ICU, postoperative renal failure, and inhospital mortality, despite higher EF, when compared with men.

HLA-DR matching improves survival after heart transplantation: is it time to change allocation policies?

BACKGROUND: HLA matching has improved outcome in kidney transplantation but is not considered in current allocation policies in heart transplantation. The aim of this single-center study was to assess the impact of HLA matching on long- term outcome after heart transplantation. METHODS: The records of 240 consecutive heart transplant recipients (time period 1995 to 2002; mean age 51.8 +/- 11.7 years; mean follow-up 5.9 +/- 1.8 years) were analyzed retrospectively. According to the renal allocation policy, HLA mismatches (MM) on the major antigen loci HLA-A, HLA-B and HLA-DR were calculated, demonstrating 0 to 6 MM. Patients with primary graft failure were excluded from statistical analysis. RESULTS: Survival analysis revealed a statistically significant impact of HLA-DR MM on survival. Five-year survival was 90% in patients without HLA-DR MM (n = 10), 79% in patients with 1 HLA-DR MM (n = 113), and 68.1% in patients with 2 HLA-DR MM (n = 117) (1 MM vs 2 MM: p < 0.05). Freedom from cardiac allograft vasculopathy after 5 years was 89% in HLA-DR-identical recipients (n = 10), 61% in patients with 1 HLA-DR MM (n = 102), 54% in patients with 2 HLA-DR MM (n = 104). Conventional matching with 6 mismatches over the three major HLA antigen loci revealed a trend toward a higher relative risk for adverse outcome in patients with increased MM. CONCLUSIONS: HLA-DR matching had a significant impact on survival after heart transplantation (HTx) at our center. In the effort to achieve the best comparative use of scarce donor organs the inclusion of HLA-DR matching into allocation policies might improve long-term outcome after HTx.

In vitro assessment of dose-dependent platelet activation by polyclonal antithymocyte globulins: a flow-cytometric analysis.

Polyclonal antithymocyte globulins (ATGs) are immunosuppressive drugs widely used in transplantation and hematologic disorders. Treatment with ATGs can induce side effects such as neutropenia and thrombocytopenia because of unspecific antibodies directed against nonmyeloid cells present in these preparations. Depletion, activation, and expression of adhesion molecules on platelets in vitro were studied in the whole blood of healthy volunteers by means of flow cytometry after incubation with different doses of three polyclonal ATGs. Our data show no ATG-mediated cytotoxic activity against platelets. ATGs are able to induce activation of platelets through increased expression of P-selectin and hLAMP-1 and higher percentages of gated thrombocytes expressing these molecules. Furthermore, increased expression of hLAMP-1 presented a dose-dependent pattern. ATGs induced activation and enhanced expression of adhesion molecules in unstimulated platelets. Increased adhesion may be responsible for undesirable side effects such as thrombocytopenia and reticulopenia.