Long-term prognostic role of CA-125 in noncongestive patients undergoing a cardiac transplantation.

AIM: To evaluate the possible relationship between high levels of CA-125 and long-term prognosis in chronic heart failure patients after they undergo a cardiac transplantation (CT). MATERIALS & METHODS: We retrospectively studied all patients who underwent a CT and had a previous determination of CA-125. Congestive patients and those whose survival was <1 year after CT were excluded. RESULTS: Of 55 patients, 23 had elevated CA-125 levels (>35 U/ml). After CT, survival was significantly inferior in this group (96.3 vs 81%, 84.9 vs 64%, 70.7 vs 32.9% at 2, 5 and 8 years, p = 0.014). CA-125 >35 U/ml was the only factor independently associated to long-term mortality (OR: 3.94; 95% CI: 1.2-12.82; p = 0.023). CONCLUSION: Noncongestive patients with high levels of CA-125 had inferior long-term survival after CT.

Impact of short-term mechanical circulatory support with extracorporeal devices on postoperative outcomes after emergency heart transplantation: data from a multi-institutional Spanish cohort.

OBJECTIVES: We sought to investigate the potential impact of preoperative short-term mechanical circulatory support (MCS) with extracorporeal devices on postoperative outcomes after emergency heart transplantation (HT). METHODS: We conducted an observational study of 669 patients who underwent emergency HT in 15 Spanish hospitals between 2000 and 2009. Postoperative outcomes of patients bridged to HT on short-term MCS (n=101) were compared with those of the rest of the cohort (n=568). Short-term MCS included veno-arterial extracorporeal membrane oxygenators (VA-ECMOs, n=23), and both pulsatile-flow (n=53) and continuous-flow (n=25) extracorporeal ventricular assist devices (VADs). No patient underwent HT on intracorporeal VADs. RESULTS: Preoperative short-term MCS was independently associated with increased in-hospital postoperative mortality (adjusted odds-ratio 1.75, 95% CI 1.05-2.91) and overall post-transplant mortality (adjusted hazard-ratio 1.60, 95% CI 1.15-2.23). Rates of major surgical bleeding, cardiac reoperation, postoperative infection and primary graft failure were also significantly higher among MCS patients. Causes of death and survival after hospital discharge were similar in MCS and non-MCS candidates. Increased risk of post-transplant mortality affected patients bridged on pulsatile-flow extracorporeal VADs (adjusted hazard-ratio 2.21, 95% CI 1.48-3.30) and continuous-flow extracorporeal VADs (adjusted hazard-ratio 2.24, 95% CI 1.20-4.19), but not those bridged on VA-ECMO (adjusted hazard-ratio 0.51, 95% CI 0.21-1.25). CONCLUSIONS: Patients bridged to emergency HT on short-term MCS are exposed to an increased risk of postoperative complications and mortality. In our series, preoperative bridging with VA-ECMO resulted in comparable post-transplant outcomes to those of patients transplanted on conventional support.

Preoperative INTERMACS profiles determine postoperative outcomes in critically ill patients undergoing emergency heart transplantation: analysis of the Spanish National Heart Transplant Registry.

BACKGROUND: Postoperative outcomes of patients with advanced heart failure undergoing ventricular assist device implantation are strongly influenced by their preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles. We sought to investigate whether a similar association exists in patients undergoing emergency heart transplantation. METHODS AND RESULTS: By means of the Spanish National Heart Transplant Registry database, we identified 704 adult patients treated with emergency heart transplantation in 15 Spanish centers between 2000 and 2009. Post-transplant outcomes were analyzed pertaining to patient preoperative INTERMACS profiles, which were retrospectively assigned by 2 blinded cardiologists. Before transplantation, INTERMACS profile 1 (critical cardiogenic shock) was present in 207 patients, INTERMACS profile 2 (progressive decline) in 291, INTERMACS profile 3 (inotropic dependence) in 176, and INTERMACS profile 4 (resting symptoms) was present in 30 patients. In-hospital postoperative mortality rates were, respectively, 43%, 26.8%, and 18% in patients with profiles 1, 2, and 3 to 4 (P<0.001). INTERMACS 1 patients also presented the highest incidence of primary graft failure (1: 31.3%, 2: 22.3%, 3-4: 21.8%; P=0.03) and postoperative need for dialysis (1: 33.2%, 2: 18.9%, 3-4: 21.5%; P<0.001). Adjusted odds-ratios for in-hospital postoperative mortality were 4.38 (95% confidence interval, 2.51-7.66) for profile 1 versus 3 to 4, 2.49 (95% confidence interval, 1.56-3.97) for profile 1 versus 2, and 1.76 (95% confidence interval, 1.02-3.03) for profile 2 versus 3 to 4. Long-term survival after hospital discharge was not influenced by preoperative INTERMACS profiles. CONCLUSIONS: Preoperative INTERMACS profiles determine outcomes after emergency heart transplantation. Results call for a change in policies related to the management of heart transplant candidates presenting with INTERMACS profiles 1 and 2.

Antibodies against heterogeneous nuclear ribonucleoprotein K in patients with cardiac allograft vasculopathy.

BACKGROUND: Cardiac allograft vasculopathy (CAV) is the most serious long-term complication after cardiac transplantation. T-cell-mediated immune response has been implicated as the central mechanism for this form of graft rejection, but the role of humoral immunity is still controversial. METHODS: This study investigated whether human leukocyte antigen (HLA) and non-HLA antibodies are associated with CAV and if their presence can be used to identify patients at high risk of developing CAV. Diagnosis of CAV was made by angiography and intravascular ultrasound (IVUS) technology. Sera from 48 heart transplant recipients were assessed for the presence of antibodies. RESULTS: Although anti-HLA or anti-major histocompatibility complex class I chain-related gene A (MICA) antibodies in patients with or without CAV were not statistically different, heterogeneous nuclear ribonucleoprotein K (hnRNP-K) was identified as a new antigenic target after the screening of a human coronary artery smooth muscle cells complementary DNA (cDNA) expression library with a serum sample from a CAV patient. Four years after transplantation, presence of anti-hnRNP-K antibodies was significantly higher in the IVUS-defined CAV group (85.3%) and angiography-defined CAV patients (90.5%) compared with the non-CAV group (p < 0.0001 and p = 0.0023 respectively). CONCLUSIONS: The presence of anti-hnRNP-K antibodies 4 years after the transplant is statistically associated with CAV disease, regardless of the diagnostic technique. Therefore, prospective detection of these antibodies could be proposed as a helpful biomarker in CAV diagnosis.

Conferencia de Consenso de los Grupos Españoles de Trasplante Cardiaco / Spanish Heart Transplant Units Consensus Conference

La Sección de Insuficiencia Cardiaca, Trasplante Cardiaco y otras Alternativas Terapéuticas de la Sociedad Española de Cardiología desarrolló en Sevilla, en junio de 2005, una Conferencia de Consenso sobre trasplante cardiaco (TC) a la que fueron invitados a participar todos los grupos españoles de TC. El objetivo fue determinar, discutir y consensuar los aspectos más relevantes y/o controvertidos de diferentes áreas del TC en la actualidad: organización, selección del receptor, donantes, rechazo, inmunosupresión, enfermedad vascular del injerto, complicaciones a largo plazo y TC pediátrico. Este documento reúne las recomendaciones del grupo de trabajo incluyendo el grado de evidencia con que se respalda cada una (AU)

The Spanish Society of Cardiology’s working group on heart failure, heart transplantation and associated therapies organized a consensus conference on heart transplantation that was held in Seville, Spain in June 2005 and to which all Spanish heart transplant teams were invited. The aim was to evaluate, discuss and reach a consensus on the most important and controversial topics in different areas of heart transplantation today: organization, recipient selection, donors, rejection, immunosuppression, allograft vasculopathy, long-term complications, and pediatric heart transplantation. This report summarizes the working group’s recommendations, and reports the level of evidence supporting each recommendation (AU)

Espasmo arterial coronario en pacientes con corazón trasplantado / Coronary artery spasm in patient with heart transplantation

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