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Conclusions: Survival of patients with PGD and PGF is significantly
reduced. In recent time eras survival haa increased. International
guidelines for prevention and treatment of these complications are needed.
Human Leukocyte Antigen Mismatch in Heart Transplants Continues ToPredict Outcomes in Modern Era of ImmunosuppressionT. Carvajal,1 E.P. Kransdorf,2 D.L. Kasper,1 R.L. Scott,2
D.E. Steidley,2 R.S. Gopalan,2 A.V. Kalya,2 F.A. Arabia,1 O.E. Pajaro.11Division of Cardiothoracic and Transplant Surgery, Mayo Clinic -Arizona, Phoenix, AZ; 2Division of Cardiovascular Disease, MayoClinic - Arizona, Phoenix, AZ.
Purpose: HLA mismatches (HLA-MM) have been shown to affect
survival after heart transplantation (HTX). However, it is generally felt
that current immunosuppressive therapies (IS) minimize the effects of
HLA-MM. This study wishes to test the hypothesis that despite advances
in IS, HLA-MM still plays a predictive role in determining outcomes.
Methods and Materials: We retrospectively analyzed survival and
freedom from immunologic adverse events on all patients undergoing
HTX at our institution between 2005 and 2012 (n¼129). Groups were
stratified by number of HLA-MM at HLA-A, B, DQ and DR (Group
1, 3-4 MM) (Group 2, 5-6 MM) (Group 3, 7-8 MM). Events
considered as adverse were biopsy-proven rejection (BPR) (ISHLT
grade 4 2R), allograft dysfunction (EF o 50% at Z 7 days post-
transplant) and death from cardiac causes. Time-to-event and survival
functions were calculated using the Kaplan-Meier method. IS
consisted of tacrolimus/mycophenolate/steroids in 98% and tacroli-
mus/steroids in 2%. Induction with thymoglobulin was used in 14 %(18/129), and with basiliximab in 5% (6/129).
Results: 100% of patients had 4 3 MM. Group 1-15/129, (12%),
Group 2-59/129 (46%), Group 3-55/129 (43%). Freedom from adverse
events and survival were significantly worse in patients with 44 MM
(Group 2 and 3) (Figure 1).
Conclusions: Despite the use of triple-drug immunosuppression includ-
ing tacrolimus in our patients, HLA-MM remains a significant predictor
of adverse events and survival. Given this, novel immunologic strategies
to abrogate the effect of HLA-MM are urgently needed.
Exploring Parenthood in the New Zealand Heart Transplant ProgramC. Wasywich,1 A. Ruygrok,2 H. Gibbs,1 L. Painter,1 A. Coverdale,1
P. Ruygrok.1 1New Zealand Heart and Lung Transplant Service,Auckland City Hospital, Auckland, New Zealand; 2Faculty of Medicine,University of Otago, Dunedin, New Zealand.
Purpose: After heart transplantation (HT) most recipients return to
‘normal life’ and may wish to have children. This study aimed to
describe new parenthood after transplant in the New Zealand HT
Methods and Materials: All recipients transplanted December 1987-
December 2010 who survived to 3 months post HT and older than 18
years at the time of the study were included. A survey pertaining to
family status and new parenthood was administered to the recipient or
if deceased, their next of kin.
Results: Over the study period 234 patients were transplanted and of
the 199 (85%) eligible for this study, 146 agreed to participate and 145
completing the survey a mean of 12.2 years after HT. Age at HT was
46 years, 80% were male and 22% considered having children after HT
of whom 69% recalled discussing this with the transplant team prior to
HT. Only 26% used contraception following HT. After HT 19 (13%)
recipients or their or partners (2 female, 17 male recipients) had 27
children at a mean age of 33 years. Their first child was born an
average of 4.5 years post HT. Only 56% of pregnancies were planned -
both female recipients obtained preconception counseling, few male
recipients did. One male recipient transplanted for congenital
heart disease had a child with an atrial septal defect. One female
recipient experienced rejection during pregnancy. Overall survival for
the study population was excellent (50% survival 19.1 years) however
2/19 recipients died after the birth of their child (child aged 2.6 years
and 14.1 years respectively). HT parents survived a mean of 7.1 years
(0.2 to 21.0 years) after the birth of their child (time to death or
Conclusions: An important minority of HT recipients wish to become
new parents. This study emphasizes the importance of discussing
parenthood with appropriate recipients prior to HT. Pre conception
counseling is important for both male and female recipients; issues
such as potentially heritable cardiac conditions and reduced longevity
after HT are relevant to both genders.
Primary Graft Dysfunction Following Heart Transplantation; Validity ofa Pragmatic Self-Reporting DefinitionV.B. Dronavalli,1,6,7 H. Small,1,7 C.A. Rogers,4,7 H. Thomas,2,7
P. Gosling,1 J.K. Parameshwar,3,7 N.R. Banner.5,7 1Queen ElizabethHospital, University Hospitals Birmingham, Birmingham, UnitedKingdom; 2NHS Blood and Transfusion, Bristol, United Kingdom;3Papworth hospital, Papworth, United Kingdom; 4Bristol Heartinstitute, Bristol, United Kingdom; 5Harefield Hospital, London, UnitedKingdom; 6University of Birmingham, Birmingham, United Kingdom;7On behalf of the Steering Group UK Cardiothoracic Transplant Audit,United Kingdom.
Purpose: There are no international consensus definitions of primary
graft dysfunction(PGD) and failure(PGF) following heart transplan-
tation(HTx), this limits audit and research. We report the character-
istics of centre self-reported PGD(s-rPGD) cases using post-operative
inotrope support and outcome data.
Methods and Materials: In a UK-wide prospective study we asked
centres to s-rPGD as ‘‘a severe impairment of systolic graft function
affecting the right, left, or both ventricles accompanied by hypoten-
sion, low cardiac output, and high filling pressures in the absence of
hyperacute rejection or technical factors’’. We collected donor and
recipient data including pre- and post-operative support, morbidity,
mortality data and recipient cause of death to establish if s-rPGD
would be a valid outcome measure.
Results: Of 294 HTx, s-rPGD incidence was 94/294 (32%). S-rPGD
cases had older donors 41(32-48) vs 36(28-43); p¼0.003 and slightly
s-rPGD(N¼94) Non-PG(N¼199) p
Inotrope score posttransplant(median(IQR))6-hour 0.57(0.30,1.15) 0.55(0.24,0.98) ¼0.0724-hour 0.66(0.38,1.38) 0.35(0.18,0.89) ¼0.00148-hour 0.46(0.14,1.13) 0.143(0.002,0.44) o0.00172-hour 0.35(0.05,0.94) 0.002(0,0.22) o0.001Prolonged(72h-inotropes) 63/84(75%) 39/184(21%) o0.001IABP 46/85(54%) 31/184(17%) ¼0.001VAD/ECMO 27/88(31%) 0/198(0%) o0.00130-day Mortality 29/83(35%) 9/183(5%) o0.001ITU-LOS median(25th,75thcentile) 8(5,20) 5(4,9) ¼0.003