M. Kawano

The long‐term outcome of treated sensitized patients who undergo heart transplantation

Kobashigawa JA, Patel JK, Kittleson MM, Kawano MA, Kiyosaki KK, Davis SN, Moriguchi JD, Reed EF, Ardehali AA. The long‐term outcome of treated sensitized patients who undergo heart transplantation.
Clin Transplant 2011: 25: E61–E67.

Heart transplant recipients supported with extracorporeal membrane oxygenation: Outcomes from a single-center experience

BACKGROUND Extracorporeal membrane oxygenation (ECMO) provides hemodynamic support in refractory cardiogenic shock and may be used after heart transplantation for primary graft dysfunction or rejection. We hypothesized that survival after ECMO support is contingent upon patient selection. METHODS We examined consecutive adult heart transplant recipients at a single center who underwent transplantation between 1997 and 2009 and required ECMO support. Patients were divided by clinical presentation: pre-emptive therapy, escalating inotropic requirements despite support by intra-aortic balloon pump (IABP); and salvage therapy, cardiac arrest undergoing cardiopulmonary resuscitation with chest compressions. RESULTS Between 1997 and 2009, there were 37 instances of ECMO use in 32 patients: 23 episodes (19 patients) for pre-emptive therapy and 14 episodes (14 patients) for salvage therapy; 1 patient had both pre-emptive and salvage therapy. Patients did not differ in age, gender or ischemic time. ECMO support was for a median 6 days in both groups, and the incidence of serious vascular complications was comparable (35% and 36%). In the pre-emptive therapy group, 15 episodes (79%) were associated with survival to hospital discharge and 5 patients (26%) were alive at 1 year. In the salvage therapy group, 2 episodes (14%) were associated with survival to hospital discharge and 1 patient (7%) was alive at 1 year. CONCLUSIONS ECMO support is a viable option for adult heart transplant recipients with severe rejection and refractory cardiogenic shock. To maximize the benefit of this aggressive approach in heart transplant recipients requires early intervention, with a heightened awareness of this option to facilitate expedited use.

Donor–recipient sex mismatch portends poor 10-year outcomes in a single-center experience

BACKGROUND Several studies have indicated that survival after heart transplantation is affected by donor-recipient sex matching. In most studies, male recipients of a female heart have the poorest survival rates, whereas survival of female recipients is not affected by donor sex. The purpose of the current study was to determine the long-term outcomes of recipients at a large single center on uniform immunosuppression therapy in the current era. METHODS We reviewed the records of 857 patients transplanted at a single center between 1994 and 2008. Patients were divided into 4 groups based on donor-recipient sex: male donor to male recipient (male/male, n = 506); female donor to female recipient (female/female, n = 113); male donor to female recipient (male/female, n = 106); and female donor to male recipient (female/male, n = 132). Ten-year outcomes were assessed for: survival; freedom from cardiac allograft vasculopathy (CAV); and freedom from non-fatal major adverse cardiac events (NF-MACE). RESULTS Ten-year actuarial survival was comparable in male/male and female/female groups, at 69% and 71%, respectively (p > 0.05). Compared with the male/male group, 10-year actuarial survival was significantly lower in the sex-mismatch groups: 58% in the male/female group (p = 0.03) and 59% in the female/male group (p = 0.01). There was no significant difference in 10-year freedom from CAV or NF-MACE among the groups. CONCLUSIONS Heart transplant patients with donor-recipient sex mismatch have lower survival, extending the results of prior studies to suggest that sex mismatch is undesirable in female, as well as male, recipients. This may impact donor selection and recipient wait time to transplantation.