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Risk prediction model for cutaneous squamous cell carcinoma in adult cardiac allograft recipients

World Journal of Transplantation 2021年第3期11卷 54-69页

作者： Nandini Nair Zhiyong Hu Dongping Du enrique gongora Division of Cardiology Department of Internal MedicineTexas Tech Health Sciences CenterLubbockTX 79430United States Department of Industrial Manufacturing and Systems EngineeringTexas Tech UniversityLubbockTX 79409United States Department of Cardiothoracic Surgery University of Alabama at BirminghamBirminghamAL 35233United States

BACKGROUND Heart transplant recipients are at higher risk of developing skin cancer than the general population due to the long-term immunosuppression treatment.Cancer has been reported as one of the major causes of morbidity and mortality for patients after heart transplantation.Among different types of skin cancers,cutaneous squamous cell carcinoma(cSCC)is the most common one,which requires timely screening and better management.AIM To identify risk factors and predict the incidence of cSCC for heart transplant recipients.METHODS We retrospectively analyzed adult heart transplant recipients between 2000 and 2015 extracted from the United Network for Organ Sharing registry.The whole dataset was randomly divided into a derivation set(80%)and a validation set(20%).Uni-and multivariate Cox regression were done to identify significant risk factors associated with the development of cSCC.Receiver operating characteristics curves were generated and area under the curve(AUC)was calculated to assess the accuracy of the prediction model.Based on the selected risk factors,a risk scoring system was developed to stratify patients into different risk groups.A cumulative cSCC-free survival curve was generated using the Kaplan-Meier method for each group,and the log-rank test was done to compare the intergroup cSCC rates.RESULTS There were 23736 heart-transplant recipients during the study period,and 1827 of them have been reported with cSCC.Significant predictors of post-transplant cSCC were older age,male sex,white race,recipient and donor human leukocyte antigen(HLA)mismatch level,malignancy at listing,diagnosis with restrictive myopathy or hypertrophic myopathy,heart re-transplant,and induction therapy with OKT3 or daclizumab.The multivariate model was used to predict the 5-,8-and 10-year incidence of cSCC and respectively provided AUC of 0.79,0.78 and 0.77 in the derivation set and 0.80,0.78 and 0.77 in the validation set.The risk scoring system assigned each patient with a risk score within the range of 0-11,based on whi

关键词： Cutaneous squamous cell carcinoma Heart transplantation Cox proportional hazard model Risk assessment Squamous cell carcinoma Mortality outcomes

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Role of Oxidative Stress in Cardiac Allograft Vasculopathy

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Open Journal of Organ Transplant Surgery 2013年第2期3卷 36-41页

作者： Nandini Nair enrique gongora Joshua Reynolds Department of Cardiology and Cardiothoracic Surgery Scott & White Healthcare Temple USA Department of Cardiothoracic Surgery Drexel University College of Medicine/Hahnemann University Hospital Philadelphia USA

Cardiac Allograft Vasculopathy, an accelerated form of arterial occlusive disease, is the major cause of death in the long-term after heart transplantation. Multiple factors influence the initiation and progression of CAV. These include ischemia-reperfusion, dyslipidemia, insulin resistance, and hypertension due to the use of immunosuppressive agents, the direct effects of immunosuppressive agents on endothelial function, and viruses (CMV). Impaired endothelial function reflects abnormalities in the production or activity of several vasoactive substances. Disruption of the nitric oxide synthase (NOS) pathway leads to changes in vascular reactivity, structure, and interaction with circulating blood components. Since endothelium-derived nitric oxide (NO) suppresses vascular cell proliferation and vascular inflammation, a deficit in vascular NO facilitates development of CAV. The link between oxidative stress and CAV largely exists in the balance between free radical superoxide generation and NO production. This review focuses on identifying the oxidative stress factors affecting CAV.

关键词： Cardiac Allograft Vasculopathy Oxidative Stress Asymmetric Dimethyl Arginine Cyto Megalo Virus Transplantation

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Do Continuous Flow LVADS Improve Diastolic Dysfunction?

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Open Journal of Organ Transplant Surgery 2014年第3期4卷 23-28页

作者： Nandini Nair Sudhir Thotakura enrique gongora Memorial Cardiac and Vascular Institute Hollywood FL USA Scott and White Memorial Hospital and TAMHCS College of Medicine Temple TX USA

Background: Ventricular assist devices are now used as a bridge to recovery/decision/transplant or as destination therapy in end-stage heart failure. Continued improvements in technology and pump design have made implantation an easier process with reduced operative risks and pump-related adverse events. Considering the beneficial effects of these devices in the clinical setting, it seemed logical to address the long-term effect of the continuous flow pumps on diastolic dysfunction. Methods: This study addresses the effect of HeartMate IITM(HMII) support for 284+/-97 days on echocardiographic parameters of diastolic function. Data from fifteen patients was retrospectively studied status post left ventricular assist device (LVAD) implantation. The data at approximately 1-year post implantation was compared with that obtained prior to implantation. Statistical analyses were performed using the Microsoft Excel Program/MSExcel Stats. Echocardiographic measurements were carried out in accordance with the American Society of Echocardiography guidelines. Results: Of all the echocardiographic parameters assessed only E/Ea and calculated left atrial pressure (LAP) showed a statistically significant decrease. Two parameters that showed a trend towards significance are Ea (septal) and global functional index (p = 0.05). Conclusions: Continuous Flow LVAD support appears to improve diastolic dysfunction. This study has limitations in that we used a single type of continuous flow device (HeartMate IITM) and was conducted as a retrospective analysis. Further studies with larger populations and longer support are required to validate this finding.

关键词： Continuous Flow Device Diastolic Function HeartMate IITM Left Ventricular Assist Devise

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Attention to Details Reduces Infection Rates in Patients with Continuous Flow Pumps

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Open Journal of Organ Transplant Surgery 2014年第2期4卷 15-22页

作者： Nandini Nair enrique gongora Basar Sareyyupoglu Ian Collier Sherry Alvarado Aasya Nasar Kenton Zehr Department of Hospital Pharmacy Scott and White Hospital Texas A & M HSC College of Medicine Temple USA Division of Cardiology Scott & White Healthcare Texas A & M HSC College of Medicine Temple USA Division of Cardiothoracic Surgery Scott & White Healthcare Texas A & M HSC College of Medicine Temple USA

The increased use of mechanical circulatory support has led to a rise in infectious complications in the recent years predisposing this population of patients to higher morbidity and mortality. In this study, we report a significantly lower rate of driveline infections of 0.12 episodes/patient-year as compared to the rates reported in the existing literature in patients with the HMII (Heartmate II). The study is limited by the fact that it is based on a small population of patients and was conducted retrospectively making recall bias hard to rule out. It is strictly restricted to one type of continuous flow pump (HMII) solely to decrease variations in the data reviewed. The exact cause of the low infection rate noted in this study is difficult to define. However, detailed teaching to the caregivers and the patient as well as close follow-ups in the perioperative period may substantially contribute to the outcome noted. Continued research limited to similar continuous flow ventricular assist devices in larger study populations would shed light on defining causes of infections in this population and developing robust algorithms to prevent such complications.

关键词： Driveline Infections Continuous Flow Pumps

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Does Cyclosporine Down Regulate IL-17 in Cardiac Allograft Vasculopathy?

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Open Journal of Organ Transplant Surgery 2013年第1期3卷 1-4页

作者： Nandini Nair Luciano Potena Sandeep Kumar Sudhiranjan Gupta enrique gongora Federica Angeli Paolo Romani Central Texas VA Health Care System/Texas A&M Health Science Center College of Medicine Temple USA Department of Cardiology Scott & White Healthcare/Texas A&M Health Science Center College of Medicine Temple USA Department of Cardiology University of Bologna Bologna Italy Division of Cardiothoracic Surgery Hahnemann University Hospital/Drexel University College of Medicine Philadelphia USA

Background: Cardiac Allograft Vasculopathy (CAV) is characterized by vascular inflammation and intimal proliferation which results in luminal stenosis and myocardial infarction. During vascular inflammation elaboration of several cytokines and differential expression of growth factors have been noted. CAV remains the major threat to long-term graft survival. CD4 and CD8 T-cell subsets play a significant role in the development of transplant rejection. Chronic transplant rejection often leads to development of CAV. A new CD4 effector cell subset that produces IL-17 (Th17) has been shown to be up-regulated in the murine system in the setting of CAV. This study assesses the level of IL-17 in cardiac transplant patients with and without CAV as compared to nontransplanted controls. Methods: Levels of IL-17, IL-6, MCP-1 were measured by ELISA in plasma of four nontransplanted controls, nine cardiac allograft recipients with CAV (HT-GVD) and eight post transplant subjects without a diagnosis of CAV (HT-No GVD). All post transplant patients were immune suppressed with cyclosporine. HT-GVD patients were 1-15 years post transplant while HT-No GVD subjects were 1 - 10 years post transplant. Results: IL-17, MCP-1 and IL-6 were significantly down regulated in HT-GVD subjects compared to the HT-No GVD subjects (p 0.001) but not significant between controls and HT-No GVD (p = ns). Conclusions: A decrease in IL-17 in HT-GVD subjects as compared to HT-No GVD in the presence of cyclosporine treatment could be a consequence of down regulation of IL-6. It is likely that cyclosporine differentially regulates pro inflammatory molecules in the setting of graft vascular disease.

关键词： Allograft CD4 and CD8 T-Cells Cardiac Allograft Vasculopathy IL-17 Luminal Stenosis

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Role of cardiovascular imaging in selection of donor hearts

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World Journal of Transplantation 2015年第4期5卷 348-353页

作者： Nandini Nair enrique gongora Division of Cardiology Texas Tech Health Sciences Center Memorial Cardiac and Vascular Institute

AIM:To perform a systematic review of literature on use of cardiovascular imaging in assessment of donor hearts.METHODS: A systematic search of current literature from January 1965 to August 2015 was performed using Pub Med and Google Scholar to investigate the different imaging modalities used to assess donor hearts.RESULTS: Recent literature still estimates only a 32% utilization of available donor hearts in the United States. Most common imaging modality used is transthoracic echocardiography. Use of advanced imaging modalities such as 3D echocardiography, cardiac computer tomography and cardiac magnetic resonance to evaluate donor hearts is not reported in literature. This review attempts to highlight the relevant imaging modalities that can be used to assess cardiac function in a time-efficient manner. The algorithm suggested in this review would hopefully pave the way to standardized protocols that can be adopted by organ procuring organizations to increase the donor pool.CONCLUSION: Use of advanced imaging techniques for a thorough assessment of organs will likely increase the donor pool.

关键词： Donor heart utilization Echocardiography Cardiovascular imaging Cardiac magnetic resonance Donor heart selection Cardiac computed tomography

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