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Incidence, risk factors and clinical outcome of multidrug-resistant organisms after heart transplantation

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World Journal of transplantation 2024年第2期14卷 107-118页

作者： Sophia Hatzianastasiou Paraskevas Vlachos Georgios Stravopodis Dimitrios Elaiopoulos Afentra Koukousli Josef Papaparaskevas Themistoklis Chamogeorgakis Kyrillos Papadopoulos Theodora Soulele Despoina Chilidou Kyriaki Kolovou Aggeliki Gkouziouta Michail Bonios Stamatios Adamopoulos Stavros Dimopoulos Microbiology Department and Infection Control Office Onassis Cardiac Surgery CenterAthens 17674Greece heart transplantation Unit Onassis Cardiac Surgery CenterAthens 17674Greece Cardiac Surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece

BACKGROUND Transplant recipients commonly harbor multidrug-resistant organisms(MDROs),as a result of frequent hospital admissions and increased exposure to antimi-crobials and invasive *** To investigate the impact of patient demographic and clinical characteristics on MDRO acquisition,as well as the impact of MDRO acquisition on intensive care unit(ICU)and hospital length of stay,and on ICU mortality and 1-year mortality post heart *** This retrospective cohort study analyzed 98 consecutive heart transplant patients over a ten-year period(2013-2022)in a single transplantation *** was collected regarding MDROs commonly encountered in critical *** Among the 98 transplanted patients(70%male),about a third(32%)acquired or already harbored MDROs upon transplantation(MDRO group),while two thirds did not(MDRO-free group).The prevalent MDROs were Acinetobacter baumannii(14%),Pseudomonas aeruginosa(12%)and Klebsiella pneumoniae(11%).Compared to MDRO-free patients,the MDRO group was characterized by higher body mass index(P=0.002),higher rates of renal failure(P=0.017),primary graft dysfunction(10%vs 4.5%,P=0.001),surgical re-exploration(34%vs 14%,P=0.017),mechanical circulatory support(47%vs 26%P=0.037)and renal replacement therapy(28%vs 9%,P=0.014),as well as longer extracorporeal circulation time(median 210 vs 161 min,P=0.003).The median length of stay was longer in the MDRO group,namely ICU stay was 16 vs 9 d in the MDRO-free group(P=0.001),and hospital stay was 38 vs 28 d(P=0.006),while 1-year mortality was higher(28%vs 7.6%,log-rank-χ2:7.34).CONCLUSION Following heart transplantation,a predominance of Gram-negative MDROs was *** acquisition was associated with higher complication rates,prolonged ICU and total hospital stay,and higher post-transplantation mortality.

关键词： heart transplantation Multi drug resistant organisms transplantation complications transplantation outcome

Cardiac rehabilitation in a heart failure patient after left ventricular assist device insertion and subsequent heart transplantation:A case report

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World Journal of Clinical Cases 2022年第8期10卷 2577-2583页

作者： Tae Woong Yang Seunghwan Song Hye Won Lee Byeong-Ju Lee Department of Rehabilitation Medicine Biomedical Research InstitutePusan National University HospitalPusan 602-739South Korea Department of Thoracic and Cardiovascular Surgery Pusan National University School of MedicinePusan National University HospitalPusan 602-739South Korea Division of Cardiology Department of Internal MedicinePusan National University School of MedicinePusan National University HospitalPusan 602-739South Korea

BACKGROUND Insertion of a left ventricular assist device(LVAD)and heart transplantation(HT)improve the survival of patients with heart *** addition,cardiac rehabilitation(CR)further increases the functional *** case report describes a successful case of CR after LVAD insertion and subsequent *** SUMMARY In the present case,during the LVAD insertion period,peak oxygen consumption(VO2)increased by 12.16%after *** was performed 7 mo after the LVAD insertion,and the patient participated in phases I and II *** peak VO2 increased from 17.24 to 22.29 m L/kg/*** improvement was more significant than that reported in previous studies on CR after LVAD insertion or *** patient’s quality of life also *** total average score of the short form-36 questionnaire increased from 29.5 points at admission to 53.3 points 9 mo after *** A tailored CR program after LVAD insertion or HT may improve the patients’quality of life and increase survival.

关键词： Left ventricular assist device heart transplantation Cardiac rehabilitation Case report

Type A aortic dissection following heart transplantation:A case report

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World Journal of Clinical Cases 2022年第15期10卷 5077-5081页

作者： Zhu Zeng Lin-Jie Yang Chao Zhang Fen Xu Department of Cardiovascular Surgery Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022Hubei ProvinceChina

BACKGROUND Cardiac transplantation is considered the standard treatment for refractory endstage heart ***,5074 heart transplantations were performed in *** 100 heart transplants are performed at the authors’center each *** usual complications of heart transplantation include graft rejection,infection,and graft *** dissection after heart transplantation is very rare and is a serious complication that requires a hybrid *** SUMMARY A 58-year-old female patient was admitted to Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in July 2020 because of unprovoked low back pain without precipitating *** resonance imaging and computed tomography angiography showed type A aortic dissection with an aberrant right subclavian *** admission,urapidil was used to control blood *** days later,the patient underwent ascending aortic and aortic arch replacement,subclavian artery reconstruction,and endovascular repair of abdominal and thoracic aortic aneurysms.A cardiopulmonary bypass was established through the right femoral artery and femoral *** aberrant right subclavian artery,innominate artery,left common carotid artery,and left subclavian artery were blocked,and the left and right common carotid arteries were cannulated for bilateral cerebral *** The right axillary artery could not be selected for cardiopulmonary bypass intubation because of aberrant right subclavian artery.

关键词： Type A aortic dissection heart transplantation Aberrant right subclavian artery Cardiopulmonary bypass Case report

Effect of TGF-β1 on the Expression of IL-12, IL-15, IL-18, IL-4 and IL-10 in heart transplantation Rejection in Rats

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2007年第6期27卷 643-645页

作者：赵金平李平高思海王现国高小见 Department of Thoracic and Cardiac Surgery Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Department of Cardiac Surgery Union Hospital Tongji Medical College Huazhong University of Science and Technology

To investigate the effect of TGF-β1 on the expressions of IL-12, IL-15, IL-18, IL-4 and IL-10 in heart transplantation rejection in rats, a model of rat cervical heterotopic heart transplantation was set up and the model rats were randomly divided into three groups： control group, transplant group and TGF-β1 group. The mRNA expression levels of IL-12, IL-15, IL-18, IL-4 and IL-10 were determined by RT-PCR at the 5th day after the transplantation. The mRNA expression levels of IL- 12, IL-15, IL-18 were increased obviously and those of IL-4, IL-10 were significantly decreased in the transplant group as compared with the control group （P〈0.01）. In the TGF-β1 group, the mRNA ex- pression levels of IL- 12, IL- 15, IL- 18 were significantly decreased and those of IL-4, IL- 10 were significantly increased as compared with the transplant group （P〈0.01）. The immunosuppressive effect of TGF-β1 on heart transplantation rejection was related to its inhibition of the expressions of Th1-type cytokines （IL-12, IL-15, IL-18 etc） and its promotion of the expressions of Th2-tpye cyto- kines （IL-4, IL-10）.

关键词： heart transplantation TGF-β1 rejection cytokines

Left Ventricle Geometry Remolding after heart transplantation:A Two-dimensional Ultrasound Study

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2013年第6期33卷 892-896页

作者：覃小娟李贺尤君吕清张菁高菡静谢明星 Department of Medical Ultrasound Union HospitalTongji Medical CollegeHuazhong University of Science and Technology Department of Cardiosurgery Union HospitalTongji Medical CollegeHuazhong University of Science and Technology Department of Medical Ultrasound People's Liberation Army 161st Central Hospital

The function of the transplanted heart will be affected by acute allograft rejection, chronic rejection, high blood pressure and so on, which may induce the reconstruction of the left ventricle and the increase of left ventricular mass （LVM）, and eventually lead to left ventricular hypertrophy that will significantly affect the prognosis of heart transplantation （HT）. The purpose of this study was to dy- namically monitor the changes of left ventricular geometric patterns after HT using two-dimensional echocardiography and to understand the remodeling process and its possible influencing factors. The left ventricular internal diameter, interventricular septal wall thickness, posterior wall thickness at end dias- tole were measured and the relative wall thickness （RWT）, left ventricular mass, left ventricular mass index were calculated respectively in 34 HT patients and 34 healthy volunteers by two-dimensional echocardiography. The type of left ventricular geometry was identified based on the echocardiographic determination of LVM index （LVMI） and RWT. The HT patients were divided into three groups ac- cording to the time length after surgery： A （3 months postoperatively）, B （6 months postoperatively） and C （12 months postoperatively）. We compared the parameters of left ventricle between HT group and normal control group, and explored the risk factors causing the increase of LVM. The results showed that 4 patients （16%） in group A had concentric remodeling. Nine patients （34.62%） in group B had re- construction, including 5 cases of concentric remodeling, 2 cases of concentric hypertrophy and 2 cases of eccentric hypertrophy. The hypertrophy incidence rate was 15.4% in group B. 15 patients （62.5%） had reconstruction in group C, including 9 cases of concentric remodeling, 5 cases of concentric hyper- trophy, and 1 case of eccentric hypertrophy. The prevalence of hypertrophy was 25%. Multivariate analysis showed that hypertension and acute rejection history were the ri

关键词： two-dimensional echocardiography heart transplantation left ventricular remodeling left ventricular hypertrophy

Exercise training in heart transplantation

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World Journal of transplantation 2021年第11期11卷 466-479页

作者： Christos Kourek Eleftherios Karatzanos Serafim Nanas Andreas Karabinis Stavros Dimopoulos Clinical Ergospirometry Exercise&Rehabilitation LaboratoryEvaggelismos HospitalAthens 10676AtticaGreece Cardiac Surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece

heart transplantation remains the gold standard in the treatment of end-stage heart failure(HF).heart transplantation patients present lower exercise capacity due to cardiovascular and musculoskeletal alterations leading thus to poor quality of life and reduction in the ability of daily *** vascular function and diastolic dysfunction cause lower cardiac output while decreased skeletal muscle oxidative fibers,enzymes and capillarity cause arteriovenous oxygen difference,leading thus to decreased peak oxygen uptake in heart transplant *** training improves exercise capacity,cardiac and vascular endothelial function in heart transplant ***-rehabilitation regular aerobic or combined exercise is beneficial for patients with end-stage HF awaiting heart transplantation in order to maintain a higher fitness level and reduce complications afterwards like intensive care unit acquired weakness or cardiac *** hospitalized patients after heart transplantation should be referred to early mobilization of skeletal muscles through kinesiotherapy of the upper and lower limbs and respiratory physiotherapy in order to prevent infections of the respiratory system prior to hospital ***,all heart transplant recipients after hospital discharge who have not already participated in an early cardiac rehabilitation program should be referred to a rehabilitation center by their health care *** high intensity interval training seems to have more benefits than moderate intensity continuous training,especially in stable transplant patients,individualized training based on the abilities and needs of each patient still remains the most appropriate *** rehabilitation appears to be safe in heart transplant ***,long-term follow-up data is incomplete and,therefore,further high quality and adequately-powered studies are needed to demonstrate the long-term benefits of exercise training in this popu

关键词： heart transplantation Endothelial dysfunction Exercise training High intensity interval training Moderate intensity continuous training Cardiac rehabilitation

Immune responses on allograft heart transplantation in inbred rats infected with Echinococcosis multilocularis

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Chinese Medical Journal 2012年第24期125卷 4412-4417页

作者： Mai Hepiretihan.Ai Erken ZHAO Jin-ming GUAN Xiao-yan WEN Hao WANG Yun-hai Department of Gastrointestinal Surgery First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang 830054 China Department of Laparoscopic Surgery First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang 830054 China Department of Medical Examining Center First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang 830054 China State Key Lab Breeding of Xinjiang Major Disease Research Digestive and Vascular Surgical Center First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang 830054 China

Background Alveolar echinococcosis （AE） is caused by the metacestode stage of Echinococcus multilocularis （E. multilocularis） and is a rare but life-threatening disease. This disease commonly is characterized by an infiltrative, tumor-like growth of the E. multilocularis metacestode in the liver of human. Liver transplantation is an effective therapy for end-stage of hepatic AE, but the characteristics of host immunity associated with E. multilocularis infection with organ transplantation are poorly defined. We hereby aimed to study the immunological status and allograft heart survival in inbred rats with E. multilocularis infection. Methods Rat models of AE were established by injecting the E. multilocularis suspension made from E. multilocularis infected tissues into the abdomen of Lewis （LEW） rats. Three months later, in the experimental group, allograft heart transplantation was performed from Brown-Norway （BN） rats to the E. multilocularis infected LEW rats. In the control group, we transplanted hearts from BN rats to healthy LEW rats. The influence of the disturbed immune system in E. multilocularis infected rats on the heart transplantation was assessed, including observation of allograft heart survival time, histopathological examination of grafts and immunohistochemical examination of infiltrating cells （CD4＋ T cells, CD8＋ T cells and eosinophile granulocytes）, measurement of interleukin （IL）-4 and interferon （IFN）-γ in the serum by enzyme-linked immunosorbent assay （ELISA） and analysis of CD4＋CD25＋ regulatory T cells in peripheral blood by fluorescence activated cell sorting （FACS） flow cytometric analysis. Results The survival time of recipients in the experimental group was prolonged compared with those in the control group. The numbers of graft infiltrating CD8＋ T cells were decreased whereas the graft infiltrating eosinophil granulocytes （CD15＋） were increased in grafts in the experimental group （P 〈0.05）. Furthermore, the proportion of CD4＋CD25＋regula

关键词： immune responses heart transplantation echinococcosis CD4+ CD25+ regulatory T cells allografi heart transplantation

Radiofrequency catheter ablation in patients with symptomatic atrial flutter/tachycardia after orthotopic heart transplantation

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Chinese Medical Journal 2006年第24期119卷 2036-2041页

作者： LI Yi-gang Gerian Gronefeld Carsten Israel LU Shang-biao WANG Qun-shan Stefan H Hohnloser Department of Cardiology Xinhua Hospital Shanghai Jiaotong University Shanghai 200092 China Department of Medicine Division of Cardiology J.-W.Goethe-University Frankfurt Germany

Background Atrial tachycardia or flutter is common in patients after orthotopic heart transplantation. Radiofrequency catheter ablation to treat this arrhythmia has not been well defined in this setting. This study was conducted to assess the incidence of various symptomatic atrial arrhythmias and the efficacy and safety of radiofrequency catheter ablation in these patients. Methods Electrophysiological study and catheter ablation were performed in patients with symptomatic tachyarrhythmia. One Halo catheter with 20 poles was positioned around the tricuspid annulus of the donor right atrium, or positioned around the surgical anastomosis when it is necessary. Three quadripolar electrode catheters were inserted via the right or left femoral vein and positioned in the recipient atrium, the bundle of His position, the coronary sinus. Programmed atrial stimulation and burst pacing were performed to prove electrical conduction between the recipient and the donor atria and to induce atrial arrhythmias. Results Out of 55 consecutive heart transplantation patients, 6 males [（58±12） years] developed symptomatic tachycardias at a mean of （5±4） years after heart transplantation. Electrical propagation through the suture line between the recipient and the donor atrium was demonstrated during atrial flutter or during recipient atrium and donor atrium pacing in 2 patients. By mapping around the suture line, the earliest fragmented electrogram of donor atrium was assessed. This electrical connection was successfully ablated in the anterior lateral atrium in both patients. There was no electrical propagation through the suture line in the other 4 patients. Two had typical atrial flutter in the donor atrium which was successfully ablated by completing a linear ablation between the tricuspid annulus and the inferior vena cava. Two patients had atrial tachycardia which was ablated in the anterior septal and lateral donor atrium. There were no procedure-related complications. Patients w

关键词： atrial flutter atrial tachycardia heart transplantation ablation

Using intramyocardial electrograms combined with other noninvasive methods for monitoring acute rejection following human heart transplantation

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Chinese Medical Journal 2009年第2期122卷 136-139页

作者： JIA Yi-xin MENG Xu SUN Ling-bo HAN Jie CHEN Yang-tian Cardiac Surgery Department Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

Background Acute allograft rejection in heart transplantation remains as one of the major complications. Obligatory graft surveillance is still achieved with the invasive and expensive endomyocardial biopsy （EMB）. Our study aimed to study the use of intramyocardial electrograms combined with other noninvasive methods for the monitoring of acute rejection after human heart transplantation. Methods Permanent pacemakers were implanted in 58 patients undergoing heart transplantations. Intramyocardial electrograms （IMEG） were recorded periodically and the results were compared with those from EMBs. The R wave amplitude of the IMEG was used as the index value, the average R wave amplitude at the third week following transplantation was considered as the baseline, and a reduction of 〉20% compared with the baseline was regarded as a positive result. EMB was performed in cases of positive IMEG results and also at other times. Other noninvasive methods were used to help the diagnosis. Acute rejection （AR） was defined as International Society of heart-Lung transplantation grade IliA or higher. Results We obtained 1231 IMEG records and 127 EMBs. Of the total 127 EMBs, 53 were positive, in which there were 42 IMEG positive results and 11 negative, while in the rest 74 negative EMBs, there were 9 IMEG positive results and 65 negative. The sensitivity of IMEG for the diagnosis of AR was 79.2%, and the specificity was 87.8%. The positive predictive value was 82.4% and the negative predictive value was 85.5%. Of the total of 1231 IMEG records, 51 were positive and 1180 were negative. Excluding 11 proved by EMB to be false negative, if the other 1169 were considered as no evidence of rejection, through the other noninvasive methods, AR diagnosed by this noninvasive monitoring strategy, the sensitivity was 79.2%, and the specificity was 99.2%. The positive predictive value was 82.4% and the negative predictive value was 99.1%. Conclusions IMEG can be used as a noninvasive method for m

关键词： heart transplantation rejection intramyocardial electrogram