Lack of Impact of Presence of Positive C4d Staining in Capillaries in Myocardial Biopsies on Long-term Survival of Heart Transplant Patients.

BACKGROUND: The long-term survival of 209 consecutive patients (mean age, 46 ± 15 years) from a single center with ≥1 diagnostic myocardial biopsy after heart transplantation was analyzed. METHODS: Patients were considered as C4d positive if a capillary staining (immunohistochemistry in paraffin samples) was observed in ≥1 myocardial biopsy. Data were analyzed according to pathologic consensus of antibody mediated rejection definition of C4d+ positivity: 2004 definition in group A and the 2013 definition in group B and compared with their respective controls, composed of patients who do not meet those criteria. Age, follow-up time, and number of biopsies were comparable between patients with C4d+ and controls in both groups. Follow-up was 100% complete with mean of observation time 2143 days. RESULTS: During the follow-up period, 62 patients died (group A: C4d+ 32% vs controls 29%; group B: C4d+ 36% vs controls 29% [P = NS]). There were no differences in survival between patients with positive staining and without C4d+ staining when Kaplan-Meier survival curves were compared. CONCLUSIONS: The presence of C4d positive staining in myocardial capillaries of heart biopsies of patients after heart transplantation, as an isolated finding, was not related to worse long-term survival.

Influence of "urgent" versus "planned" heart transplantation on healthy behaviors among patients.

OBJECTIVE: The aim of this study was to compare health behaviors among patients after heart transplantation, depending on the mode of qualification for the surgery. PATIENTS AND METHODS: A questionnaire was completed by 115 patients who underwent heart transplantation surgery. The first part covered sociodemographic data before and after transplantation; the second part the medical data, and the last part behaviors before and after transplantation, such as smoking tobacco, drinking alcohol, and systematic compliance to medications. Behaviors associated with health were evaluated with the of a health behavior inventory including 24 statements referring to behaviors associated with health. RESULTS: Fifty-two patients (45.21%) including 13 women and 39 men underwent a heart transplantation performed in the "urgent" mode. They were significantly younger than those with a "planned" transplantation: 50.65±16.19 vs 57.22±10.26 (P<.05). No significant differences were observed in smoking tobacco or drinking alcohol after the transplantation. However, patients transplanted in the "urgent" mode more frequently were compliant to the medication regimen than those in the "planned" mode. These results showed a significant influence of the transplantation mode both on the eating habits and every day health practices after transplantation (P<.05). People awaiting transplantation at home showed a stronger conviction about the influence of coincidental (chance) factors on their health, in opposition to their own behavior or the actions of the medical staff (P<.05). CONCLUSIONS: Patients transplanted in the urgent mode showed a higher level of health practices after transplantation, more frequent attention to their health condition as dependent on their own behavior or the medical crew's actions, and a higher level of health practices compared with other cardiac patients.

The influence of the recipient's body weight on the probability to obtain a heart transplant-POLKARD HF registry.

INTRODUCTION: The aim of the study was to analyze the influence of body weight of the adult heart recipient on the chance to obtain a transplant. METHODS: We analyzed the data from all 658 patients listed for heart transplantation. RESULTS: During the follow-up period, 325 (49%) of listed patients underwent transplantation with 102 (15%) succumbing before heart transplantation. The mean weight of transplanted patients was 73.7 +/- 13.7 kg and 81.2 +/- 15.4 kg for those not transplanted (P < .00001). Patients were divided according to body weight in two groups: light = below 80 kg (n = 360) or heavy > or = 80 kg or above (n = 297). On the transplant list, 111 heavy patients (37%) versus 213 light patients (59%) underwent the procedure, a significant difference. The waiting time among light patients was 255 versus heavy patients of 395 days (P < .005). There was a similar number of deaths before transplantation among the light (n = 56 360 patients; 15.5%) versus the heavy group (49/297; 16%). Upon multivariate Cox mode analysis independent factors related to not receiving a heart transplant were greater weight, systolic blood pressure, pulmonary vascular resistance, Heart Failure Survival Score (HFSS) score and lower N-terminal pro-brain natriuretic peptide (NTproBNP) levels. CONCLUSIONS: Among adult heart transplant candidates, the chance to receive a heart transplant significantly decreased when the recipient's weight exceeded 80 kg. Patients with a body weight more than 110 kg had a poor chance to receive a heart transplantation.

A limited sampling strategy for estimating mycophenolic acid area under the curve in adult heart transplant patients treated with concomitant cyclosporine.

OBJECTIVE: Heart transplantation studies have shown a relationship between the mycophenolic acid area under the curve (AUC) 0-12 h (MPA AUC(0-12h)) values and risk of acute rejection episodes and fewer side-effects in patient receiving cyclosporine during the first year post-transplant. However, measurement of full AUC is costly and time consuming and in this case it is an impractical approach to drug monitoring. Therefore, the authors describe a limited sampling strategy to estimate the MPA AUC(0-12h) value in adult heart transplant recipients. METHODS: Ninety MPA pharmacokinetic (PK) profiles were studied. The samples were collected immediately before and 0.5, 1, 1.5, 2, 2.5, 3, 4, 6, 9, 12 h after the morning dose of mycophenolate mofetil (MMF) following an overnight fast. PK profiles were determined at 6-8 weeks, 6, 12 months and more than 1 year after transplantation. Using stepwise multiple linear regression analysis a sampling strategy from 60 of PK profiles was obtained and next the bias and precision of the model were evaluated in another 30 PK profiles. RESULTS: The three-point model using C(0.5h), C(1h), C(2h) was found to be superior to all other models tested (r(2) = 0.841). The regression equation for AUC estimation which gave the best fit to this model is: 9.69 + 0.63C(0.5) + 0.61C(1) + 2.20C(2). Using that model 63 of the 90 (70%) full AUC values were estimated within 15% of their actual value. For the best-fit model, the mean prediction error was 3.2%, with 95% confidence intervals for prediction error to range from -42.2% to 40.3%. All other models which use one, two or three time-points over the first 2 h are poorer predictors of the full AUC than the model above. CONCLUSION: The proposed three time-point equation to estimate AUC will be helpful in optimizing immunosuppressive therapy in heart transplantation.