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Abstracts
average of 10 hemoglobin (Hgb) measurements in the first transplant
year: Hgb 4 13 g/dL, Hgb 11-13 g/dL, and Hgb o 11 g/dL. Endpoints
were 5-year survival, freedom from cardiac allograft vasculopathy
(CAV), and non-fatal major adverse cardiac events (NF-MACE;
myocardial infarction, heart failure, percutaneous intervention, stroke).
Multivariate analysis was used to assess effect of recipient age, donor
age, sex, Cr, desensitization pre-transplantation, diabetes, and induction
therapy on the relationship between anemia and survival.
Results: Chronic anemia did not impact post-transplant 5-year survival,
CAV, or NF-MACE (Table). In the multivariate analysis, Cr had the
strongest impact on survival. For every 1 mg/dL increase in Cr, there
was a 4.3-fold increase in the risk of death (p ¼ 0.027).
Conclusions: Chronic anemia in the first year does not impact survival
after heart transplantation. However, even in a population of heart
transplant recipients with normal creatinine, higher serum creatinine
increases the risk of death post-transplantation. Further study is
needed to determine if protocols to minimize renal insufficiency will
improve outcomes in these patients.
703
Early Inflammatory Predictors of Post-Transplant Major Adverse Cardiac
Events
C.A. Labarrere,1 J.R. Woods,2 J.W. Hardin,3 B.R. Jaeger,4
M. Zembala,5 M.C. Deng,6 P.C. Kirlin,7 D.E. Pitts.7 1CBL Partners for
Life, Noblesville, IN; 2Methodist Research Institute, Indiana University
Health, Indianapolis, IN; 3Epidemiology and Biostatistics, University of
South Carolina, Noblesville, SC; 4Dr. Stein und Kollegen,
Mönchengladbach, Germany; 5Silesian Center for Heart Diseases,
Zabrze, Poland; 6Ronald Reagan UCLA Medical Center, Los Angeles,
CA; 7St Vincent Heart Center of Indiana, Indianapolis, IN.
Purpose: To determine whether adding inflammatory markers to an
established atherothrombotic (AT) model improves prediction of
major adverse cardiac events (MACE) following heart transplantation.
Methods and Materials: Inflammatory markers interleukin-6 (IL-6) and
C-reactive protein (CRP) and AT markers (myocardial fibrin, loss of
vascular antithrombin and tissue plasminogen activator, arterial endothelial intercellular adhesion molecule-1 expression) were measured in
serial serum and heart biopsy samples of 172 patients followed
prospectively for 8.9⫾5.0 years for MACE (myocardial infarction,
percutaneous cardiac interventions, coronary artery bypass graft,
implantable cardiac defibrillator, cardiac death/retransplantation). Multivariate stepwise logistic regression models were estimated using AT
markers obtained from (1) the first post-transplant biopsy only (median:
9 days), or (2) all biopsies obtained within 3 months. The additional
predictive value of adding inflammatory markers (IL-6 and CRP) was
evaluated by inclusion into the established AT model. Final models were
adjusted for covariates (eg., recipient sex) and cross-validated in 200
bootstrapped samples drawn with replacement from the original sample.
Results: Most AT markers univariately predicted MACE at 5- and 10years; however, in multivariate models (Table 1), antithrombin and
fibrin were the only significant (po0.005) predictors. Table 1 shows
that adding IL-6, but not CRP, to the best AT model improves
discriminatory power (as indicated by the change in the ROC value).
Conclusions: Loss of antithrombin and presence of fibrin as early as
9 days post-transplant are significant predictors of future MACE.
Adding IL-6, but not CRP, improves the AT model.
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704
End of an Era: Reduced Severity of Tricuspid Regurgitation in Cardiac
Transplant Recipients Managed with Molecular Diagnostic Testing
S. Feitell,1 J. Patel,1 P. Pirlamarla,1 J. Whittier,1 E. Gongora,1
T. Rowe,2 S. Hankins,1 H.J. Eisen.1 1Division of Cardiology/
Department of Medicine, Drexel University College of Medicine,
Philadelphia, PA; 2Center for Advanced Heart Failure Care,
Hahnemann University Hospital, Philadelphia, PA.
Purpose: A well-established complication of right ventricular endomyocardial biopsy (EMB) used for the diagnosis of acute cellular
rejection is damage to the tricuspid valve and subsequent tricuspid
regurgitant flow. Since the advent of Molecular Diagnostic Testing
(MDT) as a screening test for determining which patients require
EMB, the need for EMB at our center has decreased significantly. We
hypothesized that the severity of tricuspid regurgitation (TR) should
therefore be reduced with greater reliance on MDT and reduced
utilization of EMB.
Methods and Materials: 58 echocardiograms from cardiac transplant
patients who survived at least two years post-transplant were reviewed
by observers blinded to post-transplant rejection surveillance strategies. 30 patients were in the pre-MDT group, from 2002-2004, when
only EMB was used for post-transplant rejection surveillance. 28
patients were in the MDT group, from 2008-2010, when MDT
was used as a screen to determine if EMB was required. TR was
graded on a scale of zero to four, with zero representing no
regurgitation present on echocardiography, one representing trace,
two representing mild, three representing moderate and four representing severe TR.
Results: Of the 30 patients evaluated from the pre-MDT group, from
2002-2004, the average TR score was 1.87. In the 28 patients evaluated
after routine MDT testing was implemented, from 2008-2010, the
average score was 1.30, indicating a statistically significant reduction in
tricuspid regurgitation severity(p ¼ 0.0297). There was no evidence of
severe TR in the MDT patients.
Conclusions: Our findings demonstrate that with greater use of MDT,
the severity of tricuspid regurgitation has been reduced. MDT has
become an established method for monitoring immune activation and
as a screen for identifying the need for EMB in low risk cardiac
transplant recipients. Our findings further support the continued use of
MDT as a screening test before resorting to EMB.
705
Role of Donor-Recipient Match in Determining the Risk for Primary
Graft Failure after Heart Transplantation
C. Lonetti, V. Manfredini, L. Potena, V. Pece, M. Masetti, S. MartinSuarez, E. Pilato, A. Loforte, G. Magnani, F. Grigioni, G. Arpesella,
A. Branzi. Cardiovascular Department, University of Bologna, Bologna,
Italy.
Purpose: Non-functional recovery of the graft (primary graft failure,
PGF) is still the major cause of early adverse outcome after heart
transplantation (HT). While several donor- and recipient-related
factors have been taken into account to explain PGF onset, few data
are available analyzing how donor-recipient match may be optimized
to reduce PGF occurrence. In this study, we explored PGF risk factors,
aiming to identify specific donor-recipient matches associated with
PGF onset.
Methods and Materials: We reviewed data from all adult patients
transplanted between 1999 and 2011 at our center, including those with
pre-HT laboratory and hemodynamic data availability. Study endpoint was occurrence of PGF defined as need of mechanical circulatory
support with ECMO/intra-aortic balloon pump, or cardiac index
o2.5 l/min/m2 for three consecutive hours despite adequate filling
pressure, during the first 24 post-HT hours.
Results: Out of 370 patients included, 63(17%) presented PGF. Among
all clinical and laboratory variables analyzed, recipient female sex
(Po0,01), transpulmonar gradient Z12 mmHg (GTP) (P¼0.02), and
increasing calculated pulmonary arterial resistances (RVP) were
associated with the risk of PGF (P¼0.04). To analyze the interplay