- MeSH
- antikoagulancia aplikace a dávkování farmakologie MeSH
- dospělí MeSH
- embolie a trombóza * farmakoterapie prevence a kontrola MeSH
- inhibitory agregace trombocytů aplikace a dávkování farmakologie MeSH
- INR normy MeSH
- ischemická choroba srdeční farmakoterapie MeSH
- kardiochirurgické výkony MeSH
- kardiovaskulární komplikace v těhotenství MeSH
- krvácení chemicky indukované prevence a kontrola MeSH
- lidé MeSH
- pooperační péče * MeSH
- protézy a implantáty MeSH
- srdeční chlopně umělé MeSH
- těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- Klíčová slova
- Godasal 100,
- MeSH
- antikoagulancia farmakologie terapeutické užití MeSH
- antithrombiny farmakologie terapeutické užití MeSH
- Aspirin aplikace a dávkování farmakologie škodlivé účinky MeSH
- chirurgická náhrada chlopně metody MeSH
- glycin aplikace a dávkování farmakologie MeSH
- ischemická choroba srdeční chirurgie MeSH
- kardiochirurgické výkony metody MeSH
- lidé MeSH
- perioperační péče MeSH
- srdeční chlopně umělé MeSH
- stenty MeSH
- warfarin aplikace a dávkování škodlivé účinky MeSH
- Check Tag
- lidé MeSH
BACKGROUND: B-type natriuretic peptide (BNP) is a strong predictor of prognosis in chronic heart failure. We aimed to evaluate the clinical correlates and interpretation of BNP monitoring in LVAD out-patient recipients. METHODS: We performed a prospective study in 136 individuals after HeartMate II LVAD implantation. During follow-up they were divided into group A (severe adverse events requiring hospitalisation), group B (mild to moderate adverse events) and group C (an uneventful course). BNP was measured pre-implant, at the first out-patient visit, and then every 2 months. We identified the lowest level, and the level at the clinical event and/or the highest value in patients without clinical events (BNP peak). RESULTS: During a median follow-up of 298 days, 8 patients (6%) died, 21 patients (15%) experienced a severe adverse event (group A) and 38 patients (28%) had other adverse event (group B). Both the absolute value of BNP peak and its percentage values relative to pre-implant, first visit and minimum BNP had similar areas under the curve (AUC) to identify individuals with adverse events (group A and B) from group C. The performance of BNP peak rose from detection of infection to diagnosis of heart failure and culminated in individuals with pump thrombosis (AUC 0.68 vs. 0.75 vs. 0.93). CONCLUSIONS: Serial measurement of BNP in outpatients with LVAD correlates with the occurrence of adverse events. Assessment of absolute values of BNP peak seems to have a similar accuracy to analysis of intra-individual variation of BNP and it is more practical.
- MeSH
- ambulantní monitorování metody MeSH
- ambulantní péče metody MeSH
- biologické markery metabolismus MeSH
- dospělí MeSH
- dysfunkce levé srdeční komory krev terapie MeSH
- infekce spojené s protézou krev diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- natriuretický peptid typu B metabolismus MeSH
- plocha pod křivkou MeSH
- podpůrné srdeční systémy * MeSH
- pooperační komplikace krev diagnóza MeSH
- prospektivní studie MeSH
- senioři MeSH
- srdeční selhání krev terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: Antibodies targeting angiotensin II type 1 receptor (AT1R) have been associated with malignant hypertension, autoimmune diseases and acute rejection and graft loss in solid organ transplantation. The aim of our study was to assess the impact of anti-AT1R antibodies on survival and incidence of acute cellular rejection (ACR) and pathology antibody-mediated rejection (pAMR) in a population of heart transplant recipients who were bridged to transplantation with a durable mechanical assist device Heart Mate II. METHODS: Sera of 69 consecutive heart transplant recipients transplanted between October 2008 and August 2014 were tested for the presence of angiotensin II type 1 receptor antibodies before Heart Mate II device implantation and at the time of transplantation. Overall survival and post-transplant rejection-free survival were compared between antibody-negative and antibody-positive recipients using Kaplan-Meier and log-rank tests. RESULTS: Anti-AT1R antibodies were present in 8 patients (11.6%) before Heart Mate II implantation. During the left ventricular assist device (LVAD) bridging, 44 patients (63.8%) who were initially anti-AT1R antibody-negative became positive, leaving 17 (24.6%) anti-AT1R antibody-negative patients at the time of transplantation for all comparisons. One- and 5-year survival was 88 ± 8 and 76 ± 10% for anti-AT1R antibody-negative and 87 ± 5 and 81 ± 7% for anti-AT1R antibody-positive patients, respectively (P = 0.582). Freedom from ACR at 1 year was 68 ± 12% for anti-AT1R-negative and 75 ± 6% for anti-AT1R-positive recipients (P = 0.218). None of the anti-AT1R-negative patients developed AMR 1 year post-transplantation, whereas freedom from pAMR in anti-AT1R-positive recipients was 98 ± 2% (P = 0.198). CONCLUSIONS: Our data showed no difference in the overall post-heart transplant survival and freedom from acute cellular and antibody-mediated rejection between anti-AT1R-negative and anti-AT1R-positive recipients. Further research is needed to assess the role of anti-AT1R antibodies in the risk stratification of LVAD-bridged recipients on the post-heart transplantation outcomes.
- MeSH
- akutní nemoc MeSH
- autoprotilátky krev MeSH
- buněčná imunita MeSH
- časové faktory MeSH
- dospělí MeSH
- humorální imunita MeSH
- Kaplanův-Meierův odhad MeSH
- lidé středního věku MeSH
- lidé MeSH
- podpůrné srdeční systémy * MeSH
- přežívání štěpu MeSH
- receptor angiotensinu typ 1 imunologie MeSH
- rejekce štěpu imunologie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- srdeční selhání krev diagnóza imunologie chirurgie terapie MeSH
- transplantace srdce * škodlivé účinky mortalita MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
Solid-phase assays (SPA) have facilitated detection and definition of antibodies to human leukocyte antigens (HLA) and major histocompatibility complex class I chain-related antigen A (MICA). However, clinical consequences of pretransplant SPA results in heart transplantation have been studied insufficiently in the current era of immunosuppression and rejection surveillance. Pretransplant sera, panel-reactive antibodies (PRA), pretransplant crossmatch, and clinical data were retrospectively analyzed in 264 adult heart transplant recipients. The specificity of HLA and MICA antibodies and C1q-binding activity of donor-specific antibodies (DSA) were defined using SPA. Pretransplant HLA antibodies were detected in 57 (22%) individuals, in 28 individuals (11%); these antibodies were DSA after transplant. Preformed DSA and elevated peak PRA were independent predictors of pathologic AMR, which occurred in 19 individuals (7%). The increasing number of DSA and the cumulative mean fluorescence intensity of DSA were associated with AMR. C1q-binding assay was a suboptimal predictor of AMR in our cohort. Pretransplant allosensitization and MICA antibodies were related neither to impaired graft survival nor to other adverse clinical events during a median follow-up of 39 months. Identification of preformed DSA by SPA, in addition to PRA monitoring, may predict AMR in the contemporary era of heart transplantation.
- MeSH
- analýza rozptylu MeSH
- dospělí MeSH
- HLA antigeny krev imunologie MeSH
- hodnocení rizik MeSH
- homologní transplantace škodlivé účinky metody MeSH
- imunizace metody MeSH
- imunologická tolerance fyziologie MeSH
- imunosupresivní léčba metody MeSH
- Kaplanův-Meierův odhad MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- míra přežití MeSH
- následné studie MeSH
- prediktivní hodnota testů MeSH
- předoperační péče metody MeSH
- přežívání štěpu imunologie MeSH
- proporcionální rizikové modely MeSH
- rejekce štěpu imunologie MeSH
- retrospektivní studie MeSH
- ROC křivka MeSH
- rozdělení chí kvadrát MeSH
- specificita protilátek MeSH
- testování histokompatibility MeSH
- transplantace srdce škodlivé účinky metody mortalita MeSH
- transplantační imunologie fyziologie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
BACKGROUND: Antibody-mediated rejection (AMR) is a serious complication of organ transplantation, and its treatment is complex. The aim of this study was to assess immunoadsorption (IA) for treatment-immunized patients before heart transplantation (HTX) and as the first step of AMR treatment after HTX. METHODS: The cohort consisted of 10 patients (8 men, 2 women; age range, 20-57 years). For 3 of these patients, IA was included in the desensitization protocol before HTX; for 7 patients, IA was the first step of the treatment protocol. One patient underwent IA before and after HTX. RESULTS: A comparison of values before IA and after the last procedure showed a decrease in immunoglobulin subgroups (G, M, and A). In patients before HTX, a decline was noted in panel reactive antibodies. After HTX, IA procedures led to a significant decrease in donor-specific antibody (DSA) class I; DSA class II fell in 6 of 7 patients, with 51% falling below the detection limit. CONCLUSIONS: IA in patients during HTX is safe procedure for reducing DSA. The removal of antibodies is the first step in comprehensive treatment and must be followed by a procedure that prevents their further development.
- MeSH
- dárci tkání MeSH
- desenzibilizace imunologická metody MeSH
- dospělí MeSH
- imunosorpční techniky * MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- protilátky imunologie MeSH
- rejekce štěpu imunologie MeSH
- transplantace ledvin MeSH
- transplantace srdce metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
AIMS: One of the proposed limitations of left ventricular assist device (LVAD) therapy is high degree of sensitization. Apart from human leukocyte antigen (HLA), antibodies against Angiotensin II Type 1 Receptor (AT1R) have been associated with adverse outcomes. The purpose of this study was to compare complications and survival of anti - AT1R positive versus negative Heart Mate II (HMII) recipients. METHODS: Altogether 96 patients received HMII at our institution between 2008 and 2012. These were stratified into three groups: antibody positive before implantation (AT1R+), antibody conversion during support (AT1R-/+) and patients who remained antibody negative (AT1R-). Survival, major on-device adverse events and post-transplant rejections were assessed with Kaplan-Meier and log-rank tests. RESULTS: Two year on-device and overall survival was 78 ± 12% and 75 ± 10% in AT1R-, 60 ± 23% and 60 ± 15% in AT1R+ and 92 ± 6% and 87 ± 5% in AT1R-/+ group (P = 0.409, P = 0.185). Freedom from major adverse event at two years for AT1R-, AT1R+ and AT1R-/+ was 49 ± 14%, 53 ± 16% and 41 ± 11% (P = 0.875). Freedom from rejection was 63 ± 17% in patients who were both anti-AT1R and HLA negative and 65 ± 13% in those who were antibody positive (P = 0.788). CONCLUSION: Patients who were anti-AT1R antibody positive had similar on-device survival and rate of complications in comparison to those who were antibody negative. In transplanted patients, there were no differences in the overall survival and rejection between the groups.
- MeSH
- dospělí MeSH
- HLA antigeny imunologie MeSH
- infekce spojené s protézou etiologie mortalita MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci nervového systému etiologie mortalita MeSH
- podpůrné srdeční systémy škodlivé účinky MeSH
- pooperační krvácení etiologie MeSH
- protilátky metabolismus MeSH
- receptor angiotensinu typ 1 imunologie MeSH
- rejekce štěpu imunologie MeSH
- selhání protézy MeSH
- srdeční selhání imunologie mortalita terapie MeSH
- transplantace srdce mortalita MeSH
- transplantační imunologie imunologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- Publikační typ
- abstrakt z konference MeSH
Evidence regarding the use of bortezomib-containing schemes in primary treatment of antibody-mediated rejection in heart transplant recipients is scarce. This case report presents the clinical experience with upstream use of bortezomib in primary treatment of early antibody-mediated rejection in an adult heart transplant recipient. Two cycles of bortezomib together with methylprednisolone, immunoadsorption, rituximab, and supplementary doses of intravenous immunoglobulin G reversed signs of heart failure, production of donor-specific antibodies, and findings of antibody-mediated rejection in biopsy. This treatment regimen was tolerated with only mild hematologic toxicity and proved to be successful during a 12-month follow-up. Primary treatment with a bortezomib-containing regimen appears to be a new therapeutic option for severe antibody-mediated rejection in heart transplant recipients. However, the efficacy and safety of this treatment need to be tested in prospective trials.
- MeSH
- alografty účinky léků MeSH
- antitumorózní látky aplikace a dávkování MeSH
- bortezomib MeSH
- dospělí MeSH
- imunosupresiva aplikace a dávkování MeSH
- intravenózní imunoglobuliny terapeutické užití MeSH
- isoprotilátky imunologie MeSH
- kombinovaná farmakoterapie MeSH
- kyseliny boronové aplikace a dávkování MeSH
- lidé MeSH
- methylprednisolon aplikace a dávkování terapeutické užití MeSH
- myší monoklonální protilátky aplikace a dávkování terapeutické užití MeSH
- prospektivní studie MeSH
- pyraziny aplikace a dávkování MeSH
- rejekce štěpu farmakoterapie etiologie MeSH
- rituximab MeSH
- transplantace srdce škodlivé účinky MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
