Browsing by Author "Sola, E"
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- Cardiac allograft systolic function. Is the aetiology (ischaemic or idiopathic) a determinant of ventricular function in the heart transplant patient?Publication . Antunes, MJ; Biernet, M; Sola, E; Oliveira, L; Prieto, D; Franco, F; Providência, LAThe natural history of the LV systolic function (LV-SF) and functional capacity of survivors of heart transplantation (Htx) has not been defined. Some investigators suggest that SF may be different in recipients with different pre-transplant aetiologies: ischaemic or dilated, idiopathic disease. Routine transthoracic echocardiograms (TTE) were performed during a 1-year follow-up in 48 Htx recipients (total 864 examinations; mean 18/patient). Patients were divided into two groups based on pre-transplant diagnosis: ischaemic (CAD-CMP: n=13, age 54+/-1.7 years, 23% females) and idiopathic dilated cardiomyopathy (ID-CMP: n=35, age 51+/-2.3 years, 26% females). Patients with valvular and toxic aetiology were excluded. All patients underwent left ventriculography (VENT) 12-15 months after Htx. The majority of 1-year survivors of Htx maintained normal LV-SF: mean LVEF 65+/-4% by echocardiography and 68+/-3% by ventriculography, but in the ID-CMP group LVEF was significantly higher: 67+/-4% vs. 62+/-4% (TTE) and 77+/-4% vs. 60+/-4% (VENT), without significant differences in functional capacity (NYHA). 82.9% of ID-CMP patients had LVEF >65% vs. 39% in CAD-CMP. The incidence of acute cellular rejection, freedom from cardiac vasculopathy, renal failure, diabetes, hypertension and pre-transplant alloantibody level was similar. Our study shows a strong correlation between pre-transplant heart disease and the systolic function of the cardiac allograft at 1-year follow-up.
- A decade of cardiac transplantation in Coimbra: the value of experiencePublication . Prieto, D; Correia, P; Batista, M; Sola, E; Franco, F; Costa, S; Antunes, PE; Antunes, MJINTRODUCTION AND OBJECTIVES: To analyze the experience gained in 10 years of the heart transplantation program of the University Hospital of Coimbra. METHODS: Between November 2003 and December 2013, 258 patients with a mean age of 53.0±12.7 years (3-72 years) and predominantly male (78%) were transplanted. Over a third of patients had ischemic (37.2%) and 36.4% idiopathic cardiomyopathy. The mean age of donors was 34.4±1.3 years and 195 were male (76%), with gender difference between donor and recipient in 32% of cases and ABO disparity (non-identical groups but compatible) in 18%. Harvest was distant in 59% of cases. In all cases total heart transplantation with bicaval anastomoses, modified at this center, was used. Mean ischemia time was 89.7±35.4 minutes. All patients received induction therapy. RESULTS: Early mortality was 4.7% (12 patients) from graft failure and stroke in five patients each, and hyperacute rejection in two. Thirteen patients (5%) required prolonged ventilation, 25 (11.8%) required inotropic support for more than 48 hours, and seven required pacemaker implantation. Mean hospital stay was 15.8±15.3 days (median 12 days). Ninety percent of patients were maintained on triple immunosuppressive therapy including cyclosporine, the remainder receiving tacrolimus. In 23 patients it was necessary to change the immunosuppression protocol due to renal and/or neoplastic complications and humoral rejection. All but two patients have been followed in the Surgical Center. Fifty patients (19.4%) subsequently died from infection (18), cancer (10), vascular (eight), neuropsychiatric (four), cardiac (two) or other causes (eight). Forty-six patients (17.8%) had episodes of cellular rejection (>2 R on the ISHLT classification), eight had humoral rejection (3.1%), and 22 have evidence of graft vascular disease (8.5%). Actuarial survival at 1, 5, and 8 years was 87±2%, 78±3% and 69±4%, respectively. CONCLUSION: This 10-year series yielded results equivalent or superior to those of centers with wider and longer experience, and have progressively improved following the introduction of changes prompted by experience. This program has made it possible to raise and maintain the rate of heart transplantation to values above the European average.
- Diabetes as an outcome predictor after heart transplantationPublication . Saraiva, J; Sola, E; Prieto, D; Antunes, MJWe aimed to compare post-transplantation morbidity and survival among heart transplant recipients with and without diabetes mellitus. A retrospective review of 141 adult patients submitted to heart transplantation from November 2003 to June 2009 (with a minimum follow-up of one year) was undertaken. The patients were divided into two groups: those with (29%) and those without (71%) pre-transplantation diabetes. Those with diabetes were older (57.6±6.1 vs. 52.3±11.1 years; P=0.020) and had lower creatinine clearance (53.6±15.1 vs. 63.7±22.1; P=0.029). Nine patients died in hospital (6.4%; P=non-significant). No significant differences in lipid profiles (diabetes vs. no diabetes) existed before transplantation or at one year afterwards. Patients with diabetes showed a significant deterioration in their one-year lipid profile (158±43 vs.192±38 mg/dL; P=0.001), although one-year fasting diabetic was lower than before (178±80 vs. 138±45 mg/dL; P=0.016). During the first year, 17 (17%) patients previously free of diabetes developed new-onset diabetes. No significant differences were seen in rejection at one year (14% vs. 20%), infection (31% vs. 33%), new-onset renal dysfunction (8% vs. 14%) or mortality (17% vs. 7%). One-year survival was not significantly different (83% vs. 94%), but there was a significant decrease in the survival of individuals with diabetes at three years (73% vs. 91%; P=0.020). No significant difference was found in one-year survival or in terms of higher morbidity in the heart transplant patients with diabetes, but a longer follow-up showed a significant decrease in survival. Nonetheless, the patients with diabetes benefited significantly from transplantation and should not be excluded from it.
- Heart transplantation from donors of different ABO blood typePublication . Neves, C; Prieto, D; Sola, E; Antunes, MJINTRODUCTION: ABO blood group compatibility between donors and recipients of heart transplants is required to reduce the risk of hyperacute rejection. Ideally, ABO-identical cardiac grafts should be used but transplantating using ABO compatible types allows reduced waiting times among recipients with rarer types without a significant increase in hyperacute rejection. However, previous reports have indicated that use of donors with minor ABO mismatches may adversely influence late outcomes, although more recent studies do not confirm this suggestion. Our purpose was to analyze this practice in our center. METHODS: We analyzed 121 patients who underwent heart transplantation between November 2003 and May 2008. One hundred nine patients (90.0%) received ABO-matched grafts (population 1 [P1]) and 12 (9.9%) received ABO-compatible grafts (population 2 [P2]). P1 included 60 group A, 44 group 0, and 5 group B patients; P2 included 5 group A, 5 group B, and 2 group AB patients. The populations did not differ statistically in age, gender, urgency status, surgical technique, ischemic time, donor features, or immunosuppression. They were assessed for left ventricle ejection fraction (LVEF), rejection, and mortality. RESULTS: There were no significant differences in total mortality (P1, 13.7%; P2, 8.3%), rejection grade > or =2R (P1, 21.1%; P2, 33.3%), or LVEF (6 months: P1, 65%; P2, 71%; 1 year: P1, 68%; P2, 69%). CONCLUSION: Minor ABO mismatches did not adversely affect 1-year outcomes of heart transplantation. This practice may facilitate organ allocation for end-stage heart failure patients, thereby reducing waiting time for heart transplantation
- Hepatic UDP-glucose 13C isotopomers from [U-13C]glucose: a simple analysis by 13C NMR of urinary menthol glucuronidePublication . Antunes, MJ; Biernat, M; Sola, E; Oliveira, L; Prieto, D; Franco, F; Providência, LAMenthol glucuronide was isolated from the urine of a healthy 70-kg female subject following ingestion of 400 mg of peppermint oil and 6 g of 99% [U-(13)C]glucose. Glucuronide (13)C-excess enrichment levels were 4-6% and thus provided high signal-to-noise ratios (SNRs) for confident assignment of (13)C-(13)C spin-coupled multiplet components within each (13)C resonance by (13)C NMR. The [U-(13)C]glucuronide isotopomer derived via direct pathway conversion of [U-(13)C]glucose to [U-(13)C]UDP-glucose was resolved from [1,2,3-(13)C(3)]- and [1,2-(13)C(2)]glucuronide isotopomers derived via Cori cycle or indirect pathway metabolism of [U-(13)C]glucose. In a second study, a group of four overnight-fasted patients (63 +/- 10 kg) with severe heart failure were given peppermint oil and infused with [U-(13)C]glucose for 4 hr (14 mg/kg prime, 0.12 mg/kg/min constant infusion) resulting in a steady-state plasma [U-(13)C]glucose enrichment of 4.6% +/- 0.6%. Menthol glucuronide was harvested and glucuronide (13)C-isotopomers were analyzed by (13)C NMR. [U-(13)C]glucuronide enrichment was 0.6% +/- 0.1%, and the sum of [1,2,3-(13)C(3)] and [1,2-(13)C(2)]glucuronide enrichments was 0.9% +/- 0.2%. From these data, flux of plasma glucose to hepatic UDPG was estimated to be 15% +/- 4% that of endogenous glucose production (EGP), and the Cori cycle accounted for at least 32% +/- 10% of GP.
- Transplantação cardíaca: cinco anos de actividadePublication . Antunes, MJ; Prieto, D; Sola, E; Antunes, PE; Oliveira, JF; Franco, F; Providência, LAOBJECTIVE: To analyze the initial five years experience of the new heart transplant program of Coimbra University Hospitals. METHODS: Between November 2003 aid December 2008, 132 patients were transplanted, with a mean age of 52.0 years (range 3-71 years), of whom 98 were male (74%). Half of the patients had dilated cardiomyopathy and 33% ischemic cardiomyopathy. The mean age of donors was 31.7 years and 102 were male (77%). Donor hearts were harvested at a distance in 62% of cases. There was a gender mismatch between donor and recipient (F:M) in 19% of cases and ABO blood type disparity (not identical but compatible) in 11%. In all cases we used the technique of total transplantation with bicaval anastomosis, modified in this center. Mean ischemia time was 88.9 +/- 32.2 minutes. All patients received induction therapy with basiliximab and methylprednisolone. RESULTS: Six patients (4.5%) died within 30 days or during hospitalization, due to graft failure in four and hyperacute rejection in two. Two patients required prolonged ventilation, ten (8%) required inotropic support for more than 48 hours, and four required pacemaker implantation. Mean hospital stay was 15.6 +/- 15.2 days (median 13 days). Ninety percent of patients (116/129) were maintained on triple immunosuppressive therapy, including cyclosporine, the remainder receiving tacrolimus. In 23 patients it was necessary to change the immunosuppressive regimen due to renal and/or tumoral complications, or humoral rejection. All patients are followed regularly in the Surgical Center. Thirteen patients (10%) died late of cancer (6 patients), infection (4 patients), and pancreatitis, pulmonary hypertension and suicide (one patient each). Twenty-two patients (17%) had 25 episodes of cellular rejection (> or = 2R), with clinical consequences in only one case, and five had humoral rejection (3.9%). No patients died of late rejection, but there is evidence of mild graft vascular disease in one. Actuarial survival (Kaplan-Meier) at one and five years was 90% and 82%, respectively. CONCLUSION: In this initial series of five years we obtained results equivalent to or bette than those in centers with wider and longer experience, aided by self-correction arising from our own experience. This program has increased the rate of cardiac transplantation in Portugal to above the European average.