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  1. Article ; Online: Donor Age, Sex, and Cause of Death and Their Relationship to Heart Transplant Recipient Cardiac Death

    Margo E. Hammond / Charles Zollinger / Andrija Vidic / Gregory L. Snow / Joseph Stehlik / Rami A. Alharethi / Abdallah G. Kfoury / Stavros Drakos / M Elizabeth H. Hammond

    Journal of Clinical Medicine, Vol 12, Iss 24, p

    2023  Volume 7629

    Abstract: Background: Recent studies indicate that donor innate immune responses participate in initiating and accelerating innate responses and allorecognition in the recipient. These immune responses negatively affect recipient outcomes and predispose recipients ...

    Abstract Background: Recent studies indicate that donor innate immune responses participate in initiating and accelerating innate responses and allorecognition in the recipient. These immune responses negatively affect recipient outcomes and predispose recipients to cardiovascular death (CV death). We hypothesized that a donor cause of death (COD) associated with higher levels of innate immune response would predispose recipients to more adverse outcomes post-transplant, including CV death. Methods: We performed a single-institution retrospective analysis comparing donor characteristics and COD to recipient adverse cardiovascular outcomes. We analyzed the medical records of local adult donors (age 18–64) in a database of donors where adequate data was available. Donor age was available on 706 donors; donor sex was available on 730 donors. We linked donor characteristics (age and sex) and COD to recipient CV death. The data were analyzed using logistic regression, the log-rank test of differences, and Tukey contrast. Results: Donor age, female sex, and COD of intracranial hemorrhage were significantly associated with a higher incidence of recipient CV death. Conclusions: In this single institution study, we found that recipients with hearts from donors over 40 years, donors who were female, or donors who died with a COD of intracranial hemorrhage had a higher frequency of CV death. Donor monitoring and potential treatment of innate immune activation may decrease subsequent recipient innate responses and allorecognition stimulated by donor-derived inflammatory signaling, which leads to adverse outcomes.
    Keywords innate immunity ; intracranial hemorrhage ; heart transplantation ; donor factors ; antibody mediated rejection ; cardiovascular death ; Medicine ; R
    Subject code 610
    Language English
    Publishing date 2023-12-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: ISHLT pathology antibody mediated rejection score correlates with increased risk of cardiovascular mortality: A retrospective validation analysis.

    Hammond, M Elizabeth H / Revelo, Monica P / Miller, Dylan V / Snow, Gregory L / Budge, Deborah / Stehlik, Josef / Molina, Kimberly M / Selzman, Craig H / Drakos, Stavros G / Rami A, Alharethi / Nativi-Nicolau, Jose N / Reid, Bruce B / Kfoury, Abdallah G

    The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

    2016  Volume 35, Issue 3, Page(s) 320–325

    Abstract: Background: Antibody-mediated rejection (AMR) in cardiac transplant recipients is a serious form of rejection with adverse patient outcomes. The International Society of Heart and Lung Transplantation (ISHLT) has published a consensus schema for the ... ...

    Abstract Background: Antibody-mediated rejection (AMR) in cardiac transplant recipients is a serious form of rejection with adverse patient outcomes. The International Society of Heart and Lung Transplantation (ISHLT) has published a consensus schema for the pathologic diagnosis of various grades of antibody-mediated rejection (pathology antibody-mediated rejection [pAMR]). We sought to determine whether the ISHLT pAMR grading schema correlates with patient outcomes.
    Methods: Using our database, which contains a semi-quantitative scoring of all pathologic descriptors of pAMR, we retrospectively used these descriptors to convert the previous AMR categories to the current ISHLT pAMR categories. Cox proportional hazard models were fit with cardiovascular (CV) death or retransplant as the outcome. The pAMR value was included as a categorical variable, and cellular rejection (CR) values were included in a separate model.
    Results: There were 13,812 biopsies from 1,014 patients analyzed. The pAMR grades of pAMR1h, pAMR1i, and pAMR2 conferred comparable increased risk for CV mortality. Significantly increased risk of CV mortality was conferred by biopsies graded as severe AMR (pAMR3).
    Conclusions: The new ISHLT pAMR grading schema identifies patients at increased risk of CV mortality, consistent with risks published from several programs before 2011. The current schema is validated by this analysis in a large biopsy database. Because pAMR1h, pAMR1i, and pAMR2 have similar CV risks associated with them, the threshold for a positive diagnosis of pAMR should be re-evaluated in future iterations of the ISHLT schema.
    MeSH term(s) Adolescent ; Adult ; Aged ; Antibodies/immunology ; Cardiovascular Diseases/etiology ; Cardiovascular Diseases/mortality ; Child ; Child, Preschool ; Female ; Graft Rejection/complications ; Graft Rejection/immunology ; Heart-Lung Transplantation ; Humans ; Infant ; Male ; Middle Aged ; Postoperative Complications/etiology ; Postoperative Complications/mortality ; Retrospective Studies ; Risk Assessment ; Young Adult
    Chemical Substances Antibodies
    Language English
    Publishing date 2016-03
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Validation Studies
    ZDB-ID 1062522-7
    ISSN 1557-3117 ; 1053-2498
    ISSN (online) 1557-3117
    ISSN 1053-2498
    DOI 10.1016/j.healun.2015.10.035
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