The aim was to evaluate the association of molecular‐level human leukocyte antigen (HLA) mismatching with post‐transplant graft survival, rejection, and cardiac allograft vasculopathy (CAV). We ...retrospectively analyzed all primary cardiac transplant recipients between 01/1984‐06/2016. 1167 patients fulfilled inclusion criteria and had HLA typing information available. In 312 donor‐recipient pairs, typing at serological split antigen level was available. We used the Epitope MisMatch Algorithm to calculate the number of amino acid differences in antibody‐verified HLA eplets (amino acid mismatch load (AAMM)) between donor and recipient. Patients with a higher HLA‐DR AAMM load had inferior 1‐year graft survival (hazard ratio HR, 1.14; 95% confidence interval CI, 1.01–1.28). The HLA‐AB AAMM load showed no impact on graft survival. In the subgroup with available split‐level information, we observed an inferior graft survival for a higher HLA‐DR AAMM load 3 months after transplantation (HR, 1.22; 95% CI, 1.04–1.44) and a higher risk for rejection for an increasing HLA‐AB (HR, 1.70; 95% CI, 1.29–2.24) and HLA‐DR (HR, 1.32; 95% CI, 1.09–1.61) AAMM load. No impact on the development of CAV was found. Molecular‐level HLA mismatch analysis could serve as a tool for risk stratification after heart transplantation and might take us one step further into precision medicine.
The adapted Heart Donor Score Angleitner, Philipp; Kaider, Alexandra; Smits, Jacqueline M. ...
Transplant international,
March 2021, Volume:
34, Issue:
3
Journal Article
Peer reviewed
Open access
Summary
The Heart Donor Score (HDS) predicts donor organ discard for medical reasons and survival after heart transplantation (HTX) in the Eurotransplant allocation system. Our aim was to adapt the ...HDS for application in the United Network for Organ Sharing (UNOS) registry. To adjust for differences between the Eurotransplant and UNOS registries, the “adapted HDS” was created (aHDS) by exclusion of the covariates “valve function,” “left‐ventricular hypertrophy,” and exclusion of “drug abuse” from the variable “compromised history.” Two datasets were analyzed to evaluate associations of the aHDS with donor organ discard (n = 70 948) and survival (n = 19 279). The aHDS was significantly associated with donor organ discard odds ratio 2.72, 95% confidence interval (CI) 2.68–2.76, P < 0.001; c‐statistic: 0.937). The score performed comparably in donors <60 and ≥60 years of age. The aHDS was a significant predictor of survival as evaluated by univariate Cox proportional hazards analysis (hazard ratio 1.04, 95% CI 1.01–1.07, P = 0.023), although the association lost significance in a multivariable model. The aHDS predicts donor organ discard. Negative effects of most aHDS components on survival are likely eliminated by highly accurate donor selection processes.
The sterol profile of Tunisian virgin olive oils produced from Chétoui cultivar, the second main variety cultivated in the north of the country, grown under different environmental conditions, was ...established by gas chromatography using a flame ionisation detector. More than ten compounds were identified and characterised. As expected for virgin olive oil, the main sterols found in all Chétoui olive oils were β-sitosterol, Δ5-avenasterol, campesterol and stigmasterol. Cholesterol, 24-methylenecholesterol, clerosterol, campestanol, sitostanol, Δ7-stigmastenol, Δ5,24-stigmastadienol, and Δ7-avenasterol were also found in all samples, but in lower amounts. Most of these compounds are significantly affected by the geographical origin. The majority of the Chétoui virgin olive oils analysed respected EC Regulation No. 2568, and in all cases total sterol amounts were higher than the minimum limit set by legislation, ranging from 1017 to 1522mg/kg.
Two triterpenic dialcohols (erythrodiol and uvaol), were also detected besides the sterolic components. Their content was below the upper legal limit of 4% in all analysed samples, with a range from 1.2% to 3.2%. These results suggest that, besides the genetic factor, environmental conditions influence the sterolic fraction.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
► New data on Tunisian mono-cultivar olive oils. ► Data were obtained using analytical methods and quality control procedures. ► Phenols, sterols, dialcohols and triacylglycerols were affecetd by ...genetic factors. ► Tunisian extra virgin olive oils were identified as sources of antioxidant components. ► Various commercial applications owing to high phenolic contents and greater stability.
The aim of the present investigation is to discriminate five minor Tunisian olive cultivars (Hor Kesra, Sredki, Chladmi, Betsijina and Aloui) by studying their sterol and phenol compositions. This is the first study of the chemical composition of virgin olive oils (VOO) from these cultivars. The majority of analytical parameters presented statistically significant differences (P<0.01). The examined varieties produce excellent oils with a chemical composition within the regulatory limits and an appreciable amount of natural antioxidants. Our results showed that Betsijina oil was characterized by high mean values of total phenols (1400mgkg−1) and oxidative stability (113h). VOOs studied demonstrate that the differences in phenols (min: 253–max: 1400mgkg−1), tocopherol (139–402mgkg−1), sterols (1039–1567mgkg−1), triterpene dialcohols (19.1–32.4mgkg−1) and triacylglycerols profiles may be explained by genetic factors. Results of PCA and HCA analyses show a good discrimination between varieties according to phenol, triacylglycerol and sterol data. These components seem to be an effective tool to discriminate between the varieties.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Summary
Evidence concerning an association between cytomegalovirus (CMV) infection and accelerated cardiac allograft vasculopathy (CAV) is inconclusive. Data were analyzed retrospectively from 297 ...consecutive heart transplants between 1.1.2002 and 31.12.2012. Patients ≤18 years of age, survival, and follow‐up ≤1‐year post‐transplant and patients with early CAV were excluded. CMV‐infection was diagnosed and monitored closely in the first year. CAV was diagnosed by coronary angiography via left heart catheterization, and results were categorized according to the International Society of Heart and Lung Transplantation (ISHLT) scoring system. Risk factors for CAV were tested in a multivariable model. Median follow‐up was 7.5 years (IQR: 5.6–10.3). CMV infection in the first year after transplantation occurred in 26% of patients (n = 78), CMV disease in 5% (n = 15). CAV ≥1 ISHLT was detected in 36% (n = 108). Incidence of CAV >1 ISHLT and severity of CAV increased over time. No statistically significant association between CMV infection and disease within the first year and risk of CAV after 1‐year post‐HTx was detected in the univariate (P = 0.16) and multivariable hazard ratio (HR), 1.36; confidence interval (CI), 0.89–2.07; P = 0.16 Cox regression. In the multivariable Cox regression, donor age (HR, 1.04; 95% CI, 1.02–1.06; P < 0.01) and acute cellular rejection (ACR) ≥2R in the first year after HTx (HR, 1.77; 95% CI, 1.06–2.95; P = 0.03) were independent risk factors for CAV development. In our cohort, CMV infection and disease in the first year after transplantation did not significantly influence the risk of CAV in the long‐term follow‐up.
Este artículo indaga cómo el modelo del Socialismo del Siglo XXI incrementó la violencia institucional y política. Los autores de este artículo han asumido que este tipo de violencia explica la ...masiva emigración internacional venezolana observada durante los últimos veinte años. El marco conceptual básico proviene de la teoría push-pull. Para ello se utiliza la Tipología de la Migración de William Petersen, que caracteriza la migración forzada e impulsada que surge de la política migratoria del Estado. Además, los autores de este artículo utilizaron las ideas de Johan Galtung sobre la violencia visible e invisible. Varias fuentes secundarias nacionales e internacionales sustentan la relación entre la violencia y el éxodo masivo internacional. El análisis revela que el clima de tensión, desconfianza en las instituciones, desigualdad y vulneración de derechos fundamentales, desde hace dos décadas, podrían explicar la movilidad internacional de la población venezolana.
Le but de l’article est d’examiner comment le modèle socialiste du XXIe siècle a augmenté la violence institutionnelle et politique, ce qui est supposé être l’une des causes qui expliquentl’émigration internationale massive du Venezuela, observée au cours des quatre dernièresdécennies. Le cadre conceptuel de base provient de la théorie push-attraction. Les concepts de William Petersen, qui caractérise la migration forcée et poussée de la politique migratoire de l’État, et de Johan Galtung sur la violence visible et invisible sont utilisés. Diverses sources secondaires internationales et nationales ont été utilisées pour étayer la relation entre la violence et l’exode massif international. L’analyse réalisée révèle que le climat de tension, la méfiance à l’égard des institutions, les inégalités et la violation des droits fondamentaux depuis deux décennies pourraient expliquer la mobilité internationale de la population vénézuélienne.
Este artigo investiga como o modelo de socialismo do século XXI aumentou a violência institucional e política. Os autores deste artigo assumiram que esse tipo de violência explica a emigração internacional venezuelana maciça observada nos últimos vinte anos. A estrutura conceitual básica vem da teoria do push-pull. Para isso, é utilizada a Tipologia da Migração de William Petersen, que caracteriza a migração forçada e impulsionada que decorre da política migratória do Estado. Além disso, os autores deste artigo usaram as ideias de Johan Galtung sobre violência visível e invisível. Várias fontes secundárias nacionais e internacionais apoiam a relação entre a violência e o êxodo em massa internacional. A análise revela que o clima de tensão, desconfiança nas instituições, desigualdade e violação de direitos fundamentais, por duas décadas, poderia explicar a mobilidade internacional da população venezuelana.
This article searches how the Socialism of the 21st Century model increased institutional and political violence. This article has assumed that this type of violence explains the massive Venezuelan international emigration observed during the last twenty years. The basic conceptual framework comes from the push-pull theory. The Typology of Migration of William Petersen is used, which characterizes forced and impelled migration that surged from the migratory policy of the state. Also, the authors of this article used Johan Galtung's ideas on visible and invisible violence. Various national and international secondary sources support the relationship between violence and the massive international exodus. The analysis reveals that the climate of tension, mistrust in institutions, inequality, and the violation of fundamental rights, observed for two decades could explain the international mobility of the Venezuelan population.
ABSTRACTThis brief overview discusses recent data on the use of mammalian target of rapamycin (mTOR) inhibitors in heart transplantation. Trials on de novo use have shown good efficacy of mTOR ...inhibitors; however, adverse events are often seen. Conversion protocols in long-term patients are mainly used in patients with renal insufficiency. Calcineurin inhibitor minimization and conversion to calcineurin inhibitor–free protocols have proven to stabilize renal function in recent trials. Lastly, beneficial effects of mTORs against the development of graft vasculopathy, cytomeglovirus infection and malignancy have been shown. Nevertheless, lower tolerability of the drug has affected the long-term use in patients. Future consideration of using mTORs will be individualized protocols in special subpopulation after heart transplantation.
Despite the evident shift toward biological prostheses, the optimal choice of valve remains controversial in composite valve graft (CVG) replacement. We investigated long-term morbidity and mortality ...after CVG implantation in an all-comer cohort with a subgroup analysis of patients aged 50-70 years stratified after valve type.
A total of 507 patients underwent the Bentall procedure with either a mechanical (MCVG,
= 299) or a biological (BCVG
= 208) CVG replacement between 2000 and 2020. A single-center analysis comprising clinical and telephone follow-up was conducted to investigate late mortality and morbidity.
The 30-day mortality in all patients age 56 ± 14 years, 78.1% male, EuroSCORE II 3.12 (1.7; 7.1) was 5.9%. Patients who were electively operated on had a 30-day mortality of 1.5% (
= 5) while it remained higher in urgent/emergent procedures (
= 25, 15.4%). Survival at 10 and 15 years was 78.19 ± 2.26% and 72.6 ± 3.2%, respectively. In patients aged 50-70 years (
= 261; MCVG = 151, BCVG = 110), survival did not differ significantly between the valve groups (
= 0.419). Multivariable analysis showed no significant impact of valve type on survival (
= 0.069). A time-varying relation with survival was notable, showing a higher risk in the MCVG group in the early postoperative phase, which declined compared to the BCVG group in the course of follow-up.
The Bentall technique presents with excellent mortality when performed electively. The type of valve prosthesis showed no statistically significant effect on mortality in patients aged 50-70 years. However, a time-varying relation showing an initially higher risk with MCVG which decreased compared to BCVG at long-term follow-up was notable. Further studies with even longer follow-up of BCVGs will clarify the ideal choice of prosthesis in this patient subset.
Nose‐shaped mass in the ascending aorta Osorio‐Jaramillo, Emilio; Strassl, Andreas; Kocher, Alfred ...
Journal of cardiac surgery,
June 2022, Volume:
37, Issue:
6
Journal Article
Peer reviewed
Open access
A 79‐year‐old man was referred for urgent coronary artery bypass grafting. Contrast‐enhanced computed tomography revealed an atypically nose‐shaped contrast defect, which intraoperatively turned out ...to be an atheromatous plaque. Its preoperative detection allowed us to prevent an adverse cerebral event. This case highlights that a thorough preoperative work‐up should ideally include a CT angiography, in patients where atherosclerotic changes are to be expected.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
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