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Background: In this study, we try to determine risk factors for acute kidney injury in orthotopic cardiac transplantation patients., Methods: Between February 2003 and December 2022, all cardiac transplantation patients were retrospectively reviewed. Finally, 102 patients enrolled in this study. Demographic data, comorbidities, preoperative cardiac catheterization parameters, preoperative and postoperative blood test results, intraoperative parameters, acute kidney injury developed or not, stage of acute kidney injury, and whether renal replacement therapy was required or not was recorded., Results: Of the 102 patients, 68 were male. Fifty-four of these patients developed acute kidney injury, and 31 required renal replacement therapy postoperatively. The mean age of developed acute kidney injury group (AKI+) was older than non-developed acute kidney injury group (non-AKI) (P = .01). The average body surface area of the AKI+ was 1.81 ± 0.32, whereas in non-AKI it was 1.57 ± 0.35 (P = .01). More patients were ex-smokers (P = .007) and had a history of hypertension (P= .011) in the AKI+ group. Preoperative serum creatinine was 1.12 ± 0.26 mg/dL in the AKI+ group and 0.82 ± 0.13 mg/dL in the non-AKI group (P = .02). The intraoperative urine output was 491.20 ± 276.48 mL for AKI+ and 676.45 ± 478.84 mL for the non-AKI group (P = .03)., Conclusions: Acute kidney injury development after cardiac transplantation is common. In our study, high body surface area, older age, ex-smoker, hypertension, low intraoperative urine output, and high preoperative serum creatinine levels were risk factors for acute kidney injury development in cardiac transplantation patients. Mortality and morbidity after cardiac transplantation might be reduced if acute kidney injury development can be lowered., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Cardiac transplantation is an important treatment option that increases the survival and decreases the limitations in effort capacity among patients with end-stage heart disease. In this study we have presented the midterm results of 13 patients who underwent cardiac transplantation between 2003 and 2007., Patients and Methods: There were 10 male and three female patients of mean age of 32 +/- 13.27 years (12 to 54). In one patient, we performed combined cardiac and renal transplantation. Ischemic cardiac disease was present in six patients and cardiomyopathy in seven patients. The mean age of the donors was 23.3 +/- 11.8 years (12 to 46). Corticosteroids, cyclosporine, and mycophenolate mofetil were used for immunosuppression. Sirolimus was employed in five cases due to impaired renal function. Patients were followed by echocardiography, endomyocardial biopsy, and dobutamine stress echocardiography., Results: The mean follow-up was 18.6 +/- 13.4 (1 to 38) months. In four patients, there was grade IIIA (II-R) rejection. In five patients, tacrolimus or cyclosporine was replaced with sirolimus due to elevated creatinine levels. Dobutamine stress echocardiography was positive in one patient, who displayed a severe left main coronary artery lesion. There was no operative mortality. There was only one hospital mortality (7.6%). Two patients died in the midterm. The overall mortality on follow-up was 3 (23.1%). The survival rates in the first, second, and third years were 92%, 88%, and 75%, respectively. Ejection fraction were more than 50%; all of posttransplant survivors showed good effort capacity., Conclusion: Cardiac transplantation is a definitive, safe, and effective treatment for patients with end-stage heart failure.

Objective: The surgical techniques was first described by Lower and Shumway for cardiac transplantation have not changed for many years; they are still being commonly used worldwide despite recently presented alternatives. We sought to evaluate the surgical complications among our cardiac transplantation patients in whom we performed the standard technique., Patients and Methods: The standard biatrial anastomosis technique was used in 13 patients who have a mean follow-up of 18.6 (1 to 38) months. During the follow-up, echocardiographic assessment was performed to evaluate left and right atrial diameters, tricuspid and mitral valve regurgitation, interatrial septum, and suture lines. Elecotrocardiograms were evaluated for arryhthmia and pacemaker requirements in the midterm., Results: The mean left and right atrial diameters were measured as 40.5 (32 to 57) x 66.6 (48 to 78) and 37.9 (32 to 43) x 56.3 (48 to 69) mm, respectively. The jet area was calculated at less than 5 cm(2) for mitral and tricuspid valve regurgitation, which can be defined as "mild" regurgitation. There was no increase in the degree of regurgitation of both atrioventricular valves during the follow-up period. In one patient, a thrombus was detected in the suture line; there was a nonsignificant left to right shunt in another patient. A temporary pacemaker was indicated in two patients. Atrial fibrillation was detected in three patients, who responded to medical therapy. During the follow-up atrial fibrillation developed in one patient., Conclusion: The cardiac transplantation operation using the standard technique may result in atrial dysfuntion due to deformation of atrial integrity and geometry. However, when we evaluated our results, we concluded that the standard surgical technique was a safe, simple, effective, and feasible method.

Background: The use of hearts for cardiac transplantation from donors with brain death due to exposure to high concentrations of carbon monoxide is still under discussion. In this short report we have presented a patient who underwent a successful cardiac transplantation from a brain-dead donor who had cardiopulmonary resuscitation after carbon monoxide intoxication., Method: A standard biatrial anastomosis technique was used in our patient. The transplantation was uneventful with donor ischemic time of 180 minutes. The patient was treated with mechanical ventilation for 72 hours. The donor liver biopsy during harvesting did not reveal irreversible changes. Although the donor had a history of cardiopulmonary resuscitation, the left ventricular ejection fraction was 55% and the echocardiographic evaluation revealed normal cardiac contractions with acceptable hemodynamic parameters. Positive inotropic support was needed in the early postoperative period. We did not observe any changes related to intoxication in the endomyocardial biopsy., Conclusions: We concluded that successful heart transplantation can be performed using hearts from patients succumbing to carbon monoxide poisoning in the presence of adequate cardiac functional parameters. This group will increase the number of cardiac transplantations and decrease the incidence of deaths among patients on transplantation lists.

Objective: Renal failure after cardiac transplantation is a common and serious complication. In this study we investigated the incidence and effects of renal failure on survival among patients who underwent cardiac transplantation., Patients: Eight patients underwent cardiac and one patient combined cardiac and renal transplantation. The mean age of the patients was 33 +/- 11.6 years (range, 17 to 51). On preoperative echocardiographic evaluation, the mean ejection fraction was calculated as 19 +/- 3.11% (range, 16% to 24%). One patient had compensated renal failure and one patient, dialysis-dependent renal failure. Hemofiltration was routinely used during the operations. Corticosteroids, cyclosporine, and mycophenolate mofetil were used for immunosuppression. Early renal replacement therapy was performed in patients with acute renal failure., Results: The incidence of acute renal failure was 55.5% (5 patients). In the early postoperative and follow-up periods, the mean ejection fraction was 55 +/- 9.9% and 57 +/- 4.5%, respectively. The mean follow-up period was 21.3 +/- 8.8 (range, 6 to 33) months. In the early initiation period, the mean peak value of cyclosporine blood level was 479 +/- 201.8 ng/mL during the first month, 250 +/- 95.3 and after the third month, 195 +/- 43.7 ng/mL. The mean creatinine level at last follow-up was 1.27 +/- 0.4. One patient experienced a grade III-A rejection episode. One patient died due to coronary artery occlusive disease at 31 months after transplantation., Comment: In our study we have observed that renal failure had no negative effect on patient survival. This can be explained by improved cardiac performance, keeping cyclosporine levels low finding and utilizing early renal replacement treatment.

Recently cardiac transplantation has an important place in treatment of end-stage cardiac failure. In Turkey between 2003 and 2005 at 10 centers 64 cardiac transplantations were performed including five at our facility. Herein we have presented our results. All patients were men of mean age 34.2 +/- 10.7 (17 to 44) years. Upon preoperative echocardiography their mean ejection fraction was 18% +/- 3.27% (17% to 23%). Pulmonary vascular resistance was 4.47 wood unit in one patient and in one case, there was Rh incompatibility between donor and recipient. We used HTK solution for protection of donor hearts. Mean ischemia time was 251.2 +/- 62.7 minutes (155 to 314). Mean aortic clamping time was 84 +/- 4.7 minutes (80 to 90). In all patients we performed a biatrial anastomosis technique. Hemofiltration was used to prevent hemodilution during operation. In the postoperative period four patients had acute renal dysfunction; one, a minor cerebrovascular accident; two, reoperated because of bleeding; one, cholestasis; one, temporary atrio-ventricular block; and one, mediastinitis. Mean follow-up time was 15.6 +/- 19.7 months (2 to 50). Neither early nor late mortality has occurred. All patients are in New York Heart Association class I. In all cases we used triple immunosuppressive therapy. In the follow-up period the mean number of cardiac biopsies per patient was 4.2 +/- 3.03 (2 to 8). Two cases had cardiac catheterization. As a complication of cardiac biopsy, pericardial tamponade developed in one patient; in another one we observed a right ventricular aneursym after cardiac biopsy. Cardiac transplantation was performed with low mortality and morbidity rates in end-stage cardiac failure patients with longer life expectancy and higher life quality. Unfortunately in our country, because of difficulties to find donor hearts, cardiac transplantations were small in number. For better results, we need a larger series.