Author: "Jon Kobashigawa" / Search Limiters: Full Text - Searchworks@Jio Institute Digital Library Search Results

37 results on '"Jon Kobashigawa"'

1. Heart transplantation with super-aged donors older than 65 years

Author: Tasuku Hada, MD, Osamu Seguchi, MD, PhD, Nana Kitahata, CE, Shotaro Komeyama, MD, Hiroki Mochizuki, MD, Takuya Watanabe, MD, PhD, Satoshi Kainuma, MD, PhD, Satsuki Fukushima, MD, PhD, Yasumasa Tsukamoto, MD, PhD, Tomoyuki Fujita, MD, PhD, Jon Kobashigawa, MD, and Norihide Fukushima, MD, PhD
Subjects: heart transplantation, aged donor, donor selection, donor evaluation, cardiac function, Surgery, RD1-811, Specialties of internal medicine, RC581-951
Abstract: Background: This study elucidated the clinical outcomes and serial allograft function of heart transplant (HTx) recipients who received hearts from super-aged donors (SAD) ≥65 years of age. Methods: Adult HTx recipients between 1999 and 2022 were retrospectively reviewed and divided into 2: donor age ≥65 years [SAD group (n = 12)] and donor age
Published: 2024
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2. Alterations in the kallikrein-kinin system predict death after heart transplant

Author: Nicholas P. Giangreco, Guillaume Lebreton, Susan Restaino, Maryjane Farr, Emmanuel Zorn, Paolo C. Colombo, Jignesh Patel, Rajesh Kumar Soni, Pascal Leprince, Jon Kobashigawa, Nicholas P. Tatonetti, and Barry M. Fine
Subjects: Medicine, Science
Abstract: Abstract Heart transplantation remains the definitive treatment for end stage heart failure. Because availability is limited, risk stratification of candidates is crucial for optimizing both organ allocations and transplant outcomes. Here we utilize proteomics prior to transplant to identify new biomarkers that predict post-transplant survival in a multi-institutional cohort. Microvesicles were isolated from serum samples and underwent proteomic analysis using mass spectrometry. Monte Carlo cross-validation (MCCV) was used to predict survival after transplant incorporating select recipient pre-transplant clinical characteristics and serum microvesicle proteomic data. We identified six protein markers with prediction performance above AUROC of 0.6, including Prothrombin (F2), anti-plasmin (SERPINF2), Factor IX, carboxypeptidase 2 (CPB2), HGF activator (HGFAC) and low molecular weight kininogen (LK). No clinical characteristics demonstrated an AUROC > 0.6. Putative biological functions and pathways were assessed using gene set enrichment analysis (GSEA). Differential expression analysis identified enriched pathways prior to transplant that were associated with post-transplant survival including activation of platelets and the coagulation pathway prior to transplant. Specifically, upregulation of coagulation cascade components of the kallikrein-kinin system (KKS) and downregulation of kininogen prior to transplant were associated with survival after transplant. Further prospective studies are warranted to determine if alterations in the KKS contributes to overall post-transplant survival.
Published: 2022
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3. Correction: Complement-activating donor-specific anti-HLA antibodies and solid organ transplant survival: A systematic review and meta-analysis.

Author: Antoine Bouquegneau, Charlotte Loheac, Olivier Aubert, Yassine Bouatou, Denis Viglietti, Jean-Philippe Empana, Camilo Ulloa, Mohammad Hassan Murad, Christophe Legendre, Denis Glotz, Annette M Jackson, Adriana Zeevi, Stephan Schaub, Jean-Luc Taupin, Elaine F Reed, John J Friedewald, Dolly B Tyan, Caner Süsal, Ron Shapiro, E Steve Woodle, Luis G Hidalgo, Jacqueline O'Leary, Robert A Montgomery, Jon Kobashigawa, Xavier Jouven, Patricia Jabre, Carmen Lefaucheur, and Alexandre Loupy
Subjects: Medicine
Abstract: [This corrects the article DOI: 10.1371/journal.pmed.1002572.].
Published: 2018
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4. Complement-activating donor-specific anti-HLA antibodies and solid organ transplant survival: A systematic review and meta-analysis.

Author: Antoine Bouquegneau, Charlotte Loheac, Olivier Aubert, Yassine Bouatou, Denis Viglietti, Jean-Philippe Empana, Camilo Ulloa, Mohammad Hassan Murad, Christophe Legendre, Denis Glotz, Annette M Jackson, Adriana Zeevi, Stephan Schaub, Jean-Luc Taupin, Elaine F Reed, John J Friedewald, Dolly B Tyan, Caner Süsal, Ron Shapiro, E Steve Woodle, Luis G Hidalgo, Jacqueline O'Leary, Robert A Montgomery, Jon Kobashigawa, Xavier Jouven, Patricia Jabre, Carmen Lefaucheur, and Alexandre Loupy
Subjects: Medicine
Abstract: BACKGROUND:Anti-human leukocyte antigen donor-specific antibodies (anti-HLA DSAs) are recognized as a major barrier to patients' access to organ transplantation and the major cause of graft failure. The capacity of circulating anti-HLA DSAs to activate complement has been suggested as a potential biomarker for optimizing graft allocation and improving the rate of successful transplantations. METHODS AND FINDINGS:To address the clinical relevance of complement-activating anti-HLA DSAs across all solid organ transplant patients, we performed a meta-analysis of their association with transplant outcome through a systematic review, from inception to January 31, 2018. The primary outcome was allograft loss, and the secondary outcome was allograft rejection. A comprehensive search strategy was conducted through several databases (Medline, Embase, Cochrane, and Scopus). A total of 5,861 eligible citations were identified. A total of 37 studies were included in the meta-analysis. Studies reported on 7,936 patients, including kidney (n = 5,991), liver (n = 1,459), heart (n = 370), and lung recipients (n = 116). Solid organ transplant recipients with circulating complement-activating anti-HLA DSAs experienced an increased risk of allograft loss (pooled HR 3.09; 95% CI 2.55-3.74, P = 0.001; I2 = 29.3%), and allograft rejection (pooled HR 3.75; 95% CI: 2.05-6.87, P = 0.001; I2 = 69.8%) compared to patients without complement-activating anti-HLA DSAs. The association between circulating complement-activating anti-HLA DSAs and allograft failure was consistent across all subgroups and sensitivity analyses. Limitations of the study are the observational and retrospective design of almost all included studies, the higher proportion of kidney recipients compared to other solid organ transplant recipients, and the inclusion of fewer studies investigating allograft rejection. CONCLUSIONS:In this study, we found that circulating complement-activating anti-HLA DSAs had a significant deleterious impact on solid organ transplant survival and risk of rejection. The detection of complement-activating anti-HLA DSAs may add value at an individual patient level for noninvasive biomarker-guided risk stratification. TRIAL REGISTRATION:National Clinical Trial protocol ID: NCT03438058.
Published: 2018
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5. The Natural History of Biopsy-Negative Rejection after Heart Transplantation

Author: Zhaoyi Tang, Jon Kobashigawa, Matthew Rafiei, Lily Kagan Stern, and Michele Hamilton
Subjects: Surgery, RD1-811
Abstract: Purpose. The most recent International Society for Heart and Lung Transplantation (ISHLT) biopsy scale classifies cellular and antibody-mediated rejections. However, there are cases with acute decline in left ventricular ejection fraction (LVEF ≤ 45%) but no evidence of rejection on biopsy. Characteristics and treatment response of this biopsy negative rejection (BNR) have yet to be elucidated. Methods. Between 2002 and 2012, we found 12 cases of BNR in 11 heart transplant patients as previously defined. One of the 11 patients was treated a second time for BNR. Characteristics and response to treatment were noted. Results. 12 cases (of 11 patients) were reviewed and 11 occurred during the first year after transplant. 8 cases without heart failure symptoms were treated with an oral corticosteroids bolus and taper or intravenous immunoglobulin. Four cases with heart failure symptoms were treated with thymoglobulin, intravenous immunoglobulin, and intravenous methylprednisolone followed by an oral corticosteroids bolus and taper. Overall, 7 cases resulted in return to normal left ventricular function within a mean of 14 ± 10 days from the initial biopsy. Conclusion. BNR includes cardiac dysfunction and can be a severe form of rejection. Characteristics of these cases of rejection are described with most cases responding to appropriate therapy.
Published: 2013
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6. Experience With SynCardia Total Artificial Heart as a Bridge to Transplantation in 100 Patients

Author: Jad Malas, Qiudong Chen, Akbarshakh Akhmerov, Louis Philippe Tremblay, Natalia Egorova, Aasha Krishnan, Jaime Moriguchi, Jon Kobashigawa, Lawrence Czer, Robert Cole, Dominic Emerson, Joanna Chikwe, Francisco Arabia, and Fardad Esmailian
Subjects: Pulmonary and Respiratory Medicine, Surgery, Cardiology and Cardiovascular Medicine
Abstract: The SynCardia total artificial heart (TAH-t) is an effective bridge to transplantation for patients with severe biventricular failure. However, granular single-center data from high volume centers are lacking. We report our experience with the first 100 TAH-t recipients.A prospective institutional database was used to identify 100 patients who underwent 101 TAH-t implantations between 2012 and 2022. Patients were stratified and compared according to Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1 versus2. Median follow-up on device support was 94 days (IQR: 33-276 days), while median post-transplantation follow-up was 4.6 years (IQR: 2.1-6.0 years).Overall, 61 patients (61%) were successfully bridged to transplantation while 39 (39%) died on TAH-t support. Successful bridge rates between INTERMACS profile 1 and INTERMACS profile2 patients were similar (55.6%, 95% CI 40.4-68.3% versus 67.4%, 95% CI 50.5-79.6%, respectively, p=0.50). The most common adverse events (rates per 100 patient-months) on TAH-t support included infection (15.8), ischemic stroke (4.6), reoperation for mediastinal bleeding (3.5), and gastrointestinal bleeding requiring intervention (4.3). The most common cause of death on TAH-t support was multisystem organ failure (n=20, 52.6%). Post-transplantation thirty-day survival was 96.7%, while survival at 6 months, 1 year, and 5 years post-transplantation were 95.1% (95% CI 85.4-98.4%), 86.6% (95% CI 74.9-93.0%), and 77.5% (95% CI 64.2-86.3%), respectively.Acceptable outcomes can be achieved in the highest acuity patients utilizing the TAH-t as a bridge to heart transplantation.
Published: 2023

7. Addressing sex-based disparities in solid organ transplantation in the United States – a conference report

Author: Deirdre Sawinski, Jennifer C. Lai, Sean Pinney, Alice L. Gray, Annette M. Jackson, Darren Stewart, Deborah Jo Levine, Jayme E. Locke, James J. Pomposelli, Matthew G. Hartwig, Shelley A. Hall, Darshana M. Dadhania, Rebecca Cogswell, Richard V. Perez, Jesse D. Schold, Nicole A. Turgeon, Jon Kobashigawa, Jasleen Kukreja, John C. Magee, John Friedewald, John S. Gill, Gabriel Loor, Julie K. Heimbach, Elizabeth C. Verna, Mary Norine Walsh, Norah Terrault, Guiliano Testa, Joshua M. Diamond, Peter P. Reese, Kimberly Brown, Susan Orloff, Maryjane A. Farr, Kim M. Olthoff, Mark Siegler, Nancy Ascher, Sandy Feng, Bruce Kaplan, and Elizabeth Pomfret
Subjects: Transplantation, Immunology and Allergy, Pharmacology (medical)
Published: 2023

8. Donor heart selection: Evidence-based guidelines for providers

Author: Hannah Copeland, Ivan Knezevic, David A. Baran, Vivek Rao, Michael Pham, Finn Gustafsson, Sean Pinney, Brian Lima, Marco Masetti, Agnieszka Ciarka, Navin Rajagopalan, Adriana Torres, Eileen Hsich, Jignesh K. Patel, Livia Adams Goldraich, Monica Colvin, Javier Segovia, Heather Ross, Mahazarin Ginwalla, Babak Sharif-Kashani, MaryJane A. Farr, Luciano Potena, Jon Kobashigawa, Maria G. Crespo-Leiro, Natasha Altman, Florian Wagner, Jennifer Cook, Valentina Stosor, Paolo A. Grossi, Kiran Khush, Tahir Yagdi, Susan Restaino, Steven Tsui, Daniel Absi, George Sokos, Andreas Zuckermann, Brian Wayda, Joost Felius, and Shelley A. Hall
Subjects: Pulmonary and Respiratory Medicine, Brain Death, Transplantation, Consensus, adult, practice guideline, article, selection, donor selection, brain death, donor heart, donor risk factors, heart transplant, heart transplantation, Tissue Donors, risk factor, Humans, Surgery, heart graft, human, Cardiology and Cardiovascular Medicine, donor
Abstract: The proposed donor heart selection guidelines provide evidence-based and expert-consensus recommendations for the selection of donor hearts following brain death. These recommendations were compiled by an international panel of experts based on an extensive literature review. © 2022 International Society for Heart and Lung Transplantation
Published: 2023

9. The evolving use of biomarkers in heart transplantation: consensus of an expert panel

Author: Jon Kobashigawa, Shelley Hall, Palak Shah, Barry Fine, Phil Halloran, Annette M. Jackson, Kiran K. Khush, Kenneth B. Margulies, Maryam Mojarrad Sani, Jignesh K. Patel, Nikhil Patel, Eliot Peyster, Shelly Hall, Sean Agbor-Enoh, Robert Bray, Martin Cadeiras, Patty Chang, Sharon Chih, Howie Eisen, Maryjane Farr, Kambiz Ghafourian, Annette M Jackson, Andrew Kao, Kiran K Khush, Anant Madabhushi, Kenneth B Margulies, Jignesh K Patel, Anil Parwani, Sean Pinney, Kelley Schlendorf, Keyur Shah, Josef Stehlik, Anat Tambur, and Adriana Zeevi
Subjects: Transplantation, Immunology and Allergy, Pharmacology (medical)
Published: 2023

10. Clinical Prediction Model for Antibody-Mediated Rejection: A Strategy to Minimize Surveillance Endomyocardial Biopsies After Heart Transplantation

Author: Guillaume Coutance, Evan Kransdorf, Olivier Aubert, Guillaume Bonnet, Daniel Yoo, Philippe Rouvier, Jean-Paul Duong Van Huyen, Patrick Bruneval, Jean-Luc Taupin, Pascal Leprince, Shaida Varnous, Jon Kobashigawa, Xavier Jouven, Jignesh Patel, and Alexandre Loupy
Subjects: Graft Rejection, Heart Failure, Models, Statistical, Myocardium, Biopsy, Humans, Heart Transplantation, Prognosis, Cardiology and Cardiovascular Medicine, Antibodies, Retrospective Studies
Abstract: Background: In heart transplantation, antibody-mediated rejection (AMR) is a major contributor to patient morbidity and mortality. Multiple routine endomyocardial biopsies (EMB) remain the gold standard to detect AMR, but this invasive procedure suffers from many limitations. We aimed to develop and validate an AMR risk model to improve individual risk stratification of AMR. Methods: Heart recipients from 2 referral transplant centers, Cedars-Sinai (US) and Pitié-Salpêtrière (France), were included from 2012 to 2019. Database included detailed clinical, immunologic, imaging, and histological parameters. The US cohort was randomly distributed in a derivation (2/3) and in a test set (1/3). The primary end point was biopsy-proven AMR. A mixed effect logistic regression model with a random intercept was applied to identify variables independently associated with AMR. Simulation analyzes were performed. Results: The US and French cohorts comprised a total of 1341 patients, representing 12 864 EMB. Overall, 490 AMR episodes were diagnosed (3.8% of EMB). Among the 26 potential determinants of AMR, 5 variables showed independent association: time post-transplant ( P P =0.001), circulating donor-specific anti–human leukocyte antigen antibody ( P =0.001), graft dysfunction ( P =0.004), and prior history of definite AMR ( P Conclusions: Our results support the use of the AMR risk model as a clinical decision tool to minimize the number of routine EMB after heart transplantation.
Published: 2022

11. Initial Invasive or Conservative Strategy for Stable Coronary Disease

Author: Maron D. J., Hochman J. S., Reynolds H. R., Bangalore S., O'Brien S. M., Boden W. E., Chaitman B. R., Senior R., Lopez-Sendon J., Alexander K. P., Lopes R. D., Shaw L. J., Berger J. S., Newman J. D., Sidhu M. S., Goodman S. G., Ruzyllo W., Gosselin G., Maggioni A. P., White H. D., Bhargava B., Min J. K., John Mancini G. B., Berman D. S., Picard M. H., Kwong R. Y., Ali Z. A., Mark D. B., Spertus J. A., Krishnan M. N., Elghamaz A., Moorthy N., Hueb W. A., Demkow M., Mavromatis K., Bockeria O., Peteiro J., Miller T. D., Szwed H., Doerr R., Keltai M., Selvanayagam J. B., Gabriel Steg P., Held C., Kohsaka S., Mavromichalis S., Kirby R., Jeffries N. O., Harrell F. E., Rockhold F. W., Broderick S., Bruce Ferguson T., Williams D. O., Harrington R. A., Stone G. W., Rosenberg Y, ISCHEMIA Research Group: Joseph Ricci, A Tello Montoliu, A I Robero Aniorte, Abbey Mulder, Abhay A Laddu, Abhinav Goyal, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Abraham Oomman, Adam J Jaskowiak, Adam Kolodziej, Adam Witkowski, Adnan Hameed, Adriana Anesini, Afshan Hussain, Agne Juceviciene, Agne Urboniene, Agnes Jakal, Agnieszka Szramowska, Ahmad Khairuddin, Ahmed Abdel-Latif, Ahmed Adel, Ahmed Aljzeeri, Ahmed Kamal, Ahmed Talaat, Aimee Mann, Aira Contreras, Ajit Kumar, V K Kumar, Akemi Furukawa, Akshay Bagai, Akvile Smigelskaite, Alain Furber, Alain Rheault, Alaine Melanie Loehr, Alan Rosen, Albert Varga, Albertina Qelaj, Alberto Barioli, Aldo Russo, Alec Moorman, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alena Kuleshova, Alessandro Sionis, Alexander A Sirker, Alexander M Chernyavskiy, Alexandra Craft, Alexandra Vazquez, Alexandre Ciappina Hueb, Alexandre S Colafranseschi, Alexandre Schaan de Quadros, Alexandre Tognon, Ali Alghamdi, Alice Manica Muller, Aline Nogueira Rabaça, Aline Peixoto Deiro, Alison Hallam, Allegra Stone, Allison Schley, Almudena Castro, Alvaro Rabelo Ales, Amanda Germann, Amanda O'Malley, Amar Uxa, Amarachi Ojajuni, Amarino C Oliveira Jr, Amber B Hull, Ambuj Roy, Amer Zarka, Amir Janmohamed, Ammani Brown, Ammy Malinay, Amparo Martinez Monzonis, Amy J Richards, Amy Iskandrian, Amy Ollinger, Ana D Djordjevic-Dikic, Ana Fernández Martínez, Ana Gomes Almeida, Ana Paula Batista, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anam Siddiqui, Anastasia M Kuzmina-Krutetskaya, Andras Vertes, Andre S Sousa, Andre Gabriel, André Schmidt, Andrea M Lundeen, Andrea Bartykowszki, Andrea Lorimer, Andrea Mortara, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew G Howarth, Andrew J Moriarty, Andrew Docherty, Andrew Starovoytov, Andrew Zurick, Andrzej Łabyk, Andrzej Swiatkowski, Andy Lam, Anelise Kawakami, Angela Hoye, Angela Kim, Angelique Smit, Angelo Nobre, Anil V Shah, Anja Ljubez, Anjali Anand, Ankush Sachdeva, Ann Greenberg, Ann Luyten, Ann Ostrander, Anna Di Donato, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Proietti, Anna Teresinska, Anne Marie Webb, Anne Cartwright, Anne Heath, Anne Mackin, Anong Amaritakomol, Anong Chaiyasri, Anoop Chauhan, Anoop Mathew, Anthony Gemignani, Anto Luigi Andres, Antonia Vega, Antonietta Hansen, Antonino Ginel Iglesias, Antonio Carlos Carvalho, Antonio Di Chiara, Antonio Serra Peñaranda, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anupama Rao, Aquiles Valdespino-Estrada, Araceli Boan, Areef Ishani, Ariel Diaz, Arijit Ghosh, Arintaya Prommintikul, Arline Roberts, Arnold H Seto, Arnold P Good, Arshed Quyyumi, Arthur J Labovitz, Arthur Kerner, Arturo S Campos-Santaolalla, Arunima Misra, Ashok Mukherjee, Ashok Seth, Ashraf Seedhom, Asim N Cheema, Asker Ahmed, Atul Mathur, Atul Verma, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Baljeet Kaur, Bandula Guruge, Barbara Brzezińska, Barbara Nardi, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Belen Cid Alvarez, Benjamin J Spooner, Benjamin J W Chow, Benjamin Cheong, Benoy N Shah, Bernard de Bruyne, Bernardas Valecka, Bernhard Jäger, Beth A Archer, Beth Abramson, Beth Jorgenson, Bethany Harvey, Betsy O'Neal, Bev Atkinson, Bev Bozek, Bevin Lang, Bijulal Sasidharan, Bin Yang, Bin Zhang, Binoy Mannekkattukudy Kurian, Bjoern Goebel, Bob Hu, Bogdan A Popescu, Bogdan Crnokrak, Bolin Zhu, Bonnie J Kirby, Brandi D Zimbelman, Brandy Starks, Branko D Beleslin, Brenda Hart, Brian P Shapiro, Brian McCandless, Brianna Wisniewski, Brigham R Smith, Brooks Mirrer, Bruce McManus, Bruce Rutkin, Bruna Edilena Paulino, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Cameron Hague, Camila Thais de Ormundo, Candace Gopaul, Candice P Edillo, Carísi A Polanczyk, Carita Krannila, Carla Vicente, Carl-Éric Gagné, Carlo Briguori, Carlos Peña Gil, Carlos Alvarez, Carly Ohmart, Carmen C Beladan, Carmen Ginghina, Carol M Kartje, Caroline Alsweiler, Caroline Brown, Caroline Callison, Caroline Pinheiro, Caroline Rodgers, Caroline Spindler, Carolyn Corbett, Carrie Drum, Casey Riedberger, Catherine Bone, Catherine Fleming, Catherine Gordon, Catherine Jahrsdorfer, Catherine Lemay, Catherine Weick, Cathrine Patten, Cecilia Goletto, Cezary Kepka, Chandini Suvarna, Chang Xu, Chantale Mercure, Charle A Viljoen, Charlene Wiyarand, Charles Jia-Yin Hou, Charles Y Lui, Charles Cannan, Charles Cornet, Charlotte Pirro, Chataroon Rimsukcharoenchai, Chen Wang, Cheng-Ting Tsai, Chen-Yen Chien, Cheryl A Allardyce, Chester M Hedgepeth, Chetan Patel, Chiara Attanasio, Chih-Hsuan Yen, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Beck, Chris Buller, Christel Vassaliere, Christian Hamm, Christiano Caldeira, Christie Ballantyne, Christina Björklund, Christine R Hinton, Christine Bergeron, Christine Masson, Christine Roraff, Christine Shelley, Christophe Laure, Christophe Thuaire, Christopher Kinsey, Christopher McFarren, Christopher Spizzieri, Christopher Travill, Chun-Chieh Liu, Chung-Lieh Hung, Chunguang Li, Chun-Ho Yun, Chunli Xia, Ciarra Heard, Cidney Schultz, Clare Venn-Edmonds, Claudia P Hochberg, Claudia Wegmayr, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Claudio T Mesquita, Clemens T Kadalie, Colin Berry, Constance Philander, Corine Thobois, Costantino Costantini, Courtney Page, Craig Atkinson, Craig Barr, Craig Paterson, Cristina Bare, Cynthia Baumann, Cynthia Burman, Dalisa Espinosa, Damien Collison, Dan Deleanu, Dan Elian, Dan Gao, Dana Oliver, Daniel P Vezina, Daniel O'Rourke, Daniele Komar, Danielle Schade, Darrel P Francis, Dastan Malaev, David A Bull, David E Winchester, David P Faxon, David Booth, David Cohen, David DeMets, David Foo, David Schlichting, David Taggart, David Waters, David Wohns, Davis Vo, Dawid Teodorczyk, Dawn Shelstad, Dawn Turnbull, Dayuan Li, Dean Kereiakes, Deborah O'Neill, Deborah Yip, Debra K Johnson, Debra Dees, Deepak L Bhatt, Deepika Gopal, Deepti Kumar, Deirdre Mattina, Deirdre Murphy, Delano R Small, Delsa K Rose, Dengke Jiang, Denis Carl Phaneuf, Denise Braganza, Denise Fine, Derek Cyr, Desiree Tobin, Diana Cukali, Diana Parra, Diane Camara, Diane Minshall Liu, Diego Adrián Vences, Diego Franca de Cunha, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Dorit Grahl, Dragana Stanojevic, Duarte Cacela, Dwayne S G Conway, E Pinar Bermudez, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Edoardo Verna, Eduardo Hernandez-Rangel, Edward D Nicol, Edward O McFalls, Edward T Martin, Edyta Kaczmarska, Ekaterina I Lubinskaya, Elena A Demchenko, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise L Hannemann, Elise van Dongen, Elissa Restelli Piloto, Eliza Kaplan, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizabeth Congdon, Elizabeth Ferguson, Elizaveta V Zbyshevskaya, Ellen Magedanz, Ellie Fridell, Ellis W Lader, Elvin Kedhi, Emanuela Racca, Emilie Tachot, Emily DeRosa, Encarnación Alonso-Álvarez, Eric Nicollet, Eric Peterson, Erick Alexánderson Rosas, Erick Donato Morales, Erin Orvis, Ermina Moga, Estelle Montpetit, Estevao Figueiredo, Eugene Passamani, Eugenia Nikolsky, Eunice Yeoh, Evgeniy I Kretov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, F Marin Ortuño, Fabio R Farias, Fabio Fimiani, Fabrizio Rolfo, Fa-Chang Yu, Fadi Hage, Fadi Matar, Fahim Haider Jafary, Fang Feng, Fang Liu, Fatima Ranjbaran, Fatima Rodriguez, Fausto J Pinto, Fauzia Rashid, Federica Ramani, Fei Wang, Fernanda Igansi, Filipa Silva, Filippo Ottani, Fiona Haines, Firas Al Solaiman, Flávia Egydio, Flavio Lyra, Florian Egger, Fran Farquharson, Frances Laube, Francesc Carreras Costa, Francesca de Micco, Francesca Bianchini, Francesca Pezzetta, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francis Burt, Francisca Patuleia Figueiras, Francisco Fernandez-Aviles, Francois Pierre Mongeon, Frans Van de Werf, Franziska Guenther, Fraser N Witherow, Fred Mohr, Frederico Dall'Orto, Fumiyuki Otsuka, G De La Morena, G Karthikeyan, Gabor Dekany, Gabor Kerecsen, Gabriel Galeote, Gabriel Grossmann, Gabriel Vorobiof, Gabriela Sanchez de Souza, Gabriela Guzman, Gabriela Zeballos, Gabriele Gabrielli, Gabriele Jakl-Kotauschek, Gail A Shammas, Gail Brandt, Gang Chen, Gary E Lane, Gary J Luckasen, Gautam Sharma, Gelmina Mikolaitiene, Gennie Yee, Georg Nickenig, George E Revtyak, George J Juang, Gerald Fletcher, Gerald Leonard, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Geza Fontos, Ghada Mikhail, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Giles Roditi, Gilles Barone-Rochette, Girish Mishra, Giuseppe Tarantini, Glenda Wong, Glenn S Hamroff, Glenn Rayos, Gong Cheng, Gonzalo Barge-Caballero, Goran Davidović, Goran Stankovic, Gordana Stevanovic, Grace Jingyan Wang, Grace M Young, Graceanne Wayser, Graciela Scaro, Graham S Hillis, Graham Wong, Grazyna Anna Szulczyk, Gregor Simonis, Gregory Kumkumian, Gretchen Ann Peichel, Grzegorz Gajos, Gudrun Steinmaurer, Guilherme G Rucatti, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillem Pons Lladó, Gunnar Frostfelt, Gurpreet S Wander, Gurpreet Gulati, Gustavo Pucci, Hafidz Abd Hadi, Haibo Zhang, Haitao Wang, Halina Marciniak, Han Chen, Hanan Kerr, Hani Najm, Hanna Douglas, Hannah Phillips, Hao Dai, Haojian Dong, Haqeel Jamil, Harikrishnan Sivadasanpillai, Harry Suryapranata, Hassan Reda, Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, J David Knight, Jacek Kusmierek, Jackie M White, Jackie Chow, Jacob Udell, Jacqueline E Tamis-Holland, Jacqueline Fannon, Jacquelyn A Quin, Jacquelyn Do, Jaekyeong Heo, Jakub Maksym, James E Davies, James H O'Keefe Jr, James J Jang, James Cha, James Harrison, James Hirsch, James Stafford, James Tatoulis, Jamie Rankin, Jan Henzel, Jan Orga, Jana Tancredi, Janaina Oliveira, Jane Burton, Jane Eckstein, Jane Marucci, Janet P Knight, Janet Blount, Janet Halliday, Janetta Kourzenkova, Janitha Raj, Jan-Malte Sinning, Jaqueline Pozzibon, Jaroslaw Drozdz, Jaroslaw Karwowski, Jason D Glover, Jason Loh Kwok, Jason T Call, Jason Linefsky, Jassira Gomes, Jati Anumpa, Javier J Garcia, Javier Courtis, Jay Meisner, K Jayakumar, Jayne Scales, Jean E Denaro, Jean Michel Juliard, Jean Ho, Jeanette K Stansborough, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeet Thambyrajah, Jeff Leimberger, Jeffery A Breall, Jeffrey A Kohn, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Blume, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Djokic, Jelena Stojkovic, Jenne M Jose, Jenne Manchery, Jennifer A Mull, Jennifer H Czerniak, Jennifer L Stanford, Jennifer Gillis, Jennifer Horst, Jennifer Isaacs, Jennifer Langdon, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jen-Yuan Kuo, Jeremy Rautureau, Jerome Fleg, Jessica Berg, Jessica Rodriguez, Jessica Waldron, Jhina Patro, Jia Li, Jiajia Mao, Jiamin Liu, Jian'an Wang, Jianhua Li, Jianxin Zhang, Jie Qi, Jihyun Lyo, Jill Marcus, Jim Blankenship, Jing Zhang, Jingjing Liu, Jing-Yao Fan, Jiun-Yi Li, Jiwan Pradhan, Jiyan Chen, J M Rivera Caravaca, Jo Evans, Joan Garcia Picart, Joan Hecht, Joanna Jaroch, Joanna Zalewska, Joanne Kelly, Joanne Taaffe, João Reynaldo Abbud, João V Vitola, Joaquín V Peñafiel, Jocelyne Benatar, Jody Bindeman, Joe Sabik, Joel Klitch, Johann Christopher, Johannes Aspberg, John D Friedman, John F Beltrame, John F Heitner, John Joseph Graham, John R Davies, John Doan, John Kotter, John Kurian, John Mukai, John Pownall, Jolanta Sobolewska, Jon Kobashigawa, Jonathan L Goldberg, Jonathan W Bazeley, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Leipsic, Jonean Thorsen, Jorge F Trejo Gutierrez, Jorge Escobedo, Jorik Timmer, José A Ortega-Ramírez, José Antonio Marin-Neto, Jose D Salas, Jose Enrique Castillo, Jose Francisco Saraiva, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Vieira, José M Flores-Palacios, Jose Ramon Gonzalez, Jose Seijas Amigo, Jose Fragata, Josep Maria Padró, Josheph F X McGarvey Jr, Joseph Hannan, Joseph Sacco, Joseph Sweeny, Joseph Wiesel, Josephine D Abraham, Joshua P Loh, Joy Burkhardt, Joyce R White, Joyce Riestenberg-Smith, Judit Sebo, Judith L Meadows, Judith Wright, Judy Mae Foltz, Judy Hung, Judy Otis, Juergen Stumpf, Jui-Peng Tsai, Julia S Dionne, Julia de Aveiro Morata, Julie Bunke, Julie Morrow, Julio César Figal, Jun Fujita, Jun Jiang, Junhua Li, Junqing Yang, Juntima Euathrongchit, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Kai Eggers, Kamalakar Surineni, Kanae Hirase, T R Kapilamoorthy, Karen Calfas, Karen Gratrix, Karen Hallett, Karen Hultberg, Karen Nugent, Karen Petrosyan, Karen Swan, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karsten Lenk, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Kate Pointon, Kate Robb, Katherine Martin, Kathleen Claes, Kathryn Carruthers, Kathy E Siegel, Katia Drouin, Katie Fowler-Lehman, Kavita Rawat, Kay Rowe, Keiichi Fukuda, Keith A A Fox, Ken Mahaffey, Kendra Unterbrink, Kenneth Giedd, Kerrie Van Loo, Kerry Lee, Kerstin Bonin, Kevin R Bainey, Kevin T Harley, Kevin Anstrom, Kevin Chan, Kevin Croce, Kevin Landolfo, Kevin Marzo, Keyur Patel, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khaled Ziada, Khaula Baloch, Khrystyna Kushniriuk, Kian-Keong Poh, Kim F Ireland, Kim Holland, Kimberly Ann Byrne, Kimberly E Halverson, Kimberly Elmore, Kimberly Miller-Cox, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kotiboinna Preethi, Kozhaya Sokhon, Krissada Meemuk, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristina Wippler, Kristine Arges, Kristine Teoh, Krystal Etherington, Krystyna Łoboz-Grudzień, Krzysztof W Reczuch, Krzysztof Bury, Krzysztof Drzymalski, Krzysztof Kukuła, Kuo-Tzu Sung, Kurt Huber, Ladda Douangvila, Lance Sullenberger, Larissa Miranda Trama, Laszlone Matics, Laura Drew, Laura Flint, Laura Keinaite, Laura Sarti, Laurel Kolakaluri, Lawrence M Phillips, Lawrence Friedman, Lawrence Phillips, Lazar Velicki, Leah Howell, Leandro C Maranan, Leanne Cox, Ledjalem Daba, Lei Zhang, Lekshmi Dharmarajan, Leo Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Leszek Sokalski, Li Hai Yan, Li Li, Lia Nijmeijer, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilia Schiavi, Lilian Mazza Barbosa, Lillian L Khor, Lina Felix-Stern, Linda L Hall, Linda M Hollenweger, Linda Arcand, Linda Davidson-Ray, Linda Schwarz, Lindsey N Sikora, Lingping Chi, Lino Patricio, Liping Zhang, Lisa Chaytor, Lisa Hatch, Lisa McCloy, Lisa Wong, Liselotte Persson, Lixin Jiang, Liz Low, Ljiljana Pupic, Loïc Bière, Lorenzo Monti, Lori Christensen, Lori Pritchard, Loriane Black, Lori-Ann Desimone, Lori-Ann Larmand, Lorraine McGregor, Louise Morby, Louise Thomson, Luc Harvey, Luciana de Pádua Baptista, Lucilla Garcia, Ludivine Eliahou, Ludmila Helmer, Luis F Smidt, Luis Bernanrdes, Luis Guzman, Luiz A Carvalho, Luyang Xiong, Lynette L Teo, Lynn M Neeson, Lynne Winstanley, M Barbara Srichai-Parsia, M Quintana Giner, M Sowjanya Reddy, M Valdés Chávarri, M Grazia Rossi, Maarten Simoons, Maayan Konigstein, Maciej Lesiak, Maciej Olsowka, Mafalda Selas, Magalie Corfias, Magdalena Madero Rovalo, Magdalena Łanocha, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdalena Rantinella, Magdy Abdelhamid, Magnolia Jimenez, Mahboob Alam, Mahevamma Mylarappa, Mahfouz El Shahawy, Mahmoud Mohamed, Mahmud Al-Bustami, Majo X Joseph, Malgorzata Frach, Małgorzta Celińska-Spodar, Malte Helm, Manas Chacko, Mandy Murphy, Manitha Vinod, Manjula Rani, Manu Dhawan, Manuela Mombelli, Marcel Weber, Marcello Galvani, Marcelo Jamus Rodrigues, Marcia F Dubin, Marcia F Werner Bayer, Marcin Szkopiak, Marco Antonio Monsalve, Marco Bizzaro Santos, Marco Magnoni, Marco Marini, Marco Sicuro, Marco Zenati, Marcos Valério Coimbra Resende, Marek Roik, Margalit Bentzvi, Margaret Gilsenan, Margaret Iraola, Margot C Quinn, Maria A Alfonso, Maria Antonieta Pereira Moraes, María Dolores Martínez-Ruíz, María Fernanda Canales, Maria Inês Caetano, Maria P Corral, Maria Pérez García, Maria Victoria Actis, Maria Aguirre, Maria Andreasson, Maria Aprile, Maria Colton, Maria Eugenia Martin, Maria Lasala, Maria Lorenzo, Maria Posada, Maria Shier, Maria Thottam, Mariana V Furtado, Mariana Yumi Okada, Marianna D A Dracoulakis, Marianne De Andrade, Mariano Rubio, Marie Essermark, Marielle Scherrer-Crosbie, Marija T Petrovic, Marija Zdravkovic, Marilyn Black, Marina Garcia, Mario J Garcia, Mariola Szulik, Marisa Orgera, Mark A de Belder, Mark Harbinson, Mark Hyun, Mark Peterson, Mark Xavier, Marlowe Mosley, Marta Capinha, Marta Marcinkiewicz-Siemion, Marta Swiderek, Martha Meyer, Martina Ceseri, Martina Tricoli, Marvin Kronenberg, Mary Williams, Mary Ann Champagne, Mary Colleen Rogge, Mary R Soltau, Mary Streif, Massimo Villella, Massoud Leesar, Matei Claudia, Mateusz Solecki, Matías Nicolás Mungo, Matthew Wall Jr, Matthew Budoff, Matthew Jezior, Matthew Luckie, Matthias Friedrich, Mauren P Haeffner, Maximilian Tscharre, Max-Paul Winter, Mayana Almeida, Mayil S Krishnam, Mayuri Patel, Meenakshi Mishra, Megan Manocchia, Meghana Kakade, Melanie J Munro, Melissa D Chaplin, Melissa LeFevre, Mervyn Andiapen, Michael A Gibson, Michael B Rubens, Michael C Turner, Michael D Shapiro, Michael W Lee, Michael Berlowitz, Michael Davidson, Michael Mack, Michael McDaniel, Michael Mumma, Michal Wlodarczyk, Michel G Khouri, Michel S Slama, Michele Rawlins, Michelle M Bonner, Michelle M Seib, Michelle Chang, Michelle Crowder, Michelle Dixon, Michelle Mayon, Michelle McEvoy, Michelle Yee, Miguel M Fernandes, Miguel Nobre Menezes, Miguel Souto Bayarri, Miguel Barrero, Mikhail T Torosoff, Milan R Dobric, Milan Dobric, Milica Nikola Dekleva, Milind Avdhoot Gadkari, Millie Gomez, Min Tun Kyaw, Miriam Brooks, Miroslav Stevo Martinovic, Mitchel B Lustre, Mohammad Tariq Vakani, Mohammad El-Hajjar, Mohammed Al-Amoodi, 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Riezebos, Robert M Donnino, Robert Bojar, Robert Chilton, Robert Guyton, Robert Henderson, Robert Kornberg, Robert Leber, Robert Mao, Robert Stenberg, Roberta P Santos, Roberto René Favaloro, Roberto Amati, Rodolfo G S D Lima, Rodrigo J Cerci, Rogerio Tumelero, Rohit Tandon, Roma Tewari, Romalisa Miranda-Peats, Ron Wald, Ronald A Mastouri, Ronald G Morford, Ronald G Schwartz, Ronald P Pedalino, Rongrong Hu, Ronnell A Hansen, Ronny A Cohen, Rory Hachamovitch, Rosa Homem, Rosa Sandonato, Rosane Laimer, Rosann Gans, Roxanne Yost, Roy Mathew, Rubén Baleón-Espinosa, Ruben Ramos, Rubine Gevorgyan, Rui Ferreira, Rui Jing, Ruth Pérez-Fernández, S K Dwivedi, S Ramakrishnan, Saadat Khan, Sabahat Bokhari, Sabu Thomas, Sadath Lubna, Sajeeda Parveen Khan, Sajeev Chakanalil Govindan, Saket Girotra, Saleem Kassam, Sallie Canada, Salvador Cruz-Flores, Samaa Mohamed, Samantha Ly, Sameh El Kaffas, Samia Massalha, Sampoornima Setty, Samuel Nwosu, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandra M 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Pierre Michaud, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Piotr Slomka, Piyamitr Sritara, Poay-Huan Loh, Poonam Sonawane, Pouneh Samadi, Pragnesh P Parikh, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Precilia Vasquez, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puja K Mehta, Purvez Grant, Pushpa Naik, Qi Zhong, Qian Zhao, Qiang Zhou, Qianqian Yuan, Qin Yu, Qingxian Li, Qiulan Xie, Qiutang Zeng, R J Vindhya, R James Gerlach, Rachel King, Rada Vučić, Radmila Lyubarova, Radoslaw Pracon, Raewyn Fisher, Rafael Beyar, Rafael Diaz, Rafael Selgas, Raffaele Bugiardini, Raffaele Fanelli, Raisa Kavalakkat, V S Rajalekshmi, Rajat S Barua, Rajeev Menon, Rajesh Gopalan Nair, Rajesh Francis, Rajiv Narang, Rakesh Yadav, Ralph Alan Huston, T Ramakrishnan, Ramesh de Silva, Rami El Mahmoud, Ramiro Carvalho, Ramon de Jesús-Pérez, Ramona Stevens, Ran Leng, Ranjan Kachru, Ranjit Kumar Nath, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Raymond W Little, Raymundo Ocaranza Sanchez, Rebecca J Wimmer, Rebecca Bariciano, Rebecca Otis, Rebekah R Herrmann, Reem Yunis, Reinette Hampson, Renato Abdala Karam, Renee C Hessian, Renee Kaneshiro, Reshma Ravindran, Reto Andreas Gamma, Reyna Bhandari, Reza Arsanjani, Ricardo L Lopes, Ricardo Mendes Oliveira, Ricardo Costa, Richa Bhatt, Richard F Davies, Richard H J Trimlett, Richard Goldweit, Rik Hermanides, Rine Nakanishi, Rinu R Sidh, Risha Patel, Rita Coram, Rizwan A Siddiqui, Rob S Beanlands, Robert J Hamburger, Robert K Riezebos, Robert M Donnino, Robert Bojar, Robert Chilton, Robert Guyton, Robert Henderson, Robert Kornberg, Robert Leber, Robert Mao, Robert Stenberg, Roberta P Santos, Roberto René Favaloro, Roberto Amati, Rodolfo G S D Lima, Rodrigo J Cerci, Rogerio Tumelero, Rohit Tandon, Roma Tewari, Romalisa Miranda-Peats, Ron Wald, Ronald A Mastouri, Ronald G Morford, Ronald G Schwartz, Ronald P Pedalino, Rongrong Hu, Ronnell A Hansen, Ronny A Cohen, Rory Hachamovitch, Rosa Homem, Rosa Sandonato, Rosane Laimer, Rosann Gans, Roxanne Yost, Roy Mathew, Rubén Baleón-Espinosa, Ruben Ramos, Rubine Gevorgyan, Rui Ferreira, Rui Jing, Ruth Pérez-Fernández, S K Dwivedi, S Ramakrishnan, Saadat Khan, Sabahat Bokhari, Sabu Thomas, Sadath Lubna, Sajeeda Parveen Khan, Sajeev Chakanalil Govindan, Saket Girotra, Saleem Kassam, Sallie Canada, Salvador Cruz-Flores, Samaa Mohamed, Samantha Ly, Sameh El Kaffas, Samia Massalha, Sampoornima Setty, Samuel Nwosu, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandra M Rivest, Sandra S Zier, Sandra Ahoud, Sandy Carr, Sanjay Ganapathi, Sanjay Shetty, Sanjeev Sharma, Santa Jimenez, Santhosh Satheesh, Santiago A Garcia, Sara Fernandez, Sara Karlsson, Sara Salkind, Sara Temiyasathit, Sarah Medina Rodriguez, Sarah Beaudry, Sarah Hadjih, Sarah Williams, Sarah Zahrani, Sarju Ralhan, Sasa Hinic, Sasko Kedev, Satinder Singh, Satoshi Yasuda, Satvic Cholenahally Manjunath, Sau Lee, Scott M Kaczkowski, Scott Kinlay, Sean W Hayes, Sebastian Sobczak, Senait Asier, Sergey A Sayganov, Seth I Sokol, Shaheen Pandie, Shaiful Azmi Yahaya, Shamir Mehta, Shao-Ping Nie, Sharad Chandra, Sharder Islam, Sharon Tai, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Sherron C Crook, Shigeyuki Nishimura, Shintaro Nakano, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shobana Ganesan, Shruti Pandey, Shuyang Zhang, Shweta Hande, Siddharth Gadage, Sik-Yin V Tan, Silvia Zottis Poletti, Silvia Riera, Silvia Valbuena, Simon Walsh, Simona Maspoli, Simone Savaris, Si-Ting Feng, So Yang Cho, Solomon Yakubov, Songlin Zhu, Songtao Wang, Sonia Guerrero, Sonika Gupta, Sonja Salinger Martinovic, Sonya Brons, Sorin Brener, Sothinathan Gurunathan, Souheil Saba, Soundarya Nayak, Sowjanya Reddy, Srinivasa Potluri, Sriram Sudarshan, Srun Kuanprasert, Stacie Van Oosterhout, Stamatios Lerakis, Stanley E Cobos, Stefan C Bertog, Stefan M Simović, Stefan Weikl, Stefano Di Marco, Stefano Provasoli, Stephanie A Tirado, Stephanie C Boer, Stephanie M Lane, Stephanie Ferket, Stephanie Kelly, Stephanie Wasmiller, Stephen H McKellar, Stephen P Hoole, Stephen Fremes, Stephen Preston, Steve Leung, Steven A Fein, Steven J Lindsay, Steven P Sedlis, Steven Giovannone, Steven Michael, Steven Weitz, Stijn van Vugt, Subhash Banerjee, Sudhir Naik, Suellen Hosino, Sukie Desire, Sukit Yamwong, Suku T Thambar, Sulagna Mookherjee, Suman Singh, Sundeep Mishra, Sunil Kumar Verma, Supap Kulthawong, Supatchara Khwakhong, Surendra Naik, Suresh Babu, Surin Woragidpoonpol, Suryaprakash Narayanappa, Susan Derbyshire, Susan Gent, Susan Mathus, Susan Milbrandt, Susan Moore, Susan Regan, Susan Stinson, Susan Webber, Susana Silva, Susanna Stevens, Susanne Gruensfelder, Suthara Aramcharoen, Suvarna Kolhe, Suzana Tavares, Suzanne Arnold, Suzanne Welsh, Svetlana Apostolovic, Swapna Kunhunny, Ta-Chuan Hung, Taissa Zappernick, Tali Sharir, Talita Silva, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarun K Mittal, Tatiana Trifonova, Tauane Bello Duarte, Tauqir Huk, Téodora Dutoiu, Terrance Chua, Terry Weyand, Thabitha Charles, Theodoros Kofidis, Theresa McCreary, Thierry Lefevre, Thippeekaa Arumairajah, Thitipong Tepsuwan, Thomas J Mulhearn, Thomas M Meyer, Thomas P Rocco, Thomas R Downes, Thomas Crain, Thomas Haldis, Thomas Mathew, Thomas Redick, Thounaojam Indira Devi, Thuraia Nageh, Tia Cauthren, Tiago Silva, Tiffany Little, Tijana Andric, Tina Harding, Titus Lau, Tiziana Formisano, Tiziano Moccetti, Tomasz Ciurus, Tomasz Mazurek, Tomasz Tarchalski, Toshiyuki Nagai, Tri Tran, Tricia Youn, Trish Tucker, Trudie Milner, Tuhina Bose, Tushar Kotecha, Udo Sechtem, Uma S Valeti, Umberto Cucchini, Umesh Badami, Upendra Kaul, V K Bahl, V S Narain, Valentina Casali, Valeria Godoy, Valerie Robesyn, Vamshi P Priya, Vandana Yadav, Vera McKinney, Veronica De Lenges, Veronica Tinnirello, Vicente Miro, Victor Navarro, Victoria Gumerova, Victoria Hernandez, Vidya Seeratan, Vijay Kumar, Vikentiy Y Kozulin, Viktoria Bulkley, Vilmar Veiga Jr, Vincent Setang, C P Vineeth, Virginai Pubull Nuñez, Virginia Fernández-Figares, Vitor Gomes, Viviana Gabriel, Viviane Dos Santos, Viviane Almeida, Vlad A Iliescu, Vladan Mudrenovic, Vladimir Dzavik, Vojislav L Giga, Walter Enrique Mogrovejo, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Warangkana Mekara, Wassim Nona, Wayne Old, Wayne Pennachi, Weerachai Nawarawong, Wei Chen, Wei Su, Weibing Xing, Wei-Ren Lan, Wenda Crawford, Wendy L Stewart, Wendy Drewes, Wenhua Lin, William B Abernethy, William D Salerno, William F Fearon, William Vergoni, William Weintraub, Winnie C Sia, Wlodzimierz J Musial, Xacobe Flores-Ríos, Xavier Garcia-Moll Marimon, Xi Su, Xiang Ma, Xiangqiong Gu, Xiao Wang, Xiaomei Li, Xiaowei Yao, Xin Fu, Xin Su, Xin Zeng, Xinchun Yang, Xiuhong Li, Xuehua Fang, Xutong Wang, Yaming Geng, Yan Yan, Yanek Pépin-Dubois, Yanfu Wang, Yang Wang, Yanmeng Tian, Yaping Huang, Yechen Han, Yesenia Zambrano, Yi-Hsuan Yang, Ying Tung Sia, Yining Yang, Yitong Ma, Yolayfi Peralta, Yongjian Wu, Yu Kunwu, Yu Zhao, Yudong Peng, Yueh-Hung Lin, Yulan Zhao, Yumei Dong, Yunhai Zhao, Yutthaphan Wannasopha, Yvonne Taul, Zakir Sahul, Zalina Kudzoeva, Zbigniew Kalarus, Zeljko Z Markovic, Zhen Huang, Zheng Ji, Zhenyu Liu, Zhou Yue, Zhulin Zhang, Zhuxi Li, Zile Singh Meharwal, Ziliang Bai, Zixiang Yu, Zohra Huda, Zoltan Davidovits
Subjects: Male, Cardiac Catheterization, Computed Tomography Angiography, medicine.medical_treatment, Myocardial Ischemia, Coronary Disease, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Coronary Angiography, ISCHEMIA Research Group, law.invention, Angina, Coronary artery disease, 0302 clinical medicine, Randomized controlled trial, law, Cardiovascular Disease, Myocardial Revascularization, 030212 general & internal medicine, Coronary Artery Bypass, 11 Medical and Health Sciences, Cardiac catheterization, General Medicine, Middle Aged, humanities, Cardiovascular Diseases, Cardiology, Female, Human, medicine.medical_specialty, Ischemia, Article, 03 medical and health sciences, Geriatric cardiology, Percutaneous Coronary Intervention, General & Internal Medicine, Internal medicine, medicine, Humans, Angina, Unstable, Aged, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Bayes Theorem, medicine.disease, Heart failure, Quality of Life, business
Abstract: BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).
Published: 2020

12. Treatment of advanced heart failure in adults with congenital heart disease: a narrative review and clinical cases

Author: Christoph Sinning, Michael Huntgeburth, Norihide Fukushima, Rose Tompkins, June Huh, Shigeru Tataneo, Gerhard-Paul Diller, Yih-Sharng Chen, Elvin Zengin, Christina Magnussen, Ann-Sophie Kaemmerer, Yang Hyun Cho, Stefan Blankenberg, Carsten Rickers, Frank Harig, Michael Weyand, Michael Hübler, Yskert von Kodolitsch, Öztekin Oto, Andreas Zuckermann, Paulus Kirchhof, Helmut Baumgartner, Hermann Reichenspurner, Jon Kobashigawa, Harald Kaemmerer, and Koichiro Niwa
Subjects: Cardiology and Cardiovascular Medicine
Abstract: Background and Objective: The number of adults with congenital heart disease (ACHD) is increasing worldwide. Almost all congenital cardiac lesions can be successfully treated due to the progress in neonatal surgery and pediatric cardiology with a high likelihood of surviving until adulthood. However, ACHD frequently develop sequelae related to the initial cardiac anomaly. Heart failure (HF) is one of the most common complications associated with a high morbidity and mortality.Methods: The authors did search the PubMed database regarding relevant content covering publications up to March 2022. Relevant manuscripts were classified according to the impact factor of the journal, being a guideline manuscript, a position paper by a society or a comprehensive review of the current literature. Key content and findings: Optimal HF treatment remains an unmet need in ACHD. In particular, advanced HF therapy with cardiac resynchronization therapy, ventricular assist devices or organ transplantation is still very different and more specific in ACHD compared to non-ACHD. This review aims to compile international views and evidence from the literatures on the treatment of advanced HF in ACHD. Current challenges, but also the success of different treatment strategies in ACHD are illustrated by clinical cases.Conclusions: The main finding of the review is that data is still scarce regarding ACHD with advanced HF and international efforts to collect data regarding these patients needed to improve the current standard of care.
Published: 2022

13. Trainee experience on ischemic times and outcomes following orthotopic heart transplantation

Author: Amy Roach, Alfredo Trento, Achille Peiris, Jon Kobashigawa, Fardad Esmailian, Joanna Chikwe, and Dominic Emerson
Subjects: Pulmonary and Respiratory Medicine, Surgery, Cardiology and Cardiovascular Medicine
Abstract: This study was designed to evaluate the association of surgical training on outcomes following orthotopic heart transplantation in all levels of cardiothoracic surgery fellows.A retrospective cohort analysis was performed on all heart transplants at a single institution from 2011 to 2020. Transplants performed using organ preservation systems (n = 10) or with significant missing data were excluded (n = 37), resulting in 154 transplants performed by faculty surgeons and 799 total transplants performed by first-year Accreditation Council for Graduate Medical Education fellows (n = 73), second-year Accreditation Council for Graduate Medical Education fellows (n = 124), or non-Accreditation Council for Graduate Medical Education fellows (n = 602) in a transplantation and mechanical circulatory support fellowship. Primary outcome was warm ischemic time analyzed by year of fellowship. Additional secondary outcomes included 30-day mortality, primary graft dysfunction, reoperation for bleeding, and 5-year survival. Median follow-up was 3 years (interquartile range [IQR], 1.0-5.5 years) and 100% complete.The median number of transplants performed was 30 (IQR, 19.5-51.8) during the study period performed by 22 trainees. Baseline transplant characteristics performed were similar amongst the trainee years, although the first-year Accreditation Council for Graduate Medical Education fellows approached significantly fewer re-do transplants (1.4% vs 8.1% and 4.3%; P = .07). Warm ischemic time was lower in the first-year fellows (49 minutes; IQR, 42-63 minutes) versus second-year fellows (56.5 minutes; IQR, 45.5-69 minutes) and mechanical circulatory support/transplant fellows (56 minutes; IQR, 46-67 minutes) (P = .028). Crossclamp time was also lower in the first-year fellows than in second-year and mechanical circulatory support/transplant fellows, respectively (79 minutes; IQR, 65-100 minutes vs 147 minutes; IQR, 125-176 minutes and 143 minutes; IQR, 119-175 minutes) (P = .008). Secondary outcomes, including 30-day mortality (4.1% [n = 3] vs 2.4% [n = 3] vs 2.7% [n = 16]; P = .76), primary graft dysfunction (5.5% [n = 4] vs 4.0% [n = 5] vs 4.3% [n = 26]; P = .88), reoperation for bleeding (2.7% [n = 2] vs 4.8% [n = 6] vs 4.2% [n = 25]; P = .78), and 5-year survival (82.2%; 95% CI, 66.7%-84.9% vs 77.3%; 95% CI, 66.7%-84.9% vs 79.3%; 95% CI, 74.9%-83.1%; P = .84) were comparable in all groups.This cohort of nearly 800 operations demonstrates that orthotopic heart transplantation may be performed by cardiac fellowship trainees all levels of training with acceptable short- and long-term outcomes.
Published: 2022

14. Reply: Do Elderly Patients With Advanced Heart Failure Have Better Outcomes After LVAD?

Author: Dominic, Emerson, Joanna, Chikwe, Pedro, Catarino, Jon, Kobashigawa, and James K, Kirklin
Subjects: Heart Failure, Humans, Heart-Assist Devices, Aged
Published: 2021

15. Consensus conference on heart-kidney transplantation

Author: Jon, Kobashigawa, Darshana M, Dadhania, Maryjane, Farr, W H Wilson, Tang, Arvind, Bhimaraj, Lawrence, Czer, Shelley, Hall, Abdolreza, Haririan, Richard N, Formica, Jignesh, Patel, Rafael, Skorka, Savitri, Fedson, Titte, Srinivas, Jeffrey, Testani, Julie M, Yabu, Xingxing S, Cheng, and Mark, Zucker
Subjects: medicine.medical_specialty, Consensus, Heart disease, Renal function, Cardiorenal syndrome, 030230 surgery, Kidney, Organ transplantation, 03 medical and health sciences, 0302 clinical medicine, Immunology and Allergy, Medicine, Humans, Pharmacology (medical), Intensive care medicine, Kidney transplantation, Transplantation, business.industry, Consensus conference, Organ Transplantation, medicine.disease, Kidney Transplantation, Tissue Donors, United States, Heart Transplantation, business, Kidney disease
Abstract: Simultaneous heart-kidney transplant (sHK) has enabled the successful transplantation of patients with end-stage heart disease and concomitant kidney disease, with non-inferior outcomes to heart transplant (HT) alone. The decision for sHK is challenged by difficulties in differentiating those patients with a significant component of reversible kidney injury due to cardiorenal syndrome who may recover kidney function after HT, from those with intrinsic advanced kidney disease who would benefit most from sHK. A consensus conference on sHK took place on June 1, 2019 in Boston, Massachusetts. The conference represented a collaborative effort by experts in cardiothoracic and kidney transplantation from centers across the United States to explore the development of guidelines for the interdisciplinary criteria for kidney transplantation in the sHK candidate, to evaluate the current allocation of kidneys to follow the heart for sHK, and to recommend standardized care for the management of sHK recipients. The conference served as a forum to unify criteria between the different specialties and to forge a pathway for patients who may need dual organ transplantation. Due to the continuing shortage of available donor organs, ethical problems related to multi-organ transplantation were also debated. The findings and consensus statements are presented.
Published: 2021

16. Pig-to-Human Heart Transplantation: Culmination of Technology and Ingenuity

Author: Jon, Kobashigawa
Subjects: Graft Rejection, Pulmonary and Respiratory Medicine, Technology, Swine, Transplantation, Heterologous, Animals, Heart Transplantation, Humans, Surgery, Cardiology and Cardiovascular Medicine
Published: 2022

17. Reply

Author: Dominic Emerson, Joanna Chikwe, Pedro Catarino, Jon Kobashigawa, and James K. Kirklin
Subjects: Cardiology and Cardiovascular Medicine
Published: 2021

18. Accelerated Allograft Vasculopathy With Rituximab After Cardiac Transplantation

Author: Randall C. Starling, Brian Armstrong, Nancy D. Bridges, Howard Eisen, Michael M. Givertz, Abdallah G. Kfoury, Jon Kobashigawa, David Ikle, Yvonne Morrison, Sean Pinney, Josef Stehlik, Sudipta Tripathi, Mohamed H. Sayegh, Anil Chandraker, Barbara Gus, Karen Keslar, Bill Magyar, John Petrich, W. H. Wilson Tang, Kimberly Brooks, Michael Givertz, Charles Kelly, Katie Klein, Kerry Crisalli, Sandra DeBronkart, Joren Madsen, Marc Semigran, John Vetrano, Teresa DeMarco, Scott Fields, Carol Maguire, Robert Gordon, Allen Anderson, Jane Regalado, Anna Warzecha, Lee Goldberg, Caroline Olt, Kenneth Rockwell, Ashley Harris, Maryl Johnson, Susan Johnston, Chris Roginski, Rashid Ahmed, Ivy Cohen, Denise Peace, Tina Yao, Gloria Araujo, Arvind Bhimaraj, Eunice Karanga, Varsha Patel, Julie Chait, Mario Deng, Gregg Fonarow, Christina Shin, Charles Gibbs, Judson Hunt, Melissa Johnson, Tina Worley, Jeff Gibbs, John Kirk, Winter Redd, Julia Bryan, Anna French, A.G. Kfoury, Kristin Konery, Erika Feller, Myounghee Lee, Richard Pierson, Cindi Young, Theodora Hollifield, Kimberley Porter, Mariann Schulz, Adrian VanBakel, Kiran Khush, Helen Luikart, Son Nguyen, Michael Pham, David DeNofrio, Ryan O’Kelly, Lucilla Garcia, Sean Sana, Brandy Starks, Maria Thottam, Annie Yi, Barry Cabuay, Rachel Olson, Larry Tucker, Laura Uppgaard, Denise Lai, Colleen Poisker, Klaudija Dragicevic, Harrison Kelner, Darlette Luke, Jennifer Nelson, Ganesh Raveendran, Nick Kleissas, Srinivas Murali, Kenneth Rayl, Sarah Sherry, and Michele Cosgrove
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Population, 030204 cardiovascular system & hematology, Placebo, Gastroenterology, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Postoperative Complications, Double-Blind Method, hemic and lymphatic diseases, Internal medicine, Intravascular ultrasound, medicine, Humans, Immunologic Factors, 030212 general & internal medicine, Prospective Studies, Vascular Diseases, education, CD20, education.field_of_study, medicine.diagnostic_test, biology, business.industry, Immunosuppression, Middle Aged, Allografts, Transplantation, Clinical trial, biology.protein, Heart Transplantation, Rituximab, Female, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract: Background The CTOT-11 (Prevention of Cardiac Allograft Vasculopathy Using Rituximab Therapy in Cardiac Transplantation [Clinical Trials in Organ Transplantation-11]) study was a randomized, placebo-controlled, multicenter, double-blinded clinical trial in nonsensitized primary heart transplant (HTX) recipients. Objectives The study sought to determine whether B cell depletion therapy would attenuate the development of cardiac allograft vasculopathy. Methods A total of 163 HTX recipients were randomized to rituximab 1,000 mg intravenous or placebo on days 0 and 12 post-transplant. Primary outcome was change in percent atheroma volume (PAV) from baseline to 1 year measured by intravascular ultrasound. Secondary outcomes included treated episodes of acute rejection, de novo anti-HLA antibodies (including donor-specific antibodies), and phenotypic differentiation of B cells. Results There were no significant differences at study entry between the rituximab and placebo groups. Paired intravascular ultrasound measures were available at baseline and 1 year in 86 subjects (49 rituximab, 37 placebo). The mean ± SD change in PAV at 12 months was +6.8 ± 8.2% rituximab versus +1.9 ± 4.4% placebo (p = 0.0019). Mortality at 12 months was 3.4% rituximab versus 6.8% placebo (p = 0.47); there were no retransplants or post-transplant lymphoproliferative disorder. The rate of treated rejection was 24.7% rituximab versus 32.4% placebo (p = 0.28). Rituximab therapy effectively eliminated CD20+/CD19+ B cells followed by a gradual expansion of a CD19– cell population in the rituximab-treated group. Conclusions A marked, unexpected increase in coronary artery PAV with rituximab was observed during the first year in HTX recipients. One-year mortality was not impacted; however, longer-term follow-up and mechanistic explanations are required. (Prevention of Cardiac Allograft Vasculopathy Using Rituximab [Rituxan] Therapy in Cardiac Transplantation; NCT01278745)
Published: 2018

19. Incidence, characteristics, and outcome of post-heart transplant malignancy

Author: Jong-Chan Youn, In-Cheol Kim, Jin-Jin Kim, Sang Hong Baek, and Jon Kobashigawa
Subjects: endocrine system, medicine.medical_specialty, Lung, business.industry, Incidence (epidemiology), medicine.medical_treatment, Cancer, Immunosuppression, Malignancy, medicine.disease, medicine.anatomical_structure, Prostate, Internal medicine, Cancer screening, Medicine, Skin cancer, business
Abstract: Background: Post-transplant malignancy (PTM) has been an important cause of long-term morbidity and mortality in heart transplant (HTx) recipients. However, the detailed characteristics of PTM are largely unknown. We aimed to describe the charac teristics, outcomes, and predictors of de novo PTM in HTx recipients. Methods: We analyzed 989 consecutively enrolled HTx recipients without pre-transplant history of malignancy between 1997 and 2013. Main outcomes included the incidence, characteristics, outcomes, and predictors of PTM. Results: During a median follow-up period of 11.5 years, 206 patients (20.8%) had de novo PTMs (241 cancer cases). PTM pa tients, compared with non-PTM patients, showed older age, longer time on immunosuppression, and higher proportion of male and white patients. Skin cancers were the most frequent types of malignancy (60.6%) followed by prostate cancers (9.5%), lung cancers (7.1%), and breast cancers (4.1%). While most of the cancers (88.8%) were surgically resected at the initial presentation, about half of cancers (47.3%) showed recurrence or disease progression. Both patients with skin cancer and non-skin cancer, compared to patients without PTM, revealed a significantly lower overall survival (P
Published: 2020

20. Honoring 50 Years of Clinical Heart Transplantation in

Author: Josef, Stehlik, Jon, Kobashigawa, Sharon A, Hunt, Hermann, Reichenspurner, and James K, Kirklin
Subjects: Graft Rejection, Heart Failure, Graft Survival, Organ Preservation, Recovery of Function, History, 20th Century, History, 21st Century, Treatment Outcome, Risk Factors, Quality of Life, Tissue and Organ Harvesting, Animals, Heart Transplantation, Humans, Diffusion of Innovation, Immunosuppressive Agents
Abstract: Heart transplantation has become a standard therapy option for advanced heart failure. The translation of heart transplantation from innovative experiments to long-term clinical success has married prescient insights with discipline and organization in the domains of surgical techniques, organ preservation, immunosuppression, organ donation and transplantation logistics, infection control, and long-term graft surveillance. This review explores the key milestones of the past 50 years of heart transplantation and discusses current challenges and promising innovations on the clinical horizon.
Published: 2017

21. Clinical and Angiographic Outcomes with Everolimus Eluting Stents for the Treatment of Cardiac Allograft Vasculopathy

Author: Jon Kobashigawa, Raj Makkar, Amelia Young, Babak Azarbal, B S Matthew Rafiei, Michelle M. Kittleson, Lawrence Czer, Boris Arbit, Radhakrishnan Ramaraj, and Jesse Currier
Subjects: medicine.medical_specialty, Everolimus, business.industry, medicine.medical_treatment, Percutaneous coronary intervention, Stent, medicine.disease, Coronary artery disease, Stenosis, Restenosis, Internal medicine, Conventional PCI, medicine, Cardiology, Radiology, Nuclear Medicine and imaging, Radiology, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract: Objectives: This study aimed to examine clinical efficacy, safety, and intermediate clinical outcomes with everolimus‐eluting stents (EESs) in patients with transplant coronary artery disease (TCAD). Background: TCAD is a major cause of mortality in patients following orthotopic heart transplantation (OHT). Systemic everolimus in OHT patients hasbeen shown to reduce TCAD. The safety and efficacy of an EES, the Xience V, have not been evaluated in this population. Methods: Patients post‐OHT with hemodynamically significant CAD who underwent percutaneous coronary intervention (PCI) with EES were included. Participants were maintained on dual antiplatelet therapy for 1‐year post‐PCI. We examined procedural success, in‐hospital and 1‐year mortality, stent thrombosis, angiographic restenosis, and myocardial infarction rates. All patients had follow‐up angiography 1‐year after PCI. Target vessel revascularization (TVR), target lesion revascularization (TLR), in‐segment restenosis, target vessel failure (TVF), and lumen late loss were noted. Results: PCI was performed in 34 de novo lesions in 21 patients, and 40 EES were placed. Procedural success rate was 100%. Average stent was 16.5 � 5.1mm long and 3.0 � 0.6mm in diameter. All patients had angiographic follow‐up(409 � 201days).Therewasnostentthrombosis,deaths,ormyocardialinfarctionsduringfollow‐up.Two patients had focal in‐stent restenosis. TLR rate was 5.9% (2/34), and TVR rate was 11.1% (3/27). Quantitative coronary angiography (QCA) showed stenosis diameter to be 19.98 � 17.57%. Conclusions: Use of an EES is associated with a low incidence of TVR and TLR in patients with TCAD. Further studies are needed to determine whether PCI with EES changes long‐term outcomes. (J Interven Cardiol 2014;27:73–79)
Published: 2013

22. In vivo diffusion-tensor MRI of the human heart on a 3 tesla clinical scanner: An optimized second order (M2) motion compensated diffusion-preparation approach

Author: Christopher, Nguyen, Zhaoyang, Fan, Yibin, Xie, Jianing, Pang, Peter, Speier, Xiaoming, Bi, Jon, Kobashigawa, and Debiao, Li
Subjects: Adult, Heart Failure, Male, Cardiac-Gated Imaging Techniques, Reproducibility of Results, Heart, Signal Processing, Computer-Assisted, Image Enhancement, Sensitivity and Specificity, Article, Motion, Diffusion Tensor Imaging, Image Interpretation, Computer-Assisted, Humans, Female, Artifacts, Algorithms, Aged
Abstract: To optimize a diffusion-prepared balanced steady-state free precession cardiac MRI (CMR) technique to perform diffusion-tensor CMR (DT-CMR) in humans on a 3 Tesla clinical scanner METHODS: A previously developed second order motion compensated (M2) diffusion-preparation scheme was significantly shortened (40%) yielding sufficient signal-to-noise ratio for DT-CMR imaging. In 20 healthy volunteers and 3 heart failure (HF) patients, DT-CMR was performed comparing no motion compensation (M0), first order motion compensation (M1), and the optimized M2. Mean diffusivity (MD), fractional anisotropy (FA), helix angle (HA), and HA transmural slope (HATS) were calculated. Reproducibility and success rate (SR) were investigated.M2-derived left ventricular (LV) MD, FA, and HATS (1.4 ± 0.2 μmThe proposed M2 DT-CMR reproducibly yielded bulk motion robust estimations of mean LV MD, FA, HA, and HATS on a 3T clinical scanner. Magn Reson Med 76:1354-1363, 2016. © 2016 International Society for Magnetic Resonance in Medicine.
Published: 2016

23. Abstract 14780: The First Hundred Days: Gender Differences in Psychosocial Distress After Heart Transplant

Author: Lynn Doering, Belinda Chen, Kathleen Hickey, Erik Carter, Carmen Castillo, David Pickham, Donna Mancini, Mario Deng, Jon Kobashigawa, and Barbara Drew
Subjects: Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract: Early psychological distress after heart transplant (HTx) is associated with adverse outcomes (e.g. poorer medical compliance, higher risk of infection). In the HTx population, gender effects of depression and anxiety symptoms are controversial. Our objective was to examine gender differences in psychosocial measures early after HTx. Methods: We enrolled 91 adult HTx patients (29% female, mean age=51 ± 14 years) who completed measures of depression (Patient Health Questionnaire [PHQ]-9), anxiety (Brief Symptom Inventory [BSI]), perceived control (Control Attitudes Scale-Revised) and quality of life (QOL) (RAND-36 Health Survey) in the first 100 days after HTx (mean time from HTx = 50 ± 24 days). Hierarchical multiple linear regression models were used to examine gender influences on depression, anxiety, control, and QOL. Results: Compared to men, women are more likely to experience high depressive symptoms (15% vs. 39%, p=0.02), high levels of anxiety (46% vs.77%, p=0.008), and low perceived control (average score 33 vs. 29, p=0.007). For both men and women, anxiety is more prevalent than depressive symptoms (Figure). Compared to men, women had lower QOL due to pain (p=0.045) and limitations from emotional problems (p=0.02). In linear regression analyses, the effect of gender remained significant on depression (p=0.003), anxiety (p=0.03), and perceived control (p=0.02), but not QOL, after controlling for demographics (age, marital status, race, time between HTx and questionnaire completion, and Charlson Comorbidity Index). Conclusion: In the first 100 days after HTx, women experience more depressive and anxiety symptoms and less control over their heart health than men. Clinicians should monitor these symptoms early after HTx, especially in women. Development of gender-specific interventions aimed at a smooth post-HTx transition are warranted. Future research is needed to evaluate the relationship of anxiety and depressive symptoms before and after HTx.
Published: 2015

24. Abstract 16941: Questioning the efficacy of Proliferation Signal Inhibitors for established Coronary Artery Disease after Heart Transplant

Author: Adva Kornblit, Jignesh Patel, Michelle Kittleson, Zhe Yu, Frank Liou, Jamie Yabuno, Babak Azarbal, David H Chang, Lawrence Czer, and Jon Kobashigawa
Subjects: Physiology (medical), cardiovascular system, Cardiology and Cardiovascular Medicine
Abstract: Purpose: Cardiac Allograft Vasculopathy (CAV) is one of the major factors limiting long term survival after heart transplantat (HTx). The use of proliferation signal inhibitors (PSIs) such as everolimus and sirolimus has been found to be effective in the prevention of CAV in multicenter studies. There has been 1 study (Mancini et al) that has suggested the use of Sirolimus can decrease the progression of CAV in patients (Pts) long term after Htx. It is not been evaluated in the current era of Tacrolimus (TAC)/Mycophenolate Mofetil (MMF) whether a switch from MMF to PSIs has such an advantage. Methods: Between 1998 and 2010, we evaluated 26 HTx Pts who had developed CAV according to the new ISHLT CAV nomenclature (CAV1, CAV2, CAV3) and were subsequently switched from TAC/MMF to TAC/PSIs. Pts who were maintained on TAC/MMF were served as 1:1 controls. Outcomes for these Pts included worsening of CAV by category at 3 year, subsequent 3-year survival and subsequent 3-year freedom from non-fatal major adverse cardiac events (NF-MACE: Myocardial Infarction, Congestive Heart Failure, angioplasty, pacemaker/ICD and stroke). Results: There were 26 patients in the switched to PSIs group and 23 patients in the maintained on MMF group. All patients were either CAV 1 or CAV 2 at baseline. The average time to switch to PSIs was 5.3 ± 3.3 years. At 3 year follow up, the percentage of patients who had worsened CAV by category were comparable among the two groups. Subsequent 3-year survival and 3-year freedom from NF-MACE were also comparable among the two groups (see Table). Conclusions: In the current era of TAC/MMF, switch from MMF to PSI for patients with established CAV does not appear to be beneficial in preventing progression of disease. A larger number of patients are needed to confirm this finding.
Published: 2014

25. Abstract 16877: Correlation of Antibody Binding Strength to Complement Fixation

Author: Vishal Y Parikh, Nancy Reinsmoen, Jignesh Patel, Zhe Yu, Frank Liou, Jamie Yabuno, Michelle Kittleson, Babak Azarbal, David H Chang, Lawrence Czer, and Jon Kobashigawa
Subjects: Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract: Background: In patients (pts) who are highly sensitized, desensitization therapy is commonly applied to reduce antibody (Abs) load and to reduce potential morbidity and mortality following heart transplant (HTx). It is not known as to what level of antibody binding is needed to initiate desensitization therapy. It is believed that high binding Abs may have the ability to fix complement and lead to cytotoxicity. Methods: Between 2011 and 2012 we assessed 13 highly sensitized pts who were noted to have standardized fluorescence intensity (SFI) >100,000 pretransplant. A complement binding assay (C1q binding assay) was then applied to these Abs to assess for a correlation of binding to cytotoxicity. Correlation statistics were used to derive significance between higher antibody binding and capacity to bind complement. Results: There seems to be no correlation between the different binding strength and C1q positivity. However, when evaluating Luminex 1:8 test, there seems to be correlation between class I binding strength with C1q positivity. There was C1q positive rate of 10.8% in SFI 200,000 range. Conclusions: Undiluted antibodies do not correlate to C1q binding ability. However the 1:8 dilution test seems to provide an better prediction of complement binding. 1:8 dilutions should be performed to accurately assess the ability for antibodies to bind complement.
Published: 2014

26. Abstract 19328: Clinical Predictors of Renal Failure in Heart Transplant Patients Following Initiation of Calcineurin Inhibitor Free Regimen

Author: Omeed Elboudwarej, Jignesh Patel, Michelle Kittleson, Frank Liou, and Jon Kobashigawa
Subjects: Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract: Purpose: Calcineurin inhibitor (CNI) therapy has been the cornerstone of standard triple-drug immunosuppressive therapy that has significantly improved outcomes after heart transplantation (HTx). However, CNI-induced nephrotoxicity remains a significant cause of morbidity and mortality. Renal-sparing protocols (RSP) using CNI-free regimens have improved renal function in some patients (pts). The clinical variables associated with development of renal failure despite RSP initiation are unknown. We therefore evaluated HTx pts on RSP for possible risk factors associated with renal failure. Methods: Of 1,424 HTx pts between 1/1994 to 1/2011, 61 were identified who underwent RSP. Creatinine values were obtained at time of RSP initiation and ≥3 months post-RSP. The CKD-EPI Cr Equation (2009) was used to estimate GFR. We assessed pts for type of CNI, prednisone use, ACE-inhibitor/ARB use, calcium-channel blocker use, sex, race, hypertension, diabetes mellitus, obesity, and hypercholesterolemia. A logistic regression model was used to determine if there was an association between the clinical variables measured and stage IV renal failure (estimated GFR Results: 40 patients (66%) developed renal failure at an average of 14.4 ± 12.8 months after initiating RSP. Pts with an estimated GFR Conclusions: RSP does not appear to be effective in pts with advanced renal disease. RSP should be considered in pts with CNI nephrotoxicity at an earlier stage of the disease.
Published: 2014

27. Coronary computed tomography angiography: is it time to replace the conventional coronary angiogram in heart transplant patients?

Author: Jon, Kobashigawa
Subjects: Male, Multidetector Computed Tomography, Humans, Female, Allografts, Coronary Angiography
Published: 2014

28. Clinical and angiographic outcomes with everolimus eluting stents for the treatment of cardiac allograft vasculopathy

Author: Babak, Azarbal, Boris, Arbit, Radhakrishnan, Ramaraj, Michelle, Kittleson, Amelia, Young, Lawrence, Czer, Matthew, Rafiei, Jesse, Currier, Raj, Makkar, and Jon, Kobashigawa
Subjects: Male, Sirolimus, Coronary Disease, Drug-Eluting Stents, Allografts, Coronary Angiography, Percutaneous Coronary Intervention, Postoperative Complications, Treatment Outcome, Heart Transplantation, Humans, Female, Everolimus, Immunosuppressive Agents, Retrospective Studies
Abstract: This study aimed to examine clinical efficacy, safety, and intermediate clinical outcomes with everolimus-eluting stents (EESs) in patients with transplant coronary artery disease (TCAD).TCAD is a major cause of mortality in patients following orthotopic heart transplantation (OHT). Systemic everolimus in OHT patients has been shown to reduce TCAD. The safety and efficacy of an EES, the Xience V, have not been evaluated in this population.Patients post-OHT with hemodynamically significant CAD who underwent percutaneous coronary intervention (PCI) with EES were included. Participants were maintained on dual antiplatelet therapy for 1-year post-PCI. We examined procedural success, in-hospital and 1-year mortality, stent thrombosis, angiographic restenosis, and myocardial infarction rates. All patients had follow-up angiography 1-year after PCI. Target vessel revascularization (TVR), target lesion revascularization (TLR), in-segment restenosis, target vessel failure (TVF), and lumen late loss were noted.PCI was performed in 34 de novo lesions in 21 patients, and 40 EES were placed. Procedural success rate was 100%. Average stent was 16.5 ± 5.1 mm long and 3.0 ± 0.6 mm in diameter. All patients had angiographic follow-up (409 ± 201 days). There was no stent thrombosis, deaths, or myocardial infarctions during follow-up. Two patients had focal in-stent restenosis. TLR rate was 5.9% (2/34), and TVR rate was 11.1% (3/27). Quantitative coronary angiography (QCA) showed stenosis diameter to be 19.98 ± 17.57%.Use of an EES is associated with a low incidence of TVR and TLR in patients with TCAD. Further studies are needed to determine whether PCI with EES changes long-term outcomes.
Published: 2013

29. ANGIOTENSIN-CONVERTING ENZYME INHIBITION EARLY AFTER CARDIAC TRANSPLANTATION: A MULTI-CENTER, RANDOMIZED, DOUBLE-BLIND TRIAL COMPARING RAMIPRIL VERSUS PLACEBO

Author: Jon Kobashigawa, Yuhei Kobayashi, William F. Fearon, Kozo Okada, Hannah A. Valantine, Yasuhiro Honda, Garrett Cohen, Sean Sana, T. Daun, Seema Sinha, Kiran K. Khush, Helen Luikart, and Alan C. Yeung
Subjects: Ramipril, medicine.medical_specialty, biology, business.industry, Urology, Angiotensin-converting enzyme, 030204 cardiovascular system & hematology, Placebo, Double blind, Transplantation, 03 medical and health sciences, 0302 clinical medicine, medicine, biology.protein, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, medicine.drug
Published: 2016

30. THE IMPACT OF ANGIOTENSIN CONVERTING ENZYME INHIBITORS ON ASYMMETRIC DIMETHYLARGININE IN ORTHOTOPIC HEART TRANSPLANTATION RECIPIENTS: A MULTICENTER, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL

Author: Seema Sinha, Rushi V. Parikh, Jon Kobashigawa, Sean Sana, T. Daun, Alan C. Yeung, Kiran K. Khush, Helen Luikart, Garrett Cohen, Vedant S. Pargaonkar, Hannah A. Valantine, and William F. Fearon
Subjects: Heart transplantation, medicine.medical_specialty, biology, business.industry, medicine.medical_treatment, Urology, Placebo-controlled study, Angiotensin-converting enzyme, Double blind, chemistry.chemical_compound, Endocrinology, chemistry, Internal medicine, medicine, biology.protein, Cardiology and Cardiovascular Medicine, Asymmetric dimethylarginine, business
Published: 2016

31. Abstract P122: Characterization of Ventricular Assist Device Mediated Sensitization in the Bridge to Heart Transplant Patient

Author: Murray H Kwon, Jennifer Q Zhang, Ani Abrahamyan, Zilu K Zhang, David W Gjertson, Abbas Ardehali, Jon Kobashigawa, Richard J Shemin, and Elaine F Reed
Subjects: Physiology, Cardiology and Cardiovascular Medicine
Abstract: Purpose: To clarify patterns of anti-HLA antibody expression (sensitization) occurring in patients bridged to transplantation (BTT) with ventricular assist devices (VADs). Methods: The study is a retrospective review of 68 patients undergoing BTT with either Heartmate II (HMII) axial flow LVAD or paracorporal BIVAD from January 2007 to July 2010 at UCLA Medical Center. Results: Five of 15 (33.3%) HMII pts became sensitized during treatment compared to 29 of 53 (54.7%) BIVAD patients, p=0.24. Table 1 shows common etiologies for patient sensitization of which only PRBC transfusion was statistically significant. [ table 1 ] Multiple variable analysis comparing BIVAD vs. HMII while controlling for previous cardiac surgery, pregnancy, and PRBC transfusion demonstrated an Odds Ratio of 5.20, p=0.029 (robust variance estimator). Of sensitized patients, all 5 (100%) of the HMII patients had pre-existing antibodies prior to VAD placement compared to 11 of 29 (62.1%) BIVAD patients, p=0.016. Maximum cumulative MFIs for BIVAD were 46,259 ± 66,349 vs. 42540 ± 12840 for HMII, p=0.90. Time to maximum antibody expression was shorter for the HMII group (34 ± 28 days vs. 5.8 ± 9 days, p=0.04). Table 1. Sensitization Risk Factors Antibodies + Antibodies − p-value Previous Cardiac Surgery 23.5% 8.8% 0.19 Pregnancy 20.6% 2.9% 0.05 PRBC 52.1±34.7 35.9±22.3 0.04 FFP 29.4±14.4 23.6±15.2 0.15 Platelets 9.8±9.7 6.8±6.7 0.20 Cryoprecipitate 3.2±2.6 3.1±2.6 0.74 Blood products expressed as mean units ± std dev Conclusion: BIVADs were associated with a five fold increased risk for sensitization when accounting for other risk factors. HMII patients required pre-sensitization to express antibodies during their treatment interval whereas BIVAD patients developed de novo antibodies. Although the peak cumulative MFIs were similar for both VAD types, the days to reach this peak were significantly less in the HMII group. These data suggest that sensitization in HMII patients may not be due to antigenic stimulation from the device itself.
Published: 2011

32. Abstract 2890: The Long Term Outcome Of Treated Presensitized Patients Who Undergo Heart Transplantation: Is It Successful?

Author: Jon Kobashigawa, Jignesh Patel, Matt Kawano, Grace Wu, Michelle Kittleson, Krista Kiyosaki, Jamie Moriguchi, and Abbas Ardehali
Subjects: surgical procedures, operative, Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract: Background: Sensitized patients prior to heart transplantation are reportedly at risk for hyperacute rejection and for poor outcome after heart transplantation. It is not known whether reduction of circulating antibodies pre-transplant alters post-transplant outcome. Methods: Between July 1993 and July 2003 we reviewed 523 heart transplant patients of which 95 had pre-transplant PRAs >10%. 21/95 were treated pre-transplant for circulating antibodies. These 21 patients had PRAs greater than 10% (majority 50%–100%) and were treated with combination therapy including plasmapheresis and intravenous gamma globulin to reduce antibody counts. The 74 untreated patients with PRAs >10% (untreated presensitized group) and those patients with PRAs Results: Circulating antibody levels pre-transplant decreased from a median of 77.5 to 29.0% (p = 0.017), which allowed a negative prospective donor specific cross match and successful heart transplantation. Compared to the untreated presensitized group, and the control group, the treated sensitized patients had similar five year survival (81.1% vs. 75.7% vs. 71.4%, p=0.523) and freedom from cardiac allograft vasculopathy (74.3% vs. 72.7% vs. 76.2%, p=0.850). Conclusion: Treatment of sensitized patients pre-transplant appears to result in comparable long term outcome after heart transplant.
Published: 2007

33. Support with the BVS 5000 assist device during treatment of acute giant-cell myocarditis

Author: Daniel, Marelli, Reza, Kermani, Jessica, Bresson, Michael C, Fishbein, Michele, Hamilton, Jaime, Moriguchi, Gregg C, Fonarow, Benjamin, Cohen, Jon, Kobashigawa, and Hillel, Laks
Subjects: Adult, Male, Myocarditis, Acute Disease, Humans, Female, Heart-Assist Devices, Case Reports, Middle Aged, Giant Cells
Abstract: Giant-cell myocarditis is a rare and aggressive form of myocarditis with a high mortality rate. Our purpose is to summarize 3 cases of acute giant-cell myocarditis that illustrate possible outcomes with mechanical support. We reviewed the cases of 3 patients, aged 39 to 59 years, who had giant-cell myocarditis (confirmed by myocardial biopsy). The indication for ventricular assist was circulatory failure despite maximal medical treatment with 2 or more inotropic agents and intraaortic balloon pump support. Immunosuppression and a biventricular mechanical assist (BVS 5000) were used to treat all these patients. The mean duration of mechanical support was 15.7 days (range, 10 to 19 days). One patient had recovery of myocardial function and was weaned from mechanical support. This case is, to our knowledge, the first reported of ventricular support leading to cardiac recovery after diagnosis of giant-cell myocarditis. The 2nd patient was not a candidate for further surgery and died of multisystem organ failure. The 3rd patient underwent orthotopic heart transplantation after 18 days of support and was discharged. We conclude that patients with giant-cell myocarditis tend to have biventricular involvement and can recover myocardial function on mechanical support and immunosuppression. If recovery is not observed, transplantation is warranted. By avoiding left ventricular cannulation, the BVS 5000 is well suited for bridging to recovery, transplantation, or long-term support.
Published: 2003

34. Short-term bridge to heart transplant using the BVS 5000 external ventricular assist device

Author: Feng-Chun, Tsai, Daniel, Marelli, Hillel, Laks, Jaime, Moriguchi, Michael, Sopher, Jessica, Bresson, Saleh, Moghaddam, Barnard, Kubak, Fardad, Esmailian, Abbas, Ardehali, Mark, Plunkett, Paul, Litwin, and Jon, Kobashigawa
Subjects: Adult, Cardiopulmonary Bypass, Time Factors, Adolescent, Body Weight, Middle Aged, Survival Analysis, Heart Transplantation, Humans, Ventricular Function, Heart-Assist Devices, Child, Aged, Follow-Up Studies, Retrospective Studies
Abstract: From January 1995 to April 2001, 71 patients with cardiogenic shock using the BVS 5000 were treated or accepted in transfer. Of the 24 transplanted, nine had dilated cardiomyopathy, ischemic cardiomyopathy, acute myocardial infarction, giant cell myocarditis and previous Fontan procedure (group I, n = 13). The others had postcardiotomy shock (group II, n = 11); seven were transferred to our center after device implantation. Age ranged from 8 to 67 years. Ten (77%) patients in group I were implanted without cardiopulmonary bypass. The mean duration of support was 6.7 (2-24) d. Twelve patients were extubated before transplantation and 13 (five in group I, eight in group II) received nonstandard donor organs. Survival to discharge and 1-year actuarial survival was 85 and 77% for group I and 73 and 64% for group II, respectively. Patients with post-implant serum bilirubin levels10 mg/dL had a tendency to expire from multiple systemic organ failure. Patients not ventilator-dependent at the time of transplant had the best outcomes. Short-term bridge to transplantation using the BVS 5000 is feasible in selected patients. Caution is recommended when directing such patients to transplant if they need ventilator support and have high serum bilirubin levels.
Published: 2002

35. Hepatitis C-positive donors in heart transplantation

Author: Daniel Marelli, Jessica Bresson, Hillel Laks, Bernard Kubak, Gregg Fonarow, Feng‐Chun Tsai, Julie Tran, Shiobhan R. Weston, and Jon Kobashigawa
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Hepatitis C virus, Coronary Artery Disease, Hepacivirus, medicine.disease_cause, Coronary artery disease, Internal medicine, medicine, Immunology and Allergy, Humans, Pharmacology (medical), Seroconversion, Survival analysis, Aged, Heart transplantation, Hepatitis, Transplantation, business.industry, Immunosuppression, Hepatitis C, Middle Aged, medicine.disease, Survival Analysis, Tissue Donors, Surgery, Heart Transplantation, Female, business
Abstract: Hepatitis C virus (HCV) can be transmitted to heart transplant recipients by donor organs. Mid-term results were reported using HCV-positive donors in patients at risk of imminent death (group I, n = 10), or in patients who otherwise would not have been offered heart transplantation (group II, n = 10) because of age (9/10) or associated medical risk (1/10). Medical records pertaining to patients receiving HCV-positive allografts between July 1994 and December 1999 were reviewed. The recipients consisted of 19 males and one female, with a median age of 54 years for group I and 66 for group II. The HCV RNA level, seroconversion of anti-HCV antibody, biochemical liver dysfunction, and causes of death were examined. Older recipients received reduced immunosuppression. Two patients in group II were HCV positive and were also retransplants. The hospital mortality rate was 10% in group I and 20% in group II; both hepatitis C-positive recipients died postoperatively prior to discharge. All predischarge deaths were related to multi-system organ failure (MSOF). All 17 survivors were HCV negative prior to transplant. Of these, 4/17 seroconverted. HCV RNA was detected in two of them. At a median follow-up of 26.4 months, 2/11 current survivors continue to test anti-HCV positive and are RNA negative. Three-year actual survival was 40% for group I and 70% in group II. Transplant coronary artery disease (TCAD) accounted for one postoperative death in group I. Current data show that four out of 11 survivors had developed TCAD at 3-year follow-up, yielding an actual freedom from TCAD rate of 12/17 (70%) at 3-year follow-up. Hepatitis C transmission using a donor heart as the reservoir is moderate (25%). Limited use of such donors is justified in selected patients. The risk for hepatic disease may be reduced by tailoring immunosuppression specifically for such recipients, particularly if they are at low risk of rejection. Further studies are necessary to define a possible association between HCV and TCAD.
Published: 2002

36. The Effect and Safety Profile of Thymoglobulin® in Primary Cardiac Transplant Recipients

Author: Genzyme, a Sanofi Company and Jon Kobashigawa, Director of Advanced Heart Disease Program
Published: 2023

37. A Study to Compare the Effectiveness of a Drug That Suppresses the Immune System Called Thymoglobulin® in Preventing the Development of a Disease That Affects the Majority of Heart Transplant Recipients Called Cardiac Allograft Vasculopathy (CAV)

Author: Genzyme, a Sanofi Company and Jon Kobashigawa, Associate Director, Cedars-Sinai Heart Institute
Published: 2019

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