·Who will resume smoking after heart transplantation? University of Pittsburgh researchers followed more than 200 transplant recipients to identify, for the first time, the most significant predictors of smoking behavior after transplantation. Such information could help clinicians develop more effective interventions and help reduce the alarming incidence of lung cancers that develop in transplant patients with a history of smoking.
·Special ultrasound technology that quantifies the strength of the heart is an accurate way to determine if a patient's previously failing heart is showing signs of recovery while on a left ventricular assist device, allowing surgeons to remove the device and making heart transplantation no longer necessary. Two studies at the University of Pittsburgh provide results using this unique imaging system that detects heart recovery.
·Using a more precise laboratory test than the conventional one, patients who have inherently sensitive immune systems can be singled out both before and after a transplant takes place. This allows transplant teams to tailor therapies that might preempt disastrous courses for these patients at added risk for severe rejection, according to University of Pittsburgh studies in pediatric heart and adult lung transplant patients.
More information on these three studies follows. Please note specific embargo dates.
Embargoed for Thursday, April 11
Predictors for smoking relapse in heart transplant patients identified for first time
Nearly half of ex-smokers who receive heart transplants resume smoking at some point after their life-saving operation, and now researchers have good evidence to suggest who is at risk and what factors increase the risk of relapse. Leading the list: a short abstinence period before transplantation, bouts of depression or anxiety within a few months of the transplant, and a caregiver who smokes.
"Identifying who goes back to smoking should help us design more effective intervention strategies, not only for the transplant recipients but also for their caregivers," reported Carol Stilley, Ph.D., assistant professor of nursing and psychiatry, University of Pittsburgh schools of Nursing and Medicine. Of concern to transplant teams is the fact that drugs to prevent organ rejection suppress the patients' immune systems, making these patients more susceptible to infections and cancers. A smoking history and relapse to smoking could very well compound cancer risks. Indeed, in recent years, transplant teams have seen more of their heart transplant patients develop inoperable lung tumors.
The Pitt researchers studied 202 heart transplant recipients for up to three years. Of these, 144 (71 percent) had a history of smoking. Fifty-five recipients started smoking at some point after their transplant, 45 within the first year and 26 within the first two months.
(A more detailed news release is also available.)
Embargoed for Friday, April 12
New technology detects when heart's recovering on left ventricular assist device, enabling weaning from device and removal from transplant list
Left ventricular assist devices (VADs) have typically been used to provide support to a failing heart until a donor organ is available. But increasingly, transplant teams have seen their patients regaining heart function while on the devices, pointing to the possibility that VADs are a potential treatment for heart failure. But just how does one tell that a patient's heart has recovered sufficiently that it might be safe to remove the device and abandon the need for organ transplantation?
Researchers at the University of Pittsburgh believe the answer to that question may be found using unique technology that measures a heart's strength. While some centers rely on exercise physiology tests or the more invasive right heart catheterization to assess heart recovery, the Pitt team has been evaluating the use of automated border detection echocardiography, which employs standard ultrasound imaging along with state-of-the-art quantitative information about the size of the left ventricle -- the heart's main pumping chamber -- during contraction and relaxation. Adding additional information about arterial blood pressure, a computer then calculates the heart's strength as a "power value." Patients are selected for possible weaning when tests yield specific values indicating the heart is showing signs of recovery.
"Quantitative echocardiography is noninvasive and can be done on an outpatient basis or even at bedside. More importantly, we believe it yields data that is an accurate indicator of recovery," reported Don Severyn, M.S., senior biomedical engineer with the University of Pittsburgh Medical Center's Artificial Heart Program. In a second study, Robert L. Kormos, M.D., professor of surgery and director of the Artificial Heart Program, reported that six of 18 patients that underwent echocardiography showed signs of heart recovery and were subsequently weaned successfully off the devices.
The University of Pittsburgh is one of a handful of centers that is evaluating the quantitative echocardiography technology, and the only one to be using it to assess heart recovery. John Gorcsan, III, M.D., associate professor of medicine and director of echocardiography, developed this approach and conducted the previous studies that validated the use of the power calculation for heart recovery assessment.
Embargoed for Saturday, April 13
Blood test better identifies transplant patients at risk for rejection
A simple blood test takes much of the guesswork out of predicting who is at risk for severe organ rejection, according to two studies involving pediatric heart and adult lung transplant patients. The test, referred to as ELISA (enzyme linked immunosorbent assay), indicates if a patient has specific antibodies that are trained to fight the presence of foreign antigens. According to the studies' results, ELISA does a better job in identifying patients with sensitized immune systems than the widely used, less sensitive test called PRA (panel reactive antibody) based on lymphocytotoxicity. Such information may help clinicians tailor therapies to prevent rejection from actually occurring.
In the study of pediatric heart transplant patients, ELISA performed before transplantation indicated that 10 of 36 patients were susceptible to rejection. Within a year of transplantation, five of the 10 (50 percent) developed severe rejection, compared to three of the 26 (12 percent) negative-ELISA patients who developed rejection. Four of these five "rejecters" had not been identified as being sensitized by conventional PRA. Knowing in advance who may warrant more intense immunosuppression following heart transplantation is very useful clinical information, reported Sabrina Tsao, M.D., a cardiology post-doctoral fellow with the pediatric heart transplant program at the University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh. Of note, eight of the 10 ELISA-positive patients had congenital heart disease and were probably more sensitized because of blood transfusions received during past open heart surgeries.
In a similar study involving 75 adult lung transplant patients tested after transplantation, six of 14 (43 percent) who were ELISA positive developed persistent, acute rejection within the first 100 days of transplantation compared to nine of 61 (15 percent) who were negative. Similar results were obtained at follow-up periods up to a year. Alin Girnita, M.D., a transplant immunology post-doctoral fellow with the University of Pittsburgh School of Medicine, said that since ELISA can identify lung transplant recipients at high risk for persistent and recurrent cellular rejection, it may also offer clues about who may be at risk for developing chronic rejection, one of the most serious complications of lung transplantation.
(A more detailed news release is also available.)
Additional Contacts:
Lisa Rossi (Cell - 412-916-3315)
Maureen McGaffin
PHONE: (412) 647-3555
FAX: (412) 624-3184
E-MAIL:
RossiL@msx.upmc.edu
McGaffinME@msx.upmc.edu
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