The International Registry for Heart and Lung Transplantation (Registry) was established by the International Society for Heart and Lung Transplant (ISHLT) in 1983. It has since become the largest repository of heart and lung transplant data in the world. The continued relevance of the Registry and its high impact scientific contributions have been possible through accountability and responsible governance. This manuscript describes the logistics of the Registry's operations, its goals and future directions.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 10/2013; 32(10):941-50. DOI:10.1016/j.healun.2013.08.009 · 6.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: -Treatment options for end-stage heart failure include inotrope-dependent medical therapy (IDMT), orthotopic heart transplantation (OHT), left-ventricular assist device (LVAD) as destination therapy (DT) or bridge to transplant (BTT).
-We developed a state-transition model to simulate four treatment options and associated morbidity and mortality. Transition probabilities, costs, and utilities were estimated from published sources. Calculated outcomes included survival, quality-adjusted life years (QALYs), and incremental cost-effectiveness. Sensitivity analyses were performed on model parameters to test robustness. Average life expectancy for OHT-eligible patients is estimated at 1.1 years, with 39% surviving to 1-year. OHT with a median wait-time of 5.6 months is estimated to increase life expectancy to 8.5 years, and costs <$100,000/QALY gained, relative to IDMT. BTT-LVAD followed by OHT further is estimated to increase life expectancy to 12.3 years, for $226,000/QALY gained versus OHT. Among OHT-ineligible patients, mean life expectancy with IDMT is estimated at 9.4 months, with 26% surviving to 1-year. Patients who instead receive DT-LVAD are estimated to live 4.4 years on average from extrapolation of recent constant hazard rates beyond the first year. This strategy costs $202,000/QALY gained, relative to IDMT. Patient's age, time on waitlist and costs associated with care influence outcomes.
-Under most scenarios, OHT prolongs life and is cost-effective in eligible patients. BTT-LVAD is estimated to offer more than 3.8 additional life-years for patients waiting 6 months or longer, but does not meet conventional cost-effectiveness thresholds. DT-LVAD significantly improves life expectancy in OHT-ineligible patients. However, further reductions in adverse events or improved quality-of-life are needed for DT-LVAD to be cost-effective.
[Show abstract][Hide abstract] ABSTRACT: IntroductionAcute graft failure is the leading cause of early mortality after heart transplantation (HTX). Extracorporeal membrane oxygenation (ECMO) is an efficient therapeutic option to treat various pathologies, unburden the left and right ventricle and allow for functional recovery of the transplanted heart. We reviewed our ECMO experience and outcomes in HTX patients.Methods
Retrospectively, we analyzed all patients who received an orthotopic heart transplant (HTx) (n=298) in our department over a 15 year period (1997 through 2011) to assess the incidence of post-HTx ECMO-implantation, perioperative complications, early and one-year mortality as well as causes of death.ResultsECMO therapy was utilized to treat graft failure in 28 patients (10.6%) with a mean-duration of ECMO-support of 4.2 days (six hours to 9.4 days). Multivariate analysis revealed as independent predictors for mortality low cardiac output (p=0.028; OR=11.3) and stroke (p=0.008; OR=19.7). Cumulative survival rates were 46.4 ±9.4% within 30 days and 25.0 ±8.2% at 1 year. Causes of death were multi-organ failure (n=9), sepsis (n=9), lung failure (n=2) and intracerebral bleeding (n=2). ECMO was implanted due to primary graft failure (PGF, n=16), sepsis (n=4) and right heart failure (n=6).Conclusion
Temporary ECMO support for postoperative output failure is an acceptable option as a last resort for otherwise doomed patients with fatal graft failure after HTx. The small fraction of patients surviving, appear to have a decent long-term prognosis.This article is protected by copyright. All rights reserved.
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