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Objective:
Evaluate the addition of long-distance heart procurement on a heart transplant program and the status of heart transplant recipients waiting list.
Methods:
Between September 2006 and October 2012, 72 patients were listed as heart transplant recipients. Heart transplant was performed in 41 (57%), death on the waiting list occurred in 2...
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Citations
... Nevertheless, the availability of transplantation for growing population of patients with end-stage heart disease is precluded from wider application due to the limited availability of donor hearts, complications from immunosuppressive therapies and donor heart discarding reasons. Therefore, application of heart transplantation is restricted to a small proportion of demanding patients [7,8]. Long-term immunosuppression and the incidence of chronic rejection are also inevitable adverse effects of heart transplantations. ...
Aim:
The aim of this study was to evaluate the efficacy of tissue-engineered amniotic membrane (AM) in the treatment of myocardial infarction lesions.
Materials & methods:
20 rats were subjected to coronary arterial ligation in order to induce myocardial infarction injury. Decellularized human AMs were seeded with 2 × 105 adipose-derived mesenchymal stem cells and were implanted in the infarcted hearts.
Results & conclusion:
Histological and immunohistochemical evaluations indicated the regeneration of cardiomyocytes and reduction of inflammation and fibrosis in the patch-implanted group compared with a control group, 14 days after the surgery. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate biotin nick-end labeling assay was suggestive for apoptosis reduction in the patch-implanted specimens. This study suggested that human AM can be developed into a novel treatment for treating postmyocardial infarction.
... 57 Captações com tempos de isquemia maiores que 4 horas ocorrem em aproximadamente 10% das captações realizadas na Europa, 20% das captações realizadas na América do Norte e 40% das captações em outros centros (América Central, América do Sul, África, Ásia e Oceania), 58 o que justifica as novas evidências favoráveis à aceitação de órgãos submetidos a tempos de anóxia prolongados, sem prejuízo ao resultado do transplante, principalmente no caso de receptores limítrofes, priorizados ou na população pediátrica. [59][60][61] Não existe definição precisa de captação à distância. Para fins acadêmicos, caracteriza-se captação à distância como aquela realizada fora da região metropolitana do centro transplantador e/ou que envolva tempo presumível de isquemia fria ≥ 2 horas, e/ou distâncias maiores que ±100 km entre doador e receptor, independente da logística de transporte requerida. ...
... Similar findings have been corroborated in subsequent studies in which allograft ischemic time has extended beyond 300 minutes without compromising graft function or survival [8][9][10]. More recently, Atik and colleagues [11] demonstrated that the addition of long-distance heart procurements could expand the viable donor pool and reduce wait list mortality without compromising 30-day or 1-year survival. Although previous literature has demonstrated a detrimental effect of longer ischemic times on mortality after heart transplantation, the survival impact of the donor location relative to recipient location has not been previously elucidated. ...
Background:
Concerns over prolonged allograft ischemia have limited the widespread adoption of long-distance organ procurement in heart transplantation (HT). We sought to assess whether donor distance from the center of transplantation independently affects mortality.
Methods:
We queried the United Network for Organ Sharing (UNOS) database for adults undergoing isolated HT from 2005 to 2012. Risk-adjusted Cox proportional hazards models were constructed for the primary outcomes of 30-day and 1-year mortality, and the independent impact of donor distance from transplantation center at the time of procurement was assessed.
Results:
We included 14,588 heart transplant recipients. The mean distance from location of the donor heart to transplantation center was 184.4 ? 214.6 miles; 1,214 HTs (8.3%) occurred at the same location as the donor heart. Ischemic times were inversely related to the distance from the site of donor procurement to recipient transplantation. After risk adjustment, longer donor distances (in miles) were associated with a significantly lower risk of mortality at both 30 days (hazard ratio [HR] 0.9993, 95% confidence interval [CI]: 0.9988 to 0.9998, p?<?0.01) and 1 year (HR 0.9994, 95% CI: 0.9989 to 0.9999, p?= 0.015). Risk-adjusted hazards for mortality were significantly reduced in recipients receiving hearts from more than 25 miles away. The hazard reduction was greatest in recipients receiving donor hearts from more than 500 miles away (1-year HR?0.64, p < 0.01; 30-day HR 0.47, p < 0.01).
Conclusions:
Longer distances between donor location and center of heart transplantation are associated with a reduced hazard for survival at 30 days and 1 year, despite greater ischemic times. Future studies are necessary to elucidate the protective factors surrounding long-distance heart donation.
