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24. Jahrestagung der Deutschen Transplantationsgesellschaft

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08:00 - 09:30
Wissenschaftliche Sitzung: Thorakale Organe I

Vorsitz: Christian M. Hagl, München; Klaus Matschke, Dresden

08:00
V053

Verschiebt sich die Indikation zur Herztransplantation? Vs. medikamentöse Therapie

*Uwe Fuchs1
1 Herz- und Diabeteszentrum NRW der Ruhr-Universität Bochum, Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Deutschland
Abstract-Text :

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08:10
V054

Verschiebt sich die Indikation zur Herztransplantation? Vs. Assist Devices

*Jens Garbade1
1 Herzzentrum Leipzig, Klinik für Herzchirurgie, Leipzig, Deutschland
Abstract-Text :

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08:20
V055

Verschiebt sich die Indikation zur Herztransplantation?

*Volkmar Falk1
1 Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax- und Gefäßchirurgie, Berlin, Deutschland
Abstract-Text :

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08:30

Diskussion

*Uwe Fuchs1, Jens Garbade2, Volkmar Falk3
1 Herz- und Diabeteszentrum NRW der Ruhr-Universität Bochum, Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Deutschland
2 Herzzentrum Leipzig, Klinik für Herzchirurgie, Leipzig, Deutschland
3 Deutsches Herzzentrum Berlin, Klinik für Herz-, Thorax- und Gefäßchirurgie, Berlin, Deutschland
Abstract-Text :

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08:40
V056

Optimale Therapie der pulmonalen Hypertonie: Medikamentöse Therapie

*Jürgen Behr1
1 Asklepios Fachkliniken München-Gauting, Klinik für Pneumologie, Gauting, Deutschland
Abstract-Text :

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08:50
V057

Optimale Therapie der pulmonalen Hypertonie: Lungentransplantation/kombinierte Herz-Lungentransplantation

*Gregor Warnecke1
1 Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Deutschland
Abstract-Text :

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09:00

Diskussion

*Jürgen Behr1, Gregor Warnecke2
1 Asklepios Fachkliniken München-Gauting, Klinik für Pneumologie, Gauting, Deutschland
2 Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover, Deutschland
Abstract-Text :

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09:10
V058

Duration of continuous-flow ventricular assist device support does not negatively effect on post-transplant outcome – results using the United Network for Organ Sharing Database

*Alexander Bernhardt1, Allison P. Levin2, Hermann Reichenspurner1, Ulrich Jorde3, Veli Topkara2
1 Universitäres Herzzentrum Hamburg, Herz- und Gefäßchirurgie, Hamburg, Deutschland
2 Columbia University Medical Center, , New York City, Vereinigte Staaten von Amerika
3 Montefiore Medical Center , , New York City, Vereinigte Staaten von Amerika
Abstract-Text :

Background. An increasing number of patients is bridged to transplant by continuous-flow left ventricular assist devices (CF-LVAD). The purpose of this study is to analyze post-transplant outcomes of heart transplant recipients bridged to transplantation with CF-LVAD after different support durations.


Methods. The United Network for Organ Sharing Database (UNOS) was reviewed to identify first-time heart transplant recipients who were bridged to transplantation with CF-LVAD from January 2011 through September 2013.  A total number of 8,006 patients were analyzed. Of those 2,660 patients (33.23%) were bridged to transplant by a CF-LVAD. 1,320 patients with a Thoratec HeartMate II and 146 patients with a HeartWare HVAD were transplanted. Patients were divided into quartiles.


Results. Mean age in heart transplant recipients was 53.8 ± 12.4 years and 77.2% were male. Mean time on device till transplant were 315.1 ± 267.8 days. Pre-transplant characteristics were not significantly different between the groups. Post-transplant survival rates were similar between the duration groups at at 24months (90.6%, 82.8%, 81.4% and 83.1, respectively; p=n.s.). PRA peak levels were lowest in the second quartile, although the acute rejection episodes were highest in this group.


Conclusions. Post-transplant survival is not affected by the duration of pre-transplant VAD support. However, PRA levels were lowest in the second groups with a higher rate of acute rejection.



09:20
V059

Stable renal function in patients after heart transplantation on mTOR inhibitor therapy in combination with calcineurin inhibitors

*Matthias Helmschrott1, Rasmus Rivinius1, Philipp Ehlermann1, Lutz Frankenstein1, Arjang Ruhparwar2, Bastian Schmack2, Tom Bruckner3, Hugo A. Katus1, Andreas O. Dösch1
1 Universitätsklinikum Heidelberg, Medizinische Klinik, Med. III, Kardiologie, Angiologie und Pneumologie, Heidelberg, Deutschland
2 Universitätsklinikum Heidelberg, Klinik für Herzchirurgie, Heidelberg, Deutschland
3 Universitätsklinikum Heidelberg, Institut für Medizinische Biometrie und Informatik, Heidelberg, Deutschland
Abstract-Text :

Background: Deterioration of renal function is an important risk factor after heart transplantation (HTX).


Aim of study: The current retrospective study analysed renal function in patients after HTX receiving a dual immunosuppressive regimen based on mammalian target of rapamycin (mTOR) inhibitors in combination with calcineurin inhibitors (CNIs), i.e. cyclosporine A (CSA) or tacrolimus (TAC), in patients after HTX. Observation period was one year after conversion.


Patients and methods: In this study, data of 82 patients with an mTOR-based immunosuppressive treatment in combination with a CNI, were retrospectively analysed. 30 patients received CSA as concomitant immunosuppressive drug, 52 patients received mTOR inhibitors in combination with TAC. Baseline renal function (serum creatinine, estimated glomerular filtration rate (GFR)) after switch to a mTOR/CNI based regimen was compared to renal function four, eight, and twelve months after conversion.


Results: Mean time after HTX was 52.7 ± 69.7 months in mTOR/CSA group and 17.2 ± 30.3 months in mTOR/TAC patients (P=0.02851). During study period no statistically significant differences in renal function in both study groups were observed (P=ns). At baseline, serum creatinine in mTOR/CSA patients was 2.0 ± 2.3 mg/dL, in mTOR/TAC patients serum creatinine was 1.6 ± 1.0 mg/dL (P=ns). One year after conversion, serum creatinine was 2.2 ± 2.0 mg/dL in the CSA group and 1.8 ± 0.8 mg/dl in the TAC group (P=ns). Analysis of renal function by estimated glomerular filtration rate (eGFR) detected no statistically significant differences at baseline and after study period (all P=ns).


Conclusion: Our study demonstrated that the choice of CNI in combination with mTOR has no effect on renal function during one year after conversion.