Cardiac Allograft Rejection

Heart transplantation remains one of the major scientific achievements of twentieth century medicine. During the past four decades, it has evolved from an unproven experimental surgical technique to the most effective form of therapy for refractory end-stage heart disease. It has captured the public's imagination and expanded our understanding of fundamental immunologic mechanisms that are responsible for cellular and humorally-mediated immunity. Despite its successes, many clinical and scientific problems remain. One or more bouts of acute cellular or humoral (vascular) rejection will occur in over 75% of transplant recipients despite current immunosuppressive strategies. Further, rejection directly results in approximately 20% of post-transplant deaths and is believed to play a major role in the development of late allograft dysfunction and coronary vasculopathy. This book by international experts in the fields of transplantation medicine, immunobiology and cardiac imaging provides the reader with an up-to-date, consise summary of the latest developments in the diagnosis and treatment of acute cardiac rejection. It is axiomatic that a more complete understanding of the pathogenic processes involved in rejection will ultimately lead to its prevention. This volume will be useful to transplant cardiologists, cardiovascular surgeons, cardiac pathologists and transplant scientists who seek to prolong the lifespan and improve the quality of life of their transplant recipients.

This work provides a one-of- a-kind volume that includes all aspects of heart transplantation from its historic beginning to its current day standards which now make the procedure a long-term treatment option for heart failure patients. The subjects covered include technical aspects of the procurement and implant procedures, as well as the medical nuances of pre-operative preparation and post-transplant immunosuppression management; the current day multi-disciplinary make up of the transplant team along with information on the keys to building and running a successful transplant program; regulatory standards and listing policies and the impact of the growing mechanical circulatory support technologies on the transplant field; and emerging technologies and future possibilities. All chapters are written by experts in the field and include the most up-to-date peer reviewed studies and clinical guidelines. This book gives an ever-changing reference that will become the text of choice for those beginning or continuing their transplant careers.

Over the past ten years, cardiac transplantation has evolved from an exper imental procedure performed in a handful of university centers to a viable therapeutic modality now performed in more than 150 centers worldwide. The complexity of the procedure, the changing immunosuppressive re gimes, and the follow-up care have necessitated a multidisciplinary ap proach involving a variety of medical, nursing, and social sciences special ties and subspecialties. In addition, health care trainees and referring physicians are increasingly becoming involved in the care of the cardiac transplant recipient. This book does not attempt to be a comprehensive treatise on cardiac transplantation; rather, we hope that it will serve as a manual and guideline for all health professionals involved in cardiac trans plantation. JEFFREY D. HOSENPUD, M.D. Contents Preface v Contributors IX 1. Cardiac Transplantation: An Overview JEFFREY D. HOSENPUD AND ALBERT STARR Immunogenetics and Immunologic Mechanisms of 2. Rejection 15 DOUGLAS J. NORMAN 3. Medical Therapy Tailored for Advanced Heart Failure 33 LYNNE WARNER STEVENSON 4. Ventricular Assistance as a Bridge to Cardiac Transplantation 53 D. GLENN PENNINGTON AND MARC T. SWARTZ Recipient Selection for Cardiac Transplantation 71 5. GEORGE A. PANTELY 6. Donor Selection and Management for Cardiac Transplantation 85 JEFFREY SWANSON AND ADNAN COBANOGLU 7. Operative Techniques and Early Postoperative Care in Cardiac Transplantation 95 ADNAN COBANOGLU Endomyocardial Biopsy: Techniques and Interpretation of 8.

Leading physicians summarize in this easy-to-use and eminently practical handbook the day-to-day management of transplant donors and recipients at Columbia-Presbyterian Medical Center. Topics covered range from surgical techniques, pathology, and immunosuppression, to posttransplant management, pediatric heart transplantation, surgical alternatives, and mechanical circulatory assistance as a bridge to transplantation. The authors also discuss congenital transplant techniques, state-of-the-art perioperative management techniques and protocols, and UNOS regulation and nurse coordination.

This is a concise review of up-to-date concepts and techniques in the discipline of heart transplantation. It is a review and reference for practitioners managing patients with advanced heart disease, including patients with end-stage heart failure, mechanical circulatory support or transplant recipients. Heart failure is a major public health issue, with a prevalence of over 5.8 million in the USA, and over 23 million worldwide, and rising. The lifetime risk of developing heart failure is one in five. Heart failure carries substantial morbidity and mortality, with 5-year mortality that rival those of many cancers. As heart transplantation remains the best treatment option for patients with end stage heart failure, this primer will provide valuable information and management strategies for physicians caring for these patients. Also, due to continued shortage in donor organs, heart transplantation is a limited resource – which further underscores the importance of appropriately evaluating patients for transplant candidacy and managing their pre, peri- and post-transplant care for maximum benefit and best outcomes.​

This book is a comprehensive overview of heart failure and cardiac transplantation and integrates scientific and clinical information about the physiology, pathophysiology, diagnosis, and treatment of this disorder. Organized into five parts, it reviews the history and basic mechanisms of heart failure; etiology of heart failure; heart failure disease progression; advanced therapies for heart failure; and cardiac transplantation. The book presents basic concepts in the physiology, molecular biology, pathology, and epidemiology of the normal and failing heart; known causes of heart failure, such as right heart failure, valvular cardiomyopathy, molecular mechanisms of sarcomeric cardiomyopathies, and neuromuscular cardiomyopathy; cardiorenal syndrome; neurohormonal activation; cardiac resynchronization, ventricular assist devices; regenerative mechanisms; orthotopic heart transplantation; early and late management of the post-transplant patient; heart transplantation and antibody-mediated rejections; heart-lung transplantation; and cardiac xenotransplantation. Featuring contributions from leaders in the fields of heart failure, cardiac transplantation, cardiac pathology, and cardiovascular molecular research, Congestive Heart Failure and Cardiac Transplantation is a valuable compendium for cardiologists, cardiothoracic surgeons, researchers, trainees, and students.

This book addresses one of the largest unmet needs in transplantation, the need to reduce late allograft loss. In the current era, it is reasonable to expect that most allografts will serve their recipients through their life span and death with preserved graft function the ultimate goal for all transplant recipients. However, long term allograft survival has not paralleled improvements made in short term survival. Each year a percentage of the existing organ transplant patients will lose their grafts. The problem of late allograft failure is due in part to pathogenic processes, to drug management, and to transplant patient care delivery.This book pulls together the science in this area and serves as a resource and as a catalyst for further research. The book has been divided into sections covering the entirety of chronic allograft loss from basic science consideration to clinical implications. The goal of this book is to provide the reader with an overview of long term problems in solid organ transplantation. This overview not only includes the diagnosis of immunologic and non-immunologic causes of chronic graft loss but current management as well as novel therapies for future application. This book will make a useful contribution to the literature.

This is the first book to focus entirely on the role of pathology in cardiac transplantation, linked to the clinical perspective through clinical–pathological correlation, multidisciplinary team working, and collaborative research. It provides a scientific framework with up-to-date pathological protocols and classification schemes and guides the reader through the chronological phases of the transplant process in a step-by-step approach. Topics include end-stage heart failure with pathologies encountered in the native heart, current issues surrounding donor selection, the multiple faces of rejection pathology correlated with clinical management and immunology, other post-transplant complications, details of pediatric and combined heart/other organ transplantation, and a useful practical appendix. Many high-quality images and illustrative cases are presented, along with learning points and ample references. Transplantation medicine today is continuously changing as collaborative research into novel diagnostic techniques and immunosuppressive therapies translates into improved recipient management and survival. This book is aimed at practicing transplant pathologists and specialist trainees. It will also appeal to general pathologists and to physicians and surgeons involved in cardiac transplantation who need to understand the role of pathology in the clinical management of transplant recipients.