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FEATURED PAPERS IN JHLT JUNE 2012

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Online Journal website: www.jhltonline.org


  • ♦ Everolimus or Mycophenolate Mofetil and CNI Lowering for Renal Protection (Potena)
    Link to Article

In the Long-term follow-up of the SHIRAKISS randomized, prospective study, 34 recipients 1 to 4 years after heart transplantation and with 25 to 60 ml/min of creatinine clearance (CrCl) were randomized to everolimus with a very low dose (C0: 50 to 90 ng/ml, n = 17) or MMF with low dose of cyclosporine (C0: 100 to 150 ng/ml, n = 17). Follow-up was prolonged up to 3 years, and calculated CrCl was the main efficacy measure. Cyclosporine nephrotoxicity improved after a prolonged dose reduction in patients receiving MMF. At 3 years, the everolimus-based strategy provided a similar benefit only in patients without baseline proteinuria.


  • ♦ Pulmonary Hypertension In Chronic Obstructive Pulmonary Disease (Wrobel)
    Link to Article

The presence of pulmonary hypertension (PHT) in COPD subjects is associated with increased mortality, morbidity and use of health-care resources. In this review paper the evidence supporting the postulated mechanisms contributing to PHT in COPD are discussed. Hypoxia plays a pivotal role in the development of COPD-associated PHT. However, other mechanisms are also likely involved in the pathogenesis of increased pulmonary vascular resistance in this cohort, including acidemia, dynamic pulmonary hyperinflation, parenchymal destruction, pulmonary vascular remodeling, endothelial dysfunction and inflammation. These mechanisms are interdependent, modulated by genetic factors, and may be confounded by comorbidities such as sleep-disordered breathing, left heart failure and pulmonary thromboembolism.


  • ♦ Bronchial Carcinoma After Lung Transplantation (Yserbyt)
    Link to Article

The development of primary bronchial carcinoma (BC) and its outcomes impact was examined in 9 of 92 single Lung Transplant (LTx) patients (transplanted for emphysema or lung fibrosis) who developed a bronchial carcinoma in their native lung, whereas only 4 of 224 bilateral LTx patients (also for emphysema or fibrosis) developed a bronchial carcinoma (p = 0.0026). At diagnosis, 4 patients had local disease (cT1N0M0 and cT2N0M0), whereas all others had regionally advanced or metastatic disease. Five patients were surgically treated; however, 1 had unforeseen N2 disease with additional pleural metastasis at surgery. All other patients (except 2 who died very soon after diagnosis) were treated with chemotherapy with or without radiotherapy. The median survival after diagnosis was only 10 ± 7 months.

  • ♦ B-Type Natriuretic Peptide Infusion and Total Artificial Heart Implantation (Shah)
    Link to Article

In this pilot study, infusion of low-dose exogenous BNP increased urine output after ventriculectomy and implantation of a Total Artificial Heart in 5 patients who were compared to a cohort of 5 historical controls. These encouraging findings require further detailed study to define the influence of longer term outcomes.



  • ♦ MELD Scores And Outcomes After MCS Or Transplantation (Chokshi)
    Link to Article

Advanced HF is associated with congestive hepatopathy and progressive functional and ultrastructural changes of the liver. In the first of 2 separate papers, investigators examined the relationship of the Standard Model for End-stage Liver Disease (MELD) scores were calculated and a modified MELD score with albumin replacing INR (modMELD) to eliminate the confounding effects of anti-coagulation, with outcomes after Heart Transplantation. Individuals with a higher pre-transplantation MELD or modMELD score had worse outcome 30 days post-transplant and reduced long-term survival over a 10-year follow-up. In the 2nd paper examining this relationship on Ventricular Assist Devices (VAD), Patients with MELD or MELD-eXcluding INR (MELD-XI) < 17 had improved on-VAD and overall survival (p < 0.05) with a higher predictive power for MELD-XI. During VAD support, cholestasis initially worsened but eventually improved. Patients with pre-VAD liver dysfunction who survived to transplant had lower post-transplant survival (p = 0.0193). However, if MELD-XI normalized during VAD support, post-transplant survival improved and was similar to that of patients with low MELD-XI scores.