Everolimus in different combinations as maintenance immunosuppressive therapy in heart transplant recipients

OBJECTIVES: We examined the experiences of heart transplant recipients receiving everolimus as maintenance therapy in different combinations over a long time. MATERIALS AND METHODS: Between 2004 and 2009, forty patients (29 men, 11 women; mean age, 51.6 y) were switched from a routine immunosuppressive regimen to everolimus. Indications were other (2), renal insufficiency (17), cardiac allograft vasculopathy (14), and ongoing cellular rejection (7). Combinations were either along with cyclosporine (24), mycophenolate mofetil (14), or others (2). Indications for the introduction of everolimus including safety, efficacy, different combinations of everolimus, biopsy-proven acute rejections, renal function, and infections were evaluated retrospectively. RESULTS: Five patients died, 4 of them were still on everolimus at the time of death; they died from intracerebral hemorrhage (1), embolism (1), cardiac arrest (2), and unknown (1). Everolimus was discontinued in 6 patients owing to severe adverse effects: Edema (2), gastrointestinal adverse effects (3), and dermal adverse effects (1). Mean everolimus trough levels were 5.8 μmol/L at 6 months and 4.9 at 60 months. Mean cyclosporine levels were 67.62 μmol/L at 6 months and 47.3 μmol/L at 60 months. Mean serum creatinine levels were stable (147.9 μmol/L after 60 months). Four life-threatening infections (all pneumonia) occurred but resulted in complete recovery. CONCLUSIONS: Everolimus is safe with different immunosuppressive combinations after receiving a heart transplant

Percent ventricular pacing with managed ventricular pacing mode in standard pacemaker population

Aims Unnecessary right ventricular pacing has deleterious effects and becomes more significant when cumulative percent ventricular pacing (Cum%VP) exceeds 40% of time. The Managed Ventricular Pacing (MVP) mode has been shown to significantly reduce the percent ventricular pacing compared to the DDD/R mode. This study assessed the percent of ventricular pacing in a standard pacemaker population programmed to MVP and for which patients it is possible to achieve a Cum%VP <= 40%. Methods and results Unselected, consecutive patients were implanted with a dual chamber pacemaker with a mean follow-up period of 76 days. The Cum%VP was calculated from device diagnostics between pre-hospital discharge (PHD) and the 1-month post implant visit. The median Cum%VP of 107 patients (age 67.2 +/- 14 years; 53% mate) who were programmed to MVP was 3.9%. The median Cum%VP was 1.4% in patients with sinus node disease (SND) and 28.8% in patients with AV block (AVB). Cum%VP <= 40% was observed in 72% of all. patients, in 50% of AVB patients, and in 86% of SND patients. Conclusion The MVP mode is capable of achieving a tow percent of ventricular pacing in a standard pacemaker population with SND and AVB. In addition, 72% of patients in MVP mode demonstrated Cum%VP <= 40%

Comparison of two strategies to reduce ventricular pacing in pacemaker patients (PACE - Pacing and Clinical Electrophysiology (2008) 31, 2, (167-176) DOI: 10.1111/j.1540-8159.2007.00965.x)

N/

Reperfusion of liver graft during transplantation: techniques used in transplant centres within Eurotransplant and meta-analysis of the literature.

It remains unclear which liver graft reperfusion technique leads to the best outcome following transplantation. An online survey was sent to all transplant centres (n = 37) within Eurotransplant (ET) to collect information on their technique used for reperfusion of liver grafts. Furthermore, a systematic review of all literature was performed and a meta-analysis was conducted based on patients' mortality, number of retransplantations and incidence of biliary complications, depending on the technique used. Of the 28 evaluated centres, 11 (39%) reported performing simultaneous reperfusion (SIMR), 13 (46%) perform initial portal vein reperfusion (IPR), 1 (4%) performs an initial hepatic artery reperfusion (IAR) and 3 (11%) perform retrograde reperfusion (RETR). In 21 centres (75%), one reperfusion technique is used as a standard, but in only one centre is this decision based on available literature. Twenty centres (71%) said they would agree to participate in randomized controlled trials (RCT) if required. For meta-analysis, IAR vs. IPR, SIMR vs. IPR and RETR vs. IPR were compared. There was no difference between any of the techniques compared. There is no consensus on a preferable reperfusion technique. Available evidence does not help in the decision-making process. There is thus an urgent need for multicentric RCTs