1.
S62 The Journal of Heart and Lung Transplantation, Vol 34, No 4S, April 2015
better understand the degree and type of mismatches that impact transplant
survival.
(147)
MELD-XI Score Predicts Early and Late Mortality in Patients Following
Heart Transplantation
J.C. Grimm ,1 J. Magruder,1 V. Valero 3rd,1 A. Kilic,1 G.J. Whitman,1
R.J. Tedford,2 S.D. Russell,2 A.S. Shah,1 C.M. Sciortino.1 1Surgery,
The Johns Hopkins Medical Institution, Baltimore, MD; 2Medicine,
The Johns Hopkins Medical Institution, Baltimore, MD.
Purpose: The Model for End-stage Liver Disease eXcluding INR (MELD-XI)
score has been validated as an accurate predictor of outcomes in heart fail-
ure patients, but its utility in orthotopic heart transplant (OHT) recipients is
unknown. Accordingly, we sought to determine the risk-adjusted influence
of an elevated MELD-XI score on early and late mortality following OHT.
Methods: The United Network for Organ Sharing database was queried
for adult ( 18 years) patients undergoing OHT between 2002 and 2012.
A MELD-XI score (incorporating serum creatinine and bilirubin) was cal-
culated. Stratification into “high” and “low” MELD-XI cohorts based on a
previously established threshold score of 17 was performed. Patient specific
characteristics, intraoperative variables and postoperative outcomes were
compared between the two cohorts. Thirty-day, 1-year and 5-year multi-
variable Cox hazard regression models were constructed to determine the
risk-adjusted impact of a “high” MELD-XI score on mortality. Kaplan Meier
estimates were utilized to compare unadjusted survival.
Results: Of the 27,126 patients that met criteria for inclusion, 22% (6,048)
had MELD-XI scores 17. Thirty-day (p 0.001), 1-year (p 0.001) and
5-year (p 0.001) survival was statistically different between the score cohorts.
Additionally, a “high” MELD-XI score was an independent predictor of 30-day
(HR: 1.75, CI: 1.52-2.02; p 0.001), 1-year (HR: 1.62, CI: 1.48-1.77; p 0.001)
and 5-year (HR: 1.33, CI: 1.25-1.43; p 0.001) mortality after adjustment with
a combination of recipient, donor and transplant specific variables. This cohort
also experienced an increased incidence of postoperative renal failure (11.7%
v. 6.5%; p 0.001) and stroke (3.3% v. 2.2%; p 0.001).
Conclusion: This is the largest known study demonstrating the unique appli-
cation of the MELD-XI scoring system in predicting early and late mortality
in patients following OHT. The MELD-XI provides another preoperative
metric to improve patient selection and, thus, optimize organ allocation.
(148)
Restoration of Pulsatile Flow Leads to a Reduction in Sympathetic
Nerve Activity Among Patients With Continuous-Flow Left Ventricular
Assist Devices
W.K. Cornwell ,1 T. Tarumi,2 A. Stickford,2 J. Kibe,3 C. Fitzsimmons,3
J. Moore,2 M. Roberts,2 R. Parker,2 D. Markham,4 M. Drazner,1
B. Levine.2 1Cardiology, Univ of Texas SW, Dallas, TX; 2Institute of
Exercise and Environmental Medicine, Dallas, TX; 3Cardiology, Univ of
Texas SW, Coppell, TX; 4Cardiology, Emory University, Atlanta, GA.
Purpose: We previously demonstrated that sympathetic nerve activity (SNA)
is markedly elevated in patients with continuous-flow (CF) left ventricular
assist devices (LVADs). In the current study, we sought to determine whether
the restoration of pulsatile flow leads to reductions in SNA in these patients.
Methods: Eight male and two female subjects (56±11 years) with Heartmate
II, CF-LVADs underwent hemodynamic and sympathetic neural assessment.
Beat-to-beat blood pressure and muscle (M) SNA, (measured directly via
microneurography) were continuously recorded to determine steady-state
(145)
Cardiac Allograft Vasculopathy in Redo-Transplants: Is It More or Less
(or) the Same the Second Time around?
L. McCreath , R. McCubrey, J. Folsom, S. Wright, J. Stehlik, D. Budge,
S.H. McKellar, M. Everitt, G. Snow, B. Reid, K. Skedros, A. Ragnhildstveit,
K. Afshar, J. Nativi, S.G. Drakos, A.G. Kfoury. UTAH Cardiac Transplant
Program, Salt Lake City, UT.
Purpose: CardiacAllograftVasculopathy (CAV) continues to hinder the long
term success of heart transplant recipients. Redo-transplantation is currently
the only definitive treatment for advanced CAV. Whether these patients are at
similar CAV-risk with the second transplant remains unknown and the topic
of interest in this study.
Methods: The UTAH Cardiac Transplant database was queried for all patients
who were retransplanted from 1985 to 2011. Heart recipients who did not
have CAV as an indication for redo-transplantation were excluded. CAV
diagnosis was made by coronary angiography and based on the 2010 ISHLT
standardized nomenclature for CAV. Patient demographics, rejection history,
and CAV incidence were analyzed.
Results: Of the 1,169 eligible patients, 135 (11.5%) developed CAV post their
first transplant; 78 cases within 10 years and 54 beyond 10 years. The mean
time to CAV was 6.58 years. Of the 135 patients who developed CAV, only 21
(15.5%)endeduprequiringaredo-transplant. Of the 21 patients retransplanted,4
(19.0%) developed CAV again; 2 patients within 10 years and 2 patients beyond
10 years.The incidence of CAV was statistically similar (p= NS) between 1st and
redo-transplant. Baseline characteristics (see table) are included.
Conclusion: Our results indicate that CAV is as likely to develop in redo-
transplants despite recent advances in immunosuppression and the standard-
ized use of lipid-lowering agents.Although outcomes in redo-transplantation
for the indication of CAV are favorable, efforts to better understand and
minimize CAV are needed, especially in the face of scarce donor organs.
(146)
Influence of HLA Mismatch on Outcomes After Heart Transplantation:
UNOS Registry Data
K. Pandya , J. Zhang, M. Hickey, A. Nsair, A. Baas, M. Cadeiras, D. Cruz,
L. Reardon, M. Deng, A. Ardehali, E. Reed, E. Depasquale. Advanced
Heart Failure and Cardiac Transplantation, University of California,
Los Angeles, Los Angeles, CA.
Purpose: HLA matching has been shown to improve survival in renal trans-
plants, however, is not currently a major consideration in heart transplanta-
tion (HT). We sought to evaluate the impact of HLA mismatch on long term
outcomes after heart transplantation.
Methods: 37516 patients were identified from the UNOS registry (1987-
2014) and stratified by number of HLA mismatches ( 3 vs ≤ 3). Exclusions:
age 18, multiorgan or re-HT. Survival was censored at 12-y. Multivariate
Cox proportional hazard regression models were adjusted for age, sex, DM,
race, ischemic time, dialysis, etiology, life support and wait times.
Results: 5791 were identified with ≤ 3 HLA mismatches compared to
31720 with 3 HLA mismatches. Mean age was 52.1 ± 11.7 years (p= NS
between groups). Most common etiologies were dilated (42%) and ischemic
cardiomyopathy (41%). Mean follow up was 6.4 ± 5.6 years. Number of
mismatches by HLA loci ( 3 vs ≤ 3): A Locus [1.5 ± 0.6 vs 0.7 ± 0.6], B
Locus [1.8 ± 0.4 vs 1.1 ±0.6] and DR Locus [1.6 ± 0.5 vs 0.9 ± 0.6] (p 3,
respectively). Crude 1, 5, 10 year survival was: HLA mismatch ≤ 3 [88, 73,
52%] vs HLA mismatch 3 [87, 71, 51%] (log-rank, p= 0.006). Multivariate
Cox regression analysis yielded a hazard ratio of 1.07 (CI 1.02 -1.12).
Conclusion: HT recipients with fewer mismatches appear to have small
but significantly improved outcomes. Further study is warranted to