The Journal of Heart and Lung Transplantation February 2007
rats, a huge infiltrative response was observed within the xenografts that widened the mean adventitial diameter from 143⫾93 mm to 809⫾209 mm (p⬍0.01) and caused extensive myocyte necrosis. Tacrolimus ⬎FK778 ⬎⬎sirolimus dose-dependently diminished xenograft infiltration and in the same order reduced vessel wall myocyte necrosis. Tacrolimus 4mg/kg significantly suppressed CD4⫹ cells compared with sirolimus 2mg/kg (p⫽0.008), and CD8⫹ (p⬍1840.015) and ED1⫹ cells (p⫽0.001) compared with FK778 20mg/kg and sirolimus 2mg/kg, respectively. Tacrolimus FK778 sirolimus reduced in vivo lymphocyte activation (T-cell CD25 surface expression) and Tacrolimus ⬎FK778 ⬎⬎sirolimus diminished mixed lymphocyte reactions (p⫽0.06 tacrolimus 4mg/kg vs. FK778 20mg/ kg; p⫽0.043 tacrolimus 4mg/kg vs. sirolimus 2mg/kg). Xeno-reactive antibody production was vigorously upregulated few days after transplantation (p⬍0.001), and tacrolimus ⬎FK778 ⬎⬎sirolimus significantly reduced circulating xeno-reactive IgM as well as IgG. Combination regimens revealed no significant benefit when compared with the corresponding monotherapy groups. Conclusions: Tacrolimus is most powerful and so far, no other single drug protocol has shown a comparable efficacy on the different mechanisms during xenograft rejection. 273 NATIONAL TRANSPLANTATION PREGNANCY REGISTRY (NTPR): PREGNANCY OUTCOMES IN FEMALE THORACIC TRANSPLANT RECIPIENTS L. Ohler,1 L.A. Coscia,2 C.H. McGrory,2 M.J. Moritz,3 V.T. Armenti,2 1 Nursing, Virginia Commonwealth University/MCV, Richmond, VA; 2Surgery, Temple University School of Medicine, Philadelphia, PA; 3Surgery, Lehigh Valley Hospital, Allentown, PA Purpose: This study analyzed pregnancy outcomes in heart (H), heart-lung (H/L) and lung (L) transplant recipients. Methods and Materials: Data were collected via questionnaires, phone interviews and hospital records. Results: Fifty-four recipients (36 H, 3 H/L, 15 L) reported 80 pregnancies. Maternal factors and pregnancy outcomes are listed below.
Maternal factors during pregnancy Hypertension Preeclampsia Infection Rejection Pregnancy outcomes Livebirths Spontaneous abortions Therapeutic abortions Stillbirths Ectopic Newborn outcomes Mean gestational age (wks) Mean birthweight (g) Low birthweight (⬍2500 g) Graft loss ⬍2 yrs of pregnancy
43% 11% 14% 19% (60) 70% 18% 8% 2% 2% (42) 37 2674 33% 0%
33% 33% 67% 0% (3) 100% 0% 0% 0% 0% (3) 37 2363 67% 33%
53% 10% 18% 24% (17) 59% 12% 29% 0% 0% (10) 35 2407 60% 18%
One L recipient offspring was followed for an atrial septal defect and has a pacemaker. All remaining children were reported healthy and developing well (H 36, H/L 3, L 7). Conclusions: Successful pregnancy outcomes have been reported for thoracic transplant recipients; maternal risks appear greater for lung recipients. Additional entries and long-term follow-up are essential to assess pregnancy risks in this population. Grant Support; Supported by grants from Novartis Pharmaceuticals, Corp., Astellas Pharma US, Inc., Roche Laboratories Inc., and Wyeth Pharmaceuticals. 274 THE BURDENS EXPERIENCED BY CAREGIVERS OF CANDIDATES WAITING FOR LUNG TRANSPLANT C.J. Whytehead,1 1Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada Purpose: To assess the burdens experienced by caregivers of candidates waiting for lung transplant and, to determine if caregivers who relocated experienced greater burden than caregivers who did not need to relocate. Methods and Materials: An anonymous questionnaire was distributed over a 6-month period. The questionnaire consisted of: 1) Caregiver Reaction Assessment (CRA), a measure of the burdens of caregiving with five separate sub-scales: disrupted schedule (DS), financial burden (FB), lack of support (LS), physical health (PH), and self-esteem (SE), 2) The Centers for Epidemiological Studies Depression Scale (CES-D), a measure of symptoms of depression in the general population used as a measure of emotional burden, 3) a perceived overall burden scale, 4) An open-ended question. Results: 31 of 49 eligible caregivers (63%) returned the questionnaire. Five (16%) relocated to provide care. Disrupted schedule was the only sub-scale that scored over the mid-point on the CRA (Mean ⫽ 3.21 ⫾ SD ⫽ 1.02). Other negative measures scored relatively low: FB (2.77 ⫾1.09); LS(1.87 ⫾ 0.69); PH (2.01 ⫾ 0.77), and overall burden score (3.68 ⫾ 2.45). Self-esteem, a positive scale, scored high (4.33 ⫾ 0.44). Mean depression scores were low (12.83 ⫾ 10.09). Nine of 31 (29%) scored greater than the cut-off on the CES-D indicating they were experiencing symptoms of depression. Depression was significantly and positively associated with all negative measures of burden on the CRA: DS (r ⫽ .54, p ⬍.01), FB (r ⫽ .49, p ⬍.01), LS (r ⫽ .37, p ⬍.05), PH (r ⫽ .44, p ⬍.05). There were no differences in any of the burden scores based on whether a caregiver was required to relocate. Three themes were identified on the open-ended question: waiting, commitment, and a positive experience. Conclusions: Caregivers of candidates waiting for lung transplant did not feel overly burdened. Depression was common and was associated with higher levels of burden. Screening and appropriate treatment of caregiver depression might improve the waiting experience for transplant candidates and their caregivers. 275
Immunosuppression was cyclosporine-based in 61 and tacrolimusbased in 19 pregnancies. Three had exposure to mycophenolate mofetil (1 livebirth no malformations; 2 spontaneous abortions). At last recipient follow-up, adequate graft function was: 27 H, 1 H/L and 10 L recipients (one retransplant). Reduced H function was reported in 1 H/L recipient (retransplant 1.2 yrs postpartum). Recipient deaths have been reported in 9 H, 1 H/L and 5 L recipients. Childhood follow-up of the H recipient offspring revealed 3 managed medically for cardiomyopathy (mothers same diagnosis), one had hypospadias repair and one was treated for ADHD; one trauma related child death.
TELEVISION, HEART TRANSPLANTATION AND “ON LINE” NATIONAL DONOR REGISTER REGISTRATIONS S.A. Beer, P. Pocock, R.S. Bonser Department of Heart & Lung Transplantation, Cardiothoracic Surgery, University Hospital of Birmingham NHSF Trust: Queen Elizabeth, Edgbaston, Birmingham, United Kingdom; Statistics and Audit Directorate, UK Transplant & Blood, Bristol, Avon, United Kingdom; Department of Heart & Lung Transplantation and Cardiothoracic Surgery, University Hospital of Birmingham:Queen Elizabeth, Edgbaston, Birmingham, United Kingdom