ΠΕΤΡΟΣ Δ. ΣΦΥΡΑΚΗΣ
ΚΑΡΔΙΟΧΕΙΡΟΥΡΓΟΣ
METROPOLITAN HOSPITAL ΑΘΗΝΑ
29/06/2018 SFIRAKIS D. PETROS 1
29/06/2018 SFIRAKIS D. PETROS 2
Adult and Pediatric Heart Transplants
Number of Transplants by Year and Location
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
5500
Nu
mb
er
of
tra
nsp
lan
ts
Other
North America
Europe
NOTE: This figure includes only the heart transplants that are
reported to the ISHLT Transplant Registry. As such, the
presented data may not mirror the changes in the number of
heart transplants performed worldwide.
2017JHLT. 2017 Oct; 36(10): 1037-1079
29/06/2018 SFIRAKIS D. PETROS 3
HEART TRANSPLANTS 137 pts + 2 Retransplant
LONG-TERM ASSIST DEVICES 115 pts (BTT-BTC-DT)
LUNG TRANSPLANTS 12 pts + 1 Retransplant
ONASSIS CARDIAC SURGERY CENTER 04/1995-09/2015
0
2
4
6
8
10
12
14
16
18
20
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
HEART TRANSPLANTS 137 pts (45,25% VAD pts)
LONG-TERM ASSIST DEVICES 115 pts DEVICES 123
LUNG TRANSPLANTS 12
SFIRAKIS D. PETROS 429/06/2018
0
25
50
75
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
Su
rviv
al
(%)
Years
2017JHLT. 2017 Oct; 36(10): 1037-1079
Adult and Pediatric Heart TransplantsKaplan-Meier Survival
Median survival = 10.9 years;Median survival conditional on surviving to 1 year = 13.5 years
N = 127,097
(Transplants: January 1982 – June 2015)
HEART TRANSPLANTS - DEATHS
4/1995-09/2015 (137 +2 Retransplant)
0
20
40
60
80
100
120
140
160
HEART TRANSPLANTS 137 + 2
RETRANSPLANTS
DEATHS 31 (22,62%), ( 14 pts on DEVICE
45,16%)
SFIRAKIS D. PETROS 629/06/2018
0
10
20
30
40
50
0-30 Days(N=6,774)
31 Days - 1Year (N=5,842)
>1-3 Years(N=4,129)
>3-5 Years(N=3,579)
>5-10 Years(N=9,122)
>10-15 Years(N=6,468)
>15 years(N=4,664)
% o
f D
ea
ths
CAV Acute Rejection
Malignancy (non-Lymph/PTLD) Infection (non-CMV)
Graft Failure Multiple Organ Failure
Renal Failure
Since only leading causes of death are shown, the sum
of percentages for each time period is less than 100%.
2017JHLT. 2017 Oct; 36(10): 1037-1079
Adult Heart Transplants Relative Incidence of Leading Causes of Death
(Deaths: January 1994 – June 2016)
EVENTS OF TRANSPLANTED PATIENTS
0
5
10
15
20
25
30 REJECTION 28
CAV 18
PTCA 11
CMV 14
PACER 9
AICD 2
GF 6
CND 3
PE 2
Renal F. 4
Malignacies 5
TR 3
G. Surgery 7
Aspergilus 1
Retrans 2
SFIRAKIS D. PETROS 829/06/2018
Adult and Pediatric Heart TransplantsDonor Age by Year of Transplant
0
5
10
15
20
25
30
35
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Me
dia
n d
on
or
ag
e (
ye
ars
)
% o
f tr
an
sp
lan
ts
0-9 10-17 18-39 40-59 60-69 70+ Median Age
2017JHLT. 2017 Oct; 36(10): 1037-1079
THE MEAN AGE OF DONORS
AND RECIPIENTS
0
10
20
30
40
50
60
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
MEAN AGE OFDONORS
MEAN AGE OFRECIPIENTS
SFIRAKIS D. PETROS 1029/06/2018
Changes and the Future ofHeart Transplantation
-Recipient and Donor Demographics
-Survival after Heart Transplantation
-Technological and pharmaceutical
-Patient and Donor selection
-Medical management
-Operative care
-Long-term follow-up
29/06/2018 SFIRAKIS D. PETROS 11
Immunosuppression-Calcineurin inhibitors (CNI) in 1980
-Steroid weaning
-CNI monotherapy
-CNI –free immunosuppression
-Mammalian Target of Rapamycin (mTOR)
(Sirolimus, Everolimus)
-Inhibitors of CD28/B7
-Customized immunosuppression
-Therapeutic antibodies (rituximab-antiCD20,
basiliximad-anti-IL2,alemtuzumab antiCD52,
bortezomib 26S proteasome inhibitor, Belatacept
CD 28/B7 inhibitor, eculizumab anti-C5 )
29/06/2018 SFIRAKIS D. PETROS 12
Regection
-Achilles heel of organ transplantation
-Cellular mediated rejection (CMR)
-Antibody mediated rejection (AMR)
-HLA class I ,class II, non-HLA antigen
-Donor-Specific Antibodies (DSA)
-AlloMap test (CMR)
-Donor derived cell-free DNA, microRNA
and messenger RNA
29/06/2018 SFIRAKIS D. PETROS 13
Cardiac allograft vasculopathy (CAV)
-Late post-transplant mortality 50% at 10y.
-Diffuse coronary process
-Form of chronic rejection
-Cardiovascular risk factors
-Chronic inflammation
-Donor specific antigens (DSA)
-Ischemia-reperfusion injury
29/06/2018 SFIRAKIS D. PETROS 14
Mechanical Circulatory Support (MCS)
-MCS as a Bridge to Transplantation (BTT)
-Complications
-Status priority
-Short and Long-term Device
-Bridge to Recovery
-Destination Therapy
29/06/2018 SFIRAKIS D. PETROS 15
29/06/2018 SFIRAKIS D. PETROS 16
Figure 1
The Journal of Heart and Lung Transplantation 2018 37, 685-691DOI: (10.1016/j.healun.2018.01.1294)
Copyright © 2018 International Society for the Heart and Lung Transplantation Terms and Conditions
Figure 2
The Journal of Heart and Lung Transplantation 2018 37, 685-691DOI: (10.1016/j.healun.2018.01.1294)
Copyright © 2018 International Society for the Heart and Lung Transplantation Terms and Conditions
Figure 3
The Journal of Heart and Lung Transplantation 2018 37, 685-691DOI: (10.1016/j.healun.2018.01.1294)
Copyright © 2018 International Society for the Heart and Lung Transplantation Terms and Conditions
From: The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) of the European Association for Cardio-Thoracic Surgery (EACTS): second reportEur J Cardiothorac Surg. 2017;53(2):309-316. doi:10.1093/ejcts/ezx320
Eur J Cardiothorac Surg | © The Author 2017. Published by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.29/06/2018 SFIRAKIS D. PETROS 20
Ex vivo Preservation
-OCS (Organ Care System)
-PROCEED II clinical trial
(130 patients)
-DCD (Donation after Cardiac Death)
29/06/2018 SFIRAKIS D. PETROS 21
Xenotransplantation
-Size and anatomy
-Immunological risks
-Infection risks
-Primary graft dysfunction
-Ethical problems
29/06/2018 SFIRAKIS D. PETROS 22
Biomaterial for Cardiopumonary System
-Embryonic stem cells, cardiac stem cells,
endothelial progenitor cells, skeletal myoblasts,
bone marrow mononuclear cells
-Extracellular Matrix of the Heart
-Natural Biomaterials
-Synthetic Biomaterials
-Nanotechnology in Cardiomyogenesis
-Tissue Engineering in Regeneration
29/06/2018 SFIRAKIS D. PETROS 23
ΕΥΧΑΡΙΣΤΩ ΠΟΛΥ
29/06/2018 SFIRAKIS D. PETROS 24
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