heart transplantation

Kawasaki disease (KD) is an acute, self-limiting vasculitis that predominantly affects children under five years of age. It is recognized as the leading cause of acquired coronary artery disease in this age group.

This manuscript presents two cases of KD complicated by significant coronary artery abnormalities, which ultimately necessitated heart transplantation.

Emphasizing the importance of early diagnosis and treatment, this study underscores the critical need for continued research to improve outcomes for affected patients.

Heart transplantation brings about a shift in lifestyle and quality of life for children and adolescents post-surgery. Enhancing the quality of life in pediatric heart transplant recipients is among the crucial responsibilities of nurses. This study aimed to investigate the impact of a tele-nursing supportive educational program on adherence to treatment and quality of life in children aged 12-18 years.

This study was a quasi-experimental single-group design. This study investigated the effectiveness of interactive and supportive education programs on the quality of life and medication adherence of 41 pediatric patients referred to a specialized hospital for heart transplantation in Tehran. Participants were selected through census sampling and received education through communication software such as WhatsApp, Skype, and Telegram, which were chosen by the patients and their parents. The program lasted for eight weeks, and data were collected using a socio-demographic questionnaire, the Pediatric Quality of Life Inventory for Cardiac Problems, and the Modanloo Medication Adherence Scale. The collected data were analyzed using SPSS version 16.

Results showed a significant improvement in the mean score of quality of life and its dimensions (p=0.001) as well as the medication adherence score and its dimensions (p=0.001) following the implementation and follow-up of the intervention program.

The intervention program had a positive impact on the quality of life and medication adherence of the participants. Tele-nursing interventions can be an effective and accessible method to enhance treatment adherence and improve the quality of life for pediatric heart transplant recipients.

Heart transplantation is the preferred treatment for end-stage heart failure. This study investigated the intra-operative risk factors affecting post-transplantation mortality. This single-center retrospective cohort study examined 239 heart transplant patients over eight years, from 2011-2019, at the oldest dedicated cardiovascular center, Shahid Rajaee Hospital (Tehran, Iran). The primary evaluated clinical outcomes were rejection, readmission, and mortality one month and one year after transplantation. For data analysis, univariate logistic regression analyses were conducted. In this study, 107 patients (43.2%) were adults, and 132 patients (56.8%) were children. Notably, reoperation due to bleeding was a significant predictor of one-month mortality in both children (OR=7.47, P=0.006) and adults (OR=172.12, P<0.001). Moreover, the need for defibrillation significantly increased the risk of one-month mortality in both groups (children: OR=38.00, P<0.001; adults: OR=172.12, P<0.001). Interestingly, readmission had a protective effect against one-month mortality in both children (OR=0.02, P<0.001) and adults (OR=0.004, P<0.001). Regarding one-year mortality, the use of extracorporeal membrane oxygenation (ECMO) was associated with a higher risk in both children (OR=7.64, P=0.001) and adults (OR=12.10, P<0.001). For children, reoperation due to postoperative hemorrhage also increased the risk (OR=5.14, P=0.020), while defibrillation was a significant risk factor in both children and adults (children: OR=22.00, P<0.001; adults: OR=172.12, P<0.001). The median post-surgery survival was 22 months for children and 24 months for adults. There was no correlation between sex and poorer outcomes. Mortality at one month and one year after transplantation was associated with the following risk factors: the use of ECMO, reoperation for bleeding, defibrillation following cross-clamp removal, and Intensive Care Unit (ICU) stay. Readmission, on the other hand, had a weak protective effect.

This study aimed to evaluate the association between plasma levels of high‑sensitivity cardiac troponin I (cTnI) in heart transplant patients and the grading of graft rejection.

In a cross‑sectional study, 92 biopsy samples from the patients who had undergone heart transplantation during 2022, at Rajaie Cardiovascular Medical and Research Center, the largest referral center in Tehran, Iran, were evaluated for heart transplant rejection. Transplant rejection grades, high‑sensitivity troponin I plasma levels, and the relationship between them were assessed statistically.

Forty‑two patients (mean age 37 ± 9.6 years, 26 (62%) male) were assessed. The mean transplant age was 3 ± 1.8 years. In terms of graft rejection, 30 (33%) biopsies showed Grade 1R and 4 (4%) showed Grade 2R. Quilty effect was observed in 43 (47%). The median (Q1–Q3) of the cTnI was 0.02 (0.02–0.75) and 43 (47%) had high troponin level (>0.03 ng/mL). A positive association was observed between high cTnI and rejection (P = 0.025).

The association between the troponin level and rejection grade suggested the considerable myocardial injury during the rejection process.

Pregnancy after a heart transplant is a concern for many female recipients, and it remains a medical challenge that raises many questions. A 24-year-old woman, gravida 3, para 0, contacted us for obstetric care in the first trimester of gestation, about 3 years after an orthotopic cardiac transplant. She was a known case of dextrocardia with congenitally corrected transposition of the great arteries. The transplant had been performed for severe retractable heart failure, manifesting during her previous lost pregnancy. The course of the current gestation was uneventful. The patient’s cardiovascular function was good throughout the pregnancy. She was admitted to the hospital for dyspnea at 35 weeks and 4 days of gestational age. A cardiovascular consult and echocardiography were performed. The results were within the normal range, and labor pains explained the patient’s dyspnea. Because of labor pain, a repeat Cesarean section was performed at 35 weeks and 4 days of gestational age. A male baby weighing 2700 g, with an Apgar score of 7/9, was delivered. The patient was discharged after delivery with enoxaparin (40 mg), prednisolone (5 mg), levothyroxine, and mycophenolate mofetil (500 mg) without any complications. Follow-up was carried out at 1 month, and no abnormality was found. Here, we report a case of a successful pregnancy in a young woman after a heart transplant.

 After solid organ transplantation, patients require lifelong immunosuppressive medication, increasing susceptibility to COVID-19. We evaluated the clinical outcomes of heart transplant recipients in patients with COVID-19.

 We enrolled twenty-two COVID-19 cases of adult heart transplantation from February 2020 to September 2021.

 The most common symptoms in patients were fever and myalgia. The death occurred in 3 (13.6 %).

 Although heart transplantation mortality may increase in the acute rejection phase concomitant with COVID-19, immunosuppressive dose reduction may not be necessary for all heart transplant patients with COVID-19.

This study aims to evaluate the entire experience in heart-lung transplantation (HLTx) in a country of the European Union with 47 million inhabitants according to the etiologies that motivated the procedure.

A retrospective study on 1,751 consecutive transplants (HLTx: 78) was performed from 1990 to 2020 in two centers. Overall survival, adjusted for clinical profile and etiological subgroups, was compared. 7 subgroups were considered: 1) Cardiomyopathy with pulmonary hypertension (CM + PH). 2) Eisenmenger syndrome. 3) Congenital heart disease (CHD). 4) Idiopathic pulmonary arterial hypertension (IPAH). 5) Cystic fibrosis. 6) Chronic obstructive pulmonary disease (COPD)/Emphysema. 7) Diffuse interstitial lung disease (ILD).

Early mortality was 44% and that of the rest of the follow-up was 31%. There were differences between HTLx and HTx in survival, also comparing groups with a similar clinical profile with propensity score (p= 0.04). Median survival was low in CM + PH (18 days), ILD (29 days) and CHD (114 days), intermediate in Eisenmenger syndrome (600 days), and longer in IPAH, COPD/Emphysema and cystic fibrosis.

HLTx has a high mortality. The etiological analysis is of the utmost interest to make the most of the organs and improve survival.

The waiting list for heart transplants is a valuable data registry that would offer very useful information on the characteristics of patients who have various outcomes while waiting in the list.

The purpose of this study was to look at the prognosis of those waiting for heart transplants as well as the factors that increase mortality.

Advanced heart failure patients' demographic, clinical, hemodynamic, and echocardiographic results, as well as their prognosis, were retrieved from the national registry for heart transplantation between 2011 and 2018. The study population was defined and compared in four groups: 1) Death while awaiting HTX, 2) Death after HTX, 3) Alive without a transplant, 4) Transplanted and alive.

The data of 207 patients [75% male, mean (SD) age of 34(10) years] were analyzed. The most common etiology of heart failure was idiopathic dilated cardiomyopathy. A total of 86 patients (41%) were successfully transplanted, with a median (IQR) time between listing and transplantation of 84 (30- 219) days, 54 patients (26.1%) were dead and 32% were still alive. The multivariate analysis showed right atrial pressure, pulmonary capillary wedge pressure, cardiac index, and systolic blood pressure at the time of listing as independent predictors of death.

The study on HTX waiting list is very useful for both allocation strategies and administrative planning for patients with advanced heart failure by development of accurate models and scoring systems using predictors of death in the waiting list

Solid-organ transplantation recipients were assumed highly vulnerable to coronavirus disease 2019 (COVID-19). However, the results of previous studies in patients with orthotopic heart transplantation (OHT) under immunosuppressive therapy are contradictory. Therefore, we aimed to assess the prevalence of COVID-19 infection and associated risk factors, along with the six-month outcomes in COVID-19 positive OHT patients. This single-center telephone-based survey was conducted on OHT patients. Using a detailed questionnaire, exposure to COVID-19, related symptoms, and preventive self-care measures were collected. Outcomes of COVID-19-positive patients were reassessed using another survey six months later. 118 OHT patients (male: n=87, 73.7%) were included with a mean age of 45.3±13.1 years. Sixteen patients (13.5%) reported one or more symptoms compatible with COVID-19, of whom 12 (10.2%) tested positive. Our results indicated no statistically significant association between COVID-19 and comorbidities. Poor adherence to self-care measures and contact with positive index cases were both significantly associated with COVID-19 infection (P<0.001). A later six months follow-up showed that two out of 12 (16.6%) COVID-19 positive OHT patients died. There was no statistically significant difference between the prevalence of COVID-19 in our patients compared to Iran’s general population (P=0.152). Non-compliance with personal protective protocols and a history of contact with COVID-19 cases were the most risk factors for COVID-19 infection in OHT patients.

Heart transplantation is the last therapeutic choice in patients with severe heart failure who are symptomatic despite medical treatments and are estimated to have less than a year to live. Given the dearth of information on the initial years and outcomes of heart transplantation, we conducted the present study to determine the results of this procedure at Rajaie Cardiovascular Medical and Research Center, Tehran, Iran, since the first transplantation. 

The current observational study, performed as a retrospective cohort, recruited 50 consecutive children who underwent heart transplantation between March 2014 and April 2017 in a census manner and determined their outcomes. 

Renal failure before transplantation was reported in 3 patients (6%), of whom 2 patients (4%) required dialysis. After transplantation, 11 subjects required dialysis. Eight patients (16%) developed hepatic failure before transplantation. Infectious complications were seen in 14 patients (28%) after transplantation. Nine patients (18%) had 1 rejection time. The mortality rate was 6%. 

It seems that despite similar indications for heart transplantation in different centers, our study revealed better results than previous studies. However, the technical and skill differences between physicians in various settings should be considered possible explanations. 

The frequency of organ transplantation is increasing, leading to increased stress in patients and families. Family performance assessment can express psychological and health consequences for children and their families and provide an opportunity for targeted interventions.
After necessary permits were obtained, the cases were randomly divided into experimental and control groups. Fifty parents of children who underwent heart transplantation participated in the research. Then, after the identification of the subjects in the experimental and control groups, the experimental group was subjected to the family-centered model. Following the completion of the training and 1 month later, anxiety and care-burden questionnaires were distributed to the experimental and control groups. Finally, the data obtained from the questionnaires were collected and analyzed.
Fifty individuals participated in this study. The results of the independent t test showed no significant difference concerning anxiety among parents before and after the intervention between the 2 study groups (P=0.217). Care burden was less in the intervention group than in the controls (P=0.039).
After training, anxiety and care burden in the intervention group improved compared with the control group. Information support of patients’ families will help them better adapt to stressful situations. Educating patients and their families can increase their information and reduce their anxiety. (Iranian Heart Journal 2022; 23(2): 87-95)

Heart transplantation is an established treatment for end-stage heart failure patients, but its cost-effectiveness is under question.

This study aimed to assess the cost of heart transplantation in Iran as a developing country in Asia to contribute to future planning in the region.

This study was conducted in two phases. First, in a retrospective multicenter study, hospital data of heart transplant and hospitalization of three active heart transplant centers in Tehran, Iran, were reviewed from April 2013 to May 2015. Then pre-transplantation, transplantation, and one-year post- transplant costs were calculated according to the ABC (activity-based costing) method in 2016.

Data were obtained for 120 patients, among which 95 (79.17%) were males with a mean (SD) age of 35.31±13.41 years. Mean (SD) hospital and ICU length of stay were 17.85±14.91 and 9.74±8.94 days, respectively. A significant correlation existed between the mean of hospital and ICU length of stay (P<0.001, r: 0.754). The mean heart transplant and hospitalization cost was 3445.47±1243.29 USD from 2013 to 2015. Using the activity-based costing method, the cost of pre-transplantation, transplantation, and one-year -post-transplantation were extracted 6.5%, 73.5%, and 20%, respectively, with a total cost of 26232 USD.

Compared to other countries, the cost of heart transplantation in Iran is very low. Numerous reasons lead to this difference. Firstly, a heart transplantation surgery is performed in university-based hospitals and is supported by the government. On the other hand, a significant difference exists between personnel costs in Iran compared to other countries.

Toxoplasmosis is an opportunistic infection that affects solid organ transplant (SOT) recipients. The parasite transmission may be occurred from a Toxoplasma-seropositive donor to a Toxoplasma-seronegative recipient by organ transplantation.

In this study, a nested PCR was carried out using different primers targeting the B1, SAG4, and MAG1 genes to assess Toxoplasma infection in pediatric heart transplantation at Shahid Rajaei Heart Center in Tehran.

Blood samples were collected from 46 pediatric heart transplant patients aged 1 - 17 years referring to Rajaei Cardiovascular Medical and Research Center from 2018 - 2019. All patients were on oral administration of Trimethoprim-sulfamethoxazole (cotrimoxazole). Blood samples were collected, and peripheral blood mononuclear cell (PBMC) isolation using the Ficoll gradient method was performed. DNA was extracted from PBMC, and nested PCR was carried out. Serologic tests were performed using ELISA to determine IgG and IgM anti - Toxoplasma gondii antibodies.

The results of serologic tests showed that all 46 patients had negative anti-T. gondii IgM antibody. Furthermore, 6 (13.05%) and 3 (6.5 %) out of the 46 patients were positive for IgG T. gondii antibody before and after transplantation, respectively. All 46 patients were evaluated using PCR using B1, MAG-1, and SAG-4 genes, and PCR results were negative.

In general, due to the negative results of Toxoplasma with PCR using B1 and bradyzoite-specific genes (SAG-4 and MAG-1), it is possible that the results obtained in this study are because of prophylaxis with cotrimoxazole.

Although the phenomenon of adjustment to a new heart in transplant recipients is very complex, very few studies have been conducted on this important issue. Therefore, no careful and clear definition exists for this concept.

This concept analysis was conducted in Iran in 2018 on 13 patients undergoing heart transplantation. In the theoretical phase, a conceptual framework was created according to the existing data in the literature about the phenomenon. In this study, 13 participants were selected using purposive sampling with maximum diversity.‎ In the fieldwork phase, 20 deep and semistructured interviews were conducted with patients undergoing heart transplantation over 4 months. After data saturation, interviews were analyzed using the qualitative content analysis method proposed by Granheim and Lundman (2009). At the final analytical phase, the results of the two previous phases were integrated using a hybrid model.

Adjustment to a new heart is a unique multiphase process in patients undergoing heart transplantation. The antecedents include the transplantation time, physical conditions, social and family support, relationship with congeners, and spiritual beliefs. The desirable consequences of adjustment to a new heart may include a new life, inner peace, and spiritual excellence, and the undesirable consequences may include psychological abuse and emotional stagnation.

According to the results, the health‑care team should consider the patient as a unique client and initiate discussions before and following heart transplantation that address patients’ adjustment to a new heart in all their physical, sexual, and emotional aspects.

 Changes in the dosage of immunosuppressive drugs following organ transplantation, especially the heart, can be a potential predictor of long-term post-transplant outcomes. It may also be related to the degree of histopathological involvement of endomyocardium.

 We aimed to evaluate cyclosporine and tacrolimus dose changes during post-transplantation biopsies and their association with endomyocardial biopsy grades.

 This retrospective study was performed on 100 cardiac transplant patients who underwent endomyocardial biopsies to assess graft stability. In the present study, the patients were divided into two groups receiving cyclosporine (13 cases) and tacrolimus (87 cases). The data was collected by reviewing the recorded files.

 Regarding the administration of cyclosporine, at different times after biopsy, there was no significant relationship between the plasma level of the drug and the grade of biopsy. Concerning tacrolimus, there was a significant reverse association between serum concentration and biopsy grade at the first biopsy after transplantation (about one month after transplantation), although this relationship was not observed in the subsequent steps of biopsy. Also, the Quilty effect frequency was not significantly associated with biopsy grade in different biopsies for both drugs.

 There is a lack of association between endocardial biopsy grade in the heart and the serum level of cyclosporine after transplantation. However there is a significant reverse relationship between endomyocardial biopsy grade and serum Tacrolimus concentration in the first weeks after transplantation and thus monitoring serum Tacrolimus after transplantation may play an important role in predicting acute rejection.

Muscular dystrophies constitute a group of disorders characterized by muscular weakness and the involvement of the other systems such as the cardiovascular system. In some patients, cardiac involvement is severe and necessitates heart transplantation. Although there are some concerns regarding heart transplantation in these patients due to post-transplantation complications and the deleterious side effects of immunosuppressant drugs, there are several cases of heart transplantation in these patients worldwide. There is, however, no reported case in our country, Iran. Herein, we present 3 successful heart transplantations in patients with muscular dystrophies in Iran. (Iranian Heart Journal 2020; 21(3): 150-153)

Heart transplantation is a major procedure which imposes high emotional stress on patients. Illness perception (IP) is a psychological issue which affects psychological adjustment after transplantation. This study aimed to investigate the association between IP and emotional status in Iranian post-heart transplantation patients.

The present cross-sectional study, conducted between 2018 and 2019 in Imam Khomeini Hospital, Tehran, Iran, recruited 121 post-heart transplantation patients. IP was measured using the Brief Illness Perception Questionnaire (B-IPQ), and emotional status was measured using the Hospital Anxiety and Depression Scale. The association between IP and depression/anxiety was assessed.

Men comprised 80.2% of the study population. The mean age of the participants was 43.9±12.95 years. Definite caseness for depression and anxiety was reported in 11.6% and 18.2% of the participants, respectively. The median score of IP was 55. The association between anxiety and IP in total IP and the 3 dimensions of IP was statically significant (P=0.015, P=0.018, P=0.002, and P=0.023 for the cognition, emotion, and understanding dimensions and the total IPQ, respectively). Additionally, the association between depression and IP was significant (P=0.001, P=0.029, and P=0.002 for the cognition and emotion dimensions and the total IPQ, correspondingly, except for the understanding dimension). Furthermore, lower levels of anxiety in the patients showed a greater impact on IP than did depression.

There was a significant association between IP and depression and anxiety in our study population. Therefore, the diagnosis and management of anxiety and depression in heart transplantation patients may improve IP. The cross-sectional design of the present study precluded an investigation of the causality between IP and emotional status.

Heart transplantation is a valuable technique but the side effects of this surgery should be considered. The purpose of this study was to investigate the effect of rehabilitation training in patients who candidate for heart transplantation. This study was done by semi-experimental clinical trial method. Participants were selected from people who refer to the clinic (2010–2018). The information of the patients who candidate for heart transplantation (4 women, 14 men) were obtained (age: 60 ± 13, body mass index: 26.7 ± 3.7). Hemodynamic parameters were measured before and after the treatments. Training setting was at least 3 months and based on the exercise test of patients. Pharmacological and nutritional control and lifestyle education were also carried out. The hemodynamic parameters were improved significantly (P ≤ 0.05). In some cases improvement in Pro Brain natriuretic peptide and homocysteine were observed. Along with other surgical techniques, it was possible to change the lifestyle as much as possible and encourage patients to noninvasive treatment. Patients should follow strict discipline, nutritional and drug policies. Patients should continue this lifestyle and positive thinking regularly. Probably the most important reason for patients undergoing heart transplant is sarcomeropathy. For this reason, regular exercise with effects on genetic signaling pathways can improve this condition if diagnosed early. Despite all the medical controls, it is likely that the most important point that improves patient's reliance is the patient's trust in the treatment method and the existence of a human relationship between the patients and the physician.