Research Spotlight

Wall, A., G. H. Lee, J. Maldonado and D. Magnus (2019). “Medical Contraindications to Transplant Listing in the USA: A Survey of Adult and Pediatric Heart, Kidney, Liver, and Lung Programs.” World J Surg May 20. [Epub ahead of print].

Full text of this article.

INTRODUCTION: Listing practices for solid organ transplantation are variable across programs in the USA. To better characterize this variability, we performed a survey of psychosocial listing criteria for pediatric and adult heart, lung, liver, and kidney programs in the USA. In this manuscript, we report our results regarding listing practices with respect to obesity, advanced age, and HIV seropositivity. METHODS: We performed an online, forced-choice survey of adult and pediatric heart, kidney, liver, and lung transplant programs in the USA. RESULTS: Of 650 programs contacted, 343 submitted complete responses (response rate = 52.8%). Most programs have absolute contraindications to listing for BMI > 45 (adult: 67.5%; pediatric: 88.0%) and age > 80 (adult: 55.4%; pediatric: not relevant). Only 29.5% of adult programs and 25.7% of pediatric programs consider HIV seropositivity an absolute contraindication to listing. We found that there is variation in absolute contraindications to listing in adult programs among organ types for BMI > 45 (heart 89.8%, lung 92.3%, liver 49.1%, kidney 71.9%), age > 80 (heart 83.7%, lung 76.9%, liver 68.4%, kidney 29.2%), and HIV seropositivity (heart 30.6%, lung 59.0%, kidney 16.9%, liver 28.1%). CONCLUSIONS: We argue that variability in listing enhances access to transplantation for potential recipients who have the ability to pursue workup at different centers by allowing different programs to have different risk thresholds. Programs should remain independent in listing practices, but because these practices differ, we recommend transparency in listing policies and informing patients of reasons for listing denial and alternative opportunities to seek listing at another program.

Vijayaraghavan, K., P. A. McCullough, B. Singh, M. Gupta, E. Enas, V. Mohan, A. Misra, P. Deedwania and E. A. Brinton (2019). “Cardiometabolic-Renal Disease in South Asians: Consensus Recommendations from the Cardio Renal Society of America.” Cardiorenal Med May 10; 9(4): 240-251. [Epub ahead of print].

Full text of this article.

BACKGROUND: Rates of cardiometabolic-renal disease are extremely high among South Asians (India, Pakistan, Bangladesh, Sri Lanka, Bhutan, the Maldives, and Nepal) residing in their home countries and worldwide. The Cardio Renal Society of America, National Kidney Foundation of Arizona, and Twinepidemic Inc. convened a task force to examine evidence and reach consensus regarding cardiometabolic-renal disease prevention in South Asians. The task force distilled the findings from 5 years of face-to-face and virtual meetings addressing questions derived from expert reviews of published data using the Delphi technique to create these consensus statements. SUMMARY: Several high-quality observational studies document the high and increasing incidence and prevalence of cardiometabolic-renal disease among South Asians, starting well before adulthood, owing to genetic, cultural, and environmental factors. Despite the need for additional prospective studies, especially randomized trials, of educational, screening, and other prevention efforts, sufficient information is already available to expand and intensify ongoing efforts in professional and lay education to help control this epidemic. The task force proposes to provide this expansion over the next 10 years through scientific and lay publications and other educational programs to promote more effective action among the public, health care professionals, payers, and regulators in screening for and treating cardiometabolic-renal risk factors and preventing disease in South Asians, starting at an early age. Key Messages: These consensus statements describe risk factors and prognoses characteristic of South Asians regarding cardiometabolic-renal diseases, to aid physician decision-making, health care system delivery, and research initiatives to improve the quality of care for South Asians worldwide.

Tlayjeh, H., Y. M. Arabi, N. D. Ferguson, Q. Zhou, F. Lamontagne, A. Arroliga, V. Danesh, G. Dominguez-Cherit, E. Jimenez, A. Mullaly, B. Staub and M. O. Meade (2019). “Body Mass Index and Mortality in Subjects With ARDS: Post-hoc Analysis of the OSCILLATE Trial.” Respir Care May 28. [Epub ahead of print].

Full text of this article.

BACKGROUND: Studies on the association of obesity with mortality in subjects with ARDS have yielded inconsistent results. METHODS: In a sub-analysis of the Oscillation for ARDS Treated Early (OSCILLATE) randomized controlled trial, 451 subjects were divided into 5 strata based on their body mass index (BMI) using the World Health Organization definitions: underweight < 18.5 kg/m(2); normal weight 18.5-24.99 kg/m(2); overweight 25-29.99 kg/m(2); obese 30-39.99 kg/m(2); severely obese > 40 kg/m(2). The primary outcome was all-cause hospital mortality across BMI strata for all subjects and for the 2 study arms (high-frequency oscillatory ventilation [HFOV] vs conventional ventilation) separately using multivariable logistic regression adjusting for potential confounding variables. RESULTS: Hospital mortality was not different across the BMI strata for all subjects (P = .86), for the HFOV arm (P = .94) or for the conventional ventilation arm (P = .59). After risk adjustment, BMI was not associated with increased risk for hospital mortality (odds ratio 1.01, 95% CI 0.97-1.04, P = .67), whereas HFOV was independently associated with increased mortality (odds ratio 1.74, 95% CI 1.11- 2.72, P = .02) with no effect modification by BMI strata (for this interaction, P = .56). Although there was no difference in the use of rescue therapies or in the number of days on sedation or analgesia, higher daily doses of fentanyl and midazolam were administered as BMI increased. CONCLUSIONS: There was no difference in adjusted hospital mortality across BMI strata in subjects with moderate to severe ARDS. Processes of care were not different across BMI strata except for higher daily doses of fentanyl as BMI increased.

Thakkar, S. J., P. A. Grayburn, S. A. Hall and W. C. Roberts (2019). “Orthotopic Heart Transplantation for Ankylosing Spondylitis Masquerading as Nonischemic Cardiomyopathy.” Am J Cardiol 123(10): 1732-1735.

Full text of this article.

Described herein is a 48-year-old man who underwent orthotopic heart transplantation because of severe heart failure considered clinically due to idiopathic dilated cardiomyopathy, but examination of the operatively excised native heart disclosed classic features of ankylosing spondylitis. Orthotopic heart transplantation for this condition has not been reported previously.

Tecson, K. M., H. Hashemi, A. Afzal, T. A. Gong, P. Kale and P. A. McCullough (2019). “Community-Acquired Acute Kidney Injury as a Risk Factor of de novo Heart Failure Hospitalization.” Cardiorenal Med 9(4): 252-260.

Full text of this article.

OBJECTIVES: Because patients with hospital-acquired acute kidney injury (AKI) are at risk for subsequent development of heart failure (HF) and little is known about the relation between community-acquired AKI (CA-AKI) and HF, we sought to determine if CA-AKI is a risk factor for incident HF hospitalization. METHODS: We utilized Baylor Scott & White Health databases at the primary care and inpatient hospitalization levels to identify adults without a prior history of HF who had 2 or more serum creatinine measurements within 13 months in the primary care setting. We defined CA-AKI as a serum creatinine increase >/=0.3 mg/dL or >/=1.5 times the baseline for consecutive values within a 13-month period. We created a flag for de novo HF hospitalization at 90, 180, and 365 days following CA-AKI evaluation. RESULTS: In the analyses, 210,895 unique adults were included, of whom 5,358 (2.5%) had CA-AKI. Those with CA-AKI had higher rates of comorbidities, higher rate of males (48 vs. 42%, p < 0.001), and were older (61.5 [50.3, 73.1] vs. 54.1 [42.8, 64.7] years, p < 0.001) than those who did not have CA-AKI. In total, 607 (0.3%), 833 (0.4%), and 1,089 (0.5%) individuals had an incident HF hospitalization in the 90, 180, and 365 days following the CA-AKI evaluation, respectively. After adjusting for demographic and clinical characteristics, patients with CA-AKI had >2 times the risk of de novo HF hospitalization compared with patients who did not have CA-AKI (90 days: 2.35 [1.83-3.02], p < 0.001; 180 days: 2.52 [2.04-3.13], p < 0.001; 365 days: 2.16 [1.77-2.64], p < 0.001). These multivariable models yielded strong predictive abilities, with the areas under the receiver-operating characteristic curve >0.90. CONCLUSION: After controlling for baseline and clinical characteristics, patients with CA-AKI were at approximately twofold the risk of de novo HF hospitalization (within 90, 180, and 365 days) compared with those who did not have CA-AKI. Hence, detecting CA-AKI may provide an opportunity for early intervention at the primary care level to possibly delay HF development.