| 1. |
- Imamura, Teruhiko, et al.
(författare)
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Everolimus-incorporated immunosuppressant strategy improves renal dysfunction while maintaining low rejection rates after heart transplantation in Japanese patients
- 2013
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Ingår i: International Heart Journal. - : International Heart Journal Association. - 1349-2365 .- 1349-3299. ; 54:4, s. 222-227
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Tidskriftsartikel (refereegranskat)abstract
- The long-term survival of heart transplantation (HTx) recipients has increased significantly in recent years, however, the nephrotoxic adverse effects of calcineurin inhibitors (CNIs) are still a major concern. Recently, an inhibitor of mammalian target of rapamycin, everolimus (EVL), has emerged as an alternative immunosuppressant drug that may allow CM dosage reduction and thereby spare renal function. Data were collected from 20 HTx recipients who had received EVL (target trough level 3-8 ng/mL) along with a dose reduction of CNIs and/or mycophenolate mophetil (MMF) and had been followed for 1 year. Estimated glomerular filtration rate increased significantly with a reduction in the CM dosage in a dose-dependent manner (P less than 0.001, r = -0.807). Neutrophil count increased significantly (P less than 0.05) with a reduction in the dosage of MMF (P = 0.009, r = -0.671). Cytomegalovirus antigenemia remained negative after EVL administration among all candidates without any antiviral agents (P = 0.001). There were no significant increases in the acute rejection rates among recipients with EVL compared to those without EVL (P = 0.132). An immunosuppressant strategy incorporating EVL could reduce the CM and MMF dosages, which resulted in improvements in renal dysfunction and neutropenia while maintaining low rejection rates among HTx recipients.
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| 2. |
- Imamura, Teruhiko, et al.
(författare)
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Successful treatment of hemodynamic compromise caused by antibody-mediated and cellular rejection in a recipient 12 years after heart transplantation
- 2013
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Ingår i: International Heart Journal. - : International Heart Journal Association. - 1349-2365 .- 1349-3299. ; 54:5, s. 328-331
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Tidskriftsartikel (refereegranskat)abstract
- Heart transplantation (HTx) is an established therapy for stage D heart failure due to recent advances in immunosuppressive regimens. However, antibody-mediated rejection remains an unsolved problem because of its refractoriness to standard immunosuppressive therapy with high mortality and graft loss. We experienced a 16-year old patient with hemodynamic compromise caused by both cellular and antibody-mediated rejection 12 years after HTx. The rejection was refractory to repeated steroid pulse treatment, intravenous immunoglobulin administration, and intensifying immunosuppression including addition of everolimus. Eventually, she was successfully treated with repeated plasma exchange accompanied by a single administration of the anti-CD20 monoclonal antibody rituximab.
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| 3. |
- Perkiö Kato, Naoko, 1980-, et al.
(författare)
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Quality of Life and Influential Factors in Patients Implanted With a Left Ventricular Assist Device
- 2015
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Ingår i: Circulation Journal. - : JAPANESE CIRCULATION SOC. - 1346-9843 .- 1347-4820. ; 79:10, s. 2186-2192
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Tidskriftsartikel (refereegranskat)abstract
- Background: Improving quality of life (QOL) has become an important goal in left ventricular assist device (LVAD) therapy. We aimed (1) to assess the effect of an implantable LVAD on patients QOL, (2) to compare LVAD patients QOL to that of patients in different stages of heart failure (HF), and (3) to identify factors associated with patients QOL.Methods and Results: The QOL of 33 Japanese implantable LVAD patients was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and Short-form 8 (SF-8), before and at 3 and 6 months afterwards. After LVAD implantation, QOL significantly improved [MLHFQ, SF-8 physical component score (PCS), SF-8 mental component score (MCS), all Pless than0.05]. Implanted LVAD patients had a better QOL than extracorporeal LVAD patients (n=33, 32.1 +/- 21.9 vs. n=17, 47.6 +/- 18.2), and Stage D HF patients (n=32, 51.1 +/- 17.3), but the score was comparable to that of patients who had undergone a heart transplant (n=13). In multiple regression analyses, postoperative lower albumin concentration and right ventricular failure were independently associated with poorer PCS. Female sex and postoperative anxiety were 2 of the independent factors for poorer MCS (all Pless than0.05).Conclusions: Having an implantable LVAD improves patients QOL, which is better than that of patients with an extracorporeal LVAD. Both clinical and psychological factors are influence QOL after LVAD implantation.
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| 4. |
- Perkiö Kato, Naoko, et al.
(författare)
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Quality of life of family caregivers of patients with a left ventricular assist device in Japan
- 2018
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Ingår i: Journal of Cardiology. - : ELSEVIER SCIENCE BV. - 0914-5087 .- 1876-4738. ; 71:1-2, s. 81-87
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Tidskriftsartikel (refereegranskat)abstract
- Background: The role of caregivers is important for the successful support of left ventricular assist device (LVAD) patients. We aimed to (1) evaluate quality of life (QoL) of caregivers pre-and post-LVAD implant and (2) identify factors associated with caregivers QoL. Methods: The caregivers QoL was assessed with the Short Form-8 before implant, at 3 and 6 months after LVAD implantation. The physical and mental component summary (PCS and MCS) scores were calculated. Caregiver burden was evaluated using the 8-item Zarit Caregiver Burden Interview. Results: Data were collected from LVAD patients as bridge-to-transplant and their family caregivers in Japan. No significant changes were found in caregivers PCS scores during the follow-up (before 52.7 +/- 7.1; at 3 months 49.7 +/- 6.5, and at 6 months 50.7 +/- 6.4, n = 20). Compared with the scores before implant (38.9 +/- 9.3), the caregivers MCS scores improved after LVAD implantation at 3 months (44.2 +/- 7.7; p = 0.03) and at 6 months (46.2 +/- 7.4, p = 0.003), but they were still lower than those of the Japanese general population (p amp;lt; 0.01). In multiple regression analysis at 3 months (n = 40), caregivers lower PCS scores were associated with older patient age [standard partial regression coefficients (s beta) = -0.36, p = 0.02] and caregiver unemployment (s beta = 0.30, p = 0.04), whereas being female (s beta = -0.26, p = 0.03), being the patients spouse (s beta = -0.23, p = 0.03), and having a mild to moderate caregiving burden (s beta = -0.63, p amp;lt; 0.001) were associated with lower MCS scores among caregivers. Conclusions: LVAD implantation improves caregivers mental QoL. Since caregivers MCS scores are lower than the general population, it is important to identify family caregivers at risk for low QoL and reduce their caregiving burden. (C) 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
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