Heart Transplantation/trends

ABCIC

Case Report

Ramp-Test Echocardiography in Patients with Long-Term Continuous-Flow Ventricular Assist Device: Case Report and Systematic Review

Marco Stephan Lofrano-Alves et al. Carolina Santana dos Reis Santos Ana Carolina Miguel Pedro Henrique Basto Miranda … Marlon Almeida Guedes Silvia Moreira Ayub-Ferreira

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ABC

Editorial

Progress in Heart Transplantation in Brazil: is it Time to Build a National Database?

Mônica Samuel Avila et al. Deborah de Sá Pereira Belfort

Heart transplantation (HT) is the therapy of choice for advanced heart failure. Survival has greatly improved since the first heart transplant 50 years ago, especially after the introduction of calcineurin inhibitors and better management of complications related to immunosuppression. In Latin America, Brazil is renowned for the high number of HTs performed annually. Despite its importance, reports on survival, immunosuppression and complications of HT are scarce in Brazil.

A retrospective open cohort of HT in Brazil is presented in this issue of Arquivos Brasileiros de Cardiologia. The article shows important data regarding epidemiology, survival and complications of HT recipients between 2000 and 2015. Median survival in this cohort was 8.3 years, and one- and 5-year survival rates were 70.9% and 59.5%, respectively. These results are better than those from 1984 to 1999, when the one- and 6-year survival rates were 66% and 54% respectively, suggesting improvement in post-transplant care. However, this median survival is lower than 12.2-year survival and one- and 5-year survival of 81% and 69% reported by the International Society of Heart and Lung Transplantation (ISHLT), probably due to sociodemographic and economic differences between Brazil and developed countries.

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ABC

Original Article

Sixteen Years of Heart Transplant in an Open Cohort in Brazil: Analysis of Graft Survival of Patients using Immunosuppressants

Natália Cristina Cardoso Freitas et al. Mariangela Leal Cherchiglia Charles Simão Filho Juliana Alvares-Teodoro … Francisco de Assis Acurcio Augusto Afonso Guerra Junior

Abstract

Background:

Heart transplant is the main therapeutic alternative for advanced heart failure patients. Several risk factors affect these patients’ survival; however, few studies about the topic are available in Brazil.

Objectives:

To review the survival rates of heart transplant patients in the Brazilian Public Health System (Sistema Único de Saúde – SUS) between 2000 and 2015.

Methods:

This is a non-concurrent, open cohort study, involving cardiac transplant patients in Brazil. The cumulative survival probability was estimated by the Kaplan-Meier curve, and the curve comparison was done using the Log-Rank test. The Cox model was used to calculate the Hazard-Ratio (HR). Analyses were conducted at the 95% confidence level.

Results:

The heart transplant survival rate median in Brazil, during the period, was 8.3 years. Each additional year in the recipient’s age, the occurrence of infections, and the performance of the surgical procedure in the South Region were associated with a higher risk of graft loss. A higher use ratio of immunosuppressants mycophenolate and azathioprine acted as a protection factor.

Conclusions:

The analyses conducted provide the first information about the median survival time in heart transplant patients in Brazil. The difference noticed among the geographical regions may be related to the different treatment protocols adopted in the country, especially in the early 2000s. The rate of mycophenolate and azathioprine use as a protection factor suggests that, despite the absence of differences among therapeutic strategies, use of these drugs may favor survival of certain patients. The study provides robust epidemiological data, which are relevant for public health.

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Ramp-Test Echocardiography in Patients with Long-Term Continuous-Flow Ventricular Assist Device: Case Report and Systematic Review

Progress in Heart Transplantation in Brazil: is it Time to Build a National Database?

Sixteen Years of Heart Transplant in an Open Cohort in Brazil: Analysis of Graft Survival of Patients using Immunosuppressants

Abstract

Background:

Objectives:

Methods:

Results:

Conclusions:

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