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Biomedical subjects

J M Arizón

Publications and source records attributed to J M Arizón.

At least 19 recordsLinked to original sources
PubMed2006

sHLA-G levels in the monitoring of immunosuppressive therapy and rejection following heart transplantation.

The aim of this study was to further determine the immediate influence, over a 12-h period, after the initiation of daily immunosuppressive treatment on the serum levels of sHLA-G in heart transplant patients during the post-transplant period (1 month). It was found that there are two patterns of patients in term of the changes observed in their levels of sHLA-G in response to the immunosuppressive treatment. One group (group A) showed no changes on sHLA-G while the other group (group B) a significant rise in sHLA-G levels was observed at 2 to 4 h post dose. Interestingly, it was observed that the patients in group B have better prognosis of acceptance of the heart graft than those of group A. On the other hand it was found that the patients with high levels of sHLA-G (77.3+/-34.8 ng/ml) in pre-transplant sera have a better prognosis of acceptance of the heart graft than those with low sHLA-G levels (9.7+/-7.1 ng/ml). In conclusion, both the intensity of changes of sHLA-G levels induced by immunosuppression and basal levels in pre-transplant could be used in the monitoring of the immunosuppression as well as the heart transplant evolution.

Acute Disease↗
PubMed2006

Soluble HLA-G in heart transplantation: their relationship to rejection episodes and immunosuppressive therapy.

The aims of this study were to quantify the level of soluble HLA-G in heart transplant patients, to determine the relationship between the sHLA-G levels and the appearance of acute rejection episodes, and to identify the influence of immunosuppressive therapy on sHLA-G levels. Analysis of sHLA-G, measured by enzyme-linked immunosorbent assay in the transplant patients, revealed the existence of two similarly sized groups of patients. One group displayed a significant increase (p < 0.001) in sHLA-G during the first month after transplantation while the other group maintained low levels of the molecule (0-30 ng/ml) throughout the study. The latter group displayed a high incidence of recurrent severe rejection. A significant increase (p < 0.01) in sHLA-G 2 hours after administration of immunosuppressive treatment (mycophenolate mofetil, cyclosporine A/FK506, corticoids) was found. These results suggest that sHLA-G participates in the induction of certain levels of immunological tolerance in these recipients.

Adolescent↗
PubMed2005

Relationship between pharmacokinetic parameters of cyclosporin and the incidence of acute rejection after heart transplantation.

Despite two decades of use, there are limited data on the best way to monitor Cyclosporine (CsA) for heart transplantation. The aim of our study was to determine the relationships between pharmacokinetic parameters and clinical outcomes after heart transplantation and to evaluate the range of CsA trough levels provided the most effective protection against graft rejection. We retrospectively analyzed the clinical outcomes of all adult patients who received a heart transplant between January 1998 and February 2005. All had routine monitoring of CsA trough levels and scheduled endomyocardial biopsies. Rejection was defined as grade > or =3, based on International Society for Heart and Lung Transplantation (ISHLT) criteria. Follow-up period was 1 year. All patients were on CsA, corticosteroids, and azathioprine/mycophenolate mofetil with or without antilymphocyte induction (eight patients with basiliximab). Data were analyzed by unpaired Student t-test, Cox regression model, and ROC curve. Among 70 patients (60 men and 10 women) who entered the study, 34 (48.6%) had at least one acute rejection episode of grade > or =3 during the first posttransplant year. Mean CsA trough level (C(0)) measured at first week posttransplant was significantly lower in the rejection than the no-rejection group (125.17 +/- 56.9 ng/mL versus 169.33 +/- 48.27 ng/mL, P = .001). C(0) was the strongest predictor of acute graft rejection (P = .000, HR = .985.) The risk decreased by 1.5% for each unit increase of the C(0) value. ROC analysis showed that C(0) of 150 ng/mL provided the optimal cutoff. Patients with mean C(0) >150 ng/mL over the first week had less incidence of acute rejection than patients with levels <150 ng/mL (30.3% versus 64.9%) (P = .009, Cochran-Mantel-Haenszel test). In conclusion, our data suggest that in heart transplant patients it may be crucial to target early trough levels above 150 ng/mL during the first days postsurgery to avoid rejection.

Adolescent↗
PubMed2000

Role of orthotopic liver transplant in the treatment of homozygous familial hypercholesterolemia.

UNLABELLED: Homozygous familial hypercholesterolemia is an inherited metabolic disease that leads to decreased catabolism of low-density lipoprotein cholesterol. As a result coronary artery disease ensues by the first or second decade. Because most low-density lipoprotein receptors (50-75%) are located in the liver, liver transplantation has been introduced as a therapeutic option in this disorder. AIMS: To report our experience in the treatment of homozygous familial hypercholesterolemia with ortothopic liver transplantation. We evaluated metabolic results and patient survival. METHOD: We treated two affected siblings. One of them received a sequenced heart-liver transplantation because of cardiac failure due to severe coronary disease. RESULTS: The operative and postoperative course was favourable in both patients, with a decrease in cholesterol levels to normal values. Four years later both were alive and both had normal liver and heart functions. Neither patient needed cholesterol-lowering drugs, and the disease had not progressed. CONCLUSIONS: As shown by our results and those reported by others, liver transplantation is the treatment of choice for homozygous familial hypercholesterolemia until gene therapy becomes a viable option. Transplantation should be done before of cardiovascular complications develop.

Adolescent↗
PubMed1998

Bezafibrate and lovastatin decrease the oxidizability of low-density lipoproteins in heart transplant recipients with hyperlidemia.

BACKGROUND: Oxidized low-density lipoprotein plays an important role in the development of atherosclerosis. We evaluated the effect of two lipid-lowering drugs, bezafibrate and lovastatin, on the susceptibility of low-density lipoproteins for oxidation in vitro in 21 heart transplant recipients with hyperlipidemia. METHODS: Patients were given the same diet for 3 months, and after that they were randomized to lovastatin or bezafibrate for a period of 8 weeks and then crossed over to an additional 8 weeks of either bezafibrate or lovastatin. Baseline parameters were also compared with those of a control group of healthy subjects and after both periods of pharmacologic treatment. RESULTS: The low-density lipoproteins of transplant recipients presents a shorter lag time than in control subjects (64+/-3 vs 80+/-4 minutes, respectively). This parameter increases after both bezafibrate and lovastatin treatment (83+/-5 and 80+/-4 minutes, respectively). Moreover, we did observe a negative correlation between insulinemia and the lag time of oxidation after bezafibrate treatment (r = -0.5014, P < .021) and between the polyunsaturated fatty acids/monounsaturated fatty acids ratio in low-density lipoprotein cholesterol esters and lag time after lovastatin treatment (r = -0.4631, P < .04). CONCLUSIONS: Bezafibrate and lovastatin decrease the oxidizability of low-density lipoproteins in heart transplant recipients with hyperlipemia.

Bezafibrate↗
PubMed1997

[Primary cardiac lymphoma: presentation of a case and review of the literature].

We describe a case of primary cardiac lymphoma presenting with chest pain, complete AV block, negative T waves, and infiltration of the basal segments and right free ventricular wall on echocardiography, interpreted initially as hypertrophy. One month later the patient was readmitted with systemic disease and cardiac insufficiency. Furthermore multicentric myocardial infiltration with a nodular mass in the right atrium producing severe tricuspid stenosis was demonstrated. Surgical biopsy was performed and a high grade non-Hodgkin's lymphoma diagnosed. The patient died during the immediate post-operative period without receiving specific chemotherapeutic treatment. Reviewing the published cases, we found that primary cardiac lymphomas are fast growing tumors that infiltrate predominantly the right cavities and have limited therapeutic options.

Fatal Outcome↗
PubMed1994

Comparison of the effectiveness of lovastatin therapy for hypercholesterolemia after heart transplantation between patients with and without pretransplant atherosclerotic coronary artery disease.

With the aim of assessing the effectiveness and safety of lovastatin in patients with hypercholesterolemia after heart transplantation, as well as the potential differences in the lipid-lowering effect of lovastatin between patients with or without pretransplant coronary artery disease (CAD), we studied 63 heart transplant patients who had serum total cholesterol > 250 mg/dl in spite of dietary therapy. Mean age of subjects was 47 +/- 2 years. Triple-drug immunosuppressive therapy consisted of cyclosporine, azathioprine, and steroids. Thirty-nine patients (62%) had pretransplant CAD and 24 (38%) did not. Pretreatment serum lipid levels were: total cholesterol, 302 +/- 32 mg/dl; low-density lipoprotein (LDL) cholesterol, 201 +/- 35 mg/dl; high-density lipoprotein (HDL) cholesterol, 60 +/- 19 mg/dl; triglycerides, 205 +/- 86 mg/dl; and total/HDL cholesterol ratio, 5.4 +/- 1.6. Patients received 10 to 40 mg/day of lovastatin (mean dose 17 +/- 6) for 13 +/- 4 months. There were no serious adverse events. At 3 months, lovastatin decreased total cholesterol by 15% (p < 0.001), LDL cholesterol by 21% (p < 0.001), triglycerides by 17% (p < 0.05), and total/HDL cholesterol ratio by 17% (p < 0.001), and increased HDL cholesterol by 3% (NS). Although lovastatin was effective in both patients with pretransplant CAD and non-CAD, analysis of its effect in each subgroup (CAD and non-CAD) revealed that its lipid-lowering effect was higher for non-CAD patients (-20% vs -12% for total cholesterol, and -27% vs -17% for LDL cholesterol, both p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Cholesterol↗
PubMed1994

[The echocardiographic findings in patients with brain death. The implications for their selection as heart transplant donors].

INTRODUCTION AND AIMS: Brain death causes myocardial impairment by some mechanisms not yet well understood. The aim of this work was to assess the echocardiographic features found in these patients and their implication in donor selection for heart transplantation. METHODS: With this aim, we have studied 38 consecutive patients with brain death assessed as possible donors for heart transplant in our hospital in the last 3 years. Age was 23 +/- 13 years; 77% were male. No history of cardiac disease was present in any patient. An adequate transthoracic echocardiogram was obtained in 74% of patients; transesophageal view was used in the remaining 26%. RESULTS: Echocardiogram was strictly normal in only 14 patients (37%). Mild valvular alterations were found in 5 patients (13%); a dilated aortic root in 1 (3%); moderate concentric left ventricular hypertrophy in 5 (14%); mild pericardial effusion in 1 (3%); mild septal hypokinesia with normal left ventricular ejection fraction in 4 (10%); abnormal left ventricular diastolic function in 7 (18%); and diffuse hypokinesia with ejection fraction less than 60% in 14 (37%). In 7 patients (18%) ejection fraction was lower than 40% (one of them was cocaine-addict). Mean ejection fraction was 59 +/- 15% (23 to 83%). Only 2 of the 19 (10%) donor hearts implanted in our hospital showed early dysfunction after transplant, but no relation to pretransplant ejection fraction was found. Ejection fraction increased from 62% pretransplant to 73% at one week after transplant in the other 17 cases. CONCLUSIONS: Brain death commonly causes alterations of left ventricular function, and this impairment is severe in almost 20% of cases. These echocardiographic features must be known when selection of donors for heart transplantation is concerned.

Adolescent↗
PubMed1994

[The incidence, mechanisms and clinical factors predictive of sudden death in patients with severe heart failure evaluated in anticipation of heart transplantation].

INTRODUCTION AND OBJECTIVES: Sudden death is not uncommon in patients with severe congestive heart failure. The aim of our study was to assess the incidence, mechanisms and clinical predictors of sudden death in a large series of patients with severe congestive heart failure evaluated for heart transplantation. METHODS: With this aim we have reviewed our experience on 240 consecutive patients with severe heart failure studied in our hospital from May 1986 to June 1992. Heart failure was due to ischemic heart disease in 35% of patients and idiopathic dilated cardiomyopathy in 65%. Age was 47 +/- 12 years, left ventricular ejection fraction was 20 +/- 6%, and symptom class was IV in 88% of patients and III in 12%. RESULTS: Sixty-eight of the 240 patients (28%) died without transplantation. Death was sudden in 21 patients (31% of deaths, and 9% of all patients), due to heart failure in 41 (68%), and due to malignancy (ampuloma) in 1 (1%). Mechanism of sudden death could be identified in 12 cases: ventricular tachycardia/fibrillation in 8 and bradycardia/electromechanical dissociation in 4. On multivariate analysis (stepwise logistic regression), a lower tolerated captopril dosage (p = 0.004), a lower systolic blood pressure (p = 0.079) and a history of a ventricular tachycardia/fibrillation (p = 0.073) were independent predictors of sudden death. CONCLUSIONS: It seems possible to identify, between patients with severe heart failure, a subgroup of patients at higher risk for sudden death by means of such simple clinical parameters.

Acute Disease↗
PubMed1994

[Short- and long-term course of heart transplantation recipients with severe dysfunction of the graft associated with acute rejection].

INTRODUCTION AND OBJECTIVES: Acute rejection is still a common cause of death after heart transplantation, in spite of cyclosporine. The aim of our study was to assess the incidence of severe graft dysfunction associated with acute rejection and the short and long-term outcome of these patients. METHODS: Ten of our 100 first heart transplant patients have developed rejection-induced severe cardiac dysfunction (left ventricular ejection fraction determined by echocardiography < 35% associated with 3A, 3B or 4 acute rejection). Clinical outcome, complications and evolution of left ventricular function were studied. RESULTS: Five patients were given intravenous methylprednisolone 500 to 1000 mg/day for 3 days. The other 5 patients had severe heart failure and received antilymphocyte antibodies. Three patients treated with methylprednisolone alone and one patient treated with antilymphocyte antibodies died within the first week after therapy. Left ventricular ejection fraction increased from 26 +/- 4% to 51 +/- 6% at 1 month after therapy in the 6 survivor patients. Four of the 6 survivor patients also died before 1 year after rejection (3 due to infection). Thus, long-term, overall mortality was 80%. CONCLUSIONS: Although favorable short-term results can be achieved in patients with rejection-induced severe cardiac dysfunction with immunosuppressive therapy (mainly antilymphocyte antibodies), long-term prognosis seems poor, due to the increased rate of life-threatening infections.

Acute Disease↗
PubMed1993

Clinical and hemodynamic predictors of survival in patients aged < 65 years with severe congestive heart failure secondary to ischemic or nonischemic dilated cardiomyopathy.

To identify which clinical or hemodynamic parameters predict survival in patients with end-stage heart failure due to dilated cardiomyopathy, 130 consecutive patients aged < 65 years (mean 46 +/- 13) assessed for heart transplantation from May 1986 to April 1991 were studied. Mean follow-up was 15 +/- 11 months. Left ventricular ejection fraction was 22 +/- 7%. Left ventricular end-diastolic pressure was 27 +/- 9 mm Hg, and cardiac index was 2.2 +/- 0.6 liter/min/m2. Symptom class was IV in 91% of patients and III in 9%. Etiology was ischemic in 40% of patients and idiopathic in 60%. After intensive medical therapy, heart transplantation was considered indicated in 53% of patients, contraindicated in 20% and not indicated in 27%. Transplantation was performed in 36% of patients during follow-up, and 35% died and 29% were alive without transplantation. A comparison, excluding patients with transplantation, was performed between those who were alive and had survived > or = 6 months after assessment, and those who died. On multivariate analysis, the following 3 parameters were independent predictors of prognosis: intravenous inotropic requirement (p < 0.001), maximal, tolerated captopril dose (p = 0.013) and systolic blood pressure (p = 0.003). When patients with transplantation were considered as deaths, stabilization on medical therapy also reached statistical significance (p = 0.009). Classic prognostic markers including ventricular arrhythmias, left ventricular end-diastolic pressure, cardiac index, amiodarone therapy and etiology were not associated with prognosis in this homogeneous population of severely ill patients.

Adolescent↗
PubMed1993

[Infectious endocarditis due to Q fever. A report of 4 new cases].

Q fever (Coxiella burnetii) is an uncommon cause of culture-negative infective endocarditis. Four cases of Q fever endocarditis diagnosed at our hospital in the last 7 years are reported (8% of all infective endocarditis). Infection involved a prosthetic heart valve in 3 cases (15% of all prosthetic valve endocarditis), and one patient with single ventricle and pulmonary stenosis in the remaining case. Important complications developed in all cases, and 3 patients underwent cardiac surgery. Mortality was 50%. Some diagnostic and therapeutical aspects of this disease are discussed.

Adult↗
PubMed1993

[Orthotopic heart transplant. Study of early morbimortality (< or = 30 days). Experience at the Reina Sofía Hospital (Córdoba)].

From may 1986 to december 1991, we have performed 90 heart transplantation in the Hospital "Reina Sofía" from Córdoba. In the present study we analyze the early morbidity and mortality in a retrospective study on complications and factors determining its incidence. Seventy patients were male (86%) and 13 female (14%). Age ranged from 12 and 65 years. The 31% of patients needed in pharmacological support before transplantation, 15 of them were operated in a emergency situation because of cardiogenic shock. The pulmonary resistances oscillated between 0.5 and 8.7 units/m2 (Wood) (mean 2.5 +/- 1.4 units/m2). The mean time of ischaemia was 136 +/- 38 minutes (range 5-255 min). Hospital mortality (< or = 30 days) was 8.8% (8/90). No predictive factors from donor and recipient were found. Three main influences on complications were analyzed: a) influence of myocardial temperature, b) role of hematic cardioplegia, and c) usefulness of Aprotinin. Eighteen patients (20%) developed severe bradyarrhythmia needing a pacemaker in the post-operative period. We found a significant relationship with myocardial temperature (4.3 +/- 2.1 vs 6.2 +/- 2.6; p < 0.05) and transport solution temperature (5.8 +/- 2.3 vs 7.3 +/- 1.9; p < 0.05). No significant influence was found on the time of ischaemia, previous heart disease, previous treatment with Amiodarona, clinical condition, etc.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Spontaneous clinical and hemodynamic improvement in patients on waiting list for heart transplantation.

Heart transplantation is currently the most effective therapy for patients with severe heart failure due to dilated cardiomyopathy, although long-term survival without transplantation has been described in a few patients. We have identified five patients with severe heart failure who experienced a significant clinical and hemodynamic improvement while they were waiting for heart transplantation. At initial assessment, all five patients were symptom-class 4; left ventricular end-diastolic pressure was 33 +/- 4 mm Hg, left ventricular ejection fraction was 0.20 +/- 0.01, left ventricular end-systolic volume was 130 +/- 3 ml/min/m2, and cardiac index was 2.1 +/- 0.1 L/min/m2. These patients showed a marked improvement at two to ten months after initial assessment, while they were waiting for a donor heart. After a follow-up of 10 to 31 months (mean follow-up, 20 months), the five patients were still alive and their clinical and hemodynamic condition remained stable. On the contrary, survival was less than 15 percent at six months for the remaining patients with indications for heart transplantation but in whom transplant could not be performed because of the existence of contraindications or lack of donors; all these patients were dead at 18 months after initial assessment. The five patients who developed spontaneous favorable outcome showed a trend to have higher serum sodium values, shorter symptomatic history, lesser need for intravenous inotropic support, and better response to medical therapy than the other patients. Our findings suggest that some patients with transplants could have experienced a sustained and spontaneous clinical and hemodynamic recovery with medical therapy alone, although it seems currently difficult to identify patients with this favorable outcome.

Adult↗