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Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
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Transplante cardiaco
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Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
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Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
Transplante cardiaco
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Transplante cardiaco

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Aspectos generales del trasplante cardíaco, resultados, indicaciones, complicaciones y selección de candidatos

Aspectos generales del trasplante cardíaco, resultados, indicaciones, complicaciones y selección de candidatos

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  • This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, the presented data may not mirror the changes in the number of heart transplants performed worldwide .
  • Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not known for all patients. Therefore, 95% confidence limits are provided about the survival rate estimate; the survival rate shown is the best estimate but the true rate will most likely fall within these limits. The half-life is the estimated time point at which 50% of all of the recipients have died. The conditional half-life is the estimated time point at which 50% of the recipients who survive to at least 1 year have died. Because the decline in survival is greatest during the first year following transplantation, the conditional survival provides a more realistic expectation of survival time for recipients who survive the early post-transplant period.
  • UNOS:
  • This figure shows the maintenance immunosuppression reported as being provided at the time of the 1-year and 5-year annual follow-up forms. To provide a snapshot of current practice, only follow-ups occurring between January 2007 and June 2009 were included. Therefore, this figure does not represent changes in practice between the 1-year follow-up and 5-year follow-up on a cohort of patients. The patients in the 1-year tabulation are not the same patients as in the 5-year tabulation.
  • This table shows the percentage of patients experiencing various morbidities as reported within 1, 5 and 10 years following transplantation. The percentages are based on patients with known responses. To reduce bias, only patients with responses reported on every follow-up through the 5-year annual (or 10-year annual) follow-up were included in the 5-year (or 10-year) analysis. Because the outcomes are reported to be unknown at different rates the number with known responses for each outcome are also provided.
  • Only known causes of death are included in the tabulation.
  • This figure shows the functional status reported on the 1-year, 3-year, 5-year and 7-year annual follow-ups. Because all follow-ups between 1995 and June 2009 were included, the bars do not include the same patients.
  • El estudio Veteranos II es la mayor base de datos de determinaciones de capacidad funcional en p con IC. En el análisis multivariado el VO2 pico fue el primer predictor de mortalidad y seguido por la FEVI. El ajuste del VO2 max por sexo, edad y peso corporal refina su valor pronóstico. Alcanzar un porcentaje de VO2 max predicho menor o igual a 50% pareciera ser un predictor más fuerte de mortalidad que el valor absoluto. Un valor inferior de VO2 max es considerado una indicación clase 1 de TxC. Los valores entre 10 y 14 son considerados diferentes según los centros. La utilidad del test señala a los p con valores normales ( mayores de 18-20) que tienen muy buena evolución., mientras que en aquellos con valores menores es la medición de parámetros hemodinámicos de esfuerzo la que debe guiar la toma de decisiones.
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    • 1. TRANSPLANTE CARDIACO - Resultados - Selección de candidatos a transplante cardiaco Edgardo J. Kaplinsky
    • 2. La Historia del Transplante Cardíaco 3 de Diciembre de 1967
    • 3. Primera supervivencia: 18 días Christiaan Barnard Louis Washkansky . La Historia del Transplante Cardíaco
    • 4. La Historia del Transplante Cardíaco
    • 5. Tolypocladium inflatum  Gams 1983 Ciclosporina A: mejora la supervivencia
    • 6. Biopsia Endomiocárdica: Optimiza el diagnóstico del rechazo
    • 7. Graduación de la BEM (Version de 1990) International Society For Heart and Lung Transplantation Infiltrado difuso con daño miocítico extenso ± edema ± hemorragia ± vasculitis 4 - Severo Infiltrado difuso con daño miocítico Multifocal B - Difuso Infiltrado multifocal con daño miocítico 3 - Moderado A - Multifocal Un foco de infiltrado c/ daño miocítico 2 - Moderado (focal) Infiltrado difuso sin daño miocítico B - Difuso Infiltrado focal perivascular y/o intersticial sin daño miocítico 1 - leve A - Focal No evidencia de rechazo 0 Descriptiva Grado de rechazo
    • 8. Grado 1A: Infiltrado focal perivascular sin daño miocítico leve Grado 1B: Infiltrado difuso sin daño miocítico Grado 2: Infiltrado difuso con al menos un foco de daño miocítico
    • 9. Grado 3A: Infiltrado multifocal c/ daño miocítico Moderado Grado 3B: Infiltrado difuso confluyente con daño miocítico Grado 4: Infiltrado polimorfo difuso con al daño miocítico / edema / hemorragia Severo
    • 10. Requieren tratamiento Rechazo Celular Agudo 3B y 4 Severo 3 R 3A Moderado 2 R Combina: 1A, 1B, y 2 Leve 1 R Sin rechazo Sin rechazo 0 1990 ISHLT 2004 ISHLT
    • 11. NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR NOTE: This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry.  As such, the presented data may not mirror the changes in the number of heart transplants performed worldwide 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
    • 12. Transplante Cardíaco en España
    • 13. HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2005) HEART TRANSPLANTATION Kaplan-Meier Survival (1/1982-6/2008) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
    • 14. Transplante Cardíaco en España
    • 15. Sobrevida actuarial: transplantados vs. no transplantados Hospitalizados Ambulatorios United Network for Organ Sharing (UNOS)
    • 16. DIAGNOSIS IN ADULT HEART TRANSPLANTS Characteristics of Donors & Recipients 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141 <0.0001 33.0 ± 13.0 (16.0 - 55.0) 31.0 ± 12.9 (15.0 - 54.0) Donor age (years) 0.0906 54.0 ± 12.4 (25.0 - 67.0) 54.0 ± 11.0 (28.0 - 65.0) Recipient age (years) p-value 2002-6/2009 (N=21,862) 1992-2001 (N= 36,836 )
    • 17. Transplante Cardíaco en España Edad media donante: 37 a
    • 18. ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up (Follow-ups: January 2007 - June 2009) NOTE: Different patients are analyzed in Year 1 and Year 5 Analysis is limited to patients who were alive at the time of the follow-up 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
    • 19. Transplante Cardíaco en España
    • 20. POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors at 1, 5 and 10 Years Post-Transplant (Follow-ups: April 1994 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
    • 21. Enfermedad Vascular del Injerto
    • 22. ADULT HEART TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death (Deaths: January 1992 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
    • 23. Transplante Cardíaco en España
    • 24. ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2009) Percentages represent % of deaths in the respective time period CAUSE OF DEATH 0-30 Days (N = 3,771 ) 31 Days – 1 Year (N = 3,675 ) >1 Year – 3 Years (N = 2,848 ) >3 Years – 5 Years (N = 2,448 ) >5 Years – 10 Years (N = 5,592 ) >10 Years – 15 Years (N = 3,070 ) >15 Years (N =1,075) Cardiac Allograft Vasculopathy 63 (1.7%) 173 (4.7%) 394 (13.8%) 386 (15.8%) 806 (14.4%) 455 (14.8%) 134 (12.5%) Acute Rejection 242 (6.4%) 442 (12.0%) 292 (10.3%) 110 (4.5%) 100 (1.8%) 28 (0.9%) 8 (0.7%) Lymphoma 2 (0.1%) 69 (1.9%) 93 (3.3%) 106 (4.3%) 254 (4.5%) 119 (3.9%) 43 (4.0%) Malignancy, Other 4 (0.1%) 82 (2.2%) 311 (10.9%) 448 (18.3%) 1,064 (19.0%) 599 (19.5%) 188 (17.5%) CMV 4 (0.1%) 44 (1.2%) 18 (0.6%) 5 (0.2%) 6 (0.1%) 1 (0.0%) 0 Infection, Non-CMV 484 (12.8%) 1,116 (30.4%) 365 (12.8%) 245 (10.0%) 601 (10.7%) 313 (10.2%) 131 (12.2%) Graft Failure 1,553 (41.2%) 651 (17.7%) 681 (23.9%) 495 (20.2%) 1,015 (18.2%) 499 (16.3%) 153 (14.2%) Technical 270 (7.2%) 42 (1.1%) 19 (0.7%) 19 (0.8%) 41 (0.7%) 27 (0.9%) 11 (1.0%) Other 201 (5.3%) 303 (8.2%) 272 (9.6%) 211 (8.6%) 518 (9.3%) 275 (9.0%) 104 (9.7%) Multiple Organ Failure 508 (13.5%) 419 (11.4%) 144 (5.1%) 132 (5.4%) 382 (6.8%) 236 (7.7%) 90 (8.4%) Renal Failure 24 (0.6%) 36 (1.0%) 46 (1.6%) 88 (3.6%) 332 (5.9%) 254 (8.3%) 105 (9.8%) Pulmonary 154 (4.1%) 147 (4.0%) 111 (3.9%) 120 (4.9%) 235 (4.2%) 134 (4.4%) 59 (5.5%) Cerebrovascular 262 (6.9%) 151 (4.1%) 102 (3.6%) 83 (3.4%) 238 (4.3%) 130 (4.2%) 49 (4.6%) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
    • 25. ADULT HEART RECIPIENTS Cross-Sectional Analysis Functional Status of Surviving Recipients (Follow-ups: 1995 - June 2009) 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
    • 26.  
    • 27. Selección de candidatos a transplante cardiaco
    • 28. Transplante cardiaco: Indicaciones <ul><li>Shock cardiogénico requirente de asistencia mecánica </li></ul><ul><li>IC refractaria requirente de terapia inotrópica continua . </li></ul><ul><li>CF NYHA IV persistente y refractaria a tratamiento médico máximo </li></ul>Hospitalizados Ambulatorios
    • 29. Transplante cardiaco: Indicaciones <ul><li>Angina refractaria no revascularizable (tto percutáneo o cirugía) </li></ul><ul><li>Arritmia ventricular amenazante de vida intratable (tto médico, ablación, DAI). </li></ul>Miocardiopatia hipertrófica o restrictiva severamente sintomática. Tumores cardiacos sin metastasis. Cardiopatia congenita compleja o corazón izquierdo hipoplásico
    • 30. Transplante cardiaco: candidato ambulatorio Tratamiento medico máximo Descartadas otras alternativas Cirugia de revascularización, Reparación o reemplazo valvular, Resincronización, etc . MVO2 >14ml/kg/min 10 a 14 ml/kg/min <10 ml/kg/min: Lista espera p/ TxC Desestima p/ TxC ??????
    • 31. <ul><li>SOLVD Prev </li></ul><ul><li>SOLVD Tto </li></ul><ul><li>MERIT HF </li></ul><ul><li>US Carvedilol </li></ul><ul><li>CIBIS II </li></ul><ul><li>BEST </li></ul><ul><li>COPERNICUS </li></ul><ul><li>I / II 28 % 5 % </li></ul><ul><li>II / III 24 % 15 % </li></ul><ul><li>II / III 28 % 11 % </li></ul><ul><li>II / III 23 % 11.1 % </li></ul><ul><li>III / IV 28 % 13.2 % </li></ul><ul><li>III / IV 23 % 16.6 % </li></ul><ul><li>IV 19 % 18.5 % </li></ul>Insuficiencia Cardiaca: FE vs. Clase funcional Trial Clase Funcional FEVI Mortalidad Anual Placebo
    • 32. Mejor sobrevida en pacientes con un VO 2 pico > 14 ml/kg.min Reprinted from European Heart Journal , Volume 15, pages 495-502, with the kind permission of Harcourt Publishers Ltd. © 1994 The European Society of Cardiology. Roul G, Moulichon ME, Bareiss P, et al. Exercise peak VO 2 determination in chronic heart failure: is it still of value? European Heart Journal . 1994;15:498. Un sólido predictor de mortalidad Consumo Máximo de Oxígeno (MVO 2 ) N=75 VO 2 > 14 ml/kg.min N = 52 VO 2 < 14 ml/kg.min N = 23 Tasa de Sobrevida (%) 100 0 20 40 60 80 1 2 3 4 5 6 7 8 9 10 11 12 Meses
    • 33. Chon J. Circ.1993 Consumo Máximo de Oxígeno (MVO 2 )
    • 34. Transplante cardiaco: Contraindicaciones ABSOLUTAS
    • 35. Transplante cardiaco: Contraindicaciones ABSOLUTAS
    • 36. Transplante cardiaco: Contraindicaciones RELATIVAS
    • 37. Transplante cardiaco: Contraindicaciones RELATIVAS
    • 38. Selección de pacientes para transplante cardiaco: resistencias pulmonares
    • 39. Transplante cardiaco: casos especiales <ul><li>Receptores > 70 años </li></ul><ul><li>Diabéticos </li></ul><ul><li>HIV </li></ul><ul><li>Hipertensión pulmonar </li></ul>
    • 40. ADULT HEART TRANSPLANTS RECIPIENT AGE DISTRIBUTION BY LOCATION Transplants between January 2000 and June 2009 Mean/median recipient age: Europe = 50.7/53.0 North America = 51.7/54.0 Other = 48.2/51.0 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
    • 41. ADULT HEART TRANSPLANTS RECIPIENT DIABETES MELLITUS BY LOCATION Transplants between January 2000 and June 2009 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
    • 42. ADULT HEART TRANSPLANTATION % OF PATIENTS BRIDGED WITH MECHANICAL CIRCULATORY SUPPORT* (Transplants: 1/2000 – 12/2008) * LVAD, RVAD, TAH 2010 ISHLT J Heart Lung Transplant. 2010 Oct; 29 (10): 1083-1141
    • 43. Heart Transplantation in Human Immunodeficiency Virus–Positive Patients J Heart Lung Transplant. 2009 Jul;28(7):667-9. Epub 2009 May 6
    • 44. Primera supervivencia: 18 días Christiaan Barnard Louis Washkansky . La Historia del Transplante Cardíaco
    • 45. Kaylee Davidson trasplante cardiaco en 1987 Mario Bosetti Trasplante cardiaco en 1988 Oscar Cassarino trasplante cardiopulmonar en 1999

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