Sunday, December 29, 2013

World's longest surviving heart transplant at 31 years 

Heart transplant patient is a record breaker

A man from Newport Pagnell near Milton Keynes has become the world's longest surviving heart transplant patient.
When he had the operation in 1982, John McCafferty was told that if the transplant was successful he could survive for five more years.
Thirty one years on, he says he's forever grateful to the doctors and the donor who saved his life.
Click below to watch Olivia Paterson's report.

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Monday, December 09, 2013

Killer "T" cells “learn” to hunt down and attack cancer cells, researchers claim.

New wonder drug matches and kills all kinds of cancer — human testing starts 2014

New wonder drug matches and kills all kinds of cancer — human testing starts 2014

Stanford researchers are on track to begin human trials of a potentially potent new weapon against cancer, and would-be participants are flooding in following the Post’s initial report on the discovery.
The progress comes just two months after the groundbreaking study by Dr Irv Weissman, who developed an antibody that breaks down a cancer’s defense mechanisms in the body.
A protein called CD47 tells the body not to “eat” the cancer, but the antibody developed by Dr Weissman blocks CD47 and frees up immune cells called macrophages — which can then engulf the deadly cells.
The new research shows the miraculous macrophages effectively act as intelligence gatherers for the body, pointing out cancerous cells to cancer-fighting “killer T” cells.
The T cells then “learn” to hunt down and attack the cancer, the researchers claim.
“It was completely unexpected that CD8+ T (killer T) cells would be mobilized when macrophages engulfed the cancer cells in the presence of CD47-blocking antibodies,” said MD/PhD student Diane Tseng, who works with Dr. Weissman.
The clinical implications of the process could be profound in the war on cancer.
When macrophages present “killer T” cells with a patient’s cancer, the T cells become attuned to the unique molecular markers on the cancer.
This turns them into a personalized cancer vaccine.
“Because T cells are sensitized to attack a patient’s particular cancer, the administration of CD47-blocking antibodies in a sense could act as a personalized vaccination against that cancer,” Tseng said.
The team of researchers at Stanford plan on starting a small 10-100 person phase I clinical human trial of the cancer therapy in 2014.
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Friday, December 06, 2013

Scientists used human stem cells for lung tissue

Scientists had previously converted stem cells into cells of the heart, intestine, liver, nerves and pancreas, Fox News reports.

"Now, we are finally able to make lung and airway cells," study leader Dr. Hans-Willem Snoeck, a professor of microbiology and immunology at Columbia University in New York, said in a statement.

Patients who receive lung transplants today have a poor prognosis. But future approaches involving transplants that use the patient's own stem cells to generate lung tissue could reduce the chances that a patient's immune system would reject the transplant, the researchers said. 
In the new study, Snoeck's team found evidence suggesting the cells could develop into six types of lung and airway epithelial cells.

The technology could enable researchers to model certain lung diseases.

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Wednesday, December 04, 2013

Left ventricular assist device (LVAD) and an association with substantial morbidity and mortality.

Increased rates of LVAD pump thrombosis reported at 3 centers

Starling RC. N Engl J Med. 2013;doi:10.1056/NEJMoa1313385. Today
Three US centers report increasing rates of pump thrombosis related to the use of the HeartMate II left ventricular assist device and an association with substantial morbidity and mortality.

“Pivotal trials and postmarketing approval studies of the HeartMate II provide a reference occurrence of thrombosis of 2% to 4%; however, an unexpected abrupt increase in the incidence of pump thrombosis was observed in a single-center quality review,”Randall C. Starling, MD, MPH, of Cleveland Clinic, and colleagues wrote inThe New England Journal of Medicine. “To confirm that this finding was not an isolate phenomenon, two additional experienced centers pooled data to investigate the incidence of pump thrombosis and of elevated lactate dehydrogenase (LDH) levels as its clinical biomarker (indicating hemolysis), LDH levels that may presage thrombosis and outcomes of thrombosis-management strategies.”
The analysis included data on 837 patients and 895 HeartMate II devices (Thoratec) that were implanted from 2004 to mid-2013 at Cleveland Clinic, Duke University Medical Center and Washington University Barnes-Jewish Hospital.
Confirmed pump thrombosis served as the primary endpoint. According to results, 72 pump thromboses were confirmed in 66 patients. Thirty-six additional thromboses of unique devices were suspected.
From March 2011 to January 2013, the occurrence of confirmed pump thrombosis at 3 months post-implantation increased from 2.2% to 8.4%. The median time from implantation to thrombosis decreased, from 18.6 months before March 2011 to 2.7 months after March 2011.
An increased occurrence of elevated LDH levels at 3 months post-implantation also increased during the study period. Thrombosis was presaged by LDH levels that increased from 540 IU/L to 1,490 IU/L in the weeks before diagnosis, according to the study results.
Eleven patients had their pump thrombosis managed by heart transplantation; one patient died 31 days after transplantation. Twenty-one patients had their thrombosis managed by pump replacement. In this group, mortality was similar to that of patients with no thrombosis. The researchers also reported data on 40 thromboses in 40 patients not managed by transplantation or pump replacement; in the 6 months after pump thrombosis, the actuarial mortality was 48.2%.
“Further investigation of predisposing patient and device factors and preventive and therapeutic strategies are urgently needed to resolve this important safety issue,” the researchers concluded. “We recognize that LVADs provide life-sustaining treatment for many patients with advanced heart failure. However, recommendations for LVAD therapy should account for this updated risk-benefit profile.”
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.

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Tuesday, December 03, 2013

Rehospitalization after kidney transplant caused by complexity of the condition, not poor quality of care

Most early rehospitalization after kidney transplant caused by complexity of the condition, not poor quality of care

A study of over 750 kidney transplant patients over a five-year period conducted by researchers at the Perelman School of Medicine at the University of Pennsylvania has found that 90% of early rehospitalizations (within 30 days of surgery) were caused by complex medical factors related to the transplantation process. Only nine percent of rehospitalizations – which occurred among only three percent of the entire group of patients – were categorised as potentially preventable.
The study, published online this week in the American Journal of Transplantation, found that 237 patients (nearly one-third) were rehospitalized early following surgery, with a median of nine days to rehospitalization after discharge from kidney transplant. In most of these cases, the readmissions were unplanned and occurred as a result of common postsurgical complications. Deep vein thrombosis (blood clots), post-operative pain, organ rejection, fluid imbalances including volume overload (too much fluid in the blood) or volume depletion (decrease in volume of blood plasma, potentially leading to shock), and wound infections were key complicating factors leading to early rehospitalisation.
“Nationally, high rates of early rehospitalization after kidney transplantation have been reported, but little information is available about what caused these events and whether they could be prevented,” said lead study author Meera Nair Harhay, MD, MSCE, instructor of Medicine in the Renal, Electrolyte and Hypertension Division at Penn. “Early rehospitalization has also been examined by Medicare as a hospital quality of care indicator, with financial penalties for early rehospitalization after certain medical conditions. However, our findings indicate that transplant recipients are a particularly vulnerable group that often requires additional care after undergoing surgery and being exposed to new medications.”
In the study, which is the first to use intensive chart review to assess preventability of early rehospitalization, two physicians independently examined the medical charts of the 237 readmitted transplant patients. Only 19 cases were found to be preventable readmissions by the reviewing physicians. Preventable causes of readmission identified by the study include 1) patients not having had an outpatient physician/nurse practitioner assessment before being admitted, 2) an alternative medical regimen not having been prescribed at discharge, 3) patients not having been compliant with their medication regimen, and 4) inadequate outpatient diagnostic or therapeutic procedures having been available.
The study also found that 30% of rehospitalized patients were originally discharged after their transplant on the weekend, versus 23% of patients who were not readmitted –a statistically significant finding highlighting the need for careful transitions of care when staffing is variable and more limited, such as occurs on the weekends. “If further multicenter studies confirm these findings, transplant centers should consider augmenting staffing and the oversight related to weekend discharges,” said senior author Peter Reese MD, MSCE, assistant professor of Medicine and Epidemiology at Penn.
The study also revealed how long waiting times for transplantation increase the risk of post-transplant complications. For every year of additional waiting time prior to kidney transplantation, recipients were 10% more likely to experience early rehospitalization. Kidney transplant recipients who were rehospitalized within 30 days of transplant were 55% more likely to die within a six-year follow-up period than those who were not rehospitalized. “These findings indicate that early rehospitalization may be a strong signal of patient vulnerability, and such patients may benefit from more careful clinical monitoring post-transplant,” said Harhay.
(Source: University of PennsylvaniaAmerican Journal of Transplantation
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