Publications by authors named "Dor Lotan"
Hemophagocytic lymphohistiocytosis (HLH) is a rare and deadly disease that presents significant diagnostic challenges. The complexity of diagnosis and treatment is further increased among transplant recipients, yet reports on solid organ transplants, and specifically heart transplant recipients, remain scarce. Herein, we elucidate the diagnostic journey, clinical evolution, and therapeutic approach undertaken for a heart transplant recipient afflicted with hemophagocytic lymphohistiocytosis, followed by a review of the literature.
View Article and Find Full Text PDFMonoclonal immunoglobulin deposition disease (MIDD) is characterized by deposits of intact monoclonal immunoglobulin protein, most commonly in the kidney, but other organs such as the heart can be involved. Patients are treated with plasma cell-directed therapies. Here we describe the first reported case of a patient with refractory MIDD with renal and cardiac involvement who was successfully treated with a BCMA-drected therapy.
View Article and Find Full Text PDFBackground: GLP-1 RAs improve cardiometabolic outcomes in obese, diabetic, and heart failure patients. Data on the safety and efficacy of GLP-1 RA in advanced heart failure with durable LVAD is limited.
Objectives: To assess the safety and efficacy of GLP-1 RA in durable LVAD patients.
Background: Cardiac allograft vasculopathy (CAV) leads to impaired myocardial blood flow (MBF), increasing the risk of cardiovascular death or retransplant among heart transplantation (HT) recipients. Data on elevation in donor-derived cell-free DNA (dd-cfDNA) and CAV in the absence of rejection are mixed. We sought to test the hypothesis that CAV with reduced MBF (RMBF) is associated with elevated dd-cfDNA.
View Article and Find Full Text PDFBackground: Donor-derived cell-free DNA (dd-cfDNA) has emerged as a reliable, noninvasive method for the surveillance of allograft rejection in heart transplantation (HT) patients, but its utility in multi-organ transplants (MOT) is unknown. We describe our experience using dd-cfDNA in simultaneous MOT recipients.
Methods: A single-center retrospective review of all HT recipients between 2018 and 2022 that had at least one measurement of dd-cfDNA collected.
Background: Cancer survivors (CS) comprise a particularly high-risk group for both de-novo and recurrent malignancies after solid organ transplantation.
Case Presentation: We report a case of relapsed melanoma, presented as metastatic disease seven months after heart transplantation in a patient who had an early-stage melanoma resected 25 years prior. Treatment with a combination of dabrafenib, a BRAF inhibitor, and trametinib, a mitogen-activated protein kinase (MEK) inhibitor resulted in a near-complete metabolic response, without major adverse effects.
Article Synopsis
- Heart failure (HF) is a major public health issue in the U.S., leading to numerous deaths but treatable through medical and device therapies that can improve heart function.
- Artificial intelligence (AI) and machine learning (ML) are emerging as powerful tools for identifying predictors of heart recovery, offering potential advancements in patient care.
- The review explores how ML can aid in predicting heart recovery, understanding its mechanisms, challenges in clinical application, and future research directions.
Article Synopsis
- The increasing demand for organ transplants and advancements in LVAD technology have made LVADs a key option for patients awaiting heart transplants.
- The text discusses the current processes involved in LVAD implantation, focusing on patient selection, preparation before the device is implanted, and outcomes after transplantation.
- A recent policy change in the US has decreased the use of LVADs for transplantation, prompting suggestions to adjust allocation criteria to improve implantation rates.
Article Synopsis
- The HeartMate 3 survival risk score was validated to predict survival chances for patients receiving a HeartMate 3 left ventricular assist device, categorizing them into different survival probability groups.
- A study involving 181 patients revealed that those in the high survival group had a significantly higher two-year survival rate compared to average and low survival groups, with rates of 93.5%, 81.6%, and 82.0%, respectively.
- Although the score's original stratification didn't clearly show survival differences, using a binary cutoff indicated better survival for patients in the high-risk category, demonstrating its potential utility in clinical settings.
Article Synopsis
- - The study investigated the effects of two heart preservation methods—ice-cold storage (ICS) and the Paragonix SherpaPak CTS—on ischemia reperfusion injury (IRI) following heart transplantation, as ischemic times have increased since the 2018 allocation system change.
- - Analysis of biopsies from 90 heart transplant recipients showed similar IRI rates between the two methods, but the CTS group had a significant reduction in coagulative myocyte necrosis (CMN) from weeks 1 to 4, and both methods showed reductions by week 8.
- - Despite longer ischemic times with CTS, the study found no significant differences in rejection rates or survival between the groups, suggesting that CTS is a viable option
Objectives: To evaluate the clinical implications of adjunctive molecular gene expression analysis (MMDx ) of biopsy specimens in heart transplant (HT ) recipients with suspected rejection.
Introduction: Histopathological evaluation remains the standard method for rejection diagnosis in HT. However, the wide interobserver variability combined with a relatively common incidence of "biopsy-negative" rejection has raised concerns about the likelihood of false-negative results.
Background: Age and sex can be estimated using artificial intelligence on the basis of various sources. The aims of this study were to test whether convolutional neural networks could be trained to estimate age and predict sex using standard transthoracic echocardiography and to evaluate the prognostic implications.
Methods: The algorithm was trained on 76,342 patients, validated in 22,825 patients, and tested in 20,960 patients.
Article Synopsis
- Recurrent pericarditis (RP) affects about 30% of patients who initially experience acute pericarditis (AP), with a study examining 765 patients revealing that 17.5% had recurrence within an average of 101 days.
- Patients experiencing recurrence often show less severe clinical signs compared to their first event, with notable differences in ECG changes, pericardial effusion, and inflammatory markers.
- There is a need for further research on advanced biomarkers and imaging techniques to better identify and understand true RP events.
Article Synopsis
- Belatacept (BTC) is a fusion protein that inhibits T-cell activation and has primarily been used for immunosuppression in kidney transplants, but its effectiveness for heart transplant patients remains less understood.
- A retrospective study analyzed 21 heart transplant recipients who received BTC between 2017 and 2021, focusing on their health outcomes, including rejection rates and kidney function over a follow-up period that extended to December 2023.
- Results indicated that BTC treatment had a low rejection rate (4.8%) and stable graft function, with a slight improvement in kidney health for the majority of the patients, though a significant portion of them discontinued the treatment within the study period.
Article Synopsis
- Patients with HeartMate 3 LVADs show improved hemodynamics through pump speed adjustments, particularly during hemodynamic ramp tests conducted from 2015 to 2022.
- Out of 60 studied patients, only 58% had optimized filling pressures at baseline, but after speed adjustments, 65% achieved optimized measurements.
- Those who attained optimized pressures experienced significantly lower readmission rates over 6 and 12 months, mainly due to reduced cardiac-related hospitalizations, compared to nonoptimized patients.
Article Synopsis
- Among heart transplant recipients, a small number go on to receive multiple transplants, but the outcomes of these individuals are not well understood.
- A study of patients from the UNOS registry between 1990 and 2020 found that those receiving a third heart transplant had significantly higher rates of one-year and ten-year mortality compared to those who received their first or second transplant.
- The findings suggest that third heart transplants come with greater health risks, especially for older patients and those who experience acute graft failure, indicating a need for better management strategies for this unique group.
Article Synopsis
- * Out of 10 documented pregnancies during LVAD support, 8 resulted in successful births, while 1 case involved maternal and fetal mortality and another was a spontaneous abortion.
- * The study emphasizes the importance of a collaborative care approach, proper medication management, and understanding the physiological changes during pregnancy to support maternal and fetal health while on LVAD.
Article Synopsis
- Monitoring for graft rejection is essential in post-transplant care, especially in heart transplants, where traditional methods like endomyocardial biopsy (EMB) have limitations, including complications and variability in interpretation.
- Newer noninvasive tools, such as cardiac biomarkers, imaging, gene expression profiling, donor-derived cell-free DNA, and the molecular microscope diagnostic system (MMDx), have emerged as important alternatives for rejection surveillance.
- The paper argues for the use of MMDx to enhance early detection of rejection when results from EMB don't align with other noninvasive screening methods.
Article Synopsis
- Aortic regurgitation (AR) is a common issue after left ventricular assist device (LVAD) implantation, specifically in patients with HeartMate 3 (HM3).
- In a study of 62 stable patients, nearly half had at least mild AR at baseline, but hemodynamic measures did not differ significantly between those with and without AR at the start.
- While AR did not impact one-year mortality or hospitalization rates, it was associated with increased rates of worsening AR and right ventricular failure over time.
Article Synopsis
- * Liver transplantation is necessary when treatments for PA fail and can help slow the progression of heart issues, but severe heart disease can complicate the possibility of a transplant.
- * A case study is presented of a PA patient who underwent both heart and liver transplants with the aid of a Left Ventricular Assist Device, emphasizing the need for a comprehensive care approach to manage potential surgical complications, such as metabolic acidosis.
Article Synopsis
- The study examines the prevalence of heparin-induced thrombocytopenia (HIT) in critically ill COVID-19 patients, finding a significant association with severe clinical outcomes.
- Out of 107 patients, over half experienced thrombocytopenia, leading to complications such as increased ventilation needs, disseminated intravascular coagulation (DIC), and higher mortality rates.
- The research suggests that understanding HIT's role in COVID-19 is crucial due to its impact on immune response and coagulopathy, highlighting the need for precise treatment protocols.
Sex differences in patients undergoing heart transplantation and LVAD therapy.
Expert Rev Cardiovasc Ther
November 2022
Article Synopsis
- LVAD and heart transplantation (HT) are crucial therapies for end-stage heart failure, but there's a notable disparity in how they affect men and women.
- The review highlights sex differences in the use, outcomes, and complications of both treatments, referencing clinical trials and large registries.
- Women are often under-treated and less frequently referred for LVAD or HT, suggesting a need for better community outreach, education, and more female representation in clinical research to address these disparities.