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New Approach to Transplants Could Boost Supply of Donor Hearts

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THURSDAY, June 8, 2023 (HealthDay News) — A new transplant method that “reanimates” donor hearts appears safe and effective, a new clinical trial has found — in an advance that could substantially expand the supply of donor hearts available in the United States.

The trial tested an approach that allows doctors to transplant hearts from donors who have succumbed to “circulatory death” — meaning the heart has stopped beating. Traditionally, heart transplants could only be done with a heart from a donor on life support who has been declared brain dead. That means all brain functions have ceased, but the heart and other organs are being maintained by machines.

But thanks to a new “heart-in-a-box” device, doctors can now take a donor heart that has stopped beating and essentially revive it, and test its function to determine if it’s suitable for transplant.

In the new trial, conducted at 15 U.S. transplant centers, doctors found that the approach was on par with traditional heart transplants.

Of 80 patients who received a reanimated donor heart, 94% were alive six months later. That compared with 90% of 86 patients who received hearts from brain-dead donors.

Experts said the results, published June 8 in the New England Journal of Medicine, are “exciting.”

The transplant approach, known as donation after circulatory death (DCD), could expand the national supply of donor hearts by about 30%, said lead researcher Dr. Jacob Schroder, surgical director of the heart transplant program at Duke University, in Durham, N.C.

“That’s still not enough,” Schroder said. “But I’d say this is the biggest thing to happen in heart transplantation since heart transplantation.”

DCD hearts come from donors who have suffered devastating injuries that have left them on life support with no chance of recovery. In most cases, they have severe brain injuries that fall short of the strict criteria used to declare brain death. Instead, they succumb to “circulatory death” after the family decides to withdraw life support.

In the United States, DCD transplants have long been done with other organs, including the kidneys, liver and lungs. Those organs, particularly the kidneys, can tolerate a period of oxygen deprivation after circulatory death. The heart, which has stopped beating in cases of circulatory death, has been the exception.

“For the longest time,” Schroder explained, “we didn’t have the methods to preserve and reanimate the heart.”

But in recent years, with the emergence of the new technology, transplant centers in some other countries have been using DCD hearts. Small studies in Australia and the United Kingdom have indicated that transplant recipients fare just as well with DCD hearts as they do with conventional transplants.

The new trial is the first to test the approach in the United States, using the Organ Care System made by TransMedics, a Massachusetts-based medical device company that funded the study. It’s a “heart-in-a-box” device that perfuses the donor heart with warm, oxygenated blood. In addition to resuscitating the heart, the device also allows doctors to test its function.

The trial enrolled 180 adult heart transplant candidates, with half receiving a DCD heart and half receiving one from a brain-dead donor.

At the six-month mark, the researchers analyzed the outcomes of 166 transplant recipients. Overall, survival rates were comparable between the two groups, as was the risk of serious problems with the new heart.

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Patients in the DCD group were more likely to have significant heart-function issues soon after the transplant: 15% did, versus 5% in the standard transplant group. But the problems were manageable.

Right now, about 20 U.S. transplant centers perform DCD heart transplants, according to Schroder. But he said he thinks they should now be considered “a standard of care.”

Other experts expected the findings will encourage more transplant programs to adopt the approach.

The heart transplant field is, by nature, “very conservative,” said Dr. Nancy Sweitzer, a heart failure specialist and professor at Washington University School of Medicine in St. Louis.

Transplant teams want to be sure they’re “making a good trade” when they give patients a new heart, Sweitzer said.

“I do think these findings will lead more programs to go forward with this more confidently,” said Sweitzer, who wrote an editorial published with the study.

Dr. David Klassen is chief medical officer of the United Network for Organ Sharing (UNOS), the nonprofit that manages the national transplant waiting list. He said that compared with other organ transplants, heart transplants have always been more limited by donor supply.

According to Klassen, the new findings confirm what everyone has thought would be the case. But having solid data from a clinical trial is important, he said, to bolster programs’ confidence in DCD heart transplants.

Schroder said he believes it’s time to move away from the idea that heart transplants are limited by a “supply issue.” Instead, he thinks many programs can be less restrictive in what they deem a good donor heart.

In 2022, a record-high 4,111 heart transplants were performed in the United States, according to UNOS. Currently, there are 3,350 Americans on the wait list for a heart.

More information

The United Network for Organ Sharing has more on heart transplantation.

SOURCES: Jacob Schroder, MD, assistant professor, surgery, and surgical director, heart transplantation program, Duke University School of Medicine, Durham, N.C.; David Klassen, MD, chief medical officer, United Network for Organ Sharing, Richmond, Va.; Nancy Sweitzer, MD, PhD, professor, medicine, Washington University School of Medicine in St. Louis; New England Journal of Medicine, June 8, 2023

 

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Whooping cough is at a decade-high level in US

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MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.

There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.

The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.

Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.

Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.

Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.

“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.

Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.

But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.

That includes his own teenage daughter.

“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.

It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.

“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”

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AP data journalist Kasturi Pananjady contributed to this report.

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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

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Scientists show how sperm and egg come together like a key in a lock

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How a sperm and egg fuse together has long been a mystery.

New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.

“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.

The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.

Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.

It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.

Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.

Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.

The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.

The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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Older patients, non-English speakers more likely to be harmed in hospital: report

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Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.

The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.

The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.

The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.

“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.

When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.

“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.

“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.

The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.

Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.

The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.

“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.

They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.

“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”

This report by The Canadian Press was first published Oct. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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