Although heart transplantation has seen much success over the last few years, there are still some areas that are challenging. Coronary artery vasculopathy is a leading cause of death following heart transplant recipients and it believed to be due to a culmination of both immunological and nonimmunological factors. Using gene micro arrays and natriuretic peptides, we have uncovered platelets as an important and often neglected entity in heart transplant recipients. Investigating the effect of platelet function and alteration of their activation in this special population on transplant coronary artery disease will be focus of future research.
Antibody-mediated rejection has been identified as a risk for the development early graft failure and transplant coronary artery disease. Several reports consistently state females, especially multiparous females as a risk for the development of antibody-mediated rejection. The exact reason for the development of antibodies in this population is not fully understood. There is some literature investigating the importance of HLA of the spouse of multiparous females and the organ donor in renal transplant rejection and graft survival. Determining the interaction of donor and female recipient’s spouses HLA on graft survival and pattern of rejection in heart transplantation will help determine if we need to declare the spouse’s HLA as unacceptable antigens at the time of listing.
Neurohormonal blockade and newer devices have improved the survival of heart failure patients. However, there is much room for enhancement. The effect of heart failure education on survival has not been suitably investigated. Using standardized education with a core message and a testing tool to determine the adequacy of the teaching will be used to ascertain the importance of education in heart failure on outcomes including hospitalization.
Mehra MR, Uber PA, Ventura HO, Scott RL, Park MH. The impact of mode of donor brain death on cardiac allograft vasculopathy: an intravascular ultrasound study. J Am Coll Cardiol. 2004;43(5):806-10.
Mehra MR, Uber PA, Park MH, Scott RL, Ventura HO, Harris BC, Frohlich ED. Obesity And Suppressed B-Type Natriuretic Peptide Levels In Heart Failure. J Am Coll Cardiol. 2004;43(9):1590-5.
Alaeddini J, Uber PA, Park MH, Scott RL, Ventura HO, Mehra MR. Efficacy and safety of sildenafil in the evaluation of pulmonary hypertension in severe heart failure. Am J Cardiol. 2004;94(11):1475-7.
Mehra MR, Uber PA, Prasad A, Scott RL, Park MH. Recrudescent tobacco exposure following heart transplantation: clinical profiles and relationship with athero-thrombosis risk markers. Am J Transplant. 2005;5(5):1137-40.
Potluri SP, Mehra MR, Uber PA, Park MH, Scott RL, Ventura HO. Relationship among epicardial coronary disease, tissue myocardial perfusion, and survival in heart transplantation. J Heart Lung Transplant. 2005;24(8):1019-25.
Mehra MR, Uber PA, Walther D, Vesely M, Wohlgemuth JG, Prentice J, Tayama D, Billingham M. Cellular Remodeling, Vascular Impairment and Inflammation Related Genes Underlie B-Type Natriuretic Peptide Elevation In Heart Transplantation: More Than A Hemodynamic Marker. Circulation 2006 in press.