Heart Transplant Recipients Clinical Trial
Official title:
Autonomic Cardiovascular Control After Heart Transplantation
The purpose of this prospective study is to investigate denervation (ie. surgical cutting of
autonomic nerves) and re-innervation (ie. growth of autonomic nerves) in heart transplant
recipients. More specifically, we focus on:
1. The physiological consequences of denervation, in particular its consequences for
clinical symptoms, orthostatic tolerance (ie. the ability to stand upright) and exercise
capacity. We hypothesize that denervation has negative consequences for all these
factors.
2. The pathological consequences of denervation and reinnervation, in particular its
association to acute rejection and coronary artery disease (cardiac allograft
vasculopathy, CAV). We hypothesize that reinnervation protects against acute rejection
and development of CAV
3. Donor and recipient factors associated with the reinnervation process. We hypothesize
that characteristics of the surgical procedure (such as aorta cross-clamp time) as well
as the rehabilitation process of the recipient (such as physical activity) impacts on
the reinnervation process.
Heart transplantation is annually offered to more than 3500 patients worldwide. In Norway,
the number is approximately 30/year, and all transplants are carried out at one single
hospital (Oslo University Hospital, Rikshospitalet).
Normally, the heart function is intimately controlled by the autonomic nervous system (ANS),
but all nervous connections are lost during the surgical transplantation procedure, and the
transplanted heart thus becomes denervated. In time, regrowth of nerves may cause partial
reinnervation of the new heart.
Some evidence suggests that reinnervation improves exercise capacity and reduces episodes of
acute rejections and the development of cardiac allograft vasculopathy. The purpose of this
study is further to investigate the changes over time with respect to all parts of the
autonomic nervous system (the sympathetic, parasympathetic and sensoric part), and the
associated physiological and pathological consequences.
The study may provide knowledge which ultimately could help us improve health and quality of
live for heart transplant recipients.
;
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