Dr. Richard Dorn: “We must develop the follow -up of patients grafted from the heart, turning more to the city” | The doctor’s daily life | Specialties

80 %. Consequently, This is the survival rate of patients at one year from a heart transplant. However, So that “The median survival today reaches 12 to 13 years after a cardiac transplant”reports Dr. In addition, Richard Dorent. Similarly, cardiologist and heart referent, heart-poumons, and lungs within the management of the levy and the organis of the biomedicine agency. Therefore, A figure that even reaches 19 years in patients operated in their childhood. Similarly, “Survival tends to increase over time, by periods, and has really improved in recent years”welcomes the cardiologist. Therefore, “The number of transplants which are 30 years old or 40 years of transplant continues to increase”.

And for good reason: early postoperative resuscitation practices have marked notable progress, implemented by increasingly experienced teams. Consequently, The operating course constituted “An important challenge”estimates Dr. Moreover, Dorrent. Similarly, Indeed. dr. richard dorn: “we must Meanwhile, in patients grafted from the heart, most of the deaths continue to occur in the first weeks or in the year following transplantation – in connection with a high risk of transplant dysfunction, acute rejection or serious infection.

Progress expected during the early postoperative period – Dr. richard dorn: "we must

Despite the growing proportion of patients made of vital emergency. Furthermore, early postoperative survival could continue to progress. However, Because “The way of preventing. Nevertheless, diagnosing acute discharges changes, and the prevention of infections progresses slowly but surely”observe Dr. Consequently, Dorrent. Consequently, And above all. In addition, graft infusion machines, developed to improve conservation, could change the situation in terms of prevention of dysfunctions of early organ. “These devices have shown their ability to reduce the incidence of early dysfunctions”insists Dr. Dorrent. This equipment. for the moment not used routine for lack of financial care, could arrive in all transplantation centers in dr. richard dorn: “we must a relatively close future. “The biomedicine agency works to have these devices finance – potentially from next year “indicates the cardiologist.

Therefore, the number of people living with a heart transplant is increasing. However, long -term follow -up, now well formalized by the International Cardiac and Pulmonary Transplantation Company remains complex. While after the first post-grafting year. the attrition rate remains 3 % per year, the objective is to identify and treat at best various complications: cardiac dysfunction, coronary disease, allo-immunization, renal insufficiency favored by the nephrotoxicity of certain immunosuppressive treatments, Surimmunosuppression manifestations such as certain cancers.

Identify common cardiac complications in town

In this context. the organization of follow -up tends to transform itself, in particular in the sense of greater collaboration between centers of grafts and city practitioners or even local hospitals. dr. richard dorn: “we must “The follow -up will remain coordinated by the centers of grafts. but we are trying to share follow -up with city doctors and to develop relationships with hospitals closer to patients”advance Dr. Dorrent.

Certainly, some exams seem difficult to carry out in town. Like the systematic. regular research of anti-HLA antibodies specific to the donor-DSA-signing allo-immunization, which occurs in almost 40 % of patients at 10 years old. In the same spirit, difficult to change the habits of certain patients. “Some people grafted a long time ago have become used to being followed by” their doctor “from the. transplant center”recognizes Dr. Dorrent. But the COVVI-19 crisis has shown that many biology. imaging examinations, and also specialized consultations can be done in the city.

City cardiologists have in particular a role to play in the identification in particular of cardiac complications such as. dysfunctions of the heart – “In general restrictive sometimes marked by anomalies of the evidence” Specifies Dr. Dorrent. An important challenge is to detect coronary disease – immunological disease, different from the general population atheroma. “It is estimated that 50 % of patients develop a coronary arteries disease within 10 years of the transplant”estimates Dr. Dorrent. Screening, diagnosis and treatment of almost constant blood pressure can also be managed in town.

A double goal. automate and personalize monitoring

At the same time, as the city-hospital collaboration is developing, the organization of monitoring also changes within the hospitals where the transplants take place. “In order to improve the interface between the patient. the city on the one hand, and the transplant centers on the other hand, all the centers now use nurses/nurses coordinators (IDEC)”notes Dr. Dorrent. Within establishments authorized to practice several organ transplants, multi-organization day-to-day hospitals are also financially supported by the Biomedicine dr. richard dorn: “we must Agency.

In addition. the use of digital platforms not only facilitating the collection and centralization of exams carried out in the city but also their interpretation is developing. “Certain solutions make it possible to transfer biological examinations but also to automate their interpretation”. By defining for each biological variable normality thresholds beyond or below which an alarm is issued for rereading by a doctor, explains Dr. Dorrent. In this context of automation of reading exams. challenges concerning compliance with regulations, and above all the personalization of monitoring emerge. “You really have to define different alarms. thresholds depending on the patient’s profile, renal function, the presence of an allo-immunization or not, etc. »»judge Dr. Dorrent.

These tools are not used today for acute situations. Thus, the maintenance of certain direct human interactions remains necessary. According to the cardiologist. “Patients must continue to have the opportunity to quickly get dr. richard dorn: “we must in touch with professionals from a transplant center. The nursing staff as a whole must continue to provide support for patients ”.

Interview with Dr. Richard Dorent, cardiologist and heart, heart-heart, and lungs within the levy management and organs-to-to-the-purpose graft of the biomedicine agency