Einar Gude

Einar Gude, MD, PhD, Consultant Cardiologist, Department of Cardiology, Oslo University Hospital, Rikshospitalet

Einar Gude defended his thesis "Limitations of current treatment strategies in human heart transplantation: Studies on pulmonary hemodynamics, renal failure and immunosuppression." in January 2013. Gude studied risk factors prior to and after heart transplantation and potential treatment strategies to optimize the transplantation outcome.

All patients transplanted between the years 1983-2007 were analyzed considering the degree of renal failure and pulmonary hypertension before and after transplantation. These two challenges are closely associated and usually secondary to severe heart failure. Both phenomena increase the risk of adverse outcomes during and after surgery and are relative contraindications against transplantation. Immunosuppressive medications after cardiac transplantation may be renal toxic and many patients experience a deterioration of renal failure after transplantation.

The severity of pulmonary hypertension was measured in all patients before and after transplantation. The prognosis was equal for patients suffering from too high blood preassure prior to surgery and for patients with a satisfactory preoperative blood preassure. However, patients experiencing elevated pressure after transplantation have a poorer prognosis. Likewise, renal function was mapped. Reduced renal function before and after transplantation increases the risk of dialysis and increased mortality if present early after transplantation.

Necessary immunosuppressive treatment has several side effects including renal failure, both acute after transplantation and progressive over years. Intravenous administration of immunosuppressive medicine Sandimun Neoral disposed for acute renal failure. A new medicine, Everolimus, has been tested, and with early intervention after transplantation severe kidney failure was almost normalized. By intervention a few years after transplantation, one can improve, but not normalize, renal function by reducing Sandimun Neoral and adding a small dose of Everolimus.

Center for Cardiological Innovation