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Pediatric heart transplantation

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https://www.readbyqxmd.com/read/28727227/long-term-outcomes-of-simultaneous-heart-and-kidney-transplantation-in-pediatric-recipients
#1
Patricia L Weng, Juan Carlos Alejos, Nancy Halnon, Qiuheng Zhang, Elaine F Reed, Eileen Tsai Chambers
Pediatric sHKTx has become an effective therapy for patients with combined cardiac and renal failure. Often, these patients develop human leukocyte antigen antibodies from their previous allografts and are therefore more difficult to re-transplant. We describe the largest case series of a predominantly sensitized pediatric sHKTx with emphasis on medical management and patient outcomes. Demographics, clinical characteristics, antibody, and biopsy data were retrospectively collected from University of California, Los Angeles database and correlated with short- and long-term patient and allograft outcomes of all sHKTx performed between 2002 and 2015...
July 20, 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/28724792/pediatric-and-adult-dilated-cardiomyopathy-represent-distinct-pathological-entities
#2
Meghna D Patel, Jayaram Mohan, Caralin Schneider, Geetika Bajpai, Enkhsaikhan Purevjav, Charles E Canter, Jeffrey Towbin, Andrea Bredemeyer, Kory J Lavine
Pediatric dilated cardiomyopathy (DCM) is the most common indication for heart transplantation in children. Despite similar genetic etiologies, medications routinely used in adult heart failure patients do not improve outcomes in the pediatric population. The mechanistic basis for these observations is unknown. We hypothesized that pediatric and adult DCM comprise distinct pathological entities, in that children do not undergo adverse remodeling, the target of adult heart failure therapies. To test this hypothesis, we examined LV specimens obtained from pediatric and adult donor controls and DCM patients...
July 20, 2017: JCI Insight
https://www.readbyqxmd.com/read/28720202/a-novel-surgical-approach-to-mechanical-circulatory-support-in-univentricular-infants
#3
Avihu Z Gazit, Orlando Petrucci, Peter Manning, Mark Shepard, Sirine Baltagi, Kathleen Simpson, Chesney Castleberry, Charles Canter, Pirooz Eghtesady
BACKGROUND: Historically, the options for mechanical circulatory support in infants, particularly those with single-ventricle physiology, have been limited and outcomes have generally been poor. We report a new approach implemented for long-term support in a series of such patients. METHODS: This study is a single-center case series of 7 patients with single-ventricle physiology after stage 1 palliation supported with mechanical circulatory support using a novel technique, between May 2014 and September 2015...
July 15, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28712678/impact-of-the-18th-birthday-on-waitlist-outcomes-among-young-adults-listed-for-heart-transplant-a-regression-discontinuity-analysis
#4
David M Peng, Qiuying Qu, Nancy McDonald, Seth A Hollander, Daniel Bernstein, Katsuhide Maeda, Beth D Kaufman, David N Rosenthal, Doff B McElhinney, Christopher S Almond
BACKGROUND: Patients listed for heart transplant after their 18th birthday purportedly wait longer to receive a donor heart compared with patients listed before their 18th birthday. It is unclear whether there is an actual difference in wait times and whether any difference in wait time is associated with lower likelihood of transplant and/or higher risk of mortality. METHODS: Organ procurement and transplant network data were used to identify all patients listed for heart transplant between 2006 and 2014 within a 1-year period before and after their 18th birthday...
May 19, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28708333/conversion-from-calcineurin-inhibitors-to-mtor-inhibitors-as-primary-immunosuppressive-drugs-in-pediatric-heart-transplantation
#5
Alfred Asante-Korang, Jennifer Carapellucci, Diane Krasnopero, Abigail Doyle, Brian Brown, Ernest Amankwah
There are only a few reports of successful use of mammalian target of rapamycin (mTORI) as primary immunosuppression in pediatric heart transplantation. Compared to calcineurin inhibitors, mTORI have less side effects, especially nephrotoxicity, infections and malignancies. A retrospective study was conducted at our institution of all 170 heart transplants from 1995-2015. Nineteen patients were switched from tacrolimus(n=15) or cyclosporin(n=4) to everolimus(n=4) or sirolimus(n=15) due to nephrotoxicity(n=5), malignancy(n=8), EBV viremia/reactive plasmacytic changes(n=5) and immune hemolytic anemia(n=1)...
July 14, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28707755/non-invasive-detection-of-myocardial-fibrosis-in-pediatric-heart-transplant-recipients-the-role-of-cardiovascular-magnetic-resonance
#6
EDITORIAL
Jonathan H Soslow, Justin Godown
No abstract text is available yet for this article.
August 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/28690004/health-insurance-coverage-among-young-adult-survivors-of-pediatric-heart-transplantation
#7
Dmitry Tumin, Susan S Li, Deipanjan Nandi, Robert J Gajarski, Christopher McKee, Joseph D Tobias, Don Hayes
OBJECTIVE: To describe the change in health insurance after heart transplantation among adolescents, and characterize the implications of this change for long-term transplant outcomes. STUDY DESIGN: Patients age 15-18 years receiving first-time heart transplantation between 1999 and 2011 were identified in the United Network for Organ Sharing registry and included in the analysis if they survived at least 5 years. The primary exposure was change or continuity of health insurance coverage between the time of transplant and the 5-year follow-up...
July 6, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28687711/the-optimal-timing-of-stage-2-palliation-for-hypoplastic-left-heart-syndrome-an-analysis-of-the-pediatric-heart-network-single-ventricle-reconstruction-trial-public-dataset
#8
James M Meza, Edward J Hickey, Eugene H Blackstone, Robert D B Jaquiss, Brett R Anderson, William G Williams, Sally Cai, Glen S Van Arsdell, Tara Karamlou, Brian W McCrindle
Background -In infants requiring three-stage single ventricle palliation for hypoplastic left heart syndrome, attrition after the Norwood procedure remains significant. The effect of the timing of stage-2-palliation (S2P), a physician-modifiable factor, on long term survival is not well understood. We hypothesized that an optimal interval between the Norwood and S2P that both minimizes pre-S2P attrition and maximizes post-S2P survival exists and is associated with individual patient characteristics. Methods -The NIH/NHLBI Pediatric Heart Network Single Ventricle Reconstruction Trial public dataset was used...
July 7, 2017: Circulation
https://www.readbyqxmd.com/read/28682718/the-ventricular-assist-device-in-the-life-of-the-child-a-phenomenological-pediatric-study
#9
Michael A van Manen
What is it like for a child to live with an artificial heart? The use of some medical therapies in children requires developmental considerations, is associated with psychosocial consequences, and calls for ethical sensitivities. A critical case is the ventricular assist device (VAD), a mechanical pump used to support the functioning of a failing heart. As a pediatric therapy, the device can be used as a temporary solution for poor heart function, a bridge to transplantation or recovery, or as a destination therapy...
May 2017: Qualitative Health Research
https://www.readbyqxmd.com/read/28670871/clinical-practice-patterns-are-relatively-uniform-between-pediatric-heart-transplant-centers-a-survey-based-assessment
#10
Chesney Castleberry, Sonja Ziniel, Christopher Almond, Scott Auerbach, Seth A Hollander, Ashwin K Lal, Matthew Fenton, Elfriede Pahl, Joseph W Rossano, Melanie D Everitt, Kevin P Daly
Clinical practice variations are a barrier to the study of pediatric heart transplants and coordination of multicenter RCTs in this patient population. We surveyed centers to describe practice patterns, understand areas of variation, and willingness to modify protocol. Pediatric heart transplant centers were identified, and one survey was completed per center. Simple descriptive statistics were used. The response rate was 77% (40 responses from 52 contacted centers, 37 with complete responses). Median center volume of respondents was eight transplants/year (IQR 3-19)...
July 3, 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/28670855/medication-adherence-among-adolescent-solid-organ-transplant-recipients-a-survey-of-healthcare-providers
#11
Pooja Mehta, Elizabeth A Steinberg, Sarah L Kelly, Cindy Buchanan, Alana Resmini Rawlinson
The aim of this study was to assess healthcare provider perspectives on barriers to medication adherence and to discover recommendations for interventions among providers of pediatric solid-organ transplant patients. An anonymous online survey was administered to a multidisciplinary pool of pediatric transplant providers from February 2015 to March 2016. It consisted of 15 questions regarding transplant providers' attitudes, clinical practice, and beliefs pertaining to medication adherence among teenage solid-organ transplant recipients...
July 2, 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/28669108/novel-genetic-variants-in-bag3-and-tnnt2-in-a-swedish-family-with-a-history-of-dilated-cardiomyopathy-and-sudden-cardiac-death
#12
Eva Fernlund, A Wålinder Österberg, E Kuchinskaya, M Gustafsson, K Jansson, C Gunnarsson
Familial dilated cardiomyopathy is a rare cause of dilated cardiomyopathy (DCM), especially in childhood. Our aim was to describe the clinical course and the genetic variants in a family where the proband was a four-month-old infant presenting with respiratory problems due to DCM. In the family, there was a strong family history of DCM and sudden cardiac death in four generations. DNA was analyzed initially from the deceased girl using next-generation sequencing including 50 genes involved in cardiomyopathy...
July 1, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28655190/right-ventricular-function-during-exercise-in-children-after-heart-transplantation
#13
B Cifra, C T Morgan, A Dragulescu, V C Guerra, C Slorach, M K Friedberg, C Manlhiot, B W McCrindle, A I Dipchand, L Mertens
Aims: Right ventricular (RV) dysfunction is a common problem after heart transplant (HTx). In this study, we used semi-supine bicycle ergometry (SSBE) stress echocardiography to evaluate RV systolic and diastolic reserve in paediatric HTx recipients. Methods and results: Thirty-nine pediatric HTx recipients and 23 controls underwent stepwise SSBE stress echocardiography. Colour tissue doppler imaging (TDI) peak systolic (s') and peak diastolic (e') velocities, myocardial acceleration during isovolumic contraction (IVA), and RV free wall longitudinal strain were measured at incremental heart rates (HR)...
June 23, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/28646501/progressive-aortic-root-dilatation-in-pediatric-heart-transplant-recipients
#14
Shagun Sachdeva, Liyun Zhang, Pippa Simpson, Peter C Frommelt
BACKGROUND: To determine prevalence, clinical implication, and risk factors for aortic root dilation (ARD) in pediatric heart transplant recipients. METHODS: Serial echocardiograms were reviewed in all pediatric heart transplant recipients from 1999 to 2014 to assess maximal systolic diameter at the aortic annulus, aortic sinus, aortic sino-tubular (ST) junction, and ascending aorta. ARD was defined by a sinus/annulus ratio >1.56, ST junction/annulus ratio >1...
July 2017: Echocardiography
https://www.readbyqxmd.com/read/28639339/advancing-the-field-of-anti-hla-sensitization-management-prior-to-pediatric-heart-transplantation
#15
EDITORIAL
Warren A Zuckerman
No abstract text is available yet for this article.
June 22, 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/28622179/paucicellular-fibrointimal-proliferation-characterizes-pediatric-pulmonary-vein-stenosis-clinicopathologic-analysis-of-213-samples-from-97-patients
#16
Alexandra E Kovach, Philip M Magcalas, Christina Ireland, Kerry McEnany, Andre M Oliveira, Mark W Kieran, Christopher W Baird, Kathy Jenkins, Sara O Vargas
Pulmonary vein stenosis (PVS) is a luminal narrowing of extrapulmonary pulmonary veins. In pediatric patients, it arises following repair of congenital heart disease, particularly anomalous pulmonary venous return; in lung disease, especially prematurity; and rarely in isolation. The etiology is unknown and the course often fatal without lung transplantation. We hypothesized that systematic clinicopathologic review of pediatric PVS could provide further pathogenic insight. We included patients who underwent first resection of pulmonary venous tissue for symptomatic PVS at our pediatric referral center from 1995 to 2014...
June 15, 2017: American Journal of Surgical Pathology
https://www.readbyqxmd.com/read/28619384/risk-stratification-to-determine-the-impact-of-induction-therapy-on-survival-rejection-and-adverse-events-after-pediatric-heart-transplant-a-multi-institutional-study
#17
Chesney Castleberry, Elizabeth Pruitt, Rebecca Ameduri, Kenneth Schowengerdt, Erik Edens, Nancy Hagin, James K Kirklin, David Naftel, Simon Urschel
BACKGROUND: Induction therapy is increasingly being used in pediatric heart transplantation. General versus risk-adapted use remains controversial. We aimed to determine the impact of induction therapy on outcomes after stratifying patients by diagnosis and risk. METHODS: The Pediatric Heart Transplant Study (PHTS) database was used to identify patients (age ≤18 years) who underwent transplantation between January 1, 2001 and December 31, 2014. Patients were excluded if they survived <48 hours or received multiple induction agents...
May 11, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28586917/toward-the-virtual-benchmarking-of-pneumatic-ventricular-assist-devices-application-of-a-novel-fluid-structure-interaction-based-strategy-to-the-penn-state-12-cc-device
#18
Alessandro Caimi, Francesco Sturla, Bryan Good, Marco Vidotto, Rachele De Ponti, Filippo Piatti, Keefe B Manning, Alberto Redaelli
The pediatric use of pneumatic ventricular assist devices (VADs) as a bridge to heart transplant still suffers for short-term major complications such as bleeding and thromboembolism. Although numerical techniques are increasingly exploited to support the process of device optimization, an effective virtual benchmark is still lacking. Focusing on the 12 cc Penn State pneumatic VAD, we developed a novel fluid-structure interaction (FSI) model able to capture the device functioning, reproducing the mechanical interplay between the diaphragm, the blood chamber, and the pneumatic actuation...
August 1, 2017: Journal of Biomechanical Engineering
https://www.readbyqxmd.com/read/28583371/bacterial-infections-after-pediatric-heart-transplantation-epidemiology-risk-factors-and-outcomes
#19
Christina A Rostad, Karla Wehrheim, James K Kirklin, David Naftel, Elizabeth Pruitt, Timothy M Hoffman, Thomas L'Ecuyer, Katie Berkowitz, William T Mahle, Janet N Scheel
BACKGROUND: Bacterial infections represent a major cause of morbidity and mortality in heart transplant recipients. However, data describing the epidemiology and outcomes of these infections in children are limited. METHODS: We analyzed the Pediatric Heart Transplant Study database of patients transplanted between 1993 and 2014 to determine the etiologies, risk factors and outcomes of children with bacterial infections post-heart transplantation. RESULTS: Of 4,458 primary transplants in the database, there were 4,815 infections that required hospitalization or intravenous therapy, 2,047 (42...
May 11, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28576519/pediatric-post-tonsillectomy-hemorrhage-in-the-setting-of-post-transplantation-immunosuppression
#20
Lourdes Quintanilla-Dieck, Sivakumar Chinnadurai, Christopher Wootten, Steven L Goudy, Frank W Virgin
INTRODUCTION: Long-term immunosuppressants form an integral part of therapy for post-transplantation patients. Immunosuppressants may also have an anticoagulant effect, and little is known about their effects on bleeding risk after adenotonsillectomy. Our objective was to investigate whether there is an increased observed rate of post-tonsillectomy hemorrhage in a population of pediatric patients on long-term immunosuppressants after solid organ transplantation, compared to healthy controls...
April 2017: International Journal of Pediatric Otorhinolaryngology
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