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Kuklinski CA, Blatter JA. Interstitial lung disease as an indication for pediatric lung transplant. Pediatr Pulmonol 2024; 59:2313-2320. [PMID: 38131509 DOI: 10.1002/ppul.26812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 11/09/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
Interstitial lung disease can be an indication for lung transplant at any age, but it is a particularly common indication for lung transplant in infants. Nevertheless, not all interstitial lung diseases will lead to lung transplant in childhood. Genetic testing has aided the identification of these diseases in children. In severely affected patients, however, definitive diagnosis is not always necessary to consider referral to a transplant center. At experienced transplant centers, a multidisciplinary team educates patient families and aids in the transplant evaluation of children with interstitial lung disease. Children who have undergone transplant require lifetime immunosuppression and close surveillance, but can enjoy good quality of life for years following surgery.
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Affiliation(s)
- Cadence A Kuklinski
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joshua A Blatter
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
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2
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Avdimiretz N, Benden C. Pediatric lung transplantation: A new landscape following the height of the COVID-19 pandemic. J Heart Lung Transplant 2024:S1053-2498(24)01728-5. [PMID: 38959989 DOI: 10.1016/j.healun.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/06/2024] [Accepted: 06/26/2024] [Indexed: 07/05/2024] Open
Affiliation(s)
- Nicholas Avdimiretz
- Division of Pediatric Pulmonary Medicine, Pediatric Lung Transplantation, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California.
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3
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Koh W, Zang H, Ollberding NJ, Hayes D. Lung Transplantation for Children with Refractory Acute Respiratory Distress Syndrome. Ann Am Thorac Soc 2024; 21:672-675. [PMID: 38241015 DOI: 10.1513/annalsats.202308-695rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
- Wonshill Koh
- Cincinnati Children's Hospital Medical Center Cincinnati, Ohio
- University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Huaiyu Zang
- Cincinnati Children's Hospital Medical Center Cincinnati, Ohio
| | - Nicholas J Ollberding
- Cincinnati Children's Hospital Medical Center Cincinnati, Ohio
- University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Don Hayes
- Cincinnati Children's Hospital Medical Center Cincinnati, Ohio
- University of Cincinnati College of Medicine Cincinnati, Ohio
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4
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Zhou WY, Shen L, Shi JX, Gao XH, Yang J, Fu SJ, Pan XF, Zhu MF, Zhang S, Zhang C, Li F, Zhang H, Yao F, Tenover FC, Tang YW, Fang WT. Real-time, random-access organ screening for carbapenem-resistant organisms (CRO) reduces CRO-associated, donor-derived infection mortality in lung transplant recipients. Infection 2024; 52:403-412. [PMID: 37651077 PMCID: PMC10955019 DOI: 10.1007/s15010-023-02089-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Donor-derived infection (DDI) has become an important factor affecting the prognosis of lung transplantation patients. The risks versus benefits of using donor organs infected with multidrug-resistant organisms (MDRO), especially carbapenem-resistant organisms (CRO), are frequently debated. Traditional microbial culture and antimicrobial susceptibility testing at present fail to meet the needs of quick CRO determination for donor lungs before acquisition. In this study, we explored a novel screening method by using Xpert® Carba-R assay for CRO in donor lungs in a real-time manner to reduce CRO-associated DDI mortality. METHODS This study was registered on chictr.org.cn (ChiCTR2100053687) on November 2021. In the Xpert Carba-R screening group, donor lungs were screened for CRO infection by the Xpert Carba-R test on bronchoalveolar fluid (BALF) before acquisition. If the result was negative, donor lung acquisition and subsequent lung transplantation were performed. In the thirty-five potential donors, nine (25.71%) with positive Xpert Carba-R results in BALF were declined for lung transplantation. Twenty-six recipients and the matching CRO-negative donor lungs (74.29%) were included in the Xpert Carba-R screening group. In the control group, nineteen recipients underwent lung transplants without Xpert Carba-R screening. The incidence and mortality of CRO-associated DDI were collected and contrasted between the two groups. RESULTS Multivariate analysis showed that CRO-related death due to DDI within 60 days was significantly lower in the Xpert Carba-R screening group than that in the control group (OR = 0.05, 95% CI 0.003-0.74, p = 0.03). CONCLUSION Real-time CRO screening of donor lungs before transplantation at the point of care by the Xpert Carba-R helps clinicians formulate lung transplantation strategies quickly and reduces the risk of subsequent CRO infection improving the prognosis of lung transplantation.
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Affiliation(s)
- Wen-Yong Zhou
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Lei Shen
- Shanghai Institute of Immunology, Department of Immunology and Microbiology, and Key Laboratory of Cell Differentiation and Apoptosis of the Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Tumor Microenvironment and Inflammation, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-Xin Shi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xing-Hui Gao
- Medical Affairs, Danaher Diagnostic Platform/Cepheid, Shanghai, China
| | - Jun Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shi-Jie Fu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xu-Feng Pan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min-Fang Zhu
- Department of Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shen Zhang
- Department of Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chong Zhang
- Department of Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Li
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hai Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fred C Tenover
- Medical and Scientific Affairs, Cepheid, Sunnyvale, CA, USA
| | - Yi-Wei Tang
- Medical Affairs, Danaher Diagnostic Platform/Cepheid, Shanghai, China.
| | - Wen-Tao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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5
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Fraser M, Page RL, Chow S, Alexy T, Peters L. Pharmacotherapy in the heart transplant recipient: A primer for nurse clinicians and pharmacists. Clin Transplant 2024; 38:e15252. [PMID: 38341767 DOI: 10.1111/ctr.15252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/02/2024] [Accepted: 01/17/2024] [Indexed: 02/13/2024]
Abstract
Heart transplantation (HT) is the definitive treatment for eligible patients with end-stage heart disease. A major complication of HT is allograft rejection which can lead to graft dysfunction and death. The guiding principle of chronic immunosuppression therapy is to prevent rejection of the transplanted organ while avoiding oversuppression of the immune system, which can cause opportunistic infections and malignancy. The purpose of this review is to describe immunosuppressive management of the HT recipient-including agent-specific pharmacology and pharmacokinetics, outcomes data, adverse effects, clinical considerations, and recent guideline updates. We will also provide recommendations for medical prophylaxis of immunosuppressed patients based on the most recent clinical guidelines. Additionally, we highlight the importance of medical therapy adherence and the effect of social determinants of health on the long-term management of HT. HT recipients are a complex and high-risk population. The objective of this review is to describe basic pharmacotherapy in HT and implications for nurses and pharmacists.
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Affiliation(s)
- Meg Fraser
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robert L Page
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Sheryl Chow
- Department of Pharmacy Practice and Administration, Western University of Health Sciences, Pomona, California, USA
- Department of Medicine, University of California, Irvine, USA
| | - Tamas Alexy
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laura Peters
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Ehrsam JP, Meier Adamenko O, Pannu M, Markus Schöb O, Inci I. Lung transplantation in children. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S119-S133. [PMID: 38584780 PMCID: PMC10995684 DOI: 10.5606/tgkdc.dergisi.2024.25806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/05/2023] [Indexed: 04/09/2024]
Abstract
Lung transplantation is a well-established treatment for children facing advanced lung disease and pulmonary vascular disorders. However, organ shortage remains highest in children. For fitting the small chest of children, transplantation of downsized adult lungs, lobes, or even segments were successfully established. The worldwide median survival after pediatric lung transplantation is currently 5.7 years, while under consideration of age, underlying disease, and peri- and posttransplant center experience, median survival of more than 10 years is reported. Timing of referral for transplantation, ischemia-reperfusion injury, primary graft dysfunction, and acute and chronic rejection after transplantation remain the main challenges.
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Affiliation(s)
- Jonas Peter Ehrsam
- School of Medicine, University of Zurich, Zurich, Switzerland
- Department of Thoracic Surgery, Klinik Hirslanden Zurich, Zurich, Switzerland
- Klinik Hirslanden Zurich, Centre for Surgery, Zurich, Switzerland
| | | | | | - Othmar Markus Schöb
- School of Medicine, University of Zurich, Zurich, Switzerland
- Department of Thoracic Surgery, Klinik Hirslanden Zurich, Zurich, Switzerland
- Klinik Hirslanden Zurich, Centre for Surgery, Zurich, Switzerland
| | - Ilhan Inci
- School of Medicine, University of Zurich, Zurich, Switzerland
- Department of Thoracic Surgery, Klinik Hirslanden Zurich, Zurich, Switzerland
- Klinik Hirslanden Zurich, Centre for Surgery, Zurich, Switzerland
- University of Nicosia Medical School, Nicosia, Cyprus
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Marshall JM, Schneider E, O'Mahony S, Lannin N, Westall GP, Bhopti A. Self-reported engagement in everyday activities following bilateral lung transplantation in paediatric cystic fibrosis: a single centre study. BMJ Paediatr Open 2023; 7:e002251. [PMID: 38128948 DOI: 10.1136/bmjpo-2023-002251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Following lung transplantation, it is unknown how children/adolescents self-assess their performance in everyday activities, importance of these activities, and whether resumption of everyday activities influences self-reported quality of life. The aim was to examine the effect of bilateral lung transplantation on children's/adolescent's perception of engagement in everyday activities over the first 18 months post-transplant. METHODS A multiple-single-case-study pre-post test design was conducted at a National Paediatric Lung Transplant Service. Participants were aged under 18 years and were 3 months post first bilateral lung transplant at the time of recruitment. Outcomes were self-reported quality of life (Paediatric Quality of Life Inventory (PedsQL), Transplant Module and engagement in meaningful life roles (Child Occupational Self-Assessment (COSA) Scale) measured at 3 months and 18 months post-transplant from participants, and their parent(s) (PedsQL). Analysis included paired between-time differences and descriptive analysis. RESULTS Seven participants were recruited to the trial with a mean age of 13 (SD 4) years and a diagnosis of cystic fibrosis. The total mean scores on PedsQL remained stable between 3 months and 18 months for both participants and parents. The PedsQL transplant module total mean scores of participants significantly increased from 3 months (M=66.58, SD=11.83) to 18 months (M=80.25, SD=11.56), t(5) = 2.91, p=0.03 whereas parents' scores remained stable. COSA responses reported 'big problems' with self-care tasks, family engagement and coping with worries at 3 months. At 18 months, the 'big problem' activities shifted to community engagement and independence. CONCLUSION Time influences self-reported quality of life and engagement in meaningful life roles for children/adolescents and their parents 3 months to 18 months post-lung transplant. Our findings highlight the importance of focusing on occupational roles and occupational performance of children and adolescents when designing post-transplant interventions, suggesting a key role for occupational therapy after transplantation.
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Affiliation(s)
| | - Emma Schneider
- Department of Neuroscience, Monash University, Clayton, Victoria, Australia
- Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Shenae O'Mahony
- Occupational Therapy, Alfred Health, Melbourne, Victoria, Australia
| | - Natasha Lannin
- Occupational Therapy, Alfred Health, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Clayton, Victoria, Australia
| | | | - Anoo Bhopti
- Department of Occupational Therapy, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
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Lawson AA, Watanabe K, Griffin L, Laternser C, Markl M, Rigsby CK, Sojka M, Robinson JD, Husain N. Late-gadolinium enhancement is common in older pediatric heart transplant recipients and is associated with lower ejection fraction. J Cardiovasc Magn Reson 2023; 25:61. [PMID: 37932797 PMCID: PMC10626738 DOI: 10.1186/s12968-023-00971-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Chronic graft failure and cumulative rejection history in pediatric heart transplant recipients (PHTR) are associated with myocardial fibrosis on endomyocardial biopsy (EMB). Cardiovascular magnetic resonance imaging (CMR) is a validated, non-invasive method to detect myocardial fibrosis via the presence of late gadolinium enhancement (LGE). In adult heart transplant recipients, LGE is associated with increased risk of future adverse clinical events including hospitalization and death. We describe the prevalence, pattern, and extent of LGE on CMR in a cohort of PHTR and its associations with recipient and graft characteristics. METHODS This was a retrospective study of consecutive PHTR who underwent CMR over a 6-year period at a single center. Two independent reviewers assessed the presence and distribution of left ventricular (LV) LGE using the American Heart Association (AHA) 17-segment model. LGE quantification was performed on studies with visible fibrosis (LGE+). Patient demographics, clinical history, and CMR-derived volumetry and ejection fractions were obtained. RESULTS Eighty-one CMR studies were performed on 59 unique PHTR. Mean age at CMR was 14.8 ± 6.2 years; mean time since transplant was 7.3 ± 5.0 years. The CMR indication was routine surveillance (without a clinical concern based on laboratory parameters, echocardiography, or cardiac catheterization) in 63% (51/81) of studies. LGE was present in 36% (29/81) of PHTR. In these LGE + studies, patterns included inferoseptal in 76% of LGE + studies (22/29), lateral wall in 41% (12/29), and diffuse, involving > 4 AHA segments, in 21% (6/29). The mean LV LGE burden as a percentage of myocardial mass was 18.0 ± 9.0%. When reviewing only the initial CMR per PHTR (n = 59), LGE + patients were older (16.7 ± 2.9 vs. 12.8 ± 4.6 years, p = 0.001), with greater time since transplant (8.3 ± 5.4 vs. 5.7 ± 3.9 years, p = 0.041). These patients demonstrated higher LV end-systolic volume index (LVESVI) (34.7 ± 11.7 vs. 28.7 ± 6.1 ml/m2, p = 0.011) and decreased LV ejection fraction (LVEF) (56.2 ± 8.1 vs. 60.6 ± 5.3%, p = 0.015). There were no significant differences in history of moderate/severe rejection (p = 0.196) or cardiac allograft vasculopathy (CAV) (p = 0.709). CONCLUSIONS LV LGE was present in approximately one third of PHTR, more commonly in older patients with longer time since transplantation. Grafts with LGE have lower LVEF. CMR-derived LGE may aid in surveillance of chronic graft failure in PHTR.
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Affiliation(s)
- Andrew A Lawson
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Kae Watanabe
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Lindsay Griffin
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christina Laternser
- Center for Cardiovascular Innovation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cynthia K Rigsby
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Melanie Sojka
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua D Robinson
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nazia Husain
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Singh TP, Cherikh WS, Hsich E, Lewis A, Perch M, Kian S, Hayes D, Potena L, Stehlik J, Zuckermann A, Cogswell R. Graft survival in primary thoracic organ transplant recipients: A special report from the International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2023; 42:1321-1333. [PMID: 37549773 PMCID: PMC10901564 DOI: 10.1016/j.healun.2023.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023] Open
Affiliation(s)
- Tajinder P Singh
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Wida S Cherikh
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Eileen Hsich
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Alexandra Lewis
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Michael Perch
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Shaina Kian
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Don Hayes
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Luciano Potena
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Josef Stehlik
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Andreas Zuckermann
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Rebecca Cogswell
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois..
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Koh W, Zang H, Ollberding NJ, Ziady A, Hayes D. Extracorporeal membrane oxygenation bridge to pediatric lung transplantation: Modern era analysis. Pediatr Transplant 2023; 27:e14570. [PMID: 37424517 PMCID: PMC10530187 DOI: 10.1111/petr.14570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/24/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Survival outcomes of children on extracorporeal membrane oxygenation (ECMO) at time of lung transplant (LTx) remain unclear. METHODS Pediatric first-time LTx recipients transplanted between January 2000 and December 2020 were identified in the United Network for Organ Sharing Registry to compare post-transplant survival according to ECMO support at time of transplant. For a comprehensive analysis of the data, univariate analysis, multivariable Cox regression, and propensity score matching were performed. RESULTS During the study period, 954 children under 18 years of age underwent LTx with 40 patients on ECMO. We did not identify a post-LTx survival difference between patients receiving ECMO when compared to those that did not. A multivariable Cox regression model (Hazard ratio = 0.83; 95% confidence interval: 0.47, 1.45; p = .51) did not demonstrate an increased risk for death post-LTx. Lastly, a propensity score matching analysis, retaining 33 ECMO and 33 non-ECMO patients, further confirmed no post-LTx survival difference comparing ECMO to no ECMO cohorts (Hazard ratio = 0.98; 95% confidence interval: 0.48, 2.00; p = .96). CONCLUSIONS In this contemporary cohort of children, the use of ECMO at the time of LTx did not negatively impact post-transplant survival.
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Affiliation(s)
- Wonshill Koh
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Huaiyu Zang
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Nicholas J. Ollberding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Assem Ziady
- Dvision of Bone Marrow Transplant, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Don Hayes
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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11
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Guzman-Gomez A, Ahmed HF, Dani A, Zafar F, Lehenbauer DG, Potter AS, Morales DLS, Ziady AG, Hayes D. Center volume effect on acute cellular rejection and outcomes in pediatric lung transplant recipients. J Heart Lung Transplant 2023; 42:1030-1039. [PMID: 37088340 PMCID: PMC10524259 DOI: 10.1016/j.healun.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 03/31/2023] [Accepted: 04/10/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Acute cellular rejection (ACR) is common after lung transplant (LTx). We sought to determine if transplant center volume affected ACR-related outcomes in children after LTx. METHODS The United Network for Organ Sharing (UNOS) Registry was queried for patients <18-years-of-age who underwent LTx 1987-2020. Cohorts were children who survived the first-year post transplant and were treated for ACR within that first year (ACR group) and those not treated for ACR (non-ACR). LTx center volume was defined as: high volume center (HVC) (>5LTxs/year), medium volume center (MVC) (>1≤5 LTxs/year), and low volume center (LVC) (≤1LTxs/year). RESULTS 1320 patients were enrolled into the study; 269 (20.4%) did not experience ACR. The ACR cohort was older (median 14 [11-16] vs 13 [7-16] years, p < 0.001), female (65.3% vs 57.3%, p = 0.016), had cystic fibrosis (62.3% vs 45.5%, p < 0.001), and had a higher lung allocation score (37.3 [34.6-47.8] vs 35.8 [33-42.6], p = 0.029). The ACR cohort trended (p = 0.06) towards lower survival at 5-year (37% vs 47%) and 10-year (25% vs 34%) post-LTx. Among children at HVCs, ACR occurred in 17% of recipients (n = 98/574), compared to 18.5% (n = 73/395) at MVCs and 27% (n = 100/369) at LVCs. Children treated for ACR at HVCs had higher survival than LVCs at 5-years (52% vs 29%) and 10-years (36% vs 15%) (p < 0.001) but similar survival to MVCs at 5-years (52% vs 43%) and 10-years (36% vs 24%) (p = 0.081). No survival differences were detected in MVCs vs LVCs (p = 0.14). CONCLUSIONS ACR treated within the first post-LTx year influence survival of children. ACR incidence was lowest at higher volume centers whereas post-ACR treatment survival outcomes were also superior.
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Affiliation(s)
- Amalia Guzman-Gomez
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Hosam F Ahmed
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Alia Dani
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Farhan Zafar
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David G Lehenbauer
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew S Potter
- Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David L S Morales
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Assem G Ziady
- Cancer and Blood Disorder Institute, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Don Hayes
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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12
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Sill J, Baskar S, Zang H, Spar D, Iliopoulos I, Morales DLS, Hayes D, Koh W. Atrial arrhythmias following lung transplant: a single pediatric center experience. Front Pediatr 2023; 11:1161129. [PMID: 37425256 PMCID: PMC10326625 DOI: 10.3389/fped.2023.1161129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023] Open
Abstract
Background Outcomes after lung transplant (LTx) in children have slowly improved. Although atrial arrhythmia (AA) is a common and adverse complication following LTx among adults, there is limited data on pediatric recipients. We detail our pediatric single-center experience while providing further insights on occurrence and management of AA following LTx. Methods A retrospective analysis of LTx recipients at a pediatric LTx program from 2014 to 2022 was performed. We investigated timing of occurrence and management of AA following LTx, and its effect on post-LTx outcome. Results Three out of nineteen (15%) pediatric LTx recipients developed AA. The timing of occurrence was 9-10 days following LTx. Those patients in the older age group (age >12 years old) were the only ones who developed AA. Developing AA did not have a negative effect on hospital stay duration or short-term mortality. All LTx recipients with AA were discharged home on therapy that was discontinued at 6 months for those who was on mono-therapy without recurrence of AA. Conclusions AA is an early post-operative complication in older children and younger adults undergoing LTx at a pediatric center. Early recognition and aggressive management can mitigate any morbidity or mortality. Future investigations should explore factors that place this population at risk for AA in order to prevent this complication post-operatively.
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Affiliation(s)
- Jordan Sill
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Shankar Baskar
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Huaiyu Zang
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - David Spar
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Ilias Iliopoulos
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - David L. S. Morales
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Division of Pediatric Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Don Hayes
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Wonshill Koh
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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13
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Wong W, Johnson B, Cheng PC, Josephson MB, Maeda K, Berg RA, Kawut SM, Harhay MO, Goldfarb SB, Yehya N, Himebauch AS. Primary graft dysfunction grade 3 following pediatric lung transplantation is associated with chronic lung allograft dysfunction. J Heart Lung Transplant 2023; 42:669-678. [PMID: 36639317 PMCID: PMC10811698 DOI: 10.1016/j.healun.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/01/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Severe primary graft dysfunction (PGD) is associated with the development of bronchiolitis obliterans syndrome (BOS), the most common form of chronic lung allograft dysfunction (CLAD), in adults. However, PGD associations with long-term outcomes following pediatric lung transplantation are unknown. We hypothesized that PGD grade 3 (PGD 3) at 48- or 72-hours would be associated with shorter CLAD-free survival following pediatric lung transplantation. METHODS This was a single center retrospective cohort study of patients ≤ 21 years of age who underwent bilateral lung transplantation between 2005 and 2019 with ≥ 1 year of follow-up. PGD and CLAD were defined by published criteria. We evaluated the association of PGD 3 at 48- or 72-hours with CLAD-free survival by using time-to-event analyses. RESULTS Fifty-one patients were included (median age 12.7 years; 51% female). The most common transplant indications were cystic fibrosis (29%) and pulmonary hypertension (20%). Seventeen patients (33%) had PGD 3 at either 48- or 72-hours. In unadjusted analysis, PGD 3 was associated with an increased risk of CLAD or mortality (HR 2.10, 95% CI 1.01-4.37, p=0.047). This association remained when adjusting individually for multiple potential confounders. There was evidence of effect modification by sex (interaction p = 0.055) with the association of PGD 3 and shorter CLAD-free survival driven predominantly by males (HR 4.73, 95% CI 1.44-15.6) rather than females (HR 1.23, 95% CI 0.47-3.20). CONCLUSIONS PGD 3 at 48- or 72-hours following pediatric lung transplantation was associated with shorter CLAD-free survival. Sex may be a modifier of this association.
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Affiliation(s)
- Wai Wong
- Department of Pediatrics, Division of Pulmonary Medicine and Respiratory Diseases, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Brandy Johnson
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Pi Chun Cheng
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Division of Pediatric Pulmonology, Allergy, and Sleep Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Maureen B Josephson
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Katsuhide Maeda
- Department of Surgery, Division of Cardiothoracic Surgery, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Steven M Kawut
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael O Harhay
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samuel B Goldfarb
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Minnesota, Masonic Children's Hospital, Minneapolis, Minnesota
| | - Nadir Yehya
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adam S Himebauch
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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14
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Ivulich S, Paul E, Kirkpatrick C, Dooley M, Snell G. Everolimus Based Immunosuppression Strategies in Adult Lung Transplant Recipients: Calcineurin Inhibitor Minimization Versus Calcineurin Inhibitor Elimination. Transpl Int 2023; 36:10704. [PMID: 36744051 PMCID: PMC9894878 DOI: 10.3389/ti.2023.10704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 01/02/2023] [Indexed: 01/21/2023]
Abstract
Everolimus (EVE) provides an alternative to maintenance immunosuppression when conventional immunosuppression cannot be tolerated. EVE can be utilized with a calcineurin inhibitor (CNI) minimization or elimination strategy. To date, clinical studies investigating EVE after lung transplant (LTx) have primarily focused on the minimization strategy to preserve renal function. The primary aim was to determine the preferred method of EVE utilization for lung transplant recipients (LTR). To undertake this aim, we compared the safety and efficacy outcomes of EVE as part of minimization and elimination immunosuppressant regimens. Single center retrospective study of 217 LTR initiated on EVE (120 CNI minimization and 97 CNI elimination). Survival outcomes were calculated from the date of EVE commencement. On multivariate analysis, LTR who received EVE as part of the CNI elimination strategy had poorer survival outcomes compared to the CNI minimization strategy [HR 1.61, 95% CI: 1.11-2.32, p=0.010]. Utilization of EVE for renal preservation was associated with improved survival compared to other indications [HR 0.64, 95% CI: 0.42-0.97, p=0.032]. EVE can be successfully utilized for maintenance immunosuppression post LTx, particularly for renal preservation. However, immunosuppressive regimens containing low dose CNI had superior survival outcomes, highlighting the importance of retaining a CNI wherever possible.
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Affiliation(s)
- Steven Ivulich
- The Alfred Hospital, Melbourne, VIC, Australia,Centre for Medication Use and Safety, Monash University, Melbourne, VIC, Australia,*Correspondence: Steven Ivulich,
| | - Eldho Paul
- Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Carl Kirkpatrick
- Centre for Medication Use and Safety, Monash University, Melbourne, VIC, Australia
| | - Michael Dooley
- The Alfred Hospital, Melbourne, VIC, Australia,Centre for Medication Use and Safety, Monash University, Melbourne, VIC, Australia
| | - Greg Snell
- The Alfred Hospital, Melbourne, VIC, Australia
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15
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Collins MM, Ou Z, Millar MM, Kittleson MM, May LJ, Ploutz MS, Molina KM, Hayes KG, Lal AK. Attitudes & practices surrounding pregnancy post heart transplant among pediatric providers. J Heart Lung Transplant 2022; 41:1611-1616. [PMID: 36030149 PMCID: PMC10567538 DOI: 10.1016/j.healun.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/08/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Many pediatric heart transplant (HT) recipients reach adulthood and may be interested in family planning; there is little data regarding safety of pregnancy post HT and clinicians' opinions differ. Pediatric HT clinicians are instrumental in early counseling. Thus, a better understanding of pediatric HT clinicians' practices regarding family planning and how well aligned these practices are with adult transplant centers is essential. METHODS We conducted a confidential, web-based survey of pediatric HT clinicians in fall 2021. We summarized and compared answers using Fisher's exact test. RESULTS The survey was sent to 53 United States-based HT directors and to the International Society for Heart and Lung Transplantation and Pediatric Heart Transplant Society list serves. There were 69 respondents. The majority (77%) of respondents felt pregnancy was feasible in selected or all female HT recipients. Ten respondents reported that their institution had an established policy regarding pregnancy post HT. A majority (77%) of HT clinicians would either use a shared care model or recommend transition to their adult institution if pregnancy occurred, though 74% of respondents were either unaware of their corresponding adult institution's policy (62%) or had a counterpart adult program with a policy against pregnancy post HT (12%). CONCLUSIONS While many clinicians feel pregnancy is feasible in pediatric HT recipients, there remains significant practice variation. Few pediatric programs have a policy regarding pregnancy post HT. Future efforts to provide consistent messaging between adult and pediatric HT programs regarding the feasibility and care of post HT pregnancy are warranted.
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Affiliation(s)
- Megan M Collins
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah.
| | - Zhining Ou
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - Morgan M Millar
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lindsay J May
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah
| | - Michelle S Ploutz
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah
| | - Kimberly M Molina
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah
| | - Katherine G Hayes
- Department of Obstetrics & Gynecology, Division of Pediatric Gynecology, University of Utah, Salt Lake City, Utah
| | - Ashwin K Lal
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah
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16
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Hayes D, Cherikh WS, Harhay MO, Perch M, Hsich E, Potena L, Sadavarte A, Zehner A, Singh TP, Zuckermann A, Stehlik J. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Twenty-fifth Pediatric Lung Transplantation Report — 2022; Focus on Pulmonary Vascular Diseases. J Heart Lung Transplant 2022; 41:1348-1356. [DOI: 10.1016/j.healun.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/25/2022] [Indexed: 10/16/2022] Open
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17
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Koh W, Rao SB, Yasechko SM, Hayes D. Postoperative management of children after lung transplantation. Semin Pediatr Surg 2022; 31:151179. [PMID: 35725051 DOI: 10.1016/j.sempedsurg.2022.151179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pediatric lung transplantation is a highly specialized treatment option at a select few hospitals caring for children. Advancements in surgical and medical approaches in the care of these children have improved their care with only minimal improvement in outcomes which remain the lowest of all solid organ transplants. A crucial time period in the management of these children is in the perioperative period after performance of the lung transplant. Supporting allograft function, preventing infection, maintaining fluid balance, achieving pain control, and providing optimal respiratory support are all key factors required for this highly complex pediatric patient population. We review commonly encountered complications that these patients often experience and provide strategies for management.
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Affiliation(s)
- Wonshill Koh
- Heart Institute; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sangeetha B Rao
- Division of Critical Care Medicine, Boston Children's Hospital, Boston, MA; of Pediatrics, Harvard Medical School, Boston, MA
| | | | - Don Hayes
- Heart Institute; Division of Pulmonary Medicine Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
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18
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Avdimiretz N, Benden C. The changing landscape of pediatric lung transplantation. Clin Transplant 2022; 36:e14634. [PMID: 35244236 DOI: 10.1111/ctr.14634] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/20/2022] [Accepted: 02/28/2022] [Indexed: 11/29/2022]
Abstract
There has been a shift over decades in the diagnostic indications for lung transplantation in children; in particular, there has been a reduction in the proportion of pediatric cystic fibrosis (CF) patients undergoing lung transplantation early in life, and more transplants occurring in other diagnostic groups. Here, we examine trends in pediatric lung transplantation with regards to indication by analyzing data from the United Network of Organ Sharing, the International Society for Heart and Lung Transplantation Thoracic Transplant Registry, and other sources. Over the past two years, there has been a precipitous decline in both the number of transplants due to CF and the proportion of CF cases relative to the total number of transplants, likely not solely due to the COVID-19 pandemic. In 2020, primary pulmonary arterial hypertension for the first time surpassed CF as main indication for pediatric lung transplantation in the United States, a finding that is also reflected in international data. We discuss the effect of novel CFTR modulator therapies as a major factor leading to this shifting landscape. Based on our trending, pulmonary hypertension-related diagnoses and pediatric interstitial lung diseases are rising indications, for which we suggest adjustments of consensus guidelines around candidate selection criteria. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Nicholas Avdimiretz
- Division of Pediatric Respiratory Medicine, Stollery Children Hospital, University of Alberta, Edmonton, Canada
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19
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Hayes D, Melicoff-Portillo E, Ziady AG. Selection of lung transplant candidates: A pediatric perspective on the International Society for Heart and Lung Transplantation consensus document. J Heart Lung Transplant 2022; 41:998-999. [DOI: 10.1016/j.healun.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/08/2022] [Accepted: 02/19/2022] [Indexed: 11/29/2022] Open
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20
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A growing trend: CFTR modulators for cystic fibrosis lung transplant recipients. J Heart Lung Transplant 2021; 41:127-128. [PMID: 34924264 DOI: 10.1016/j.healun.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/23/2022] Open
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21
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Stehlik J, Christie JD, Goldstein DR, Amarelli C, Bertolotti A, Chambers DC, Dorent R, Gonzalez-Vilchez F, Parameshwar J, Perch M, Zuckermann A, Coll E, Levy RD, Atik FA, Gomez-Mesa JE, Moayedi Y, Peled-Potashnik Y, Schultz G, Cherikh W, Danziger-Isakov L. The evolution of the ISHLT transplant registry. Preparing for the future. J Heart Lung Transplant 2021; 40:1670-1681. [PMID: 34657795 DOI: 10.1016/j.healun.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Jason D Christie
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel R Goldstein
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Cristiano Amarelli
- Department of Cardiac Surgery and Transplants, Monaldi, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Alejandro Bertolotti
- Transplant Department, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | | | - Richard Dorent
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine Cedex, France
| | - Francisco Gonzalez-Vilchez
- Servicio de Cardiología. Hospital Universitario Marques de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - Jayan Parameshwar
- NHS Blood and Transplant and Advanced Heart Failure and Heart Transplant Service, Royal Papworth Hospital, Cambridge, UK
| | - Michael Perch
- Department of Cardiology, Heartcenter Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Robert D Levy
- Department of Medicine, Vancouver General Hospital, Vancouver, Canada
| | - Fernando A Atik
- Instituto de Cardiologia do Distrito Federal, Brasília, Brazil
| | - Juan Esteban Gomez-Mesa
- Juan Gomez - Cardiology service, Fundación Valle del Lili and Universidad Icesi, Cali, Colombia
| | - Yasbanoo Moayedi
- Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Yael Peled-Potashnik
- Cardiothoracic and Vascular Center, Yael Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Greg Schultz
- International Society for Heart and Lung Transplantation, Addison, Texas
| | - Wida Cherikh
- United Network for Organ Sharing, Richmond, Virginia
| | - Lara Danziger-Isakov
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
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22
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Chambers DC, Perch M, Zuckermann A, Cherikh WS, Harhay MO, HayesJr D, Hsich E, Khush KK, Potena L, Sadavarte A, Lindblad K, Singh TP, Stehlik J. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-eighth adult lung transplantation report - 2021; Focus on recipient characteristics. J Heart Lung Transplant 2021; 40:1060-1072. [PMID: 34446355 DOI: 10.1016/j.healun.2021.07.021] [Citation(s) in RCA: 229] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 11/29/2022] Open
Abstract
For over 30 years, the International Society for Heart and Lung Transplantation (ISHLT) International Thoracic Organ Transplant (TTX) Registry has gathered data regarding transplant procedures, donor and recipient characteristics, and outcomes from a global community of transplant centers. Almost 70,000 adult lung transplant procedures have been reported to the Registry since its inception, each one providing an opportunity for a recipient with end-stage lung disease to regain quality of life and longevity. With each year's report, we provide more detailed analyses on a particular focus theme important to recipient outcomes. Since 2013, these have been donor and recipient age; retransplantation; early graft failure; indication for transplant; allograft ischemic time; multiorgan transplantation; and donor and recipient size matching.1-7 In response to a changing regulatory environment, the ISHLT TTX Registry is undergoing an update in data acquisition, and the patient cohort examined in this report is therefore derived from the same data source or datasets as that examined in the 2019 annual reports.2,8-10 We refer the reader to the 2019 and prior reports for a detailed description of the baseline characteristics of the cohort, and additional core analyses not directly related to the focus explored in this year's report. To complement the 2020 report which focussed on donor characteristics, the goal of this year's report was to focus entirely on changes in recipient factors over the past 3 decades and to identify important recipient characteristics and transplant processes that may influence post-transplant outcomes. Due to small numbers, heart-lung transplant recipient characteristics and transplant outcomes have not been included. This 38th annual adult lung transplant report is hence based on data submitted to the ISHLT TTX Registry on 67,493 adult recipients of deceased recipient transplants between January 1, 1992 and June 30, 2018.
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Affiliation(s)
- Daniel C Chambers
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, TX
| | - Michael Perch
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, TX
| | - Andreas Zuckermann
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, TX
| | - Wida S Cherikh
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, TX
| | - Michael O Harhay
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, TX
| | - Don HayesJr
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, TX
| | - Eileen Hsich
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, TX
| | - Kiran K Khush
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, TX
| | - Luciano Potena
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, TX
| | - Aparna Sadavarte
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, TX
| | - Kelsi Lindblad
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, TX
| | - Tajinder P Singh
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, TX
| | - Josef Stehlik
- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, TX.
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- The International Society for Heart and Lung Transplantation - International Thoracic Organ Transplant Registry, Dallas, TX
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