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Landén I, Olander AE, Salmela E, Jahnukainen T, Ruokonen H, Alapulli H, Helenius-Hietala J. Oral findings in paediatric patients with severe heart, liver, and kidney failure prior to organ transplantation. Eur Arch Paediatr Dent 2024; 25:247-253. [PMID: 38483710 PMCID: PMC11058910 DOI: 10.1007/s40368-024-00879-6] [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: 09/27/2023] [Accepted: 01/31/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Organ transplantation is an effective treatment for children with severe heart, liver, and kidney diseases. These patient groups may have more oral and dental diseases than healthy controls. It is important to eliminate oral infection foci before transplantation and to maintain good oral health to avoid potential post-transplant complications. The aim of this study was to describe and compare oral health in Finnish paediatric heart, liver, and kidney transplant recipients prior to organ transplantation. METHODS Eighty-six children who received a heart (n = 21), liver (n = 19), or kidney (n = 46) transplant in Finland during the years 2014-2018 were included in this study. The inclusion criterion was a pre-transplantation oral examination. Oral hygiene, enamel anomalies, and the number of decayed, missing, and filled teeth (dmft/DMFT) were analyzed retrospectively from medical and dental records and compared between the three patient groups. RESULTS Children with liver (p = 0.043) or heart (p = 0.047) disease had higher combined primary and permanent dentition dmft/DMFT scores compared to children with kidney disease. A higher combined dmft/DMFT score was associated with poor oral hygiene (p = 0.005). No significant differences in oral hygiene between the patient groups were found. Furthermore, all patient groups had a high prevalence of developmental dental defects. CONCLUSION Children with liver or heart disease seem to have a higher combined dmft/DMFT score, indicating a higher prevalence of caries compared to children with kidney disease. Prevention of dental caries, along with promoting a good oral hygiene routine and regular check-ups, is suggested in these patient groups.
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Affiliation(s)
- I Landén
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, P.O. Box 281, 00029 HUS, Helsinki, Finland.
| | - A E Olander
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, P.O. Box 281, 00029 HUS, Helsinki, Finland
| | - E Salmela
- Department of Oral and Maxillofacial Diseases, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - T Jahnukainen
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - H Ruokonen
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, P.O. Box 281, 00029 HUS, Helsinki, Finland
| | - H Alapulli
- Department of Oral and Maxillofacial Diseases, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J Helenius-Hietala
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, P.O. Box 281, 00029 HUS, Helsinki, Finland
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Kaskinen AK, Tainio J, Pihkala JI, Peräsaari JP, Lauronen J, Raissadati A, Merenmies JM, Jalanko HJ, Jahnukainen T. Recurrent Mild Acute Rejections and Donor-specific Antibodies as Risk Factors for Cardiac Allograft Vasculopathy in a National Pediatric Heart Transplant Cohort. Transplant Direct 2023; 9:e1534. [PMID: 37745950 PMCID: PMC10513139 DOI: 10.1097/txd.0000000000001534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/24/2023] [Indexed: 09/26/2023] Open
Abstract
Background Immune-mediated factors such as acute cellular rejections and donor-specific antibodies (DSAs) are risk factors for cardiac allograft vasculopathy (CAV). We studied a national cohort with a unified setting and thorough protocol endomyocardial biopsy (EMB) data for an association between cellular rejections, especially when mild and recurrent, and DSAs with CAV in pediatric heart transplant (HTx) patients. Methods This is a retrospective, national cohort study of 94 pediatric HTxs performed between 1991 and 2019 and followed until December 31, 2020. Diagnosis of CAV was based on reevaluation of angiographies. Protocol and indication EMB findings with other patient data were collected from medical records. Associations between nonimmune and immune-mediated factors and CAV were analyzed with univariable and multivariable Cox regression analyses. Results Angiographies performed on 76 patients revealed CAV in 23 patients (30%). Altogether 1138 EMBs (92% protocol biopsies) were performed on 78 patients (83%). During the first posttransplant year, grade 1 rejection (G1R) appeared in 45 patients (58%), and recurrent (≥2) G1R findings in 14 patients (18%). Pretransplant DSAs occurred in 13 patients (17%) and posttransplant DSAs in 37 patients (39%). In univariable analysis, pretransplant DSAs, appearance and recurrence of G1R findings, and total rejection score during the first posttransplant year, as well as recurrent G1R during follow-up, were all associated with CAV. In multivariable analysis, pretransplant DSAs and recurrent G1R during the first posttransplant year were found to be associated with CAV. Conclusions Our results indicate that pretransplant DSA and recurrent G1R findings, especially during the first posttransplant year, are associated with CAV after pediatric HTx.
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Affiliation(s)
- Anu K. Kaskinen
- Department of Pediatric Nephrology and Transplantation, New Children’s Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juuso Tainio
- Department of Pediatric Nephrology and Transplantation, New Children’s Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jaana I. Pihkala
- Department of Pediatric Cardiology, New Children’s Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juha P. Peräsaari
- Finnish Red Cross Blood Service, Histocompatibility Laboratory, Helsinki, Finland
| | - Jouni Lauronen
- Finnish Red Cross Blood Service, Histocompatibility Laboratory, Helsinki, Finland
| | - Alireza Raissadati
- Division of Cardiology, Department of Pediatrics, Stanford School of Medicine, Helsinki, Finland
| | - Jussi M. Merenmies
- Department of Pediatric Nephrology and Transplantation, New Children’s Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hannu J. Jalanko
- Department of Pediatric Nephrology and Transplantation, New Children’s Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Timo Jahnukainen
- Department of Pediatric Nephrology and Transplantation, New Children’s Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Aetiology and 30-Year Long-Term Outcome of Children with Cardiomyopathy Necessitating Heart Transplantation. J Pers Med 2020; 10:jpm10040251. [PMID: 33260794 PMCID: PMC7712803 DOI: 10.3390/jpm10040251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
Studies assessing the long-term outcome after heart transplantation HTX in patients with cardiomyopathy (CM) in the paediatric age range are rare. The aim of this study was to determine the survival rate of children with CM undergoing HTX and to analyse how aetiology of cardiomyopathy influenced morbidity and mortality. We retrospectively analysed the medical records of children; who were transplanted in our centre between June 1988 and October 2019. 236 heart transplantations were performed since 1988 (9 re-transplants). 98 of 227 patients (43.2%) were transplanted because of CM. Survival rates were 93% after 1; 84% after 10 and 75% after 30 years. Overall; the aetiology of CM could be clearly identified in 37 subjects (37.7%). This rate increased up to 66.6% (12/19) by applying a comprehensive diagnostic workup since 2016. The survival rate was lower (p < 0.05) and neurocognitive deficits were more frequent (p = 0.001) in subjects with systemic diseases than in individuals with cardiac-specific conditions. These data indicate that the long-term survival rate of children with CM after HTX in experienced centers is high. A comprehensive diagnostic workup allows unraveling the basic defect in the majority of patients with CM undergoing HTX. Aetiology of CM affects morbidity and mortality in subjects necessitating HTX.
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Jahnukainen T, Lauronen J, Raissadati A, Pihkala JI, Ylinen E, Puntila JT, Salminen JT, Pätilä T, Mattila IP, Jalanko HJ. Development of Human Leukocyte Antigen (HLA) Antibodies Against Vascular Homograft Donor in Pediatric Heart Transplant Recipients. Ann Transplant 2019; 24:454-460. [PMID: 31383839 PMCID: PMC6698089 DOI: 10.12659/aot.917232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The appearance of human leukocyte antigen (HLA) antibodies after solid organ transplantation predisposes recipients to graft dysfunction. In theory, vascular homografts, which are widely used in children with congenital heart defects, may cause allosensitization. Material/Methods In this single-center retrospective study, the presence of pre-existing HLA antibodies in pediatric heart transplant (HTx) recipients with a vascular homograft was evaluated in a cohort of 12 patients. HLA antibodies were screened before and after HTx and positive screening results were confirmed and identified using the Luminex® single antigen bead method. Endomyocardial biopsies (EMB) and coronary angiography studies were re-evaluated to assess the prevalence of acute rejections and coronary artery change in these patients. Results At the time of HTx, 8 patients (67%) had HLA antibodies detected by the Luminex assay, none of which were heart donor specific (DSA). All patients had negative leukocyte crossmatch. One patient developed DSAs against homograft donor prior to HTx. After the HTx, 5 patients (42%) developed DSAs against the heart donor and 4 patients (40%) against the homograft donor. In 2 patients (17%), the antibodies were against both heart and homograft donors. The rejection rate or prevalence of coronary artery vasculopathy did not differ significantly between the homograft cohort and our historical controls. Conclusions Our results suggest that the prevalence of DSAs against homograft donor prior to HTx is relatively rare. However, almost half of the patients developed DSAs against homograft post-HTx. The clinical importance of these antibodies warrants further studies.
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Affiliation(s)
- Timo Jahnukainen
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Alireza Raissadati
- Department of Pediatric Cardiology, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana I Pihkala
- Department of Pediatric Cardiology, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Elisa Ylinen
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Tapani Puntila
- Department of Pediatric Surgery, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jukka T Salminen
- Department of Pediatric Surgery, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tommi Pätilä
- Department of Pediatric Surgery, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka P Mattila
- Department of Pediatric Surgery, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannu Jaakko Jalanko
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Sánchez Ferrer F, Castro García FJ, Pérez-Lescure Picarzo J, Roses Noguer F, Centeno Malfaz F, Grima Murcia MD, Brotons DA. Current situation of the organisation, resources and activity in paediatric cardiology in Spain. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2018.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sánchez Ferrer F, Castro García FJ, Pérez-Lescure Picarzo J, Roses Noguer F, Centeno Malfaz F, Grima Murcia MD, Brotons DA. [Current situation of the organisation, resources and activity in paediatric cardiology in Spain]. An Pediatr (Barc) 2018; 90:94-101. [PMID: 29706438 DOI: 10.1016/j.anpedi.2018.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/05/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION The results are presented on the «current situation of the organisation, resources and activity in paediatric cardiology in Spain». It was promoted by the Spanish Society of Paediatric Cardiology and Congenital Heart disease. MATERIAL AND METHODS An analysis was carried out on the results obtained from a specifically designed questionnaire, prepared by the Spanish Society of Paediatric Cardiology and Congenital Heart disease, that was sent to all hospitals around the country that offer the speciality of paediatric cardiology. RESULTS A total of 86 questionnaires were obtained, including 14 hospitals that perform cardiac surgery on children. A total of 190 paediatric cardiology consultants, 40 cardiac surgeons, and 27 middle grade doctors performing their paediatric residency (MIR program) were identified. All hospitals had adequate equipment to perform an optimal initial evaluation of any child with a possible cardiac abnormality, but only tertiary centres could perform complex diagnostic procedures, interventional cardiology, and cardiac surgery. In almost all units around the country, paediatric cardiology consultants were responsible for outpatient clinics and hospital admissions, whereas foetal cardiology units were still mainly managed by obstetricians. The number of diagnostic and therapeutic procedures was similar to those reported in the first survey, except for a slight decrease in the total number of closed cardiac surgery procedures, and a proportional increase in the number of therapeutic catheterisations. CONCLUSIONS Paediatric Cardiology in Spain is performed by paediatric cardiology consultants that were trained initially as general paediatricians, and then completed a paediatric cardiology training period. Almost all units have adequate means for diagnosis and treatment. Efforts should be directed to create a national registry that would not only allow a prospective quantification of diagnostic and therapeutic procedures, but also focus on their clinical outcomes.
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Affiliation(s)
- Francisco Sánchez Ferrer
- Hospital Universitario de San Juan de Alicante, Alicante, España. Grupo de Trabajo de Cardiología Clínica y Registros de la Sociedad Española de Cardiología y Cardiología Pediátrica y Cardiopatías congénitas.
| | - Francisco José Castro García
- Hospital Universitario Virgen de la Arrixaca, Murcia, España. Grupo de Trabajo de Cardiología Clínica y Registros de la Sociedad Española de Cardiología y Cardiología Pediátrica y Cardiopatías congénitas
| | - Javier Pérez-Lescure Picarzo
- Hospital Universitario Fundación Alcorcón, Madrid, España. Grupo de Trabajo de Cardiología Clínica y Registros de la Sociedad Española de Cardiología y Cardiología Pediátrica y Cardiopatías congénitas
| | - Ferrán Roses Noguer
- Hospital Universitario Vall Hebrón, Barcelona, España. Grupo de Trabajo de Cardiología Clínica y Registros de la Sociedad Española de Cardiología y Cardiología Pediátrica y Cardiopatías congénitas
| | - Fernándo Centeno Malfaz
- Hospital Universitario Río Ortega, Valladolid, España. Grupo de Trabajo de Cardiología Clínica y Registros de la Sociedad Española de Cardiología y Cardiología Pediátrica y Cardiopatías congénitas
| | | | - Dimpna Albert Brotons
- Hospital Universitario Vall Hebrón, Barcelona, España. Sociedad Española de Cardiología y Cardiología Pediátrica y Cardiopatías congénitas
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Rahmenbedingungen für ein Kinderherztransplantationsprogramm. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00398-017-0164-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Vener DF, Gaies M, Jacobs JP, Pasquali SK. Clinical Databases and Registries in Congenital and Pediatric Cardiac Surgery, Cardiology, Critical Care, and Anesthesiology Worldwide. World J Pediatr Congenit Heart Surg 2016; 8:77-87. [DOI: 10.1177/2150135116681730] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The growth in large-scale data management capabilities and the successful care of patients with congenital heart defects have coincidentally paralleled each other for the last three decades, and participation in multicenter congenital heart disease databases and registries is now a fundamental component of cardiac care. This manuscript attempts for the first time to consolidate in one location all of the relevant databases worldwide, including target populations, specialties, Web sites, and participation information. Since at least 1,992 cardiac surgeons and cardiologists began leveraging this burgeoning technology to create multi-institutional data collections addressing a variety of specialties within this field. Pediatric heart diseases are particularly well suited to this methodology because each individual care location has access to only a relatively limited number of diagnoses and procedures in any given calendar year. Combining multiple institutions data therefore allows for a far more accurate contemporaneous assessment of treatment modalities and adverse outcomes. Additionally, the data can be used to develop outcome benchmarks by which individual institutions can measure their progress against the field as a whole and focus quality improvement efforts in a more directed fashion, and there is increasing utilization combining clinical research efforts within existing data structures. Efforts are ongoing to support better collaboration and integration across data sets, to improve efficiency, further the utility of the data collection infrastructure and information collected, and to enhance return on investment for participating institutions.
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Affiliation(s)
- David F. Vener
- Department of Anesthesiology, Perioperative and Pain Medicine, Pediatric Cardiovascular Anesthesia, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Michael Gaies
- Department of Pediatric Cardiology, C. S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey P. Jacobs
- Cardiovascular Surgery, Johns Hopkins All Children’s Hospital, St Petersburg, FL, USA
| | - Sara K. Pasquali
- Department of Pediatric Cardiology, C. S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
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Yerebakan C, Valeske K, Akintuerk H. eComment. Paediatric cardiac transplantation - Better outcome, more challenges and novel alternatives. Interact Cardiovasc Thorac Surg 2016; 23:25. [PMID: 27325653 DOI: 10.1093/icvts/ivw174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Can Yerebakan
- Pediatric Heart Center Giessen, Justus-Liebig-University, Giessen, Germany
| | - Klaus Valeske
- Pediatric Heart Center Giessen, Justus-Liebig-University, Giessen, Germany
| | - Hakan Akintuerk
- Pediatric Heart Center Giessen, Justus-Liebig-University, Giessen, Germany
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