1
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Butto A, O'Halloran C, Kuo J, Joong A, Hauck AL, Nugent A, Mahle W, Tannous P. De Novo and Progressive Pulmonary Vein Stenosis Following Pediatric Heart Transplantation: A Multicenter Retrospective Study. Pediatr Transplant 2024; 28:e14828. [PMID: 39030991 DOI: 10.1111/petr.14828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 06/07/2024] [Accepted: 07/05/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Pulmonary vein stenosis (PVS) is a rare condition in which neointimal proliferation leads to venous and arterial hypertension. Little is known about PVS after heart transplant (HTx) in children. We sought to describe the characteristics and outcomes of children who develop PVS after HTx. METHODS We performed a retrospective review of patients ≤18 years old who underwent HTx at two HTx centers between April 2012 and October 2023. Patients with PVS were identified via database queries. Cardiac diagnosis, PVS location and extent, and outcomes were recorded. RESULTS Over 11.5 years, 422 patients underwent HTx across both centers. Nineteen patients with PVS (10 male) were identified, 15 with de novo PVS. Sixteen had underlying congenital heart disease (CHD), two with anomalous pulmonary venous return. PVS was diagnosed at a median of 2 months (range 2 weeks to 14 years) after HTx. At time of initial diagnosis, 13 patients had one-vessel PVS. At final follow-up, 7/19 (37%) had increases in the number of vessels involved. Six patients underwent surgery, and nine patients had stent or balloon angioplasty. Two patients were treated for pulmonary hypertension following PVS diagnosis. Three patients died from right heart failure secondary to PVS. CONCLUSIONS This is the largest study to describe the characteristics of post-HTx PVS in children. PVS occurs in 4.5% of HTx, and underlying CHD is a strong risk factor. Multiple vessels can be involved and may require catheter-based or surgical intervention. Clinicians must be vigilant in monitoring the development of PVS in this population.
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Affiliation(s)
- Arene Butto
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | - James Kuo
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Anna Joong
- Lurie Children's Hospital, Chicago, Illinois, USA
| | | | - Alan Nugent
- Lurie Children's Hospital, Chicago, Illinois, USA
| | - William Mahle
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Paul Tannous
- Lurie Children's Hospital, Chicago, Illinois, USA
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2
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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022; 42:e1-e141. [PMID: 37080658 DOI: 10.1016/j.healun.2022.10.015] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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3
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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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4
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Rosenthal LM, Nordmeyer J, Kramer P, Danne F, Pfitzer C, Berger F, Schmitt KRL, Schubert S. Long-term experience using CNI-free immunosuppression in selected paediatric heart transplant recipients. Pediatr Transplant 2021; 25:e14111. [PMID: 34405495 DOI: 10.1111/petr.14111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/19/2021] [Accepted: 07/29/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND CNI-free immunosuppression with conversion to mTORi-based immunosuppression has been demonstrated to reduce CNI-toxicity and to exhibit anti-proliferative properties. However, the experience of CNI-free immunosuppression in paediatric heart transplantation is limited. METHODS A retrospective analysis was conducted of 129 paediatric heart transplants performed between 1997 and 2015. Fifteen patients with clinically indicated conversion from CNI-based to CNI-free immunosuppression were identified. Survival data, rejection episodes, renal function, post-transplantation lymphoproliferative disorder and CAV, including examination with OCT were analysed. RESULTS Immunosuppression conversion was successful in all patients. Fourteen of 15 patients (93%) are currently living with good graft function. Median post-transplant survival was 15 years (range, 5-23 years), and median follow-up since conversion was 6 years (range, 1-11 years). Mild (grade 1R) ACR was present in three patients after discontinuation of CNIs. The recovery of renal function with a significant increase in eGFR was observed at 1 and 3 years after conversion. No patient had angiographic signs of macroscopic CAV according to the current ISHLT classification; however, OCT showed the signs of angiographically silent CAV in all patients. CAV did not progress in any patient, implying CAV was stabilised by mTORi-based CNI-free immunosuppression. CONCLUSIONS CNI-free immunosuppression based on mTORis is a safe and appropriate strategy for maintenance therapy in selected paediatric patients, significantly improves renal function and stabilises CAV. OCT revealed early development of angiographically silent CAV.
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Affiliation(s)
- Lisa-Maria Rosenthal
- Department for Congenital Heart Disease/Pediatric Cardiology, German Heart Institute, Berlin, Germany.,Department for Pediatric Cardiology, Charité Universitätsmedizin, Berlin, Germany
| | - Johannes Nordmeyer
- Department for Congenital Heart Disease/Pediatric Cardiology, German Heart Institute, Berlin, Germany
| | - Peter Kramer
- Department for Congenital Heart Disease/Pediatric Cardiology, German Heart Institute, Berlin, Germany
| | - Friederike Danne
- Department for Congenital Heart Disease/Pediatric Cardiology, German Heart Institute, Berlin, Germany
| | - Constanze Pfitzer
- Department for Congenital Heart Disease/Pediatric Cardiology, German Heart Institute, Berlin, Germany
| | - Felix Berger
- Department for Congenital Heart Disease/Pediatric Cardiology, German Heart Institute, Berlin, Germany.,Department for Pediatric Cardiology, Charité Universitätsmedizin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Katharina Rose Luise Schmitt
- Department for Congenital Heart Disease/Pediatric Cardiology, German Heart Institute, Berlin, Germany.,Department for Pediatric Cardiology, Charité Universitätsmedizin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Stephan Schubert
- Department for Congenital Heart Disease/Pediatric Cardiology, German Heart Institute, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany.,Center of Congenital Heart Disease, Heart and Diabetes Center North Rhine-Westfalia (HDZ-NRW), Ruhr-University of Bochum, Bad Oeynhausen, Germany
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5
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Johnson JN, Filler G. The importance of cardiovascular disease in pediatric transplantation and its link to the kidneys. Pediatr Transplant 2018; 22:e13146. [PMID: 29441655 DOI: 10.1111/petr.13146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2017] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease is a frequent cause of morbidity and mortality in pediatric patients following solid organ transplant. CKD is also common in pediatric patients after a solid organ transplant, and the link between CKD and cardiovascular morbidity is strong. In this review, we examine potential etiologies to explain the risk of cardiovascular morbidity and mortality in pediatric solid organ recipients and identify targets for improving outcomes.
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Affiliation(s)
- Jonathan N Johnson
- Department of Pediatrics/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Guido Filler
- Department of Paediatrics, Schulich School of Medicine & Dentistry, London, ON, Canada.,Department of Medicine, Schulich School of Medicine & Dentistry, London, ON, Canada.,Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
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6
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Asante-Korang A, Carapellucci J, Krasnopero D, Doyle A, Brown B, Amankwah E. Conversion from calcineurin inhibitors to mTOR inhibitors as primary immunosuppressive drugs in pediatric heart transplantation. Clin Transplant 2017; 31. [PMID: 28708333 DOI: 10.1111/ctr.13054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 11/28/2022]
Abstract
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 to 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). We monitored for rejection, infection, BUN, creatinine, hyperlipidemia, EBV and CMV copies, CBC, cardiac allograft vasculopathy (CAV), and death. Target trough levels of sirolimus and everolimus were 4-10. Four treatment failures included debilitating rash, bone marrow suppression, recurrent rejection, and renal transplantation. There were no deaths. One patient had recurrent rejection episodes, and tacrolimus was reinitiated. One patient with preexisting CAV underwent heart retransplantation. One patient, who was treated for PTLD, transformed to CD30+ Hodgkins disease, and was treated with brentuximab. There were three acute rejection episodes. Median creatinine preswitch was higher 0.82 than postswitch 0.78 (P=.016). Median eGFR was lower preswitch, 75.6, than postswitch, 91.2 (P=.0004). These results indicate that conversion to mTORI as primary immunosuppression may be safely accomplished in some pediatric heart transplant patients.
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Affiliation(s)
- Alfred Asante-Korang
- Divisions of Cardiology, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Jennifer Carapellucci
- Divisions of Cardiology, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Diane Krasnopero
- Divisions of Cardiology, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Abigail Doyle
- Divisions of Cardiology, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Brian Brown
- Pharmacy, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Ernest Amankwah
- Center for Translational Research, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA.,Hematology Oncology, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
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7
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Simmond J, Burch M. Calcineurin inhibitor-free immunosuppression. Pediatr Transplant 2017; 21. [PMID: 27933700 DOI: 10.1111/petr.12868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jacob Simmond
- Paediatric Cardiology, Great Ormond Street Hospital (GOSH), London, UK
| | - Michael Burch
- Paediatric Cardiology, Great Ormond Street Hospital (GOSH), London, UK
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8
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Sierra CM, Tan R, Eguchi J, Bailey L, Chinnock RE. Calcineurin inhibitor- and corticosteroid-free immunosuppression in pediatric heart transplant patients. Pediatr Transplant 2017; 21. [PMID: 27658616 DOI: 10.1111/petr.12808] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 12/20/2022]
Abstract
Pediatric heart transplant patients at our institution are immunosuppressed with a CNI and another immune-modulating agent without utilizing corticosteroids. Patients whose renal function worsened and who did not respond to CNI minimization had their CNI discontinued. The clinical history of 35 pediatric heart transplant patients with significant renal insufficiency whose CNI was discontinued was retrospectively analyzed. Data including serum creatinine and weight were collected before, at time of, and every 3-6 months after CNI discontinuation. This was used to calculate an eGFR. Cardiac allograft rejection and mortality data were also collected. CNI discontinuation occurred 39 times in 35 patients. The median eGFR significantly increased by 14 mL/min 3 months after CNI discontinuation and the increase continued to be significant (P≤.05) at 5 years. Freedom from rejection analysis showed no difference between graft rejection 2 years before versus after CNI discontinuation (P=.437). No mortality was associated with CNI discontinuation. Immunosuppression free of CNIs and corticosteroids appears to be a safe alternative in pediatric heart transplant patients with significant renal insufficiency. Furthermore, this strategy can significantly reverse renal insufficiency, even late after transplantation.
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Affiliation(s)
| | - Robert Tan
- Medical Center, Loma Linda University, Loma Linda, CA, USA
| | - Jim Eguchi
- Children's Hospital, Loma Linda University, Loma Linda, CA, USA
| | - Leonard Bailey
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
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9
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Recent Advances in Mammalian Target of Rapamycin Inhibitor Use in Heart and Lung Transplantation. Transplantation 2016; 100:2558-2568. [DOI: 10.1097/tp.0000000000001432] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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Abstract
OBJECTIVES Although there have been tremendous advancements in the care of severe pediatric cardiovascular disease, heart transplantation remains the standard therapy for end-stage heart disease in children. As such, these patients comprise an important and often complex subset of patients in the ICU. The purpose of this article is to review the causes and management of allograft dysfunction and the medications used in the transplant population. DATA SOURCES MEDLINE, PubMed, and Cochrane Database of systemic reviews. CONCLUSIONS Pediatric heart transplant recipients represent a complex group of patients that frequently require critical care. Their immunosuppressive medications, while being vital to maintenance of allograft function, are associated with significant short- and long-term complications. Graft dysfunction can occur from a variety of etiologies at different times following transplantation and remains a major limitation to long-term posttransplant survival.
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11
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Karakas NM, Erdogan I, Ozdemir B, Sezgin A. Pain Syndrome and Ventricular Arrhythmia Induced by Sirolimus and Resolved by Dosage Adjustment in a Child After Heart Transplant: A Case Report. EXP CLIN TRANSPLANT 2016. [PMID: 27210056 DOI: 10.6002/ect.2015.0320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
For patients with late congenital heart diseases and advanced heart failure, heart transplant is the one of the most effective known treatment methods. With the development of immunosuppressive medicines, it is possible to prevent and treat rejection, and survival after organ transplant has increased rapidly. Calcineurin inhibitors (tacrolimus and cyclosporine), mycophenolate mofetil, and corticosteroids are used together in many centers as immunosuppressive medications. Although the use of calcineurin inhibitors is essential, therapy is switched to sirolimus in some specific cases and when significant adverse effects occur. The most seen sirolimus-based adverse effects are diarrhea, constipation, vomiting, nausea, abdominal pain, leg pain, acne, headache, and sleep problems. Here, we present a patient who had abdominal pain, nausea, vomiting, and ventricular extrasystole attacks due to sirolimus toxicity, which improved with dose adjustment during follow-up after heart transplant. Pain associated with the use of calcineurin inhibitors improving with sirolimus has been previously reported before; however, because we did not encounter pain syndrome associated with use of sirolimus, we chose to report our experience with this patient.
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12
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Affiliation(s)
- Maurizio Miano
- Clinical and Experimental Haematology Unit; Department of Haematology/Oncology; IRCCS Istituto Giannina Gaslini; Genoa Italy
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13
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Miano M, Scalzone M, Perri K, Palmisani E, Caviglia I, Micalizzi C, Svahn J, Calvillo M, Banov L, Terranova P, Lanza T, Dufour C, Fioredda F. Mycophenolate mofetil and Sirolimus as second or further line treatment in children with chronic refractory Primitive or Secondary Autoimmune Cytopenias: a single centre experience. Br J Haematol 2015; 171:247-253. [PMID: 26058843 DOI: 10.1111/bjh.13533] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/30/2015] [Indexed: 01/19/2023]
Abstract
The management of refractory autoimmune cytopenias in childhood is challenging due to the lack of established evidence on escalating treatments. The long-term efficacy of immunosuppressive drugs was evaluated in children with refractory autoimmune cytopenias referred to the Haematology Unit of the Gaslini Children's Hospital between 2001 and 2014. Patients were grouped into three categories: autoimmune lymphoproliferative syndrome (ALPS), ALPS-related syndrome (at least one absolute/primary additional criterion for ALPS) and primary autoimmune cytopenia (PAC, cytopenia with no other immunological symptoms/signs). Fifty-eight children (aged 1-16 years) entered the study: 12 were categorized with ALPS, 24 were ALPS-related and 22 had PAC. Five didn't receive treatment. Fifty-three were initially treated with steroids/intravenous immunoglobulin. Fourteen responded, whereas 39 did not. Of these 39 patients, 34 (87%) received mycophenolate mofetil (MMF) as second/further-line treatment and 22 (65%) responded. Within these 34 subjects, ALPS patients responded better (11/11, 100%) than the two other groups pooled together (11/23, 48%; P = 0·002). Sirolimus was given as second/further-line treatment to 16 children, and 12 (75%) responded, including 8 who previously failed MMF therapy. Median follow-up was 3·46 years. MMF and Sirolimus were well-tolerated and enabled partial/complete and sustained remission in most children. These drugs may be successfully and safely used in children with refractory autoimmune cytopenias with or without ALPS/ALPS-related disorders and may represent a valid second/further line option.
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Affiliation(s)
- Maurizio Miano
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Maria Scalzone
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Katia Perri
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Elena Palmisani
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Ilaria Caviglia
- Infectious Disease Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Concetta Micalizzi
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Johanna Svahn
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Michaela Calvillo
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Laura Banov
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Paola Terranova
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Tiziana Lanza
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Carlo Dufour
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Francesca Fioredda
- Clinical and Experimental Haematology Unit, Giannina Gaslini Children's Hospital, Genova, Italy
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14
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Harris KC, Manouzi A, Fung AY, De Souza A, Bezerra HG, Potts JE, Hosking MC. Feasibility of Optical Coherence Tomography in Children With Kawasaki Disease and Pediatric Heart Transplant Recipients. Circ Cardiovasc Imaging 2014; 7:671-8. [DOI: 10.1161/circimaging.113.001764] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Optical coherence tomography (OCT) is a high-resolution intravascular imaging technique used in adults. We tested the hypothesis that OCT could identify coronary abnormalities not seen by angiography in children with a history of Kawasaki disease (KD) and pediatric heart transplant (TX) recipients.
Methods and Results—
Patients with KD and TX recipients were evaluated between December 2012 and October 2013 with angiography and OCT (Ilumien System, LightLabs, St Jude Medical, Westford, MA). Modifications were made to the adult OCT protocol to adapt this technique for children. Serial cross-sectional area measurements of the lumen, intima, and media were made. Entire imaging data were analyzed for the presence of qualitative changes. Seventeen children were evaluated (5 patients with KD; 12 TX recipients). In patients with KD, angiography was normal. However, OCT imaging revealed that significant vessel wall abnormalities were present in all children including intimal thickening (intima/lumen cross-sectional area ratio>0.4), loss of the normal layered structure of the vessel wall, white thrombus, calcification, and neovascularization. There was extensive destruction of the internal elastic lamina. In TX recipients, angiography was normal; however, intimal thickening (intima/media cross-sectional area ratio>1) was seen in 9 of 12 patients. The median intima/media cross-sectional area ratio was 1.18.
Conclusions—
In this initial experience with OCT in children, we have identified significant coronary abnormalities with OCT that are angiographically silent in children with a history of coronary aneurysms because of KD and in pediatric TX recipients.
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Affiliation(s)
- Kevin C. Harris
- From the Division of Pediatric Cardiology, Department of Pediatrics (K.C.H., A.M., A.D.S., J.E.P., M.C.K.H.) and Division of Cardiology, Department of Medicine (A.Y.F.), University of British Columbia, Vancouver, Canada; and Division of Cardiology, Department of Medicine, Case Western Reserve University, Cleveland, OH (H.G.B.)
| | - Anas Manouzi
- From the Division of Pediatric Cardiology, Department of Pediatrics (K.C.H., A.M., A.D.S., J.E.P., M.C.K.H.) and Division of Cardiology, Department of Medicine (A.Y.F.), University of British Columbia, Vancouver, Canada; and Division of Cardiology, Department of Medicine, Case Western Reserve University, Cleveland, OH (H.G.B.)
| | - Anthony Y. Fung
- From the Division of Pediatric Cardiology, Department of Pediatrics (K.C.H., A.M., A.D.S., J.E.P., M.C.K.H.) and Division of Cardiology, Department of Medicine (A.Y.F.), University of British Columbia, Vancouver, Canada; and Division of Cardiology, Department of Medicine, Case Western Reserve University, Cleveland, OH (H.G.B.)
| | - Astrid De Souza
- From the Division of Pediatric Cardiology, Department of Pediatrics (K.C.H., A.M., A.D.S., J.E.P., M.C.K.H.) and Division of Cardiology, Department of Medicine (A.Y.F.), University of British Columbia, Vancouver, Canada; and Division of Cardiology, Department of Medicine, Case Western Reserve University, Cleveland, OH (H.G.B.)
| | - Hiram G. Bezerra
- From the Division of Pediatric Cardiology, Department of Pediatrics (K.C.H., A.M., A.D.S., J.E.P., M.C.K.H.) and Division of Cardiology, Department of Medicine (A.Y.F.), University of British Columbia, Vancouver, Canada; and Division of Cardiology, Department of Medicine, Case Western Reserve University, Cleveland, OH (H.G.B.)
| | - James E. Potts
- From the Division of Pediatric Cardiology, Department of Pediatrics (K.C.H., A.M., A.D.S., J.E.P., M.C.K.H.) and Division of Cardiology, Department of Medicine (A.Y.F.), University of British Columbia, Vancouver, Canada; and Division of Cardiology, Department of Medicine, Case Western Reserve University, Cleveland, OH (H.G.B.)
| | - Martin C.K. Hosking
- From the Division of Pediatric Cardiology, Department of Pediatrics (K.C.H., A.M., A.D.S., J.E.P., M.C.K.H.) and Division of Cardiology, Department of Medicine (A.Y.F.), University of British Columbia, Vancouver, Canada; and Division of Cardiology, Department of Medicine, Case Western Reserve University, Cleveland, OH (H.G.B.)
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15
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Miano M, Calvillo M, Palmisani E, Fioredda F, Micalizzi C, Svahn J, Banov L, Russo G, Lanza T, Dufour C. Sirolimus for the treatment of multi-resistant autoimmune haemolytic anaemia in children. Br J Haematol 2014; 167:571-4. [DOI: 10.1111/bjh.13010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Maurizio Miano
- Haematology Unit; G. Gaslini Children's Hospital; Genoa Italy
| | | | - Elena Palmisani
- Haematology Unit; G. Gaslini Children's Hospital; Genoa Italy
| | | | | | - Johanna Svahn
- Haematology Unit; G. Gaslini Children's Hospital; Genoa Italy
| | - Laura Banov
- Haematology Unit; G. Gaslini Children's Hospital; Genoa Italy
| | - Giovanna Russo
- Paediatric Haematology/Oncology Unit; University of Catania; Catania Italy
| | - Tiziana Lanza
- Haematology Unit; G. Gaslini Children's Hospital; Genoa Italy
| | - Carlo Dufour
- Haematology Unit; G. Gaslini Children's Hospital; Genoa Italy
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