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Amdani S, Aljohani OA, Kirklin JK, Cantor R, Koehl D, Schumacher K, Nandi D, Khoury M, Dreyer W, Rose-Felker K, Nasman C, Kemna MS. Assessing Donor-Recipient Size Mismatch in Pediatric Heart Transplantation: Lessons Learned From Over 7,500 Transplants. JACC. HEART FAILURE 2024; 12:380-391. [PMID: 37676215 DOI: 10.1016/j.jchf.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/20/2023] [Accepted: 07/10/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND To date, no studies have identified an optimal metric to match donor-recipient (D-R) pairs in pediatric heart transplantation (HT). OBJECTIVES This study sought to identify size mismatch metrics that predicted graft survival post-HT. METHODS D-R pairs undergoing HT in Pediatric Heart Transplant Society database from 1993 to 2021 were included. Effects of size mismatch by height, weight, body mass index, body surface area, predicted heart mass, and total cardiac volume (TCV) on 1- and 5-year graft survival and morbidity outcomes (rejection and cardiac allograft vasculopathy) were evaluated. Cox models with stepwise selection identified size metrics that independently predicted graft survival. RESULTS Of 7,715 D-R pairs, 36.0% were well matched (D-R ratio: -20% to +20%) by weight, 39.0% by predicted heart mass, 50.0% by body surface area, 57.0% by body mass index, 71.0% by height, and 93.0% by TCV. Of all size metrics, only D-R mismatch by height and TCV predicted graft survival at 1 and 5 years. Effects of D-R size mismatch on graft survival were nonlinear. At both 1 and 5 years post-HT, D-R undersizing and oversizing by height led to increased graft loss, with graft loss observed more frequently with undersizing. Moderately undersized donors by height (D-R ratio: <-30%) frequently experienced rejection post-HT (P < 0.001). Assessing D-R size matching by TCV, minimal donor undersizing was protective, while oversizing up to 25% was not associated with increased graft loss. CONCLUSIONS In pediatric HT, D-R appear most optimally matched using TCV. Only D-R size mismatch by TCV and height independently predicts graft survival. Standardizing size matching across centers may reduce donor discard.
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Affiliation(s)
- Shahnawaz Amdani
- Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA.
| | - Othman A Aljohani
- Division of Pediatric Cardiology, Department of Pediatrics, Benioff Children's Hospital, University of California-San Francisco, San Francisco, California, USA
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ryan Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Devin Koehl
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kurt Schumacher
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Deipanjan Nandi
- Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Michael Khoury
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - William Dreyer
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Kirsten Rose-Felker
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Colleen Nasman
- Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Mariska S Kemna
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
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2
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Gill G, Rowe G, Zubair MM, Chen Q, Thomas J, Chiu P, Osho A, Sood V, Schumacher KR, Emerson D, Bowdish ME, Chikwe J, Fynn-Thompson F. Impact of donor-recipient age-difference in adolescent heart transplantation. Clin Transplant 2023; 37:e15146. [PMID: 37776273 PMCID: PMC10841908 DOI: 10.1111/ctr.15146] [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: 08/02/2023] [Revised: 08/26/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION The relationship between donor age and adolescent heart transplant outcomes remains incompletely understood. We aimed to explore the effect of donor-recipient age difference on survival after adolescent heart transplantation. METHODS The United Network for Organ Sharing database was used to identify 2,855 adolescents aged 10-17 years undergoing isolated primary heart transplantation from 1/1/2000 to 12/31/2022. The primary outcome was 10-year post-transplant survival. Multivariable Cox regression identified predictors of mortality after adjusting for donor and recipient characteristics. A restricted cubic spline assessed the non-linear association between donor-recipient age-difference and the adjusted relative mortality hazard. RESULTS The median donor-recipient age-difference was +3 (range -13 to +47) years, and 17.7% (n = 504) of recipients had an age- difference > 10 years. Recipients with an age-difference > 10 years had a less favorable pre-transplant profile, including a higher incidence of priority status 1A (81.6%, n = 411 vs. 73.6%, n = 1730; p = .01). The 10-year survival rate was 54.6% (95% confidence interval (CI) 48.8- 60.4) among recipients with a donor-recipient age-difference > 10 years and 66.9% (95% CI: 64.4-69.4) among those with an age-difference ≤10 years. An age-difference > 10 years was an independent predictor of mortality (hazard ratio 1.43, 95% CI: 1.18-1.72, p < .001). Spline analysis demonstrated that the adjusted mortality hazard increased with increasingly positive donor-recipient age-difference and became significantly higher at an age-difference of 11 years. CONCLUSION A donor-recipient age-difference > 11 years is independently associated with higher long-term mortality after adolescent heart transplantation. This finding may help inform acceptable donor selection practice for adolescent heart transplant candidates.
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Affiliation(s)
- George Gill
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Georgina Rowe
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - M. Mujeeb Zubair
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Qiudong Chen
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jason Thomas
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Peter Chiu
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA
| | - Asishana Osho
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA
| | - Vikram Sood
- Department of Cardiac Surgery, University of Michigan Congenital Heart Center, C. S. Mott Children’s Hospital, Ann Arbor, MI
| | - Kurt R. Schumacher
- Department of Pediatrics, University of Michigan Congenital Heart Center, C. S. Mott Children’s Hospital, Ann Arbor, MI
| | - Dominic Emerson
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael E. Bowdish
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Joanna Chikwe
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
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Mahdavi M, Tahouri T, Tabib A, Bakhshandeh H, Sadeghpour-Tabaei A, Shahzadi H, Harooni N. Impact of donor-to-recipient weight ratio on the hospital outcomes of pediatric heart transplantation. Egypt Heart J 2022; 74:38. [PMID: 35551518 PMCID: PMC9106769 DOI: 10.1186/s43044-022-00276-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Identifying the factors that can influence the prognosis and final outcomes of pediatric heart transplantation is important and makes it possible to prevent complications and improve outcomes. Coordination of donor characteristics with the recipient in terms of sex, weight, body mass index (BMI), and body surface area (BSA) is an important factor that can influence the outcome of the transplantation. There is still no consensus regarding the role of discrepancy in anthropometrics between donors and recipients. The aim of this study was to investigate the relationship between donor and recipient weight mismatch on the early outcomes of pediatric heart transplantation. In this historical cohort study, 80 children who had underwent heart transplantation for the first time between 2014 and 2019 in Shahid Rajaie Cardiovascular Medical and Research Center in Tehran, Iran, were enrolled and divided into three groups according to donor-to-recipient weight ratio (0.8 < D/RW ≤ 1.5, 1.5 < D/RW ≤ 2.5, and 2.5 < D/RW). The early outcomes of transplantation, during the first post-transplant month, including right heart failure, renal failure, graft rejection, inotrope dependency, duration of intubation, length of ICU stay, death and requiring extracorporeal membrane oxygenation, were recorded through reviewing patient records. Results Median donor-to-recipient BSA ratio was directly associated with higher vasoactive–inotropic score (P = 0.038), while no significant association was found between donor-to-recipient weight ratio and vasoactive–inotropic score (P = 0.07). No significant relationship was found between other outcomes and donor-to-recipient weight ratio or donor-to-recipient BSA ratio. Conclusions Patients who require heart transplantation may also benefit from mismatch donors, especially in those with significant cardiomegaly.
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Affiliation(s)
- Mohammad Mahdavi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Tahmineh Tahouri
- Shahid Modarres Educational Hospital, Department of Pediatric Cardiology, Shahid Beheshti University of Medical Science, Tehran, Iran.
| | - Avisa Tabib
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Hooman Bakhshandeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Ali Sadeghpour-Tabaei
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Hossein Shahzadi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Nader Harooni
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
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4
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Donor-Recipient Weight Match in Pediatric Heart Transplantation: Liberalizing Weight Matching with Caution. J Cardiovasc Dev Dis 2022; 9:jcdd9050148. [PMID: 35621859 PMCID: PMC9145031 DOI: 10.3390/jcdd9050148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/20/2022] [Accepted: 05/05/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: To expand the donor pool, greater donor hearts tended to be used in heart transplantation. However, the data about the feasibility of expanding the donor and recipient weight ratios (DRWRs. All donor and recipient weight ratio (DRWR) in this study or cited from other articles were converted to the DRWR calculated by ((donor weight-recipient weight)/recipient weight) × 100%.) to >30% was still scant in China’s pediatric heart transplantation (HTx). The potential risk increased along with the further expansion of the appropriate range of DRWR to >30% and its upper limit was still in debate. (2) Methods: Seventy-eight pediatric patients (age < 18 years) undergoing HTx between 2015 and 2020 at our center were divided into two groups based on the DRWR (>30% and ≤30%). Variables were summarized and analyzed via univariate analyses and multivariate analyses. A Kaplan-Meier methodology was used to calculate survival and conditional survival. (3) Results: No significant difference was found in one-year, three-year or five-year survival between the two groups. (4) Conclusions: The expansion of DRWR to >30% was acceptable for China’s pediatric HTx. Notably, continuously liberalizing of the upper DRWR boundary to more than 200% could be used as a stop-loss option but should be applied with caution.
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5
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Singh TP, Colan SD, Gauvreau K. Matching Donor and Recipient Size in Pediatric Heart Transplantation. Transpl Int 2022; 35:10226. [PMID: 35185381 PMCID: PMC8842272 DOI: 10.3389/ti.2022.10226] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022]
Abstract
Previous analyses in pediatric heart transplant (HT) recipients using weight or height have not found donor-recipient size-mismatch to be associated with post-transplant mortality. A recent study in 3,215 normal US children developed an equation for left ventricular (LV) mass using body surface area (BSA). We assessed whether donor-recipient size match using predicted LV mass (PLM) is associated with post-transplant in-hospital mortality or 1-year graft survival. We identified 4,717 children <18 yrs old who received primary HT in the US during 01/2000 to 03/2015 and divided them into five groups [10%, 10%, 60% (reference group), 10% and 10%, respectively] with increasing donor-recipient PLM ratio. In adjusted analysis, group 1 children (PLM ratio ≤.90) were at higher risk of post-transplant in-hospital mortality [Odds Ratio (OR) 1.55, 95% CI 1.04, 2.31]. This association of the most undersized donors with recipient in-hospital mortality was similar when donor-recipient weight ratio<.88 or BSA ratio<.92 (lowest decile) were used instead. There was no difference in 1-year graft survival among groups. Utilizing donors with donor-recipient PLM ratio ≤.90 is associated with higher risk of early post-transplant mortality in pediatric HT recipients. However, this metric is not superior to donor-recipient weight ratio or BSA ratio for assessing size match.
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Affiliation(s)
- Tajinder P. Singh
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- *Correspondence: Tajinder P. Singh,
| | - Steven D. Colan
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, United States
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6
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Nie W, Su X, Liu L, Li J, Fu Q, Li X, Wu C, Wang J, Deng R, Chen E, Yang S, Li S, Zhang H, Wang C. Dynamics of Donor-Derived Cell-Free DNA at the Early Phase After Pediatric Kidney Transplantation: A Prospective Cohort Study. Front Med (Lausanne) 2022; 8:814517. [PMID: 35071284 PMCID: PMC8777035 DOI: 10.3389/fmed.2021.814517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Donor-derived cell-free DNA (ddcfDNA) has been suggested as an indicator of allograft injury in adult and pediatric kidney transplantation (KTx). However, the dynamics of ddcfDNA in pediatric KTx have not been investigated. In addition, it has not been demonstrated whether donor-recipient (D/R) size mismatch affect ddcfDNA level. Methods: Pediatric KTx recipients with a single donor kidney were enrolled and followed up for 1 year. ddcfDNA, calculated as a fraction (%) in the recipient plasma, was examined longitudinally within 3 months post-transplant. D/R size mismatch degree was described as D/R height ratio. The 33rd percentile of D/R height ratio (0.70) was used as the cut-off to divide the patients into low donor-recipient height ratio group (<0.70) and high donor-recipient height ratio group (≥0.70). The dynamics of ddcfDNA were analyzed and the impact factors were explored. Stable ddcfDNA was defined as the first lowest ddcfDNA. ddcfDNA flare-up was defined as a remarkable elevation by a proportion of >30% from stable value with a peak value >1% during elevation. Results: Twenty-one clinically stable recipients were enrolled. The median D/R height ratio was 0.83 (0.62–0.88). It took a median of 8 days for ddcfDNA to drop from day 1 and reach a stable value of 0.67% (0.46–0.73%). Nevertheless, 61.5% patients presented ddcfDNA>1% at day 30. Besides, 81.0% (17/21) of patients experienced elevated ddcfDNA and 47.6% (10/21) met the standard of ddcfDNA flare-up. Donor-recipient height ratio was an independent risk factor for ddcfDNA flare-up (odds ratio = 0.469 per 0.1, 95% CI 0.237–0.925, p = 0.029) and low donor-recipient height ratio (<0.70) was found to increase the risk of flare-up occurrence (odds ratio = 15.00, 95% CI 1.342–167.638, p = 0.028). Conclusions: ddcfDNA rebounds in many stable pediatric KTx recipients without rejection. This may be induced by significant D/R size mismatch and may affect its diagnostic performance at the early phase after pediatric KTx in children.
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Affiliation(s)
- Weijian Nie
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaojun Su
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Longshan Liu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory on Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Jun Li
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian Fu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xirui Li
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chenglin Wu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiali Wang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ronghai Deng
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - E Chen
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shicong Yang
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shujuan Li
- Department of Cardiovascular Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huanxi Zhang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Changxi Wang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory on Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
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7
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Bauer TM, Weber MP, O'Malley TJ, Moncure H, Pirlamarla PR, Shah MK, Alvarez RJ, Morris RJ, Entwistle JW, Massey HT, Tchantchaleishvili V. Assessing donor-recipient size metrics for heart transplant outcomes: UNOS database analysis. Clin Transplant 2022; 36:e14598. [PMID: 35048435 DOI: 10.1111/ctr.14598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/18/2021] [Accepted: 12/31/2021] [Indexed: 11/28/2022]
Abstract
STUDY There is no widely accepted donor to recipient size-match metric to predict outcomes in cardiac transplant. The predictive ability of size-match metrics has not been studied when recipients are stratified by heart failure etiology. We sought to assess the performance of commonly used size metrics to predict survival after heart transplant, accounting for restrictive vs. non-restrictive pathology. METHODS The UNOS registry was queried from 2000-2017 for all primary isolated heart transplants. Donor-recipient ratios were calculated for commonly used size metrics and their association with survival was assessed using continuous, nonlinear analysis. RESULTS 29,817 patients were identified. Height (p<0.001), predicted heart mass (PHM) (p = 0.003), ideal body weight (IBW) (p<0.001) and body mass index (BMI) (p = 0.003) ratios were significantly associated with survival, while weight and body surface area (BSA) ratios were not. When stratified, only BMI ratio retained significance for both restrictive (p = 0.051) and non-restrictive (p = 0.003) subsets. Recipients with restrictive etiology had increased risk of mortality with both a lower and higher BMI ratio. CONCLUSIONS While many metrics show association with survival in the non-restrictive subset, BMI is the only metric that retains significance in the restrictive subset. Recipients with restrictive and non-restrictive etiologies of heart failure tolerate size mismatch differently. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Tyler M Bauer
- Department of Cardiac Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew P Weber
- Department of Cardiac Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Thomas J O'Malley
- Department of Cardiac Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Henry Moncure
- Department of Cardiac Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Preethi R Pirlamarla
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Mahek K Shah
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Rene J Alvarez
- Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Rohinton J Morris
- Department of Cardiac Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - John W Entwistle
- Department of Cardiac Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Howard Todd Massey
- Department of Cardiac Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Vakhtang Tchantchaleishvili
- Department of Cardiac Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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8
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Conway J, Ballweg JA, Fenton M, Kindel S, Chrisant M, Weintraub RG, Danziger-Isakov L, Kirk R, Meira O, Davies RR, Dipchand AI. Review of the impact of donor characteristics on pediatric heart transplant outcomes. Pediatr Transplant 2020; 24:e13680. [PMID: 32198824 DOI: 10.1111/petr.13680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 12/22/2022]
Abstract
Heart transplantation (HTx) is a treatment option for end-stage heart failure in children. HTx is limited by the availability and acceptability of donor hearts. Refusal of donor hearts has been reported to be common with reasons for refusal including preexisting donor characteristics. This review will focus on the impact of donor characteristics and comorbidities on outcomes following pediatric HTx. A literature review was performed to identify articles on donor characteristics and comorbidities and pediatric HTx outcomes. There are many donor characteristics to consider when accepting a donor heart. Weight-based matching is the most common form of matching in pediatric HTx with a donor-recipient weight ratio between 0.7 and 3 having limited impact on outcomes. From an age perspective, donors <50 years can be carefully considered, but the impact of ischemic time needs to be understood. To increase the donor pool, with minimal impact on outcomes, ABO-incompatible donors should be considered in patients that are eligible. Other factors to be considered when accepting an organ is donor comorbidities. Little is known about donor comorbidities in pediatric HTx, with most of the data available focusing on infections. Being aware of the potential infections in the donor, understanding the testing available and risks of transmission, and treatment options for the recipient is essential. There are a number of donor characteristics that potentially impact outcomes following pediatric HTx, but these need to be taken into consideration along with their interactions with recipient factors when interpreting the outcomes following HTx.
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Affiliation(s)
- Jennifer Conway
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Jean A Ballweg
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, Nebraska
| | - Matthew Fenton
- Great Ormond Street Hospital for Children Foundation Trust, London, UK
| | - Steve Kindel
- Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin and Herma Heart Institute and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Maryanne Chrisant
- The Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | - Robert G Weintraub
- Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia.,Department of Cardiology, The Royal Children's Hospital, Melbourne Heart Research Group, Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - Lara Danziger-Isakov
- Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center & University of Cincinnati, Cincinnati, Ohio
| | - Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas
| | - Oliver Meira
- Department of Congenital Heart Disease/Pediatric Cardiology, Berlin, Germany
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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9
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Rudasill SE, Sanaiha Y, Mardock AL, Xing H, Khoury H, Kwon M, Benharash P. Height mismatch: An overlooked component of adult heart transplant outcomes. Clin Transplant 2020; 34:e13863. [DOI: 10.1111/ctr.13863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 02/15/2020] [Accepted: 03/19/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Sarah E. Rudasill
- Cardiovascular Outcomes Research Laboratories David Geffen School of Medicine University of California Los Angeles CA USA
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories David Geffen School of Medicine University of California Los Angeles CA USA
| | - Alexandra L. Mardock
- Cardiovascular Outcomes Research Laboratories David Geffen School of Medicine University of California Los Angeles CA USA
| | - Hanning Xing
- Cardiovascular Outcomes Research Laboratories David Geffen School of Medicine University of California Los Angeles CA USA
| | - Habib Khoury
- Cardiovascular Outcomes Research Laboratories David Geffen School of Medicine University of California Los Angeles CA USA
| | - Murray Kwon
- Division of Cardiac Surgery University of California Los Angeles CA USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories David Geffen School of Medicine University of California Los Angeles CA USA
- Division of Cardiac Surgery University of California Los Angeles CA USA
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10
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Kirk R, Dipchand AI, Davies RR, Miera O, Chapman G, Conway J, Denfield S, Gossett JG, Johnson J, McCulloch M, Schweiger M, Zimpfer D, Ablonczy L, Adachi I, Albert D, Alexander P, Amdani S, Amodeo A, Azeka E, Ballweg J, Beasley G, Böhmer J, Butler A, Camino M, Castro J, Chen S, Chrisant M, Christen U, Danziger-Isakov L, Das B, Everitt M, Feingold B, Fenton M, Garcia-Guereta L, Godown J, Gupta D, Irving C, Joong A, Kemna M, Khulbey SK, Kindel S, Knecht K, Lal AK, Lin K, Lord K, Möller T, Nandi D, Niesse O, Peng DM, Pérez-Blanco A, Punnoose A, Reinhardt Z, Rosenthal D, Scales A, Scheel J, Shih R, Smith J, Smits J, Thul J, Weintraub R, Zangwill S, Zuckerman WA. ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation. J Heart Lung Transplant 2020; 39:331-341. [PMID: 32088108 DOI: 10.1016/j.healun.2020.01.1345] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 12/14/2022] Open
Abstract
The number of potential pediatric heart transplant recipients continues to exceed the number of donors, and consequently the waitlist mortality remains significant. Despite this, around 40% of all donated organs are not used and are discarded. This document (62 authors from 53 institutions in 17 countries) evaluates factors responsible for discarding donor hearts and makes recommendations regarding donor heart acceptance. The aim of this statement is to ensure that no usable donor heart is discarded, waitlist mortality is reduced, and post-transplant survival is not adversely impacted.
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Affiliation(s)
- Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas.
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Jennifer Conway
- Department of Pediatrics, Division of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Denfield
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jeffrey G Gossett
- University of California Benioff Children's Hospitals, San Francisco, California
| | - Jonathan Johnson
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Michael McCulloch
- University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Martin Schweiger
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Vienna and Pediatric Heart Center Vienna, Vienna, Austria
| | - László Ablonczy
- Pediatric Cardiac Center, Hungarian Institute of Cardiology, Budapest, Hungary
| | - Iki Adachi
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Dimpna Albert
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Peta Alexander
- Department of Cardiology, Boston Children's Hospital Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | | | - Estela Azeka
- Heart Institute (InCor) University of São Paulo, São Paulo, Brazil
| | - Jean Ballweg
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital and Medical Center University of Nebraska Medical Center, Omaha, Nebraska
| | - Gary Beasley
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Jens Böhmer
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alison Butler
- Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Javier Castro
- Fundacion Cardiovascular de Colombia, Santander, Bucaramanga City, Colombia
| | | | - Maryanne Chrisant
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | - Urs Christen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lara Danziger-Isakov
- Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center & University of Cincinnati, Cincinnati, Ohio
| | - Bibhuti Das
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | | | - Brian Feingold
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew Fenton
- Great Ormond Street Hospital for Children Foundation Trust, London, United Kingdom
| | | | - Justin Godown
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dipankar Gupta
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Claire Irving
- Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Anna Joong
- Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | | | | | - Steven Kindel
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Kimberly Lin
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen Lord
- New England Organ Bank, Boston, Massachusetts
| | - Thomas Möller
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Deipanjan Nandi
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Oliver Niesse
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | | | | | - Ann Punnoose
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Angie Scales
- Pediatric and Neonatal Donation and Transplantation, Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | - Janet Scheel
- Washington University School of Medicine, St. Louis, Missouri
| | - Renata Shih
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | | | | | - Josef Thul
- Children's Heart Center, University of Giessen, Giessen, Germany
| | | | | | - Warren A Zuckerman
- Columbia University Medical Center, Morgan Stanley Children's Hospital of New York, New York, New York
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11
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Hoashi T, Sakaguchi H, Shimada M, Imai K, Komori M, Ichikawa H. Application of modified bicaval technique for pediatric heart transplant with oversized donor heart. Gen Thorac Cardiovasc Surg 2019; 68:1329-1332. [PMID: 31802359 DOI: 10.1007/s11748-019-01266-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/29/2019] [Indexed: 11/25/2022]
Abstract
Whereas bicaval technique is an effective surgical method, standard bicaval technique for younger age and donor/recipient caval mismatch was reported to have a risk of superior vena caval obstruction. Between 2016 and 2019, three patients with dilated cardiomyopathy aged 10 years or younger underwent orthotropic heart transplantation with modified bicaval technique at our institute. Donor/recipient body weight and height ratios were 2.36, 0.77, and 2.61 and 1.37, 0.94, and 1.51, respectively. All patients were preoperatively supported by a left ventricular assist device: Excor Pediatric in two patients and Jarvik 2000 in one. Duration of LVAD support was 180, 238, and 220 days. One patient required revision of pulmonary anastomosis during the operation; accordingly, the chest was closed 3 days later. There was no mortality. Caval obstructions were not observed. Three months after the operation, tricuspid regurgitation was mild in two patients and trivial in one.
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Affiliation(s)
- Takaya Hoashi
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
| | - Heima Sakaguchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masatoshi Shimada
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Kenta Imai
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Motoki Komori
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, 565-8565, Japan
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12
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Rossano JW, Singh TP, Cherikh WS, Chambers DC, Harhay MO, Hayes D, Hsich E, Khush KK, Meiser B, Potena L, Toll AE, Sadavarte A, Zuckermann A, Stehlik J. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Twenty-second pediatric heart transplantation report - 2019; Focus theme: Donor and recipient size match. J Heart Lung Transplant 2019; 38:1028-1041. [PMID: 31548029 DOI: 10.1016/j.healun.2019.08.002] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Joseph W Rossano
- International Society for Heart and Lung Transplantation International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Tajinder P Singh
- International Society for Heart and Lung Transplantation International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Wida S Cherikh
- International Society for Heart and Lung Transplantation International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Daniel C Chambers
- International Society for Heart and Lung Transplantation International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Michael O Harhay
- International Society for Heart and Lung Transplantation International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Don Hayes
- International Society for Heart and Lung Transplantation International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Eileen Hsich
- International Society for Heart and Lung Transplantation International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Kiran K Khush
- International Society for Heart and Lung Transplantation International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Bruno Meiser
- International Society for Heart and Lung Transplantation International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Luciano Potena
- International Society for Heart and Lung Transplantation International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Alice E Toll
- International Society for Heart and Lung Transplantation International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Aparna Sadavarte
- International Society for Heart and Lung Transplantation International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Andreas Zuckermann
- International Society for Heart and Lung Transplantation International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Josef Stehlik
- International Society for Heart and Lung Transplantation International Thoracic Organ Transplant Registry, Dallas, Texas.
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- International Society for Heart and Lung Transplantation International Thoracic Organ Transplant Registry, Dallas, Texas
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13
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Riggs KW, Giannini CM, Szugye N, Woods J, Chin C, Moore RA, Morales DLS, Zafar F. Time for evidence-based, standardized donor size matching for pediatric heart transplantation. J Thorac Cardiovasc Surg 2019; 158:1652-1660.e4. [PMID: 31353104 DOI: 10.1016/j.jtcvs.2019.06.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/10/2019] [Accepted: 06/14/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Accurately predicting cardiac size by other body parameters has long been problematic to determine whether a donor heart will serve a given waitlist candidate, yet hundreds of heart donors are turned down annually for size mismatch. OBJECTIVES We sought to describe how donor body weight parameters are currently utilized in cardiac transplantation and its influence on waitlist outcomes. METHODS From the United Network for Organ Sharing database, pediatric (age <18 years) heart transplant candidates were divided into lower quartile, interquartile, and upper quartile categories based on final maximum acceptable donor-candidate weight ratio (DCW), expressed as percentage. Baseline characteristics and waitlist outcomes, including monthly offers/candidate and survival were compared. RESULTS Overall median DCW was 200% (range, 159%-241%). Patients with congenital heart disease had higher DCW than those with cardiomyopathy (223% vs 203%; P < .001). Number of monthly offers/candidate (5.0, 5.6, and 7.2, respectively; P < .001) increased with quartile of DCW. Posttransplant survival was similar amongst the groups (log-rank P > .05). Subgroup analysis of critically ill children showed a waitlist survival advantage in those listed with a DCW ≥200% (P < .001). CONCLUSIONS Despite substantial practice variation in acceptable donor weight in pediatric heart transplantation, patients listed with variable DCW had similar posttransplant survival. However, in critically ill patients, higher DCW was associated with greater waitlist survival. Better understanding of the importance of donor weight could reduce practice variability and improve organ use and waitlist outcomes for pediatric cardiac transplant candidates.
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Affiliation(s)
- Kyle W Riggs
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio.
| | | | - Nicholas Szugye
- Division of Pediatric Cardiology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Jason Woods
- Division of Pulmonary Imaging Research, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Clifford Chin
- Division of Pediatric Cardiology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Ryan A Moore
- Division of Pediatric Cardiology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - David L S Morales
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Farhan Zafar
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio
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14
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Donor organ turn-downs and outcomes after listing for pediatric heart transplant. J Heart Lung Transplant 2019; 38:241-251. [DOI: 10.1016/j.healun.2018.09.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 11/17/2022] Open
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15
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Abstract
PURPOSE OF REVIEW Pediatric heart transplants continue to be the therapy of choice for children with end stage heart failure. The interplay of limited donor supply, improvement in ventricular assist device (VAD) technology and utilization, and a focus on optimizing long-term outcomes make it critically important for practitioners to be aware of an evolving diagnostic and therapeutic arsenal. RECENT FINDINGS Data suitable to define best practices for pediatric heart transplantation consist of an amalgam of small single center series, registry reviews and judicious inference from adult studies. Large-scale prospective pediatric studies are essentially nonexistent; the pediatric heart transplant study group continues to be highly productive while new collaboratives are emerging. SUMMARY Outcomes for pediatric transplants continue to improve. Technology and innovation continue to drive shifts in management. Improvements in VAD support along with refinement of solid-phase assays require clinicians to develop a deeper understanding of pre and post transplant management of donor-specific antibodies and antibody-mediated rejection. Expertise in retransplantation and the care of adults with congenital heart disease will be critical in the future.
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16
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Flyer JN, Zuckerman WA. Challenging the convention of size matching by weight in pediatric heart transplantation. Pediatr Transplant 2016; 20:602-3. [PMID: 27136329 DOI: 10.1111/petr.12717] [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: 11/28/2022]
Affiliation(s)
- Jonathan N Flyer
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Warren A Zuckerman
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
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