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Chew JD, Soslow JH, Thurm C, Hall M, Dodd DA, Feingold B, Simmons J, Godown J. Heart Transplantation in Children with Turner Syndrome: Analysis of a Linked Dataset. Pediatr Cardiol 2018; 39:610-616. [PMID: 29299618 PMCID: PMC5831528 DOI: 10.1007/s00246-017-1801-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/22/2017] [Indexed: 01/15/2023]
Abstract
Turner syndrome (TS) patients with hypoplastic left heart syndrome (HLHS) have poor single ventricle palliation outcomes; therefore, consideration of other potential management strategies is important. Little is known about heart transplantation (HTx) in this group, as standard HTx databases do not allow for identification of TS. This study describes experiences and outcomes of HTx in TS using a unique linkage between the Scientific Registry of Transplant Recipients and the Pediatric Health Information System databases. All pediatric HTx recipients (2002-2016) with TS were identified in the database using ICD-9 code 758.6 (gonadal dysgenesis) in conjunction with female sex. Patient characteristics and outcomes were described. Fourteen patients with TS were identified who underwent 16 HTx procedures at eight centers. For initial HTx, HLHS was the most common indication (10/14) with a median age of 10 months (IQR 3-73 months). Median transplant-free survival following initial HTx was 4.1 years (IQR 16 days-10.5 years), with all deaths occurring in the first year post-HTx. For patients that survived past 1 year (8/14), follow-up ranged from 4.1 to 10.9 years (median 8.0 years) with no deaths observed. Our cohort demonstrates that while there is a clear risk for early mortality, there is the potential for favorable outcomes following HTx in patients with TS. Therefore, TS should not be viewed as an absolute contraindication to HTx, but careful assessment of candidate risk is needed. Primary palliation with HTx for HLHS and TS may be a reasonable consideration given the poor outcomes of single ventricle palliation in this group. Further research is needed to fully delineate the outcomes and characteristics of this unique population.
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Affiliation(s)
- Joshua D. Chew
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
| | - Jonathan H. Soslow
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
| | - Cary Thurm
- Children’s Hospital Association, Lenexa, KS
| | - Matt Hall
- Children’s Hospital Association, Lenexa, KS
| | - Debra A. Dodd
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
| | - Brian Feingold
- Pediatrics and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jill Simmons
- Pediatric Endocrinology, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| | - Justin Godown
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN
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Machlab S, Miquel M, Voltà T, Escoda MR, Vergara M. Turner syndrome as a cause of liver cirrhosis. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 41:308-309. [PMID: 28655407 DOI: 10.1016/j.gastrohep.2017.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/25/2017] [Accepted: 05/29/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Salvador Machlab
- Servicio de Aparato Digestivo, Corporación Sanitaria Parc Taulí, Universidad Autónoma de Barcelona, Sabadell, Barcelona, España
| | - Mireia Miquel
- Servicio de Aparato Digestivo, Corporación Sanitaria Parc Taulí, Universidad Autónoma de Barcelona, Sabadell, Barcelona, España; CIBERhed Instituto Carlos III, Madrid, España
| | - Tania Voltà
- Servicio de Aparato Digestivo, Corporación Sanitaria Parc Taulí, Universidad Autónoma de Barcelona, Sabadell, Barcelona, España
| | - Maria Rosa Escoda
- Servicio de Anatomía Patológica, Corporación Sanitaria Parc Taulí, Universidad Autónoma de Barcelona, Sabadell, Barcelona, España
| | - Mercedes Vergara
- Servicio de Aparato Digestivo, Corporación Sanitaria Parc Taulí, Universidad Autónoma de Barcelona, Sabadell, Barcelona, España; CIBERhed Instituto Carlos III, Madrid, España.
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Kawabata S, Sakamoto S, Honda M, Hayashida S, Yamamoto H, Mikami Y, Inomata Y. Liver transplantation for a patient with Turner syndrome presenting severe portal hypertension: a case report and literature review. Surg Case Rep 2016; 2:68. [PMID: 27358061 PMCID: PMC4927526 DOI: 10.1186/s40792-016-0194-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 06/21/2016] [Indexed: 01/15/2023] Open
Abstract
Background Liver involvement in Turner syndrome (TS) patients has been more clearly clarified in recent years. Most of the clinical manifestations in TS are asymptomatic and can be detected as liver test abnormalities; however, a few cases may present with end-stage liver disease and thus require liver transplantation (LT). To the best of our knowledge, only three cases undergoing LT for liver involvements in TS have been previously reported. Case presentation A 30-year-old female successfully underwent living donor LT for liver dysfunction related to TS syndrome. The diagnosis of TS was established by a cytogenetic analysis at 16 years of age. She received several sessions of endoscopic therapy for recurrent esophageal varices, which was complicated by ascites and spontaneous bacterial peritonitis since 27 years of age. Radiological findings of her liver before LT chronologically showed the progression of atrophy with disturbance of the major portal inflow. And then, she was finally indicated for LT. Pathologic findings of the explanted liver showed vascular abnormalities, obliterative portal venopathy, which may have induced liver dysfunction with severe portal hypertension. The patient’s postoperative course was uneventful. Conclusions The clinicopathologic information obtained by the current case can provide an insight into understanding pathophysiological mechanisms of liver involvement in TS patients. TS patients presenting with severe liver atrophy and disturbance of the major portal inflow should be indicated for LT.
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Affiliation(s)
- Seiichi Kawabata
- Department of Transplantation and Pediatric Surgery, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 862-8556, Japan
| | - Seisuke Sakamoto
- Department of Transplantation and Pediatric Surgery, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 862-8556, Japan. .,Division of Transplant Surgery, Organ Transplantation Center, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Masaki Honda
- Department of Transplantation and Pediatric Surgery, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 862-8556, Japan
| | - Shintaro Hayashida
- Department of Transplantation and Pediatric Surgery, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 862-8556, Japan
| | - Hidekazu Yamamoto
- Department of Transplantation and Pediatric Surgery, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 862-8556, Japan
| | - Yoshiki Mikami
- Department of Pathology, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 862-8556, Japan
| | - Yukihiro Inomata
- Department of Transplantation and Pediatric Surgery, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 862-8556, Japan
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