Heart transplant patients have a high incidence of VTE despite current best practice, indicating a need for a more aggressive approach to thromboprophylaxis.

Whether behavioural addictions should be conceptualised using a similar framework to substance-related addictions remains a topic of considerable debate. Previous literature has developed criteria, which allows any new behavioural addiction to be considered analogous to substance-related addictions. These imply that abstinence from a related object (e.g., smartphones for heavy smartphone users) would lead to mood fluctuations alongside increased levels of anxiety and craving. In a sample of smartphone users, we measured three variables (mood, anxiety, and craving) on four occasions, which included a 24-hour period of smartphone abstinence. Only craving was affected following a short period of abstinence. The results suggest that heavy smartphone usage does not fulfil the criteria required to be considered an addiction. This may have implications for other behavioural addictions.

Purpose: No consensus exists among pediatric heart transplant (HT) centers on the optimal routine surveillance biopsy (RSB) protocol. Data is lacking on the utility of higher RSB intensity and intensity-specific outcomes. We hypothesized that higher RSB intensity is associated with greater detection of moderate to severe (ISHLT grade 2R/3R) cellular rejection (RSBMSR). Methods: Pediatric Heart Transplant Study (PHTS) data were analyzed from 2010-2013. In addition, 34/47 PHTS centers responded to a survey on RSB practices. Identical question sets queried the current era (2005-present, primarily tacrolimus era) and past era (1995-2004, mixed immunosuppression). PHTS and survey data were integrated and analyzed as a single data set. Results: RSB detected 280/343 (81.6%) episodes of MSR in all age groups even > than 5 years after HT. In the current era, 21 centers have not replaced RSB with non-invasive imaging, 17 use BNP/NT-proBNP for routine monitoring, 7 use AlloMap or ImmuKnow, and 12 centers reduced RSB intensity without an increase in rejection. Centers were categorized as low, medium, or high intensity based on reported biopsy rate [Table 1]. In the past era, all centers were high intensity for all age groups until beyond the fifth year when the majority became medium intensity. Higher intensity was not associated with decreased 4 year mortality (p= 0.63) on proportional hazard regression, or with faster detection of first RSBMSR in the first year after HT (p= 0.87). First year RSBMSR incidence did not differ with intensity or age at HT. Conclusion: Significant variability exists in RSB intensity among pediatric HT centers, but with no impact on timing and incidence of RSBMSR or 4 year mortality. This data is reassuring that reduction of RSB intensity may be safe in certain populations, such as patients without RSBMSR in the first year after HT. Further studies are necessary to evaluate the long term effects of RSB reduction on morbidity and mortality.

Data are lacking on RSB intensity and outcomes after pediatric heart transplantation. PHTS centers received a survey on RSB practices from 2005 to present. PHTS data were obtained for 2010-2013 and integrated with center-matched survey responses for analysis. Survey response rate was 82.6% (38/46). Centers were classified as low-, moderate-, and high-intensity programs based on RSB frequency (0-more than 8 RSB/y). RSB intensity decreased with increasing time from HT. Age at HT impacted RSB intensity mostly in year 1, with little to no impact in later years. Most centers have not replaced RSB with non-invasive methods, but many added ECHO and biomarker monitoring. Higher RSB intensity was not associated with decreased 4-year mortality (P=.63) or earlier detection of moderate to severe (ISHLT grade 2R/3R) cellular rejection (RSBMSR) in the first year (P=.87). First-year RSBMSR incidence did not differ with intensity or age at HT. Significant variability exists in RSB intensity, but with no impact on timing and incidence of RSBMSR or 4-year mortality. Reduction in RSB frequency may be safe in certain patients after pediatric HT.

Few patients successfully weaned off prednisone after heart transplant develop de novo circulating antibodies but are not at increased risk for developing rejection.