The recent focus on racial inequalities highlights the need to evaluate and address systemic biases (often unrecognized and unintended) affecting minority groups in health care. Specific to pediatric heart transplantation, disparities in outcomes have been documented in national registry studies with lower survival after listing and transplantation in non-White patients. [1][2][3][4] However, registry databases do not extend to the time before waitlisting for transplantation. Therefore, the potential for bias in the pediatric heart transplant candidate referral and evaluation process has been understudied.We retrospectively studied our single-center experience evaluating
Despite the increasing effectiveness of PCI for localized ACD, the survival after development of advanced ACD remains poor. Stents appear to increase effectiveness of PCI for ACD, but other factors in the current era contribute to improved outcomes.
Background
Our pediatric heart transplant center transitioned from post‐bypass basiliximab (BAS) induction to either anti‐thymocyte globulin (ATG) or pre‐bypass BAS. The purpose of this study was to compare first‐year rejection rates before and after this change.
Methods
A single‐center retrospective analysis was conducted of pediatric heart transplant recipients from 2010 to 2019. Primary outcome was first‐year rejection. Bivariate analysis, Kaplan‐Meier curves, and multivariable regression were performed across eras.
Results
Forty‐three early era patients (55%) received post‐bypass BAS, and 35 late era patients (45%) received pre‐bypass BAS (n = 17) or ATG (n = 18). First‐year rejection decreased in the late era (31% vs 53%, p = .05). This finding was more pronounced after excluding infants (38% vs 73%, p = .006). Late era was associated with a decreased likelihood of rejection (all cohort OR 0.19, 95% CI 0.05‐0.66; infants excluded OR 0.17, 95% CI 0.04‐0.61). No differences in post‐transplant lymphoproliferative disease, donor‐specific antibody, or infection were observed.
Conclusions
Fewer late era patients receiving ATG or pre‐bypass BAS induction had first‐year rejection compared to the early era patients receiving standard post‐bypass BAS induction. This programmatic shift in induction strategy was readily achievable and potentially effective in reducing first‐year rejection.
collected from the medical record and self-administered questionnaires. Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ) (range, 0-27). SOC was assessed by the 13-item SOC scale by Antonovsky et al (range, 13-91). To assess an association of depression with SOC after adjustment for age, logistic regression analysis was performed with the presence of mild or more severe depression (defined as the PHQ score of more than 5) as dependent variable. Results: At 3 months after LVAD implantation, depressive symptoms were significantly improved (PHQ score, 6.7±5.6 to 4.9±4.8, p= 0.02), but still 27% (n= 9) had mild (10 > PHQ score ≥ 5) and 18% (n= 6) had moderate or severe depression (PHQ score ≥ 10). Preoperative SOC (54.8±7.7) did not influence on postoperative depressive symptoms (n= 24, r=-0.06, p= 0.77), whereas postoperative higher SOC (53.8±7.3) was significantly related to less depressive symptoms (n= 33, ρ =-0.53, p< 0.01). Logistic regression analysis showed that postoperative higher SOC was associated with a decrease risk of depression independent of age (odds ratio= 0.87, 95% confidence inter-val= 0.77-0.98, p= 0.02). Conclusion: Although depressive symptoms are lower at 3 months after LVAD implantation, depression is still a common mental problem reported by 45% of the patients. Postoperative lower SOC is an important factors to identify patients at high risk for depression.
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