A Systematic Review of Adherence to Immunosuppression among Pediatric Heart Transplant Patients

Nassetta, Keira; Hussain, Tasmeen; Gambetta, Katheryn; Le, Kevin; O’Dwyer, Linda; Badawy, Sherif M.

doi:10.3390/jcdd9050165

Cited by 7 publications

(7 citation statements)

References 51 publications

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“…HT presents significant psychosocial challenges, with up to 40% of paediatric HT recipients and their families reporting clinically significant levels of psychosocial risk, including emotional and behavioural difficulties 16 . Psychological adjustment has important implications for health‐related outcomes for HT recipients, including adherence to immunosuppression 17 . As such, psychological care is embedded within our HT model of care.…”

Section: Discussionmentioning

confidence: 99%

“…16 Psychological adjustment has important implications for health-related outcomes for HT recipients, including adherence to immunosuppression. 17 As such, psychological care is embedded within our HT model of care. Psychosocial assessment is undertaken prior to transplantation to understand a family's vulnerabilities and strengths, though opportunity for assessment is dependent on the acuity of transplant referral.…”

Section: Psychosocial Aspects Of Carementioning

confidence: 99%

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Quality care close to home: Objectives and early outcomes of a second paediatric heart transplant service in Australia

Basu

Irving

Roberts

et al. 2023

J Paediatrics Child Health

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Aim We describe the experience of a new paediatric heart transplant (HT) centre in Australia. New South Wales offers quaternary paediatric cardiac services including comprehensive care pre‐ and post‐HT; however, perioperative HT care has previously occurred at the national paediatric centre or in adult centres. Internationally, perioperative HT care is highly protocol‐driven and a majority of HT occurs in low volume centres. Establishing a low volume paediatric HT centre in New South Wales offers potential for quality HT care close to home. Methods Retrospective review of programme data for the first 12 months was undertaken. Patient selection was audited against the programme's intended initiation criteria. Longitudinal patient data on outcomes and complications were obtained from patient medical records. Results The programme's initial phase offered HT to children with non‐congenital heart disease and no requirement for durable mechanical circulatory support. Eight patients met criteria for HT referral. Three underwent interstate transfer to the national paediatric centre. Five children (13–15 years, weight 36–85 kg) underwent HT in the new programme. Individual predicted 90‐day mortality was 1.3–11.6%, with increased risk for recipients transplanted from veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) and with restrictive/hypertrophic cardiomyopathies. Survival at 90 days and for duration of follow‐up is 100%. Observed programme benefits include mitigation of family dislocation and improved continuity of care within a family‐centred programme. Conclusion Audit of the first 12 months' activity of a second paediatric HT centre in Australia demonstrates adherence to proposed patient selection criteria and excellent 90‐day patient outcomes. The programme demonstrates feasibility of care close to home, providing continuity for all patients including those requiring increased rehabilitation and psychosocial support post‐transplantation.

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Section: Discussionmentioning

confidence: 99%

Section: Psychosocial Aspects Of Carementioning

confidence: 99%

Quality care close to home: Objectives and early outcomes of a second paediatric heart transplant service in Australia

Basu

Irving

Roberts

et al. 2023

J Paediatrics Child Health

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“…There is a chronic shortage of donor hearts in both the adult and pediatric population, with significant challenges in both patient populations (Evers et al, 2011;Alyaydin et al, 2020;Jiritano et al, 2020;Lin and Fang, 2020;Malik et al, 2020). In both the adult and pediatric population, the quality of life is comprised in heart transplant recipients, due to the need to be on lifelong immunosuppression in both the adult and pediatric patient populations (Asleh et al, 2018;Gale et al, 2019;Heeney et al, 2019;Hussain et al, 2021;Mylonas et al, 2022;Nassetta et al, 2022). In the pediatric population, in addition to the challenges with lifelong immunosuppression, there are very unique challenges associated with retransplantation; there is a high risk for retransplant of the heart after a decade of initial transplant due to growth of the pediatric patient (Greenleaf et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Recent advances in biological pumps as a building block for bioartificial hearts

Brimmer

Ji²,

Birla³

et al. 2023

Front. Bioeng. Biotechnol.

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The field of biological pumps is a subset of cardiac tissue engineering and focused on the development of tubular grafts that are designed generate intraluminal pressure. In the simplest embodiment, biological pumps are tubular grafts with contractile cardiomyocytes on the external surface. The rationale for biological pumps is a transition from planar 3D cardiac patches to functional biological pumps, on the way to complete bioartificial hearts. Biological pumps also have applications as a standalone device, for example, to support the Fontan circulation in pediatric patients. In recent years, there has been a lot of progress in the field of biological pumps, with innovative fabrication technologies. Examples include the use of cell sheet engineering, self-organized heart muscle, bioprinting and in vivo bio chambers for vascularization. Several materials have been tested for biological pumps and included resected aortic segments from rodents, type I collagen, and fibrin hydrogel, to name a few. Multiple bioreactors have been tested to condition biological pumps and replicate the complex in vivo environment during controlled in vitro culture. The purpose of this article is to provide an overview of the field of the biological pumps, outlining progress in the field over the past several years. In particular, different fabrication methods, biomaterial platforms for tubular grafts and examples of bioreactors will be presented. In addition, we present an overview of some of the challenges that need to be overcome for the field of biological pumps to move forward.

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“…Nonadherence to daily immunosuppressant medications, medical procedures, clinic visits, and/or nutrition restrictions directly contributes to graft functionality and organ rejection (Killian et al, 2018), the need for retransplantation, and mortality (Oliva et al, 2013;Shemesh & Fine, 2010). Rates of nonadherence to immunosuppressant medications in pediatric transplant populations remain somewhat high, with estimates ranging between 4% and 60% (Dobbels et al, 2010;Kahana et al, 2008;Killian et al, 2018;Nassetta et al, 2022). Furthermore, many predictors and sequelae of nonadherence are psychosocial in nature (e.g., psychological distress, family functioning, parental stress; Amatya et al, 2021;Griffin & Elkin, 2001;Killian et al, 2018).…”

mentioning

confidence: 99%

Implementing an integrated psychology preventative care model in pediatric solid organ transplant.

Lyons¹,

Monnin²,

Ruzicka³

et al. 2023

Clinical Practice in Pediatric Psychology

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Objective: The initial posttransplant period is high-risk in terms of susceptibility to rejection episodes and poor medical outcomes for pediatric solid organ transplant (SOT) patients. Psychologists play an important role on transplant medical teams to support patients and families in improving adherence and graft outcomes. This article describes a new psychology-integrated preventative care model implemented in 2019 and examines trends in service delivery pre-and postimplementation. Method: Universal health and behavior assessment and intervention were delivered to SOT (heart, liver, and kidney) patients according to a structured method of service delivery that identified distinct time points for follow-up within the first 3-year posttransplantation. Results: Preimplementation, the SOT psychology service delivered intervention and assessment services to 44% of patients who were transplanted during the preimplementation period; postimplementation, 97% of this patient population were seen by SOT psychology. Mean psychology contacts increased significantly postimplementation (M = 2.55) of this new preventative care model, compared to preimplementation (M = 1.59). Conclusions: Psychology support is an essential component of comprehensive pediatric SOT care. Increased psychology services posttransplantation can effectively identify and target psychosocial needs for patients and families. Implications for Impact StatementThis article describes a new integrated preventative care model of psychology service delivery within pediatric solid organ transplant that greatly increased assessments and interventions during the vulnerable first 3-year posttransplant. This preventative care model allows pediatric psychologists to address adherence, behavioral and emotional concerns, and coping with illness to support optimal posttransplant psychological and medical outcomes.

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A Systematic Review of Adherence to Immunosuppression among Pediatric Heart Transplant Patients

Cited by 7 publications

References 51 publications

Quality care close to home: Objectives and early outcomes of a second paediatric heart transplant service in Australia

Quality care close to home: Objectives and early outcomes of a second paediatric heart transplant service in Australia

Recent advances in biological pumps as a building block for bioartificial hearts

Implementing an integrated psychology preventative care model in pediatric solid organ transplant.

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