Changing Indications for Pediatric Heart Transplantation

Hsu, Daphne T.; Lamour, Jacqueline M.

doi:10.1161/circulationaha.114.001377

Cited by 23 publications

(9 citation statements)

References 101 publications

(131 reference statements)

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“…According to data from the Pediatric Heart Transplant Study (PHTS) and Cardiac Transplant Research Database, the most common structural cardiac lesion from 6 months of age to adulthood necessitating heart transplant is single-ventricle anatomy. 21 This growing population of failed single-ventricle palliations will benefit from effective MCS as a bridge to transplantation or even destination therapy (DT). To date, however, this has been a disappointing endeavor, with higher mortality and morbidity reported in a variety of single-center experiences.…”

Section: Expanding Vad Support To Challenging Pediatric Populationsmentioning

confidence: 99%

Ventricular Assist Devices in Children

2014

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Section: Expanding Vad Support To Challenging Pediatric Populationsmentioning

confidence: 99%

Ventricular Assist Devices in Children

2014

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“…5 Since then, through the unremitting efforts of generations of researchers and clinicians, pediatric HT has evolved from a highrisk experimental procedure to a standard of care for children with intractable cardiomyopathy and complex congenital heart disease. 6,7 With the advancement of immunosuppressive therapy and postoperation management, the one-year survival rate of pediatric HT recipients is now over 90%. 8 However, cardiac rejection remains a common finding early after HT.…”

Section: Introductionmentioning

confidence: 99%

“…The first child reported to the International Society for Heart and Lung Transplantation (ISHLT) registration surviving beyond one year was transplanted in 1982 5 . Since then, through the unremitting efforts of generations of researchers and clinicians, pediatric HT has evolved from a high‐risk experimental procedure to a standard of care for children with intractable cardiomyopathy and complex congenital heart disease 6,7 …”

Section: Introductionmentioning

confidence: 99%

Echocardiographic assessment of pediatric heart transplantation: A single‐center experience in China

Xie,

Sun,

Zhu

et al. 2024

Echocardiography

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BackgroundPediatric heart transplant (HT) has become the standard of care for end‐stage heart failure in children worldwide. Serial echocardiographic evaluations of graft anatomy and function during follow‐up are crucial for post‐HT management. However, evolution of cardiac structure and function after pediatric HT has not been well described, especially during first year post‐HT. This study aimed to characterize the evolution of cardiac structure and function after pediatric HT and investigate the correlation between biventricular function with adverse clinical outcomes.MethodsA single‐center retrospective study of echocardiographic data obtained among 99 pediatric HT patients was conducted. Comprehensive echocardiographic examination was performed in all patients at 1‐, 3‐, 6‐, 9‐ and 12‐months post‐HT. We obtained structural, functional and hemodynamic parameters from both left‐ and right‐side heart, such as left ventricular stroke volume (LVSV), left ventricular ejection fraction (LVEF), right ventricular fractional area change (RVFAC), etc. The cardiac evolution of pediatric HT patients during first post‐HT year was described and compared between different time points. We also explored the correlation between cardiac function and major adverse transplant events (MATEs).Results1) Evolution of left heart parameters: left atrial length, mitral E velocity, E/A ratio, LVSV and LVEF significantly increased while mitral A velocity significantly decreased over the first year after HT (P < .05). Compared with 1 month after HT, interventricular septum (IVS) and left ventricular posterior wall (LVPW) decreased at 3 months but increased afterwards. (2) Evolution of right heart parameters: right ventricular base diameter and mid‐diameter; right ventricular length diameter, tricuspid E velocity, E/A ratio, tricuspid annular velocity e’ at free wall, and RVFAC increased, while tricuspid A velocity decreased over the first year after HT (P < .05). (3) Univariate logistic regression model suggests that biventricular function parameters at 1‐year post‐HT (LVEF, RVFAC, tricuspid annular plane systolic excursion and tricuspid lateral annular systolic velocity) were associated with MATEs.ConclusionGradual improvement of LV and RV function was seen in pediatric HT patients within the first year. Biventricular function parameters associated with MATEs. The results of this study pave way for designing larger and longer follow‐up of this population, potentially aiming at using multiparameter echocardiographic prediction of adverse events.

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“…The difficulty in obtaining suitable donor hearts has resulted in a preference for staged palliation as primary therapy, which usually involves three operations during the first 3‐6 years of life. The results remain suboptimal, with a 60%‐70% 5‐year survival, even though some patients may not have completed the course of palliative procedures.…”

Section: Introductionmentioning

confidence: 99%

An approach to induction of tolerance to pig cardiac xenografts in neonates

Cooper

Hara

Iwase

et al. 2018

Xenotransplantation

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There is a continuing need for donor hearts for infants with complex congenital heart defects. The transplantation of hearts from neonatal pigs would be an alternative to human organs, particularly if donor-specific immunological tolerance could be achieved. The great majority of infant humans do not make natural (preformed) antibodies against triple-knockout (TKO) pigs (that do not express any of the three known pig antigens against which humans have natural anti-pig antibodies). The transplantation of a heart from a TKO pig into an infant would therefore minimize any risk of early antibody-mediated rejection, and, with adequate immunosuppressive therapy, prolonged graft survival may well be achieved. Total host thymectomy (commonly carried out at the time of orthotopic heart transplantation in this age group) ± residual T-cell depletion and donor-specific pig thymus tissue transplantation might induce T-cell tolerance and allow immunosuppressive therapy to be discontinued (if there is in vitro evidence of T-cell and B-cell nonresponsiveness to donor-specific pig cells). Even if tolerance were not achieved, with continuing immunosuppressive therapy, the graft would likely "bridge" the patient until a suitable allograft became available or be associated with prolonged xenograft function.

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Changing Indications for Pediatric Heart Transplantation

Cited by 23 publications

References 101 publications

Ventricular Assist Devices in Children

Ventricular Assist Devices in Children

Echocardiographic assessment of pediatric heart transplantation: A single‐center experience in China

An approach to induction of tolerance to pig cardiac xenografts in neonates

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