Heart Transplantation for Congenital Heart Disease in the First Year of Life

Chinnock, Richard; Bailey, Leonard L.

doi:10.2174/157340311797484231

Cited by 52 publications

(58 citation statements)

References 41 publications

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“…Chinnock et al included neonates in his report on the Loma Linda infant experience in 2011 (6). Heart transplants were accomplished in 103 neonates from 1985 to 2010.…”

Section: Discussionmentioning

confidence: 99%

“…In clinical practice, neonatal recipients of heart transplantation have demonstrated better survival, a lower immunosuppressive burden, and less chronic rejection than their older counterparts (6). In 2001, West et al showed that ABO-incompatible heart transplants could be safely performed in infants due to the inability of the immature immune system to mount an effective response to carbohydrate antigens (7).…”

Section: Neonatal Immune Tolerancementioning

confidence: 99%

“…The number of available donors has been relatively static, while the number on the waiting list continues to gradually increase every year. Two public health measures have reduced the number of available donors: the recognition of the importance of sleep positioning to prevent sudden infant death syndrome, and mandatory infant car seats to prevent injury (6). Recent studies have examined methods to expand the donor pool and minimize the non-utilization of functional organs (20).…”

Section: Donor Organ Availabilitymentioning

confidence: 99%

“…Most pediatric centers advocate induction therapy in the perioperative period with antithymocyte globulin or an IL-2 receptor antagonist. Our immunosuppression protocol has been described elsewhere (6). We do not use induction therapy for neonatal recipients.…”

Section: O N G -T E R M I M M U N O S U P P R E S S I O N F O L L Omentioning

confidence: 99%

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Neonatal heart transplantation

John

Bailey

2018

Ann. Cardiothorac. Surg.

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Neonatal heart transplantation was developed and established in the 1980's as a durable modality of therapy for complex-uncorrectable heart disease. Patients transplanted in the neonatal period have experienced unparalleled long-term survival, better than for any other form of solid-organ transplantation. However, the limited availability of neonatal and young infant donors has restricted the indications and applicability of heart transplantation among newborns in the current era. Indications for heart transplantation include congenital heart disease not amenable to other forms of surgical palliation, and cardiomyopathy, including some primary tumors. Use of ABO-incompatible transplants, and organs with prolonged cold ischemic time or marginal function have all been associated with good outcomes in infants. These extended strategies to increase the donor pool may also someday include donation after determination of circulatory death and the use of anencephalic donors. The operative techniques for donors and recipients of neonatal heart transplantation are unique and have been well-described. Immunosuppression protocols for neonates need not include induction and are largely steroid-free. Newborn and young infant transplant recipients have fewer episodes of rejection, less coronary allograft vasculopathy, less post-transplant lymphoproliferative disease and less renal dysfunction than their older counterparts. Long-term outcomes have been very encouraging in terms of graft survival, patient survival, and quality of life. Our review highlights the history, current indications, techniques and outcomes of heart transplantation in this immunologically-privileged subset of patients.

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“…Chinnock et al included neonates in his report on the Loma Linda infant experience in 2011 (6). Heart transplants were accomplished in 103 neonates from 1985 to 2010.…”

Section: Discussionmentioning

confidence: 99%

Section: Neonatal Immune Tolerancementioning

confidence: 99%

Section: Donor Organ Availabilitymentioning

confidence: 99%

Section: O N G -T E R M I M M U N O S U P P R E S S I O N F O L L Omentioning

confidence: 99%

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Neonatal heart transplantation

John

Bailey

2018

Ann. Cardiothorac. Surg.

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“…One of us (REC) (16) reviewed the dramatic progress made over three decades in the staged palliation and reconstruction of the hypoplastic left heart beginning with a modification of the procedure first described in 1980 by Norwood (23) or other procedures and culminating in a third major operation, the Fontan procedure, performed at 18 months to 4 years of age. Reconstructive procedures continue to evolve and newer approaches to reconstruction are debated today (14); however, physiology is never fully restored by these procedures.…”

Section: Some Approaches To the “Cure” Of Cardiac Failure In The Newbornmentioning

confidence: 99%

Toward a solution for cardiac failure in the newborn

Platt

West

Chinnock

et al. 2018

Xenotransplantation

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The newborn infant with severe cardiac failure owed to congenital structural heart disease or cardiomyopathy poses a daunting therapeutic challenge. The ideal solution for both might be cardiac transplantation if availability of hearts was not limiting and if tolerance could be induced, obviating toxicity of immunosuppressive therapy. If one could safely and effectively exploit neonatal tolerance for successful xenotransplantation of the heart, the challenge of severe cardiac failure in the newborn infant might be met. We discuss the need, the potential for applying neonatal tolerance in the setting of xenotransplantation and the possibility that other approaches to this problem might emerge.

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