Paediatric heart transplantation: an update

Reinhardt, Zdenka

doi:10.1136/archdischild-2018-315682

Cited by 15 publications

(14 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A major risk factor specific to SOT is the use of intestinal or multivisceral transplants due to a high volume of donor lymphoid tissue contained in the graft, which is subject to expansion when exposed to EBV and in a highly immunosuppressed environment [8]. PTLD occurs in 2-15% of pediatric SOT patients depending on the organ transplanted and the immunosuppression used [2,6,[8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Current Practices on Diagnosis, Prevention and Treatment of Post-Transplant Lymphoproliferative Disorder in Pediatric Patients after Solid Organ Transplantation: Results of ERN TransplantChild Healthcare Working Group Survey

et al. 2021

View full text Add to dashboard Cite

(1) Background: Post-transplant lymphoproliferative disease (PTLD) is a significant complication of solid organ transplantation (SOT). However, there is lack of consensus in PTLD management. Our aim was to establish a present benchmark for comparison between international centers and between various organ transplant systems and modalities; (2) Methods: A cross-sectional questionnaire of relevant PTLD practices in pediatric transplantation was sent to multidisciplinary teams from 17 European center members of ERN TransplantChild to evaluate the centers’ approach strategies for diagnosis and treatment and how current practices impact a cross-sectional series of PTLD cases; (3) Results: A total of 34 SOT programs from 13 European centers participated. The decision to start preemptive treatment and its guidance was based on both EBV viremia monitoring plus additional laboratory methods and clinical assessment (61%). Among treatment modalities the most common initial practice at diagnosis was to reduce the immunosuppression (61%). A total of 126 PTLD cases were reported during the period 2012–2016. According to their histopathological classification, monomorphic lesions were the most frequent (46%). Graft rejection after PTLD remission was 33%. Of the total cases diagnosed with PTLD, 88% survived; (4) Conclusions: There is still no consensus on prevention and treatment of PTLD, which implies the need to generate evidence. This might successively allow the development of clinical guidelines.

show abstract

Section: Introductionmentioning

confidence: 99%

Current Practices on Diagnosis, Prevention and Treatment of Post-Transplant Lymphoproliferative Disorder in Pediatric Patients after Solid Organ Transplantation: Results of ERN TransplantChild Healthcare Working Group Survey

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Seronegative recipients receiving organs from seropositive donors are at greater risk. Other opportunistic viral agents include HSV, varicella-zoster virus, influenza viruses, and EBV [ 21 ] .…”

Section: Discussionmentioning

confidence: 99%

Pediatric Heart Transplant: Initial Experience in a Tertiary Center in Brazil

Cajueiro¹,

Croti²,

Barufi³

et al. 2022

Braz J Cardiovasc Surg

View full text Add to dashboard Cite

“…Of the annual 150 infant cardiac transplants performed w o r l d w i d e , a p p r o x i m a t e l y 7 a r e p e r f o r m e d i n Eurotransplant, which is more than ten times less than the reported American numbers, with a significantly higher number of transplants performed in small-or medium-volume centers and less CHD patients compared to the Northern American colleagues [4,[7][8][9][10].…”

Section: Introductionmentioning

confidence: 94%

Ethical and practical dilemmas in cardiac transplantation in infants: a literature review

et al. 2021

View full text Add to dashboard Cite

The waiting time in infants for a cardiac transplant remains high, due to the scarcity of donors. Consequently, waiting list morbidity and mortality are higher than those in other age groups. Therefore, the decision to list a small infant for cardiac transplantation is seen as an ethical dilemma by most physicians. This review aims to describe outcomes, limitations, and ethical considerations in infant heart transplantation. We used Medline and Embase as data sources. We searched for publications on infant (< 1 year) heart transplantation, bridge-to-transplant and long-term outcomes, and waiting list characteristics from January 2009 to March 2021. Outcome after cardiac transplant in infants is better than that in older children (1-year survival 88%), and complications are less frequent (25% CAV, 10% PTLD). The bridge-to-transplant period in infants is associated with increased mortality (32%) and decreased transplantation rate (43%). This is mainly due to MCS complications or the limited MCS options (with 51% mortality in infancy). Outcomes are worse for infants with CHD or in need of ECMO-support.Conclusion: Infants listed for cardiac transplantation have a high morbidity and mortality, especially in the period between diagnosis and transplantation. For those who receive cardiac transplant, the outlook is encouraging. Unfortunately, despite growing experience in VAD, mortality in children < 10 kg and children with CHD remains high. After transplantation, patients carry a psychological burden and there is a probability of re-transplantation later in life, with decreased outcomes compared to primary transplantation. These considerations are seen as an important ethical dilemma in many centers, when considering cardiac transplantation in infants (< 1 year).What is Known:• For infants, waitlist mortality remains high. In the pediatric population, MCS reduces the waiting list mortality.What is New:• Outcomes after infant cardiac transplantation are better than other age groups; however, MCS options remain limited, with persistently high waiting list mortality. • Future developments in MCS and alternative options to reduce waiting list mortality such as ABO-incompatible transplantation and pulmonary artery banding are encouraging and will improve ethical decision-making when an infant is in need of a cardiac transplant.

show abstract

Paediatric heart transplantation: an update

Cited by 15 publications

References 41 publications

Current Practices on Diagnosis, Prevention and Treatment of Post-Transplant Lymphoproliferative Disorder in Pediatric Patients after Solid Organ Transplantation: Results of ERN TransplantChild Healthcare Working Group Survey

Current Practices on Diagnosis, Prevention and Treatment of Post-Transplant Lymphoproliferative Disorder in Pediatric Patients after Solid Organ Transplantation: Results of ERN TransplantChild Healthcare Working Group Survey

Pediatric Heart Transplant: Initial Experience in a Tertiary Center in Brazil

Ethical and practical dilemmas in cardiac transplantation in infants: a literature review

Contact Info

Product

Resources

About