Challenges with sensitized recipients in pediatric heart transplantation

Conway, Jennifer; Dipchand, Anne I.

doi:10.6061/clinics/2014(sup01)04

Cited by 4 publications

(4 citation statements)

References 48 publications

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“…Much still needs to be learned about the significance of either pre-existing or newly detected DSA (ndDSA) posttransplant (34,35). These may be transient in which case, especially if early in the post-transplant course, may be of little significance.…”

Section: Dsa Post-transplantmentioning

confidence: 99%

Current state of pediatric cardiac transplantation

Dipchand

2018

Ann. Cardiothorac. Surg.

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109

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Pediatric heart transplantation is standard of care for children with end-stage heart failure. The diverse age range, diagnoses, and practice variations continue to challenge the development of evidence-based practices and new technologies. Outcomes in the most recent era are excellent, especially with the more widespread use of ventricular assist devices (VADs). Waitlist mortality remains high and knowledge of risk factors for death while waiting and following transplantation contributes to decision-making around transplant candidacy and timing of listing. The biggest gap impacting both waitlist and overall survival remains mechanical support options for infants and patients with single ventricle physiology. Though acute rejection has decreased progressively, both diagnosis and management of antibody-mediated rejection has become increasingly challenging and complex, as has the ability to understand the implication of anti-HLA antibodies detected both pre-and post-transplantation-including when and how to intervene. Trends in immunosuppression protocols include more use of induction therapy and steroid avoidance or withdrawal protocols. Common long-term morbidities include renal insufficiency, which can be mitigated with surveillance and renal-sparing strategies, and infections. Functional outcomes are excellent, but significant psychosocial challenges exist in relation to neurodevelopment, non-adherence, and transition from childcentered to adult-centered care. Cardiac allograft vasculopathy (CAV) remains a barrier to long-term survival, though it is more apparent that objective evidence of an impact on the allograft is important with regards to impact on outcomes. Retransplantation is rare in pediatric heart transplant recipients. Pediatric heart transplantation continues to evolve in order to address the challenges of the diverse group of patients that reach end-stage heart failure during childhood.

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Section: Dsa Post-transplantmentioning

confidence: 99%

Current state of pediatric cardiac transplantation

Dipchand

2018

Ann. Cardiothorac. Surg.

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109

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“…The production of antibodies to human leukocyte antigen (HLA) prior to transplantation has increasingly been recognized as an important contributor to clinical outcomes in heart transplantation. [38] A number of risk factors for the development of anti-HLA antibodies prior to heart transplantation have been identified including transfusion of blood products, previous organ transplantation, history of pregnancy, previous cardiac surgery (especially surgery requiring exposure to homograft materials for surgical reconstruction), and the implantation of ventricular assist devices for mechanical support. [39] Currently, anywhere from 15 to 30% of pediatric patients listed for heart transplantation are reported to be sensitized with a panel reactive antibody (PRA) ≥ 10%, and this number has been increasing in recent years.…”

Section: Sensitized Patientsmentioning

confidence: 99%

“…Listing these patients for transplant with the requirement for a negative crossmatch may decrease the risks post-transplant but at the expense of increased mortality while on the waitlist. [22,38,40]…”

Section: Sensitized Patientsmentioning

confidence: 99%

Pediatric heart transplantation: long-term outcomes

Dipchand

Laks

2019

Indian J Thorac Cardiovasc Surg

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Pediatric heart transplant has become the standard of care for end-stage heart disease in children throughout the world. The number of transplants has grown dramatically since the first transplant was performed, and over the last two decades, outcomes have consistently improved with progression in knowledge enhancing the clinical course and outcomes of these patients. Shortterm outcomes in the most recent era have been excellent resulting in a renewed focus towards medium-and long-term outcomes. This article will review the most up-to-date literature on overall heart transplantation outcomes and specific long-term outcomes including rejection, cardiac allograft vasculopathy, graft failure, infection, renal dysfunction, malignancy, and the need for retransplantation. The article also explores the post-transplantation outcomes of special populations, including Fontan patients, ABO-incompatible recipients, sensitized recipients, extracorporeal membrane oxygenation, and ventricular assist devices. The article concludes with a look at transition from pediatric to adult care and medication adherence, which are becoming major issues related to long-term outcomes as post-transplant survival increases.

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“…Shapiro and Nguyen ( 2 ) review the new immunosuppression drugs that could minimize the side effects of the current regimens. In a clinical setting, Conway and Dipchand ( 3 ) explore the current knowledge of the challenge of treating sensitized pediatric heart transplanted patients, and Aikawa et al ( 4 ) reveal an outstanding long-term follow-up of ABO blood type-incompatible kidney transplantation. Marks and Kim ( 5 ), from the United Kingdom, continue the theme by highlighting the long-term survival of pediatric transplantation patients.…”

mentioning

confidence: 99%

Common challenge topics in pediatric transplantation

Azeka¹,

Jatene²,

Miura³

et al. 2014

Clinics

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This special issue is dedicated to the common challenge topics in pediatric transplantation. It contains 11 chapters, ranging from clinical research in pediatric transplantation to translational research (from bench to bedside). It includes comprehensive reviews from renowned scientists, clinicians and surgeons from five countries from the International Pediatric Transplantation Association (IPTA), Harvard University, the University of Miami and the University of São Paulo Medical School. The clinical management of specific issues, such as sensitized patients and ABO blood type-incompatible transplantation, is addressed. In addition, the challenges facing this patient population and the future perspectives for clinical research are discussed.

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Challenges with sensitized recipients in pediatric heart transplantation

Cited by 4 publications

References 48 publications

Current state of pediatric cardiac transplantation

Current state of pediatric cardiac transplantation

Pediatric heart transplantation: long-term outcomes

Common challenge topics in pediatric transplantation

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