Late rejection is a predictor of transplant coronary artery disease in children

Mulla, Neda F.; Johnston, Joyce K.; Dussen, L. Vander; Beeson, W. Lawrence; Chinnock, Richard; Bailey, Leonard L.; Larsen, Ranae L.

doi:10.1016/s0735-1097(00)01037-8

Cited by 52 publications

(29 citation statements)

References 10 publications

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“…We also chose not to categorize the degree of CAV as previous multicenter studies have done given the already small sample of patients in the groups [16,17]. Because our inclusion criteria required the diagnosis of CAV to be made by angiography or pathology, we may not have included patients who have microvascular disease that is difficult to detect by angiography, a known limitation of this gold standard diagnostic tool [18][19][20]. Despite these limitations, we were able to demonstrate that a significant number of children with CAV die suddenly.…”

Section: Discussionmentioning

confidence: 99%

Sudden death in children with cardiac allograft vasculopathy

Hong¹,

Tejtel²,

Jeewa³

et al. 2016

Trends in Transplant

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Cardiac allograft vasculopathy (CAV) is a leading cause of late mortality in pediatric heart transplant patients. Sudden death (SD) is a known phenomenon in CAV. This study aims to characterize factors associated with SD versus heart failure death (HFD) in pediatric patients with CAV. This single center retrospective review identified 37 pediatric patients who died or were retransplanted as a result of CAV. 9 (24%) of those patients died suddenly. There were no differences in rejection episodes between SD patients and HFD/retransplant patients. Ejection fraction (EF) was significantly higher in the SD group, median EF 62% versus 50% in the HFD/retransplant group (p=0.045). Hemodynamics also differed, with a median right ventricular end diastolic pressure of 8 mmHg in the SD group versus 14 mmHg in the HFD/retransplant group (p=0.011) and a median pulmonary capillary wedge pressure of 9 mmHg in the SD group versus 14 mmHg in the HFD/ retransplant group (p=0.027). Brain natriuretic peptide (BNP) was lower in the SD group, median 260 pg/ml versus 1081 pg/ml in the HFD/retransplant group (p=0.013). SD patients were more likely to have lower BNP levels, normal hemodynamics, and normal systolic function, none of which should be reassuring in the setting of CAV.

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Section: Discussionmentioning

confidence: 99%

Sudden death in children with cardiac allograft vasculopathy

Hong¹,

Tejtel²,

Jeewa³

et al. 2016

Trends in Transplant

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“…Registry data demonstrates that CAV significantly contributes to late morbidity and mortality. Due to the lack of significant treatment options (Boucek et al, 2007;Schowengerdt, 2006;Musci et al, 1998;Razzouk et al, 1998;Mulla et al, 2001) 15% of recipients undergo cardiac re-transplant (Ross et al, 2006). Survival after re-transplant, however, is poorer than after a first heart transplant .…”

Section: Physiological Outcomesmentioning

confidence: 99%

The New Normal: A Bourdieusian Examination of Living Into Young Adulthood Being a Paediatric Heart Transplant Recipient

Mauthner

Angus

Gastaldo

et al. 2014

The Journal of Heart and Lung Transplantation

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Improved success of paediatric cardiac transplantation has resulted in increased survival of recipients into young adulthood (19 to 29 years of age). Young adults who received a heart transplant during childhood have experienced multiple life sustaining procedures. As survival and longevity increase, it is clear that transplant recipients experience negative physiological, psychological and social sequelae. With heart transplant offering individuals a chance to extend life into young adulthood, recipients need lifelong care and at age 18 they will transition from paediatric to adult healthcare facilities. The study addressed young adults circumstances of existence and their competing interests within various social environments. This research project applied Pierre Bourdieu's theoretical concepts of habitus, field and capital, to conceptualize and engage with empirical knowledge production about young adults who have received a heart transplant during childhood. Using visual methodology, focused open-ended interviews were conducted with 12 young adults who had a heart transplant during childhood. Bourdieu's work iii provided a theoretical framework to investigate transplant recipients' identities and social repositioning in relation to dominant discourses of organ transplant and shifting relationships with health services providers. This study involved an iterative process to identify recipients' encounters and new compositions in relation with others, in order to answer the research objective. These findings highlight that young adult transplant recipients struggle with relational dispositions that excludes them from various fields of social engagement; their struggle and exclusion from various fields is symbolic and is embedded in the structure of the dominant social order of the field from where they become excluded; the social order is taken up and embodied, leading young transplant recipients to practices of accommodation and "normalization". Changes

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“…The risk of an adverse outcome associated with an episode of rejection is related to the timing and severity of the event. The development of late rejection has been linked to transplant coronary artery disease (TCAD) and poor outcome [11, 14, 16]. In the pediatric population, studies have demonstrated that heart transplant recipients with a history of previous rejection episodes are at higher risk for symptomatic or fatal rejection [5].…”

Section: Introductionmentioning

confidence: 99%

Outcome of Acute Graft Rejection Associated with Hemodynamic Compromise in Pediatric Heart Transplant Recipients

et al. 2010

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We sought to analyze the outcome of hemodynamically significant acute graft rejection in pediatric heart transplant recipients from a single-center experience. Acute graft rejection remains a major cause of morbidity and mortality for patients who undergo orthotopic heart transplantation and has been associated with the severity of the rejection episode. A retrospective review of all children experiencing a hemodynamically significant rejection episode after orthotopic heart transplantation was performed. Fifty-three patients with 54 grafts had 70 rejection episodes requiring intravenous inotropic support. Forty-one percent of these patients required high-dose inotropic support, with the remaining 59% of patients requiring less inotropic support. Overall graft survival to hospital discharge was 41% for patients in the high-dose group compared to 94% in the low-dose group. Six-month graft survival in patients who required high-dose inotropes remained at 41% compared to 44% in the low-dose group. Hemodynamically significant acute graft rejection in pediatric heart transplant recipients is a devastating problem with poor short- and long-term outcomes. Survival to hospital discharge is dismal in patients who require high-dose inotropic support. In contrast, survival to discharge is quite good in patients who require only low-dose inotropic support; however, six-month graft survival in this group is low secondary to a high incidence of graft failure related to worsening or aggressive transplant coronary artery disease.

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Late rejection is a predictor of transplant coronary artery disease in children

Cited by 52 publications

References 10 publications

Sudden death in children with cardiac allograft vasculopathy

Sudden death in children with cardiac allograft vasculopathy

The New Normal: A Bourdieusian Examination of Living Into Young Adulthood Being a Paediatric Heart Transplant Recipient

Outcome of Acute Graft Rejection Associated with Hemodynamic Compromise in Pediatric Heart Transplant Recipients

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