The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Twenty-second pediatric heart transplantation report – 2019; Focus theme: Donor and recipient size match

Rossano, Joseph W.; Singh, Tajinder P.; Cherikh, Wida S.; Chambers, D.C.; Harhay, Michael O.; Hayes, Don; Hsich, Eileen; Khush, Kiran K.; Meiser, Bruno; Potena, Luciano; Toll, Alice E.; Sadavarte, Aparna; Zuckermann, Andreas; Stehlik, Josef

doi:10.1016/j.healun.2019.08.002

Cited by 187 publications

(231 citation statements)

References 11 publications

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“…34 Additionally, the median survival has improved but pOHT continues to be a temporary intervention, with a cumulative median survival of 18 years. 34 Understanding the frequency of transplant-related complications and their prognosis could play a role in exacerbating uncertainty, a common issue in chronic medical conditions. [35][36][37] As seen with CHD, parental uncertainty focuses on prognosis/outcomes and incorporating the child in the family unit, all of which may plausibly affect family functioning.…”

Section: Discussionmentioning

confidence: 99%

“…We hypothesize that this may be unique to pOHT. Individuals with higher education may have a better understanding of the risk of development of complications in the future such as allograft rejection, hospitalizations, CAV, and malignancy, which are not infrequently dealt with 34 . Additionally, the median survival has improved but pOHT continues to be a temporary intervention, with a cumulative median survival of 18 years 34 .…”

Section: Discussionmentioning

confidence: 99%

“…Individuals with higher education may have a better understanding of the risk of development of complications in the future such as allograft rejection, hospitalizations, CAV, and malignancy, which are not infrequently dealt with 34 . Additionally, the median survival has improved but pOHT continues to be a temporary intervention, with a cumulative median survival of 18 years 34 . Understanding the frequency of transplant‐related complications and their prognosis could play a role in exacerbating uncertainty, a common issue in chronic medical conditions 35‐37 .…”

Section: Discussionmentioning

confidence: 99%

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Family functioning in pediatric heart transplantation: Variables associated with poor outcomes

Tadros

Rawlinson

Martin

et al. 2020

Pediatric Transplantation

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Family functioning is integral in a child's life and is linked to quality of life in health as well as disease. This has been scarcely studied in pediatric orthotopic heart transplantation (pOHT). In this study, we evaluate demographic and clinical factors associated with family functioning in this patient population. Pediatric post-transplant families were recruited in an outpatient setting (n = 71). The PedsQL Family Impact Module was administered, along with the Parent and Adolescent Medication Barriers Scales (PMBS; AMBS) and the McArthur socioeconomic scale. Associations between clinical and demographic variables and scaled scores were evaluated. In our sample, patients with congenital heart disease, developmental delay, and enteral feeding had lower total impact (P = .026; P = .011; P = .008) and parent self-reported HRQL scores (P = .018; P = .012; P = .005). Patients with developmental delay and enteral feeding also had lower family functioning summary scores (P = .025; P = .031). Higher parent educational status was associated with lower total impact scores (P = .043). Higher PMBS scores demonstrated negative correlation with total impact (P < .001), parent self-reported HRQL (P < .001), and family functioning summary scores (P = .003). Multiple linear regression analysis identified developmental delay, parental education, and PMBS as independent variables associated with family functioning. Our study highlights important factors impacting family functioning in pOHT. Developmental delay, higher parental education, and PMBS were associated with poorer family functioning. Our findings emphasize the need for a multidisciplinary approach including serial psychological assessment and interventions in the management of pOHT patients in order to optimize family functioning. K E Y W O R D S family functioning, health-related quality of life, pediatric heart transplant, PedsQL Family Impact Module 1 | INTRODUC TI ON Pediatric orthotopic heart transplantation (pOHT) and its effects on psychosocial functioning are significant. Previous studies show that 1 in 3 pOHT recipients have impaired psychosocial functioning and approximately 24% of recipients experience significant symptoms of psychological distress during the first year post-transplant.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Family functioning in pediatric heart transplantation: Variables associated with poor outcomes

Tadros

Rawlinson

Martin

et al. 2020

Pediatric Transplantation

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“…Donor and recipient size match was the focus theme of the 2019 International Society for Heart and Lung Transplantation annual reports. In the pediatric heart report, the authors acknowledge the use by some centers of alternatives such as height, body mass index, body surface area and predicted heart mass for size matching . In a recent retrospective study of adult heart transplants, predicted heart mass was used as a surrogate for heart size to identify potential unintended ‘undersizing’ of donors that occurred as a result of the inadequacy of weight‐based size matching .…”

Section: Introductionmentioning

confidence: 99%

Volumetrics and fit assessments for donor to recipient size matching in pediatric heart transplantation: Is it time for a new paradigm?

Ploutz

Plasencia

Mirea

et al. 2020

Clinical Transplantation

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Pediatric heart transplant patients face the highest waitlist mortality in solid organ transplantation. Given the relatively fixed number of donor organs becoming available each year, improving donor organ utilization could potentially have significant impact on reducing waitlist mortality. Donor to recipient weight ratio has historically been used to identify suitable donors; however, this method does not take into account the potential for significant variance in heart size due to complex congenital heart disease or underlying cardiomyopathy. We believe, based on our experience to date, that donor matching based upon weight ratios should be augmented by improved methodologies that provide a more accurate assessment of heart volumes. Herein we describe the rationale for these methodologies and our single‐center experience using volumetrics as an alternative for donor fit assessments.

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“…The last 15 years have seen a rapid evolution in the field of pediatric mechanical circulatory support. The frequency of use of ventricular assist device (VAD) or temporary total artificial heart (TAH-t) as a bridge to transplantation has more than doubled as almost one third of patients are bridged with a VAD or TAH (1). The numbers are even more dramatic for patients >11 years of age where more than half of patients are bridged to transplant on a VAD or TAH.…”

Section: Introductionmentioning

confidence: 99%

The total artificial heart in pediatrics: outcomes in an evolving field

Villa¹,

Moore²,

Morales³

et al. 2020

Ann Cardiothorac Surg

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Background: The use of the SynCardia temporary total artificial heart (TAH-t) in adults has increased with time. The development of the smaller, 50 cc TAH-t has expanded the potential applications of the device in children. We sought to describe the evolving use of the TAH-t over time and describe outcomes in the current era. Methods: The SynCardia database was queried to identify all pediatric patients ≤18 years of age implanted with the device between December 1985 and October 2019. Patient demographics, clinical outcome and support characteristics collected. Results: Fifty-one children were supported, 36 with the 70 cc TAH-t and 15 with the 50 cc TAH-t with a total support time of 6,243 days. The number of implants has increased with time (19 between 2015 and 2019). A total of 13 patients have been converted to Freedom Driver support, seven 50 cc TAH-t and six 70 cc TAH-t. The majority of implants in the last 5 years (15/19, 79%) have been with the 50 cc TAH-t. The most common diagnosis was dilated cardiomyopathy [24 (47%)] and the average age at the time of implant was 16±2 years old. Overall survival for the patient cohort was 71%. Conclusions: The use of the SynCardia TAH-t to support children with end-stage heart failure has increased over time. Clinical outcomes with both the 50 cc and 70 cc TAH-t are similar to reported outcomes in adults who require TAH-t or other methods of biventricular support.

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The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Twenty-second pediatric heart transplantation report – 2019; Focus theme: Donor and recipient size match

Cited by 187 publications

References 11 publications

Family functioning in pediatric heart transplantation: Variables associated with poor outcomes

Family functioning in pediatric heart transplantation: Variables associated with poor outcomes

Volumetrics and fit assessments for donor to recipient size matching in pediatric heart transplantation: Is it time for a new paradigm?

The total artificial heart in pediatrics: outcomes in an evolving field

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