Right Ventricular Dysfunction by Echocardiography Is an Early Marker of Evolving Cardiac Allograft Vasculopathy in Children After Heart Transplantation.

Background: Cardiac allograft vasculopathy (CAV) is the leading cause of late graft loss in children after pediatric heart transplantation (HTx). Coronary angiography, the reference standard for diagnosis, is invasive and carries a risk of complications. Noninvasive echocardiographic methods to reliably identify CAV in children have not yet been defined.

Beyond the consult: Outcomes following pediatric VAD referral.

Background: Little is known about patients who are referred for ventricular assist device (VAD) therapy but not implanted. The purpose of this study is to describe their outcomes at 1-year post initial consultation.

Methods: Retrospective analysis for patients referred to our VAD services between 01/2019 and 12/2023.

Evaluating the Prevalence of Optimal Neurodevelopmental Outcome at 2 Years in Children Previously on Ventricular Assist Device Support.

Background: Literature reporting neurodevelopmental outcomes for patients who undergo ventricular assist device (VAD) therapy is limited to posttransplant cohorts. This study aims to determine the prevalence of optimal neurodevelopmental outcome and factors associated with nonoptimal outcome in patients implanted with a VAD at ≤15 months of age.

Methods: Patients followed by the Complex Pediatric Therapies Follow-Up Program were included in a prospective-inception cohort study if born between January 2006 and December 2022 and implanted with a VAD at ≤15 months of age.

Summary of the International Society for Heart and Lung Transplantation consensus conference on emerging understanding of antibodies and antibody-mediated rejection in heart transplantation.

The understanding of circulating antibodies and their relationship to antibody-mediated rejection (AMR) has yet to be fully elucidated in heart transplantation. Circulating antibodies are important in both pretransplant and post-transplant. In the pretransplant period, the more antibodies detected in a patient awaiting heart transplantation often significantly reduces the chance of obtaining a compatible donor heart.

Postoperative Dialysis in Fontan Patients Undergoing Heart Transplant: How Predictive is the Pretransplant Serum Creatinine?

Background: Fontan patients undergoing heart transplant (HT) appear to require hemodialysis (HD) in the early post-HT period at a rate that is higher than other patients, and often despite relatively preserved estimated renal function pre-HT; but this has not been studied formally.

Methods: The Pediatric Heart Transplant Society (PHTS) database was used to identify all children ≥ 2 years of age with Fontan circulatory failure (FCF) or cardiomyopathy (CM, benchmark lesion) who underwent isolated HT from 2005 to 2019. The primary endpoint was the need for postoperative dialysis, defined as any form of dialysis within the first 30 days post-HT.

Rejection and graft vasculopathy secondary to effects of Crohn's disease in a heart-transplanted child.

Patients require immunosuppression after heart transplantation. Conditions such as Crohn's disease can impact tacrolimus absorption and pharmacokinetics. Subtherapeutic tacrolimus levels can lead to rejection and development of donor-specific antibodies (DSA), resulting in the development of cardiac allograft vasculopathy.

Multiplex bead immunoassay in ABO-A2-incompatible kidney transplantation.

Kidney transplantation from ABO-A2 donors into ABO-O and ABO-B recipients can alleviate inequitable transplant access created by ABO demographics. ABO-A2-incompatible (ABO-A2i) eligibility is determined by anti-A hemagglutination titers. However, titers do not distinguish antibodies specific for A-II glycans, the sole A-antigen subtype in vascular endothelium, from other anti-A antibodies.

Considerations of ethical aspects of xenotransplantation in pediatric patients.

With recent advances in xenotransplantation, an increased initiative toward clinical applications in human recipients has evolved. Along with this trend, ethical concerns and considerations have been discussed. Infants and young children have been suggested as a group of patients for consideration of early clinical application given their limited mechanical circulatory support options, high waitlist mortality, and potential benefits of the immature immune system.

Access to and Health Outcomes of Pediatric Solid Organ Transplantation for Indigenous Children in 4 Settler-colonial Countries: A Scoping Review.

Solid organ transplantation (SOT) is considered the optimal treatment for children with end-stage organ failure; however, increased efforts are needed to understand the gap surrounding equitable access to and health outcomes of SOT for Indigenous children. This scoping review summarizes the literature on the characteristics of access to and health outcomes of pediatric SOT among Indigenous children in the settler-colonial states of Canada, Aotearoa New Zealand, Australia, and the United States. A search was performed on MEDLINE, EMBASE, PsycINFO, and CINAHL for studies matching preestablished eligibility criteria from inception to November 2021.

The iPeer2Peer mentorship program for adolescent thoracic transplant recipients: An implementation-effectiveness evaluation.

Background: An increase in self-management skills for adolescent thoracic transplant recipients may improve health outcomes and facilitate a successful transition to adulthood. The iPeer2Peer program is an online peer mentorship program that has been successfully implemented as a self-management intervention in multiple chronic disease populations. This study aimed to determine the implementation and effectiveness outcomes of the iPeer2Peer program for adolescent thoracic transplant recipients.

International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates-2024.

The "International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates-2024" updates and replaces the "Listing Criteria for Heart Transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates-2006" and the "2016 International Society for Heart Lung Transplantation Listing Criteria for Heart Transplantation: A 10-year Update." The document aims to provide tools to help integrate the numerous variables involved in evaluating patients for transplantation, emphasizing updating the collaborative treatment while waiting for a transplant. There have been significant practice-changing developments in the care of heart transplant recipients since the publication of the International Society for Heart and Lung Transplantation (ISHLT) guidelines in 2006 and the 10-year update in 2016.

Immune phenotyping in a pediatric multicenter transplant study: Suitability of a preformulated dry-antibody panel system.

Flow-cytometric immune phenotyping is influenced by cryopreservation and inter-laboratory variability limiting comparability in multicenter studies. We assessed a system of optimized, pre-mixed dry-antibody panel tubes requiring small amounts of whole blood for validity, reliability and challenges in a Canadian multicenter study (POSITIVE) with long-distance sample shipping, using standardized protocols. Thirty-seven children awaiting solid-organ transplant were enrolled for parallel immune-phenotyping with both validated, optimized in-house panels and the dry-antibody system.

ABO-incompatible heart transplantation-evolution of a revolution.

In the 1990s, neonates born with severe congenital heart disease faced more than 50% mortality awaiting an ABO-compatible (ABOc) transplant donor. This desperate situation, together with knowledge of gaps in the adaptive immune system in early childhood, led to the clinical exploration of intentional ABO-incompatible (ABOi) heart transplantation. In 2001, West et al.

Let's get physical: Aerobic capacity, muscle strength, and muscle endurance after pediatric heart transplantation.

Background: Pediatric heart (HTx) and kidney transplant (KTx) recipients may have lower physical fitness than healthy children. This study sought to quantify fitness levels in transplant recipients, investigate associations to clinical factors and quality of life, and identify whether a quick, simple wall-sit test is feasible as a surrogate for overall fitness for longitudinal assessment.

Methods: Aerobic capacity (6-min walk test, 6MWT), normalized muscle strength, muscle endurance, physical activity questionnaire (PAQ), and quality of life (PedsQL™) were prospectively assessed in transplanted children and matched healthy controls.

Review on clinician bias and its impact on racial and socioeconomic disparities in pediatric heart transplantation.

This expert review seeks to highlight implicit bias in health care, transplant medicine, and pediatric heart transplantation to focus attention on the role these biases may play in the racial/ethnic and socioeconomic disparities noted in pediatric heart transplantation. This review breaks down the transplant decision making process to highlight points at which implicit bias may affect outcomes and discuss how the science of human decision making may help understand these complex processes.

Evaluating a Telemedicine Video Game-Linked High-Intensity Interval Training Exercise Programme in Paediatric Heart Transplant Recipients.

Paediatric heart transplant recipients (HTRs) have reduced exercise capacity, physical activity (PA), health-related quality of life (HRQoL), and self-efficacy towards PA. Exercise interventions have demonstrated improvements in exercise capacity and functional status in adult HTRs, with a specific emerging interest in the role of high-intensity interval training (HIIT). Studies of exercise interventions in paediatric HTRs have been limited and nonrandomized to date.

Organ Donation in Canadian PICUs: A Cross-Sectional Survey, 2021-2022.

Objectives: To understand contemporary pediatric organ donation programs in Canadian PICUs, including: policies and practices, data collection and reporting, and system and process barriers.

Design: A cross-sectional survey carried out 2021-2022.

Setting: Canadian PICUs affiliated with a donor physician network.

Genetic Contribution to End-Stage Cardiomyopathy Requiring Heart Transplantation.

Background: Many cardiovascular disorders propel the development of advanced heart failure that necessitates cardiac transplantation. When treatable causes are excluded, studies to define causes are often abandoned, resulting in a diagnosis of end-stage idiopathic cardiomyopathy. We studied whether DNA sequence analyses could identify unrecognized causes of end-stage nonischemic cardiomyopathy requiring heart transplantation and whether the prevalence of genetic causes differed from ambulatory cardiomyopathy cases.

Prospective examination of HLA sensitization after VAD implantation in children and adults.

Background: Ventricular assist devices (VADs) have improved survival to heart transplantation (HTx). However, VADs have been associated with development of antibodies against human leukocyte antigen (HLA-Ab) which may limit the donor pool and decrease survival post-HTx. Since HLA-Ab development after VAD insertion is poorly understood, the purpose of this prospective single-center study was to quantify the incidence of and evaluate risk factors for HLA-Ab development across the age spectrum following VAD implantation.

Impact of the Pediatric ABO Policy Change on Listings, Transplants, and Outcomes for Children Younger Than 2 Years Listed for Heart Transplantation in the United States.

Background: We assessed the impact of the liberalized ABO pediatric policy change on candidate characteristics and outcomes for children undergoing heart transplant (HT).

Methods And Results: Children <2 years undergoing HT with ABO strategy reported at listing and HT from December 2011 to November 2020 to the Scientific Registry of Transplant Recipients database were included. Characteristics at listing, HT, and outcomes during the waitlist and post-transplant were compared before the policy change (December 16, 2011 to July 6, 2016), and after the policy change (July 7, 2016 to November 30, 2020).