The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
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J. Heart Lung Transplant. · Dec 2009
Multicenter Study Comparative StudyOutcome of pediatric patients with dilated cardiomyopathy listed for transplant: a multi-institutional study.
The course of dilated cardiomyopathy (DCM) leading to heart failure in children varies; survival with conventional treatment is 64% at 5 years. Heart transplantation (HTx) enables improved survival; however, outcomes from listing for transplant are not well described. This study reports survival of patients with DCM from listing with the availability of mechanical bridge to transplant. ⋯ Transplantation for DCM in the pediatric population offers enhanced survival compared with the natural history. Overall waitlist mortality for DCM is low, with the exception of patients on ECMO, mechanically ventilated, or with arrhythmias. DCM patients fared well after transplant, making HTx a key therapeutic intervention.
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J. Heart Lung Transplant. · Dec 2009
Multicenter Study Comparative StudyOutcomes of children with restrictive cardiomyopathy listed for heart transplant: a multi-institutional study.
Restrictive cardiomyopathy (RCM) in children often has a progressive nature, with a high risk of clinical deterioration and death. Heart transplantation (HTx) is a widely accepted therapy that offers long-term survival, but criteria for and outcomes after listing have not been well defined. ⋯ Children with RCM awaiting HTx have a generally low waitlist mortality and reasonable overall survival. Children requiring mechanical support and infants had a significantly higher risk of death while waiting. Further study is warranted to identify factors important in determining the optimal timing of listing in children with RCM before the need for inotropic or mechanical support.
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J. Heart Lung Transplant. · Dec 2009
Comparative StudyNeurodevelopmental outcomes in pediatric heart transplant recipients.
Physical functioning is without restriction in most pediatric heart transplant survivors, but only limited data are available about neuropsychologic outcomes in these children. In this study we assess neurodevelopmental outcomes in transplant survivors in comparison to population norms. ⋯ Although many pediatric heart transplant recipients display normal neurodevelopmental functioning, this population is at increased risk for cognitive difficulties, especially in expressive language, visual-motor integration and fine motor skills. Children with CHD may be at especially high risk. Early identification and intervention are essential to promote optimal neuropsychologic outcomes and overall quality of life in pediatric heart transplant recipients.
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J. Heart Lung Transplant. · Dec 2009
Multicenter Study Comparative StudyEra effect on post-transplant survival adjusted for baseline risk factors in pediatric heart transplant recipients.
Post-transplant survival in pediatric heart transplant (HT) recipients has improved for recent era recipients. However, the era effect has not been assessed after adjusting for baseline risk factors in HT recipients. ⋯ Despite the worse baseline risk profile of pediatric HT recipients in recent years, their risk-adjusted survival during the first 5 years after transplant has improved. The entire era effect appears to be due to improved survival during the first 6 months post-transplant.
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J. Heart Lung Transplant. · Nov 2009
Activated protein C in ischemia-reperfusion injury after experimental lung transplantation.
Ischemia-reperfusion injury remains the major cause of early morbidity and mortality after lung transplantation. Activated protein C (APC) has been demonstrated to attenuate various acute inflammation-related injuries in the lung and other organs. ⋯ Exogenous APC administered to the donor airway attenuates ischemia-reperfusion injury after lung transplantation. This novel administration route sustains high levels of APC in the lung tissue, which should avoid frequent administration and potential systemic side effects of bleeding. Further investigation is necessary to determine the mechanism of the beneficial effect of APC in this setting.