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. · Feb 2009
HLA sensitization in pediatric pre-transplant cardiac patients supported by mechanical assist devices: the utility of Luminex.
HLA sensitization rates in children on extracorporeal membrane oxygenation (ECMO) or ventricular assist devices (VADs) are unknown. In addition, panel-reactive antibody (PRA) assessment is increasingly being performed by Luminex, whose role in comparison to other conventional methods is unclear. We investigated HLA sensitization of mechanically supported children using established PRA methods and then retested stored serum using Luminex to assess its impact on initial PRA results and post-heart transplant (post-HTx) outcomes. ⋯ Infants supported with ECMO are at low risk for HLA sensitization. Because it provides full antibody specificity disclosure, Luminex complements more conventional PRA assays by quantitatively identifying potential donor-specific antibodies, which should facilitate the virtual crossmatch process, thereby minimizing post-HTx humoral rejection risk.
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J. Heart Lung Transplant. · Jan 2009
Multicenter StudyPredictors of death and transplant in patients with a mechanical circulatory support device: a multi-institutional study.
INTERMACS is a registry of FDA-approved durable mechanical circulatory support (MCS) devices used for the strategies of destination therapy (DT) and bridge to transplantation (BTT) or recovery. This study identifies predictors for death and transplantation based on initial results from INTERMACS. ⋯ Cardiogenic shock, advanced age and severe right heart failure manifested as ascites or increased bilirubin are risk factors for death after MCS therapy. BTT patients who require biVAD support have a transplant rate similar to that of LVAD-only patients, but their mortality at 6 and 12 months exceeds that of LVAD-only patients. Consideration should be given to MCS referral before the sequelae of right ventricular failure dominate the advanced heart failure syndrome.
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J. Heart Lung Transplant. · Jan 2009
Increased pulse wave velocity and blood pressure in children who have undergone cardiac transplantation.
Arterial hypertension and premature coronary artery disease are poorly understood complications of cardiac transplantation in children. Arterial stiffness is associated with cardiovascular risk in adults. Pulse wave velocity (PWV) may be used as a surrogate for arterial rigidity. In this study we investigate PWV in children after cardiac transplantation. ⋯ Arterial rigidity is increased in children after cardiac transplantation. An improved understanding of blood pressure and arterial stiffness may help inform the choice of blood pressure medication in these patients.
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J. Heart Lung Transplant. · Jan 2009
Single-institution study evaluating the utility of surveillance bronchoscopy after lung transplantation.
Many lung transplant physicians advocate surveillance bronchoscopy with transbronchial lung biopsy and bronchoalveolar lavage (TBB/BAL) to monitor lung recipients despite limited evidence this strategy improves outcomes. This report compares rates of infection (INF), acute rejection (AR), bronchiolitis obliterans syndrome (BOS) and survival in lung allograft recipients managed with surveillance TBB/BAL (SB) versus those with clinically indicated TBB/BAL (CIB). ⋯ With no obvious advantage identified, surveillance bronchoscopy may pose a risk to stable lung transplant recipients. A multi-center, controlled trial is required to validate the utility and safety of surveillance bronchoscopy in lung transplantation.
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J. Heart Lung Transplant. · Jan 2009
Cost utility evaluation of extracorporeal membrane oxygenation as a bridge to transplant for children with end-stage heart failure due to dilated cardiomyopathy.
Extracorporeal membrane oxygenation (ECMO) and cardiac transplantation are recognized to be expensive. ⋯ ECMO bridging is effective but expensive. The eligible target population is small, nationally, positively influencing affordability. We strongly support our national policy of mechanical bridge to transplant for suitable children in end stage heart failure. Cost effectiveness could be optimized by: 1) increased availability of organ donors, 2) reduction in mechanical support costs possibly by alternate devices and 3) inclusion of patients most likely to benefit.