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Roest S, van der Meulen MH, van Osch-Gevers LM, Kraemer US, Constantinescu AA, de Hoog M, Bogers AJJC, Manintveld OC, van de Woestijne PC, Dalinghaus M. The Dutch national paediatric heart transplantation programme: outcomes during a 23-year period. Neth Heart J 2022; 31:68-75. [PMID: 35838916 PMCID: PMC9284482 DOI: 10.1007/s12471-022-01703-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Since 1998, there has been a national programme for paediatric heart transplantations (HT) in the Netherlands. In this study, we investigated waiting list mortality, survival post-HT, the incidence of common complications, and the patients' functional status during follow-up. METHODS All children listed for HT from 1998 until October 2020 were included. Follow-up lasted until 1 January 2021. Data were collected from the patient charts. Survival, post-operative complications as well as the functional status (Karnofsky/Lansky scale) at the end of follow-up were measured. RESULTS In total, 87 patients were listed for HT, of whom 19 (22%) died while on the waiting list. Four patients were removed from the waiting list and 64 (74%) underwent transplantation. Median recipient age at HT was 12.0 (IQR 7.2-14.4) years old; 55% were female. One-, 5‑, and 10-year survival post-HT was 97%, 95%, and 88%, respectively. Common transplant-related complications were rejections (50%), Epstein-Barr virus infections (31%), cytomegalovirus infections (25%), post-transplant lymphoproliferative disease (13%), and cardiac allograft vasculopathy (13%). The median functional score (Karnofsky/Lansky scale) was 100 (IQR 90-100). CONCLUSION Children who undergo HT have an excellent survival rate up to 10 years post-HT. Even though complications post-HT are common, the functional status of most patients is excellent. Waiting list mortality is high, demonstrating that donor availability for this vulnerable patient group remains a major limitation for further improvement of outcome.
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Affiliation(s)
- Stefan Roest
- Department of Paediatric Cardiology, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marijke H. van der Meulen
- Department of Paediatric Cardiology, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Lennie M. van Osch-Gevers
- Department of Paediatric Cardiology, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ulrike S. Kraemer
- Department of Paediatric Cardiology, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Department of Paediatric Intensive Care, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Alina A. Constantinescu
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Matthijs de Hoog
- Department of Paediatric Intensive Care, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ad J. J. C. Bogers
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Department of Cardiothoracic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Olivier C. Manintveld
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Pieter C. van de Woestijne
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Department of Cardiothoracic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Michiel Dalinghaus
- Department of Paediatric Cardiology, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Rosenthal LL, Ulrich SM, Zimmerling L, Brenner P, Müller C, Michel S, Hörer J, Netz H, Haas NA, Hagl C. Pediatric heart transplantation in infants and small children under 3 years of age: Single center experience - "Early and long-term results". Int J Cardiol 2022; 356:45-50. [PMID: 35395286 DOI: 10.1016/j.ijcard.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/01/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We analyzed the early and long-term survival after ABO-compatible heart transplantation in children under 3 years of age from 1991 to 2021 at our center. This retrospective and descriptive study aimed to identify serious adverse events associated with mortality after pediatric heart transplantation. PATIENTS AND METHODS 46 patients with congenital heart failure (37%) in end-stage heart failure have undergone a pediatric heart transplantation. Primary outcome of interest was survival at follow-up time. RESULTS Median (IQR) follow-up time (y), age (y), body-weight (kg) and BMI (kg/cm2) were 13.2 (5.7-19.5), 0.9 (0.2-2.0), 6.8 (4.3-10.0) and 14.2 (12.3-15.7). Twenty-four (52%) patients were male. 15 patients (33%) had a single ventricle physiology. At 30- days survival rate was 94 ± 4%. Survival rate at 1, 5, 10 and 15 years post HTx was 87 ± 5%, 84 ± 6%, 79 ± 6% and 63 ± 8%. One child underwent re-transplantation after 4 years, and another one after 11 years - in both cases due to graft failure. Higher early mortality in patients under 3 months of age and in patients with single ventricle physiology. Transplant free survival at 15 years was in children with cardiomyopathy better (71 ± 10%) than in those with congenital heart disease (50 ± 13%). One or more previous heart surgeries prior to HTx (n = 21) were associated to more mortality. CONCLUSION Pediatric heart transplantation has acceptable long-term results and is still the best therapeutic option in children with end-stage cardiac failure. Underlying anomalies and single ventricle physiology, age below 3 months had a significant impact on survival.
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Affiliation(s)
- L Lily Rosenthal
- Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany; Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Sarah Marie Ulrich
- Division of Pediatric Cardiology and Intesive Care, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Linda Zimmerling
- Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany; Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany
| | - Paolo Brenner
- Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Christoph Müller
- Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Sebastian Michel
- Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany; Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Jürgen Hörer
- Division for Pediatric and Congenital Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Heinrich Netz
- Division of Pediatric Cardiology and Intesive Care, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Nikolaus A Haas
- Division of Pediatric Cardiology and Intesive Care, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany.
| | - Christian Hagl
- Department of Heart Surgery, Ludwig Maximilians University Munich, Campus Grosshadern, Marchionini Street 15, D-81377 Munich, Germany; Munich Heart Alliance (MHA) - DZHK, Ludwig Maximilians University Munich, Department for Epidemiology and Prevention of Cardiovascular Diseases, Pettenkoferstr. 8a & 9, D- 80336 Munich, Germany.
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Taylor RM, Wray J, Gibson F. Measuring quality of life in children and young people after transplantation: methodological considerations. Pediatr Transplant 2010; 14:445-58. [PMID: 20345615 DOI: 10.1111/j.1399-3046.2010.01316.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The measurement of QoL has become an important area for research in paediatric transplantation over the past 15 yr. While much of this work remains descriptive and exploratory, advances in treatment and the trend towards outcomes being patient centred and not just survival based suggest the measurement of QoL will be of far more importance and relevance in the future. In this discussion article, we will outline some of the issues that need to be considered when embarking on a QoL study. The aim of our account is not to be prescriptive, rather to present researchers and clinicians with questions and possible solutions to help increase the scientific robustness of future studies. We have included summary tables of instruments that are currently available as a resource for those wanting to evaluate QoL in paediatric transplantation.
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Affiliation(s)
- Rachel M Taylor
- Department of Children's Nursing, Faculty of Health and Social Care, London South Bank University, and Great Ormond STreet Hospital for Children NHS Trust, London, UK.
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Sato Y, Takayanagi Y, Onaka T, Kobayashi E. Impact of cyclosporine upon emotional and social behavior in mice. Transplantation 2007; 83:1365-70. [PMID: 17519788 DOI: 10.1097/01.tp.0000263332.65519.1f] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cyclosporine induces psychological side effects but its mechanisms of action remain to be elucidated. METHODS Mice were injected with cyclosporine (0, 10, 60 mg/kg intraperitoneal) and indexes of both anxiety-related and social behaviors were examined. Release of serotonin and dopamine in the prefrontal cortex was also investigated by microdialysis. RESULTS Intraperitoneal administration of cyclosporine increased cyclosporine concentrations in the blood and brains in mice. Cyclosporine administration at a higher-dose reduced motor activity, increased indexes of anxiety-related behavior, and decreased an index of social interaction. The administration reduced release of serotonin and dopamine in the prefrontal cortex. Clozapine administration abolished the reduced release of dopamine and partially restored the index of social behavior in cyclosporine-injected mice. CONCLUSIONS This in vivo model suggests that cyclosporine at a high dose induced hypo-function of the prefrontal cortex as a result of reduced release of serotonin and dopamine, increased anxiety-related behavior, and disturbed social behavior. Clozapine partially restored an index of social behavior. The present findings are pathologically relevant in patients who take cyclosporine.
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Affiliation(s)
- Yuki Sato
- Department of Anesthesiology, Jichi Medical University, Tochigi-ken, Japan
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Chou NK, Chang CH, Chi NH, Chang CI, Chen YS, Wu ET, Wu MH, Wang JK, Hsu RB, Huang SC, Ko WJ, Chu SH, Lin FY, Wang SS. Single-center experience of pediatric heart transplantation in taiwan. Transplant Proc 2006; 38:2130-1. [PMID: 16980021 DOI: 10.1016/j.transproceed.2006.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Heart transplantation (HTx) is a treatment for end-stage heart failure or a complex or inoperable congenital defect. The long-term survival and the adequate donor to recipient body weight (D/R BW) ratio remain to be determined. From March 1995 to May 2004, 14 children (6 months-16 years of age) underwent HTx due to underlying diseases of idiopathic dilated cardiomyopathy (n = 10; 71.4%), congenital heart disease (n = 3; 21.4%), and Kawasaki disease (n = 1; 7.1%). Donor-recipient body weight ratio ranged from 0.89 to 3.9. Big heart syndrome was present in one patient when D/R BW ratio was more than 3. Actuarial survival was 92.9% at 5 years after transplantation. Only the one patient who had Kawasaki disease died due to early primary graft failure. HTx is a feasible method with good long-term survival rates for end-stage heart failure or for complex or inoperable congenital defects. After careful pretransplant evaluation, a high D/R BW ratio (more than 3) is acceptable.
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Affiliation(s)
- N K Chou
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan
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