1
|
Gunsaulus M, Wang L, Haack L, Christopher A, Feingold B, Squires J, Horslen S, Hoskoppal A, Rose-Felker K, West S, Trucco S, Squires J, Olivieri L, Kreutzer J, Goldstein B, Alsaied T. Cardiac MRI-Derived Inferior Vena Cava Cross-Sectional Area Correlates with Measures of Fontan-Associated Liver Disease. Pediatr Cardiol 2024; 45:909-920. [PMID: 36454265 DOI: 10.1007/s00246-022-03054-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022]
Abstract
There is currently no clear consensus on screening techniques to evaluate the presence or severity of Fontan-associated liver disease (FALD). Cardiac MRI (CMR) is used routinely for post-Fontan surveillance, but CMR-derived measures that relate to the severity of FALD are not yet defined. This was a cross-sectional single-center study of post-Fontan patients who underwent a CMR. CMR exams were re-analyzed by a single pediatric cardiologist. Surrogates of FALD included Gamma-Glutamyl Transferase (GGT), Fibrosis-4 laboratory score (FIB-4), and imaging findings. Findings consistent with cirrhosis on liver ultrasound included increased liver echogenicity and/or nodularity. Statistical analyses were performed to investigate potential relationships between CMR parameters and markers of FALD. Sixty-one patients were included. A larger inferior vena cava cross-sectional area (IVC-CSA) indexed to height was significantly associated with a higher FIB-4 score (Spearman's ρ = 0.28, p = 0.04), a higher GGT level (Spearman's ρ = 0.40, p = 0.02), and findings consistent with cirrhosis on liver ultrasound (OR 1.17, 95% CI: (1.01, 1.35), p = 0.04). None of the other CMR parameters were associated with markers of FALD. A larger indexed IVC-CSA was associated with higher systemic ventricle end-diastolic pressure (EDP) on cardiac catheterization (Spearman's ρ = 0.39, p = 0.018) as well as older age (Spearman's ρ = 0.46, p = < 0.001). Indexed IVC-CSA was the only CMR parameter that was associated with markers of FALD. This measure has the potential to serve as an additional non-invasive tool to improve screening strategies for FALD.
Collapse
Affiliation(s)
- Megan Gunsaulus
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA.
| | - Li Wang
- Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Lindsey Haack
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Adam Christopher
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Brian Feingold
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - James Squires
- Pediatric Gastroenterology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Simon Horslen
- Pediatric Gastroenterology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Arvind Hoskoppal
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Kirsten Rose-Felker
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Shawn West
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Sara Trucco
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Judy Squires
- Pediatric Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Laura Olivieri
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Jacqueline Kreutzer
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Bryan Goldstein
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| | - Tarek Alsaied
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, 5th Floor Faculty Pavilion, Pittsburgh, PA, 15224, USA
| |
Collapse
|
2
|
Ammanamanchi N, Yester J, Bargaje AP, Thomas D, Little KC, Janzef S, Francis K, Weinberg J, Johnson J, Seery T, Harris TH, Funari BJ, Rose-Felker K, Zinn M, Miller SA, West SC, Feingold B, Zhou H, Steinhauser ML, Csernica T, Michener R, Kühn B. Elimination of 15N-thymidine after oral administration in human infants. PLoS One 2024; 19:e0295651. [PMID: 38271331 PMCID: PMC10810423 DOI: 10.1371/journal.pone.0295651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/28/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND We have developed a new clinical research approach for the quantification of cellular proliferation in human infants to address unanswered questions about tissue renewal and regeneration. The approach consists of oral 15N-thymidine administration to label cells in S-phase, followed by Multi-isotope Imaging Mass Spectrometry for detection of the incorporated label in cell nuclei. To establish the approach, we performed an observational study to examine uptake and elimination of 15N-thymidine. We compared at-home label administration with in-hospital administration in infants with tetralogy of Fallot, a form of congenital heart disease, and infants with heart failure. METHODS We examined urine samples from 18 infants who received 15N-thymidine (50 mg/kg body weight) by mouth for five consecutive days. We used Isotope Ratio Mass Spectrometry to determine enrichment of 15N relative to 14N (%) in urine. RESULTS/FINDINGS 15N-thymidine dose administration produced periodic rises of 15N enrichment in urine. Infants with tetralogy of Fallot had a 3.2-fold increase and infants with heart failure had a 4.3-fold increase in mean peak 15N enrichment over baseline. The mean 15N enrichment was not statistically different between the two patient populations (p = 0.103). The time to peak 15N enrichment in tetralogy of Fallot infants was 6.3 ± 1 hr and in infants with heart failure 7.5 ± 2 hr (mean ± SEM). The duration of significant 15N enrichment after a dose was 18.5 ± 1.7 hr in tetralogy of Fallot and in heart failure 18.2 ± 1.8 hr (mean ± SEM). The time to peak enrichment and duration of enrichment were also not statistically different (p = 0.617 and p = 0.887). CONCLUSIONS The presented results support two conclusions of significance for future applications: (1) Demonstration that 15N-thymidine label administration at home is equivalent to in-hospital administration. (2) Two different types of heart disease show no differences in 15N-thymidine absorption and elimination. This enables the comparative analysis of cellular proliferation between different types of heart disease.
Collapse
Affiliation(s)
- Niyatie Ammanamanchi
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Jessie Yester
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Anita P. Bargaje
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Dawn Thomas
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Kathryn C. Little
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Clinical Research Support Services (CRSS), Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
| | - Shannon Janzef
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Kimberly Francis
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Jacqueline Weinberg
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Jennifer Johnson
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Thomas Seery
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Tyler Hutchinson Harris
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Bryan J. Funari
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Kirsten Rose-Felker
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Matthew Zinn
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Susan A. Miller
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Shawn C. West
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Brian Feingold
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Hairu Zhou
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Matthew L. Steinhauser
- UPMC Heart and Vascular Institute, UPMC Presbyterian, Pittsburgh, PA, United States of America
- Aging Institute, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Timothy Csernica
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, CA, United States of America
| | - Robert Michener
- Department of Biology, Boston University Stable Isotope Laboratory, Boston, MA, United States of America
| | - Bernhard Kühn
- Division of Pediatric Cardiology, Pediatric Institute for Heart Regeneration and Therapeutics (I-HRT), UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States of America
- McGowan Institute of Regenerative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| |
Collapse
|
3
|
Affiliation(s)
- Nikkan Das
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - Brian Feingold
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| |
Collapse
|
4
|
Webber SA, Chin H, Wilkinson JD, Armstrong BD, Canter CE, Dipchand AI, Dodd DA, Feingold B, Lamour JM, Mahle WT, Singh TP, Zuckerman WA, Rossano JW, Morrison Y, Diop H, Demetris AJ, Bentlejewski C, Mohanakumar T, Odim J, Zeevi A. Impact of donor-specific anti-HLA antibody on cardiac hemodynamics and graft function 3 years after pediatric heart transplantation: First results from the CTOTC-09 multi-institutional study. Am J Transplant 2023; 23:1893-1907. [PMID: 37579817 PMCID: PMC10841212 DOI: 10.1016/j.ajt.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/19/2023] [Accepted: 08/06/2023] [Indexed: 08/16/2023]
Abstract
The aim of this study (CTOTC-09) was to assess the impact of "preformed" (at transplant) donor-specific anti-HLA antibody (DSA) and first year newly detected DSA (ndDSA) on allograft function at 3 years after pediatric heart transplantation (PHTx). We enrolled children listed at 9 North American centers. The primary end point was pulmonary capillary wedge pressure (PCWP) at 3 years posttransplant. Of 407 enrolled subjects, 370 achieved PHTx (mean age, 7.7 years; 57% male). Pre-PHTx sensitization status was nonsensitized (n = 163, 44%), sensitized/no DSA (n = 115, 31%), sensitized/DSA (n = 87, 24%), and insufficient DSA data (n = 5, 1%); 131 (35%) subjects developed ndDSA. Subjects with any DSA had comparable PCWP at 3 years to those with no DSA. There were also no significant differences overall between the 2 groups for other invasive hemodynamic measurements, systolic graft function by echocardiography, and serum brain natriuretic peptide concentration. However, in the multivariable analysis, persistent first-year DSA was a risk factor for 3-year abnormal graft function. Graft and patient survival did not differ between groups. In summary, overall, DSA status was not associated with worse allograft function or inferior patient and graft survival at 3 years, but persistent first-year DSA was a risk factor for late graft dysfunction.
Collapse
Affiliation(s)
- Steven A Webber
- Department of Pediatrics, Vanderbilt University School of Medicine, Vanderbilt, Nashville, Tennessee, USA.
| | - Hyunsook Chin
- Rho Federal Systems Division, Durham, North Carolina, USA
| | - James D Wilkinson
- Department of Pediatrics, Vanderbilt University School of Medicine, Vanderbilt, Nashville, Tennessee, USA
| | | | - Charles E Canter
- Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anne I Dipchand
- Labatt Family Heart Center, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Debra A Dodd
- Department of Pediatrics, Vanderbilt University School of Medicine, Vanderbilt, Nashville, Tennessee, USA
| | - Brian Feingold
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jacqueline M Lamour
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, New York, USA
| | - William T Mahle
- Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Tajinder P Singh
- Department of Pediatric Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Warren A Zuckerman
- Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Joseph W Rossano
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Yvonne Morrison
- Transplantation Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Helena Diop
- Transplantation Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Anthony J Demetris
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Carol Bentlejewski
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Jonah Odim
- Transplantation Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Adriana Zeevi
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
5
|
Kirmani S, Woodard PK, Shi L, Hamza TH, Canter CE, Colan SD, Pahl E, Towbin JA, Webber SA, Rossano JW, Everitt MD, Molina KM, Kantor PF, Jefferies JL, Feingold B, Addonizio LJ, Ware SM, Chung WK, Ballweg JA, Lee TM, Bansal N, Razoky H, Czachor J, Lunze FI, Marcus E, Commean P, Wilkinson JD, Lipshultz SE. Cardiac imaging and biomarkers for assessing myocardial fibrosis in children with hypertrophic cardiomyopathy. Am Heart J 2023; 264:153-162. [PMID: 37315879 PMCID: PMC11003360 DOI: 10.1016/j.ahj.2023.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Myocardial fibrosis, as diagnosed on cardiac magnetic resonance imaging (cMRI) by late gadolinium enhancement (LGE), is associated with adverse outcomes in adults with hypertrophic cardiomyopathy (HCM), but its prevalence and magnitude in children with HCM have not been established. We investigated: (1) the prevalence and extent of myocardial fibrosis as detected by LGE cMRI; (2) the agreement between echocardiographic and cMRI measurements of cardiac structure; and (3) whether serum concentrations of N-terminal pro hormone B-type natriuretic peptide (NT-proBNP) and cardiac troponin-T are associated with cMRI measurements. METHODS A cross-section of children with HCM from 9 tertiary-care pediatric heart centers in the U.S. and Canada were enrolled in this prospective NHLBI study of cardiac biomarkers in pediatric cardiomyopathy (ClinicalTrials.gov Identifier: NCT01873976). The median age of the 67 participants was 13.8 years (range 1-18 years). Core laboratories analyzed echocardiographic and cMRI measurements, and serum biomarker concentrations. RESULTS In 52 children with non-obstructive HCM undergoing cMRI, overall low levels of myocardial fibrosis with LGE >2% of left ventricular (LV) mass were detected in 37 (71%) (median %LGE, 9.0%; IQR: 6.0%, 13.0%; range, 0% to 57%). Echocardiographic and cMRI measurements of LV dimensions, LV mass, and interventricular septal thickness showed good agreement using the Bland-Altman method. NT-proBNP concentrations were strongly and positively associated with LV mass and interventricular septal thickness (P < .001), but not LGE. CONCLUSIONS Low levels of myocardial fibrosis are common in pediatric patients with HCM seen at referral centers. Longitudinal studies of myocardial fibrosis and serum biomarkers are warranted to determine their predictive value for adverse outcomes in pediatric patients with HCM.
Collapse
Affiliation(s)
- Sonya Kirmani
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Ling Shi
- New England Research Institute, Watertown, MA
| | | | - Charles E Canter
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Elfriede Pahl
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, IL
| | | | - Steven A Webber
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Joseph W Rossano
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Melanie D Everitt
- Department of Pediatrics, Children's Hospital of Colorado, Aurora, CO
| | - Kimberly M Molina
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, UT
| | - Paul F Kantor
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
| | | | - Brian Feingold
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
| | - Linda J Addonizio
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Stephanie M Ware
- Department of Pediatrics and Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Wendy K Chung
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Jean A Ballweg
- Department of Pediatrics, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Teresa M Lee
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Neha Bansal
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY
| | - Hiedy Razoky
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI
| | - Jason Czachor
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI
| | - Fatima I Lunze
- Department of Cardiology, Boston Children's Hospital, Boston, MA; German Heart Center Berlin, Charité Medical School, Berlin, Germany
| | - Edward Marcus
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Paul Commean
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - James D Wilkinson
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Steven E Lipshultz
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY.
| |
Collapse
|
6
|
Yamada M, Macedo C, Louis K, Shi T, Landsittel D, Nguyen C, Shinjoh M, Michaels MG, Feingold B, Mazariegos GV, Green M, Metes D. Distinct association between chronic Epstein-Barr virus infection and T cell compartments from pediatric heart, kidney, and liver transplant recipients. Am J Transplant 2023; 23:1145-1158. [PMID: 37187296 DOI: 10.1016/j.ajt.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/23/2023] [Accepted: 05/11/2023] [Indexed: 05/17/2023]
Abstract
Chronic Epstein-Barr virus (EBV) infection after pediatric organ transplantation (Tx) accounts for significant morbidity and mortality. The risk of complications, such as posttransplant lymphoproliferative disorders, in high viral load (HVL) carriers is the highest in heart Tx recipients. However, the immunologic signatures of such a risk have been insufficiently defined. Here, we assessed the phenotypic, functional, and transcriptomic profiles of peripheral blood CD8+/CD4+ T cells, including EBV-specific T cells, in 77 pediatric heart, kidney, and liver Tx recipients and established the relationship between memory differentiation and progression toward exhaustion. Unlike kidney and liver HVL carriers, heart HVL carriers displayed distinct CD8+ T cells with (1) up-regulation of interleukin-21R, (2) decreased naive phenotype and altered memory differentiation, (3) accumulation of terminally exhausted (TEX PD-1+T-bet-Eomes+) and decrease of functional precursors of exhausted (TPEX PD-1intT-bet+) effector subsets, and (4) transcriptomic signatures supporting the phenotypic changes. In addition, CD4+ T cells from heart HVL carriers displayed similar changes in naive and memory subsets, elevated Th1 follicular helper cells, and plasma interleukin-21, suggesting an alternative inflammatory mechanism that governs T cell responses in heart Tx recipients. These results may explain the different incidences of EBV complications and may help improve the risk stratification and clinical management of different types of Tx recipients.
Collapse
Affiliation(s)
- Masaki Yamada
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA; Thomas E. Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Camila Macedo
- Thomas E. Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kevin Louis
- Thomas E. Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Kidney Transplant Department, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Tiange Shi
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Douglas Landsittel
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Indiana, Pennsylvania, USA
| | - Christina Nguyen
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Masayoshi Shinjoh
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Marian G Michaels
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA; Thomas E. Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brian Feingold
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA; Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - George V Mazariegos
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA; Thomas E. Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael Green
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA; Thomas E. Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Diana Metes
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA; Thomas E. Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| |
Collapse
|
7
|
Bogle C, Colan SD, Miyamoto SD, Choudhry S, Baez-Hernandez N, Brickler MM, Feingold B, Lal AK, Lee TM, Canter CE, Lipshultz SE. Treatment Strategies for Cardiomyopathy in Children: A Scientific Statement From the American Heart Association. Circulation 2023; 148:174-195. [PMID: 37288568 DOI: 10.1161/cir.0000000000001151] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This scientific statement from the American Heart Association focuses on treatment strategies and modalities for cardiomyopathy (heart muscle disease) in children and serves as a companion scientific statement for the recent statement on the classification and diagnosis of cardiomyopathy in children. We propose that the foundation of treatment of pediatric cardiomyopathies is based on these principles applied as personalized therapy for children with cardiomyopathy: (1) identification of the specific cardiac pathophysiology; (2) determination of the root cause of the cardiomyopathy so that, if applicable, cause-specific treatment can occur (precision medicine); and (3) application of therapies based on the associated clinical milieu of the patient. These clinical milieus include patients at risk for developing cardiomyopathy (cardiomyopathy phenotype negative), asymptomatic patients with cardiomyopathy (phenotype positive), patients with symptomatic cardiomyopathy, and patients with end-stage cardiomyopathy. This scientific statement focuses primarily on the most frequent phenotypes, dilated and hypertrophic, that occur in children. Other less frequent cardiomyopathies, including left ventricular noncompaction, restrictive cardiomyopathy, and arrhythmogenic cardiomyopathy, are discussed in less detail. Suggestions are based on previous clinical and investigational experience, extrapolating therapies for cardiomyopathies in adults to children and noting the problems and challenges that have arisen in this experience. These likely underscore the increasingly apparent differences in pathogenesis and even pathophysiology in childhood cardiomyopathies compared with adult disease. These differences will likely affect the utility of some adult therapy strategies. Therefore, special emphasis has been placed on cause-specific therapies in children for prevention and attenuation of their cardiomyopathy in addition to symptomatic treatments. Current investigational strategies and treatments not in wide clinical practice, including future direction for investigational management strategies, trial designs, and collaborative networks, are also discussed because they have the potential to further refine and improve the health and outcomes of children with cardiomyopathy in the future.
Collapse
|
8
|
Abdulkarim A, Shaji S, Elfituri M, Gunsaulus M, Zafar MA, Zaidi AN, Pass RH, Feingold B, Kurland G, Kreutzer J, Ghassemzadeh R, Goldstein B, West S, Alsaied T. Pulmonary Complications in Patients With Fontan Circulation: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 81:2434-2444. [PMID: 37344046 DOI: 10.1016/j.jacc.2023.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 06/23/2023]
Abstract
The Fontan operation has resulted in significant improvement in survival of patients with single ventricle physiology. As a result, there is a growing population of individuals with Fontan physiology reaching adolescence and adulthood. Despite the improved survival, there are long-term morbidities associated with the Fontan operation. Pulmonary complications are common and may contribute to both circulatory and pulmonary insufficiency, leading ultimately to Fontan failure. These complications include restrictive lung disease, sleep abnormalities, plastic bronchitis, and cyanosis. Cyanosis post-Fontan procedure can be attributed to multiple causes including systemic to pulmonary venous collateral channels and pulmonary arteriovenous malformations. This review presents the unique cardiopulmonary interactions in the Fontan circulation. Understanding the cardiopulmonary interactions along with improved recognition and treatment of pulmonary abnormalities may improve the long-term outcomes in this growing patient population. Interventions focused on improving pulmonary function including inspiratory muscle training and endurance training have shown a promising effect post-Fontan procedure.
Collapse
Affiliation(s)
- Ali Abdulkarim
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shawn Shaji
- Heart Institute, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mahmud Elfituri
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Megan Gunsaulus
- Heart Institute, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Muhammad A Zafar
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ali N Zaidi
- Mount Sinai Heart, Mount Sinai Kravis Children's Heart Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert H Pass
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Division of Pediatric Cardiology and Mount Sinai Kravis Children's Heart Center, New York, New York, USA
| | - Brian Feingold
- Heart Institute, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Geoffrey Kurland
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Pediatric Pulmonology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jacqueline Kreutzer
- Heart Institute, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rod Ghassemzadeh
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Department of Critical Care, Pittsburgh, Pennsylvania, USA
| | - Bryan Goldstein
- Heart Institute, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shawn West
- Heart Institute, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Tarek Alsaied
- Heart Institute, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| |
Collapse
|
9
|
Smith KL, Gordon EB, Gunsaulus ME, Christopher A, Olivieri LJ, Tadros SS, Harris T, Saraf AP, Kreutzer J, Feingold B, Alsaied T. Surrogates of Muscle Mass on Cardiac MRI Correlate with Exercise Capacity in Patients with Fontan Circulation. J Clin Med 2023; 12:2689. [PMID: 37048773 PMCID: PMC10095035 DOI: 10.3390/jcm12072689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Sarcopenia is an increasingly recognized marker of frailty in cardiac patients. Patients with a history of congenital heart disease and Fontan procedure have a higher risk of developing progressive muscle wasting. Our objective was to determine if we could use routine cardiac MRI (CMR) for the surveillance of muscle wasting. METHODS A retrospective study of all Fontan patients (n = 75) was conducted at our institution, with CMR performed from 2010 to 2022 and exercise stress testing performed within 12 months (4.3 ± 4.2 months). The skeletal muscle area (SMA) for the posterior paraspinal and anterior thoracic muscles were traced and indexed for body surface area (BSA). Patients were stratified by percentile into the upper and lower quartiles, and the two groups were compared. Multivariable regression was performed to control for sex and age. RESULTS There was a significant positive association of both anterior (r = 0.34, p = 0.039) and paraspinal (r = 0.43, p = 0.007) SMA to peak VO2. Similarly, paraspinal but not anterior SMA was negatively associated with the VE/VCO2 (r = -0.45, p = 0.006). The upper quartile group had significantly more males (18/19 vs. 8/20; p = 0.0003) and demonstrated a significantly higher peak VO2 (32.2 ± 8.5 vs. 23.8 ± 4.7, p = 0.009), a higher peak RER (1.2 ± 0.1 vs. 1.1 ± 0.04, p = 0.007), and a significantly lower VE/VCO2 (32.9 ± 3.6 vs. 40.2 ± 6.2, p = 0.006) compared to the lowest quartile. The association of SMA to VO2 peak and VE/VCO2 was redemonstrated after controlling for sex and age. CONCLUSION Thoracic skeletal muscle area may be an effective surrogate of muscle mass and is correlated to several measures of cardiorespiratory fitness post-Fontan. CMR would be an effective tool for the surveillance of sarcopenia in post-Fontan patients given its accessibility and routine use in these patients.
Collapse
Affiliation(s)
- Kevin L. Smith
- Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Emile B. Gordon
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Megan E. Gunsaulus
- Department of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Adam Christopher
- Department of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Laura J. Olivieri
- Department of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Sameh S. Tadros
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Tyler Harris
- Department of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Anita P. Saraf
- Department of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Jacqueline Kreutzer
- Department of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Brian Feingold
- Department of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Tarek Alsaied
- Department of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| |
Collapse
|
10
|
Magnetta D, Jackson L, Zeevi A, Turnquist H, Miller S, West S, Murtagh G, Feingold B. High Sensitivity Troponin-I is Associated with Acute Rejection in Pediatric Heart Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
11
|
Ellison M, Mangiola M, Marrari M, Bentlejewski C, Sadowski J, Zern D, Kramer CSM, Heidt S, Niemann M, Xu Q, Dipchand AI, Mahle WT, Rossano JW, Canter CE, Singh TP, Zuckerman WA, Hsu DT, Feingold B, Webber SA, Zeevi A. Immunologic risk stratification of pediatric heart transplant patients by combining HLA-EMMA and PIRCHE-II. Front Immunol 2023; 14:1110292. [PMID: 36999035 PMCID: PMC10043167 DOI: 10.3389/fimmu.2023.1110292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
Human leukocyte antigen (HLA) molecular mismatch is a powerful biomarker of rejection. Few studies have explored its use in assessing rejection risk in heart transplant recipients. We tested the hypothesis that a combination of HLA Epitope Mismatch Algorithm (HLA-EMMA) and Predicted Indirectly Recognizable HLA Epitopes (PIRCHE-II) algorithms can improve risk stratification of pediatric heart transplant recipients. Class I and II HLA genotyping were performed by next-generation sequencing on 274 recipient/donor pairs enrolled in the Clinical Trials in Organ Transplantation in Children (CTOTC). Using high-resolution genotypes, we performed HLA molecular mismatch analysis with HLA-EMMA and PIRCHE-II, and correlated these findings with clinical outcomes. Patients without pre-formed donor specific antibody (DSA) (n=100) were used for correlations with post-transplant DSA and antibody mediated rejection (ABMR). Risk cut-offs were determined for DSA and ABMR using both algorithms. HLA-EMMA cut-offs alone predict the risk of DSA and ABMR; however, if used in combination with PIRCHE-II, the population could be further stratified into low-, intermediate-, and high-risk groups. The combination of HLA-EMMA and PIRCHE-II enables more granular immunological risk stratification. Intermediate-risk cases, like low-risk cases, are at a lower risk of DSA and ABMR. This new way of risk evaluation may facilitate individualized immunosuppression and surveillance.
Collapse
Affiliation(s)
- M. Ellison
- University of Pittsburgh Medical Center, Histocompatibility Laboratory, Pittsburgh, PA, United States
- *Correspondence: M. Ellison,
| | - M. Mangiola
- Transplant Institute, NYU Langone Health, New York University, New York, NY, United States
| | - M. Marrari
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - C. Bentlejewski
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - J. Sadowski
- University of Pittsburgh Medical Center, Histocompatibility Laboratory, Pittsburgh, PA, United States
| | - D. Zern
- University of Pittsburgh Medical Center, Histocompatibility Laboratory, Pittsburgh, PA, United States
| | | | - S. Heidt
- Department of Immunology, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - M. Niemann
- Research and Development, PIRCHE AG, Berlin, Germany
| | - Q. Xu
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - A. I. Dipchand
- Labatt Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - W. T. Mahle
- Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, United States
| | - J. W. Rossano
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - C. E. Canter
- Division of Cardiology, Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, United States
| | - T. P. Singh
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - W. A. Zuckerman
- Columbia University, Irving Medical Center, New York, NY, United States
| | - D. T. Hsu
- Division of Pediatric Cardiology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, NY, United States
| | - B. Feingold
- Department of Pediatrics, Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - S. A. Webber
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - A. Zeevi
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| |
Collapse
|
12
|
Feingold B, Rose-Felker K, West SC, Miller SA, Zinn MD. Short-term clinical outcomes and predicted cost savings of dd-cfDNA-led surveillance after pediatric heart transplantation. Clin Transplant 2023; 37:e14933. [PMID: 36779524 DOI: 10.1111/ctr.14933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Endomyocardial biopsy (EMB)-led surveillance is common after pediatric heart transplantation (HT), with some centers performing periodic surveillance EMBs indefinitely after HT. Donor derived cell-free DNA (dd-cfDNA)-led surveillance offers an alternative, but knowledge about its clinical and economic outcomes, both key drivers of potential utilization, are lacking. METHODS Using single-center recipient and center-level data, we describe clinical outcomes prior to and since transition from EMB-led surveillance to dd-cfDNA-led surveillance of pediatric and young adult HT recipients. These data were then used to inform Markov models to compare costs between EMB-led and dd-cfDNA-led surveillance strategies. RESULTS Over 34.5 months, dd-cfDNA-led surveillance decreased the number of EMBs by 81.8% (95% CI 76.3%-86.5%) among 120 HT recipients (median age 13.3 years). There were no differences in the incidences of graft loss or death among all recipients followed at our center prior to and following implementation of dd-cfDNA-led surveillance (graft loss: 2.9 vs. 1.5 per 100 patient-years; p = .17; mortality: 3.7 vs. 2.2 per 100 patient-years; p = .23). Over 20 years from HT, dd-cfDNA-led surveillance is projected to cost $8545 less than EMB-led surveillance. Model findings were robust in sensitivity and scenario analyses, with cost of EMB, cost of dd-cfDNA testing, and probability of elevated dd-cfDNA most influential on model findings. CONCLUSIONS dd-cfDNA-led surveillance shows promise as a less invasive and cost saving alternative to EMB-led surveillance among pediatric and young adult HT recipients.
Collapse
Affiliation(s)
- Brian Feingold
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kirsten Rose-Felker
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shawn C West
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan A Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew D Zinn
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
13
|
Van den Eynde J, Possner M, Alahdab F, Veldtman G, Goldstein BH, Rathod RH, Hoskoppal AK, Saraf A, Feingold B, Alsaied T. Thromboprophylaxis in Patients With Fontan Circulation. J Am Coll Cardiol 2023; 81:374-389. [PMID: 36697138 PMCID: PMC11040452 DOI: 10.1016/j.jacc.2022.10.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The optimal strategy for thromboprophylaxis in patients with a Fontan circulation is unknown. OBJECTIVES The aim of this study was to compare the efficacy and safety of aspirin, warfarin, and nonvitamin K oral anticoagulants (NOACs) in a network meta-analysis. METHODS Relevant studies published by February 2022 were included. The primary efficacy outcome was thromboembolic events; major bleeding was a secondary safety outcome. Frequentist network meta-analyses were conducted to estimate the incidence rate ratios (IRRs) of both outcomes. Ranking of treatments was performed based on probability (P) score. RESULTS A total of 21 studies were included (26,546 patient-years). When compared with no thromboprophylaxis, NOAC (IRR: 0.11; 95% CI: 0.03-0.40), warfarin (IRR: 0.23; 95% CI: 0.14-0.37), and aspirin (IRR: 0.24; 95% CI: 0.15-0.39) were all associated with significantly lower rates of thromboembolic events. However, the network meta-analysis revealed no significant differences in the rates of major bleeding (NOAC: IRR: 1.45 [95% CI: 0.28-7.43]; warfarin: IRR: 1.38 [95% CI: 0.41-4.69]; and aspirin: IRR: 0.72 [95% CI: 0.20-2.58]). Rankings, which simultaneously analyze competing interventions, suggested that NOACs have the highest P score to prevent thromboembolic events (P score 0.921), followed by warfarin (P score 0.582), aspirin (P score 0.498), and no thromboprophylaxis (P score 0.001). Aspirin tended to have the most favorable overall profile. CONCLUSIONS Aspirin, warfarin, and NOAC are associated with lower risk of thromboembolic events. Recognizing the limited number of patients and heterogeneity of studies using NOACs, the results support the safety and efficacy of NOACs in patients with a Fontan circulation.
Collapse
Affiliation(s)
- Jef Van den Eynde
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland, USA; Department of Cardiovascular Diseases, University Hospitals Leuven and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium. https://twitter.com/JefVandenEynde
| | - Mathias Possner
- Cardiology Department, Cantonal Hospital St Gallen, St Gallen, Switzerland; University Heart Center Zurich, Department of Cardiology, University of Zurich, Zurich, Switzerland. https://twitter.com/m_possner
| | - Fares Alahdab
- Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Gruschen Veldtman
- Scottish Adult Congenital Cardiac Service, Golden Jubilee Hospital, Glasgow, Scotland, United Kingdom
| | - Bryan H Goldstein
- The Heart and Vascular Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rahul H Rathod
- Department of Cardiology, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Arvind K Hoskoppal
- The Heart and Vascular Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anita Saraf
- The Heart and Vascular Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Brian Feingold
- The Heart and Vascular Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Tarek Alsaied
- The Heart and Vascular Institute, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| |
Collapse
|
14
|
Alsaied T, Christopher AB, Da Silva J, Gupta A, Morell VO, Lanford L, Weinberg JG, Feingold B, Seery T, Hoskoppal A, Goldstein BH, Johnson JA, Olivieri LJ, De Fonseca Da Silva L. Multimodality Imaging in Ebstein Anomaly. Pediatr Cardiol 2023; 44:15-23. [PMID: 36151322 DOI: 10.1007/s00246-022-03011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/14/2022] [Indexed: 01/24/2023]
Abstract
Ebstein anomaly is the most common form of tricuspid valve congenital anomalies. The tricuspid valve is abnormal with different degrees of displacement of the septal leaflet and abnormal rotation of the valve towards the right ventricular outflow tract. In severe forms, it results in significant tricuspid regurgitation and requires surgical repair. There is an increased interest in understanding the anatomy of the tricuspid valve in this lesion as the surgical repair has evolved with the invention and wide adoption of the cone operation. Multimodality imaging plays an important role in diagnosis, follow-up, surgical planning and post-operative care. This review provides anatomical tips for the cardiac imagers caring for patients with Ebstein anomaly and will help provide image-based personalized medicine.
Collapse
Affiliation(s)
- Tarek Alsaied
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA.
| | - Adam B Christopher
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Jose Da Silva
- DaSilva Center of Ebstein Anomaly, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Cardiothoracic Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Aditi Gupta
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Victor O Morell
- DaSilva Center of Ebstein Anomaly, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Cardiothoracic Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lizabeth Lanford
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Jacqueline G Weinberg
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Brian Feingold
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Thomas Seery
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Arvind Hoskoppal
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Bryan H Goldstein
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Jennifer A Johnson
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Laura J Olivieri
- Heart Institute, UPMC Children's Hospital of Pittsburgh, Division of Pediatric Cardiology, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, USA
| | - Luciana De Fonseca Da Silva
- DaSilva Center of Ebstein Anomaly, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Cardiothoracic Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
15
|
Pompa AG, Beerman LB, Feingold B, Zinn MD, Arora G. Arrhythmia Burden in Pediatric Patients With a Ventricular Assist Device. Circ Heart Fail 2022; 15:e009566. [PMID: 35593167 DOI: 10.1161/circheartfailure.122.009566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anthony G Pompa
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh (A.G.P., L.B.B., M.D.Z., G.A.), University of Pittsburgh School of Medicine, PA
| | - Lee B Beerman
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh (A.G.P., L.B.B., M.D.Z., G.A.), University of Pittsburgh School of Medicine, PA
| | - Brian Feingold
- Pediatrics and Clinical and Translational Science (B.F.), University of Pittsburgh School of Medicine, PA
| | - Matthew D Zinn
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh (A.G.P., L.B.B., M.D.Z., G.A.), University of Pittsburgh School of Medicine, PA
| | - Gaurav Arora
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh (A.G.P., L.B.B., M.D.Z., G.A.), University of Pittsburgh School of Medicine, PA
| |
Collapse
|
16
|
Pompa AG, Beerman LB, Feingold B, Arora G. Electrocardiogram changes in pediatric patients with myocarditis. Am J Emerg Med 2022; 59:49-53. [PMID: 35779288 DOI: 10.1016/j.ajem.2022.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/02/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is traditionally taught that pediatric patients with myocarditis almost always have an abnormal electrocardiogram (ECG) at presentation. However, there has never been a study to objectively evaluate ECG changes in pediatric myocarditis patients compared to healthy controls or explore if specific ECG changes correlate with clinical outcomes. METHODS Pediatric patients diagnosed with acute myocarditis were age and sex matched 1:2 with healthy controls in this retrospective case-control study spanning a seven-year period. ECGs from presentation through discharge were interpreted by electrophysiologists blinded to the patients' diagnoses. RESULTS Thirty-nine patients with myocarditis were identified. Twenty-eight (72%) had an abnormal ECG at presentation, 11 (28%) had a completely normal ECG. In this second group, six patients had an abnormal ECG at some point during their hospital course for a total of 34 (88%). Myocarditis patients who had an abnormal ECG at presentation spent more time in the hospital, 5 (2-19) versus 2 ((1-3) days (p < 0.01), and in the ICU, 1 (0-6) versus 0 (0-1) days (p < 0.01). Myocarditis patients were more likely to have ST elevation on their ECG compared to control patients (41% versus 17%, p < 0.01). Patients with ST elevation at presentation had a higher peak troponin level, 18.4 (5.8-31.0) versus 7.7 (0-19.1) ng/ml, (p < 0.01). CONCLUSIONS Over a quarter of patients with myocarditis had a normal ECG at presentation to the emergency department. Patients with an abnormal ECG at presentation spent more time in the hospital. The presenting ECG, particularly the presence of ST elevation, may correlate with other clinical markers and help direct early management decisions.
Collapse
Affiliation(s)
- Anthony G Pompa
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
| | - Lee B Beerman
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Brian Feingold
- Pediatrics and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Gaurav Arora
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| |
Collapse
|
17
|
Kohli U, Desai L, Chowdhury D, Harahsheh AS, Yonts AB, Ansong A, Sabati A, Nguyen HH, Hussain T, Khan D, Parra DA, Su JA, Patel JK, Ronai C, Bohun M, Freij BJ, O'Connor MJ, Rosanno JW, Gupta A, Salavitabar A, Dorfman AL, Hansen J, Frosch O, Profita EL, Maskatia S, Thacker D, Shrivastava S, Harris TH, Feingold B, Berger S, Campbell M, Idriss SF, Das S, Renno MS, Knecht K, Asaki SY, Patel S, Ashwath R, Shih R, Phillips J, Das B, Ramachandran P, Sagiv E, Bhat AH, Johnson JN, Taggart NW, Imundo J, Nakra N, Behere S, Patel A, Aggarwal A, Aljemmali S, Lang S, Batlivala SP, Forsha DE, Conners GP, Shaw J, Smith FC, Pauliks L, Vettukattil J, Shaffer K, Cheang S, Voleti S, Shenoy R, Komarlu R, Ryan SJ, Snyder C, Bansal N, Sharma M, Robinson JA, Arnold SR, Salvatore CM, Kumar M, Fremed MA, Glickstein JS, Perrotta M, Orr W, Rozema T, Thirumoorthi M, Mullett CJ, Ang JY. mRNA Coronavirus Disease 2019 Vaccine-Associated Myopericarditis in Adolescents: A Survey Study. J Pediatr 2022; 243:208-213.e3. [PMID: 34952008 PMCID: PMC8691954 DOI: 10.1016/j.jpeds.2021.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/21/2021] [Accepted: 12/16/2021] [Indexed: 12/29/2022]
Abstract
In this survey study of institutions across the US, marked variability in evaluation, treatment, and follow-up of adolescents 12 through 18 years of age with mRNA coronavirus disease 2019 (COVID-19) vaccine-associated myopericarditis was noted. Only one adolescent with life-threatening complications was reported, with no deaths at any of the participating institutions.
Collapse
Affiliation(s)
- Utkarsh Kohli
- Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University School of Medicine and West Virginia University Medicine Children's Hospital, Morgantown, WV.
| | - Lavina Desai
- Children's Hospital of Michigan, Division of Pediatric Infectious Diseases, Department of Pediatrics, Detroit, MI; Central Michigan University, College of Medicine, Mt Pleasant, MI
| | - Devyani Chowdhury
- Cardiology Care for Children, Nemours Children's Hospital, Wilmington, DE
| | - Ashraf S Harahsheh
- Division of Pediatric Cardiology, Department of Pediatrics, Children's National Hospital, Washington, DC; The George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Alexandra B Yonts
- The George Washington University School of Medicine & Health Sciences, Washington, DC; Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's National Hospital, Washington, DC
| | - Annette Ansong
- Division of Pediatric Cardiology, Department of Pediatrics, Children's National Hospital, Washington, DC; The George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Arash Sabati
- Division of Pediatric Cardiology, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
| | - Hoang H Nguyen
- Department of Pediatrics, Children's Medical Center Dallas, UTSW Medical Center, Dallas, TX
| | - Tarique Hussain
- Department of Pediatrics, Children's Medical Center Dallas, UTSW Medical Center, Dallas, TX
| | - Danyal Khan
- Department of Cardiology, Nicklaus Children's Hospital, Miami, FL
| | - David A Parra
- Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Jr Children's Hospital, Vanderbilt University Medical Center, Nashville, TN
| | - Jennifer A Su
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
| | - Jyoti K Patel
- Division of Pediatric Cardiology, Department of Pediatrics, Riley Children's Hospital, Indianapolis, IN
| | - Christina Ronai
- Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health & Science University Doernbecher Children's Hospital, Portland, OR
| | - Monique Bohun
- Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health & Science University Doernbecher Children's Hospital, Portland, OR
| | - Bishara J Freij
- Beaumont Children's Hospital, Royal Oak, MI; Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Matthew J O'Connor
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Joseph W Rosanno
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Aamisha Gupta
- Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital, University of California San Diego, San Diego, CA
| | - Arash Salavitabar
- Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Adam L Dorfman
- Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Jesse Hansen
- Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Olivia Frosch
- Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Elizabeth L Profita
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, CA
| | - Shiraz Maskatia
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, CA
| | - Deepika Thacker
- Division of Pediatric Cardiology, Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE
| | - Shubhika Shrivastava
- Division of Pediatric Cardiology, Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE
| | - Tyler H Harris
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA
| | - Brian Feingold
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA
| | - Stuart Berger
- Division of Pediatric Cardiology, Department of Pediatrics, Lurie Children's Hospital, Chicago, IL
| | - Michael Campbell
- Division of Pediatric Cardiology, Department of Pediatrics, Duke Children's Hospital, Durham, NC
| | - Salim F Idriss
- Division of Pediatric Cardiology, Department of Pediatrics, Duke Children's Hospital, Durham, NC
| | - Srikant Das
- Division of Pediatric Cardiology, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR
| | - Markus S Renno
- Division of Pediatric Cardiology, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR
| | - Ken Knecht
- Division of Pediatric Cardiology, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR
| | - S Yukiko Asaki
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah/Primary Children's Hospital, Salt Lake City, UT
| | - Sunil Patel
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC), Harrisburg, Harrisburg, PA
| | - Ravi Ashwath
- Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA
| | - Renata Shih
- Division of Pediatric Cardiology, Department of Pediatrics, University of Florida, Gainesville, Gainesville, FL
| | - John Phillips
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, VA
| | - Bibhuti Das
- Department of Pediatrics, Children's of Mississippi Heart Center, University of Mississippi Medical Center, Jackson, MS
| | - Preeti Ramachandran
- Division of Pediatric Cardiology, Department of Pediatrics, Kentucky Children's Hospital, Lexington, KY; University of Kentucky College of Medicine, Lexington, KY
| | - Eyal Sagiv
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA
| | - Aarti H Bhat
- Division of Pediatric Cardiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA
| | - Jonathan N Johnson
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic Children's Center, Rochester, MN
| | - Nathaniel W Taggart
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic Children's Center, Rochester, MN
| | - Jason Imundo
- Division of Pediatric Cardiology, Department of Pediatric, Penn State Health Children's Hospital, Hershey, PA
| | - Natasha Nakra
- Division of Pediatric Infectious Diseases, Department of Pediatrics, UC Davis Children's Hospital, Sacramento, CA
| | - Shashank Behere
- Division of Pediatric Cardiology, Department of Pediatrics, Oklahoma Children's Hospital, Oklahoma City, OK
| | - Anjlee Patel
- Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University School of Medicine and CAMC Women's and Children's Hospital, Charleston, WV
| | - Avichal Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, Houston, TX
| | - Saif Aljemmali
- Division of Pediatric Cardiology, Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - Sean Lang
- Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Sarosh P Batlivala
- Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Daniel E Forsha
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO
| | - Gregory P Conners
- Division of Pediatric Cardiology and Pediatric Infectious Diseases, Department of Pediatrics, Upstate Golisano Children's Hospital, Syracuse, NY
| | - Jana Shaw
- Division of Pediatric Cardiology and Pediatric Infectious Diseases, Department of Pediatrics, Upstate Golisano Children's Hospital, Syracuse, NY
| | - Frank C Smith
- Division of Pediatric Cardiology and Pediatric Infectious Diseases, Department of Pediatrics, Upstate Golisano Children's Hospital, Syracuse, NY
| | - Linda Pauliks
- Division of Pediatric Cardiology, Department of Pediatrics, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Joseph Vettukattil
- Division of Pediatric Cardiology, Department of Pediatrics, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Kenneth Shaffer
- Division of Pediatric Cardiology, Department of Pediatrics, Dell Children's Medical Center, Austin, TX
| | - Stefanie Cheang
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of New Orleans, New Orleans, LA
| | - Sonia Voleti
- Division of Pediatric Cardiology, Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA
| | - Rajesh Shenoy
- Division of Pediatric Cardiology, Department of Pediatrics, Jack and Lucy Clark Department of Pediatrics at the Icahn School of Medicine at Mount Sinai Children's Hospital, New York, NY
| | - Rukmini Komarlu
- Division of Pediatric Cardiology, Department of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OH
| | - Shea J Ryan
- Division of Pediatric Cardiology, Department of Pediatrics, UNC Children's Hospital, Chapel Hill, NC
| | - Christopher Snyder
- Division of Pediatric Cardiology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Neha Bansal
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY
| | - Madhu Sharma
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY
| | - Jeffrey A Robinson
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, NE
| | - Sandra R Arnold
- Division of Infectious Diseases, Department of Pediatrics, Le Bonheur Children's Hospital, Memphis, TN
| | - Christine M Salvatore
- Division of Infectious Diseases, Department of Pediatrics, Weill Cornell Medical Center, New York, NY
| | - Madan Kumar
- Division of Infectious Diseases, Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, IL
| | - Michael A Fremed
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Julie S Glickstein
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Melissa Perrotta
- Division of Pediatric Cardiology, Department of Pediatrics, Norton Children's Hospital, Louisville, KY
| | - William Orr
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, MO
| | - Tamika Rozema
- Division of Pediatric Cardiology, Department of Pediatrics, Lutheran Hospital, Fort Wayne, IN
| | - Muthayipalayam Thirumoorthi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Ascension St John Hospital, Detroit, MI
| | - Charles J Mullett
- Division of Pediatric Critical Care, Department of Pediatrics, West Virginia University School of Medicine and West Virginia University Medicine Children's Hospital, Morgantown, WV
| | - Jocelyn Y Ang
- Children's Hospital of Michigan, Division of Pediatric Infectious Diseases, Department of Pediatrics, Detroit, MI; Central Michigan University, College of Medicine, Mt Pleasant, MI
| |
Collapse
|
18
|
Webber S, Chin H, Wilkinson J, Armstrong B, Canter C, Dipchand A, Dodd D, Feingold B, Lamour J, Mahle W, Rossano J, Singh T, Zuckerman W, Morrison Y, Diop H, Bentlejewski C, Odim J, Zeevi A. No Association Between Early Donor Specific Antibody and Subsequent Allograft Function at 3 Years Post-Pediatric Heart Transplantation. First Results of a Prospective Multi-Institutional Study. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
19
|
Feingold B, Berman P, Moninger A, Huston A, Stinner B, West SC, Rose‐Felker K, Zinn MD, Miller SA, Michaels MG. Responsiveness to second and third dose of mRNA COVID-19 vaccination in adolescent and young adult heart transplant recipients. Pediatr Transplant 2022; 26:e14272. [PMID: 35340096 PMCID: PMC9115437 DOI: 10.1111/petr.14272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Third-dose mRNA COVID-19 vaccine is currently recommended in the United States for SOT recipients based in part on data showing diminished immune response, including Ab production, after a two-dose regimen. Data on vaccine response in adolescent and young adult SOT recipients are limited, including no data reported on third-dose responsiveness. METHODS Results of serologic testing in a convenience sample of 28 vaccinated adolescent and young adult HT recipients at a single institution were collected from the medical record and summarized. RESULTS At a median of 98.5 days (IQR 59-150) after second dose, 17 (61%) had an Ab response. Among 12 who had serology before and after third-dose vaccination, four of seven who were negative prior to third dose became positive at a median of 34 days (IQR 31-39.5) following third dose. No myocarditis, acute rejection, graft dysfunction, graft loss, or deaths were observed. CONCLUSIONS These findings support recommendations for the routine administration of three doses of mRNA vaccines in adolescent and young adult HT recipients and show a potential subpopulation in whom the fourth dose should be contemplated.
Collapse
Affiliation(s)
- Brian Feingold
- Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA,Clinical and Translational ScienceUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA,Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Pamela Berman
- Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Allison Moninger
- Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Allison Huston
- Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Brenda Stinner
- Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Shawn C. West
- Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA,Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Kirsten Rose‐Felker
- Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA,Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Matthew D. Zinn
- Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA,Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Susan A. Miller
- Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA,Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Marian G. Michaels
- Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA,Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of PittsburghPittsburghPennsylvaniaUSA
| |
Collapse
|
20
|
Mangiola M, Ellison M, Marrari M, Bentlejewski C, Sadowski J, Zern D, Niemann M, Feingold B, Webber S, Zeevi A, Dipchand AI, Lamour JM, Mahle WT, Rossano JW, Scheel JN, Singh TP, Zuckerman WA. Immunologic Risk Stratification of Pediatric Heart Transplant Patients by Combining Hlamatchmaker and PIRCHE-II. J Heart Lung Transplant 2022; 41:952-960. [DOI: 10.1016/j.healun.2022.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022] Open
|
21
|
Teekakirikul P, Zhu W, Xu X, Young CB, Tan T, Smith AM, Wang C, Peterson KA, Gabriel GC, Ho S, Sheng Y, Moreau de Bellaing A, Sonnenberg DA, Lin JH, Fotiou E, Tenin G, Wang MX, Wu YL, Feinstein T, Devine W, Gou H, Bais AS, Glennon BJ, Zahid M, Wong TC, Ahmad F, Rynkiewicz MJ, Lehman WJ, Keavney B, Alastalo TP, Freckmann ML, Orwig K, Murray S, Ware SM, Zhao H, Feingold B, Lo CW. Genetic resiliency associated with dominant lethal TPM1 mutation causing atrial septal defect with high heritability. Cell Rep Med 2022; 3:100501. [PMID: 35243414 PMCID: PMC8861813 DOI: 10.1016/j.xcrm.2021.100501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/24/2021] [Accepted: 12/17/2021] [Indexed: 11/22/2022]
Abstract
Analysis of large-scale human genomic data has yielded unexplained mutations known to cause severe disease in healthy individuals. Here, we report the unexpected recovery of a rare dominant lethal mutation in TPM1, a sarcomeric actin-binding protein, in eight individuals with large atrial septal defect (ASD) in a five-generation pedigree. Mice with Tpm1 mutation exhibit early embryonic lethality with disrupted myofibril assembly and no heartbeat. However, patient-induced pluripotent-stem-cell-derived cardiomyocytes show normal beating with mild myofilament defect, indicating disease suppression. A variant in TLN2, another myofilament actin-binding protein, is identified as a candidate suppressor. Mouse CRISPR knock-in (KI) of both the TLN2 and TPM1 variants rescues heart beating, with near-term fetuses exhibiting large ASD. Thus, the role of TPM1 in ASD pathogenesis unfolds with suppression of its embryonic lethality by protective TLN2 variant. These findings provide evidence that genetic resiliency can arise with genetic suppression of a deleterious mutation.
Collapse
Affiliation(s)
- Polakit Teekakirikul
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Division of Cardiology, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Cardiovascular Genomics & Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wenjuan Zhu
- Centre for Cardiovascular Genomics & Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Division of Medical Sciences, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xinxiu Xu
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Cullen B. Young
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tuantuan Tan
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Amanda M. Smith
- Department of Pediatrics and Department of Medical and Molecular Genetics, and Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chengdong Wang
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - George C. Gabriel
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sebastian Ho
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yi Sheng
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anne Moreau de Bellaing
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Daniel A. Sonnenberg
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jiuann-huey Lin
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elisavet Fotiou
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Gennadiy Tenin
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Michael X. Wang
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yijen L. Wu
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Timothy Feinstein
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - William Devine
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Abha S. Bais
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Benjamin J. Glennon
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Maliha Zahid
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Timothy C. Wong
- UPMC Heart and Vascular Institute and Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ferhaan Ahmad
- Division of Cardiovascular Medicine, Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
| | - Michael J. Rynkiewicz
- Department of Physiology & Biophysics, Boston University School of Medicine, Boston, MA, USA
| | - William J. Lehman
- Department of Physiology & Biophysics, Boston University School of Medicine, Boston, MA, USA
| | - Bernard Keavney
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | | | - Kyle Orwig
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Stephanie M. Ware
- Department of Pediatrics and Department of Medical and Molecular Genetics, and Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hui Zhao
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Branch of CAS Center for Excellence in Animal Evolution and Genetics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Brian Feingold
- Heart Institute and Division of Pediatric Cardiology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Cecilia W. Lo
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
22
|
Feingold B, Rose-Felker K, West SC, Zinn MD, Berman P, Moninger A, Huston A, Stinner B, Xu Q, Zeevi A, Miller SA. Early findings after integration of donor-derived cell-free DNA into clinical care following pediatric heart transplantation. Pediatr Transplant 2022; 26:e14124. [PMID: 34420244 DOI: 10.1111/petr.14124] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/23/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Endomyocardial biopsy (EMB) is costly and discomforting yet remains a key component of surveillance after pediatric heart transplantation (HT). Donor-derived cell-free DNA (dd-cfDNA) has been histologically validated with high negative predictive value, offering an alternative to surveillance EMB (sEMB). METHODS We implemented an alternative surveillance protocol using commercially available dd-cfDNA assays in place of sEMB after pediatric HT. Recipients ≧7 months post-HT with reassuring clinical assessment were referred for dd-cfDNA. When not elevated above the manufacturers' threshold, sEMB was deferred. Subsequent clinical status and results of follow-up EMB were analyzed. RESULTS Over 17 months, 58 recipients [34% female, median age at HT 3.1 years (IQR 0.6-10.6)] had dd-cfDNA assessed per protocol. Median age was 14.8 years (8.4-18.3) and time from HT 6.0 years (2.2-11.2). Forty-seven (81%) had non-elevated dd-cfDNA and 11 (19%) were elevated. During a median of 8.7 months (4.2-15), all are alive without allograft loss/new dysfunction. Among those with non-elevated dd-cfDNA, 24 (51%) had subsequent sEMB at 12.1 months (6.9-12.9) with 23 showing no acute rejection (AR): grade 0R/pAMR0 (n = 16); 1R(1A)/pAMR0 (n = 7). One had AR (grade 2R(3A)/pAMR0) on follow-up sEMB after decreased immunosuppression following a diagnosis of PTLD. All 11 with elevated dd-cfDNA had reflex EMB at 19 days (12-32) with AR in 4: grade 1R(1B-2)/pAMR0 (n = 3); 1R(1B)/pAMR2 (n = 1). CONCLUSIONS dd-cfDNA assessment in place of selected, per-protocol EMB decreased surveillance EMB by 81% in our pediatric HT recipient cohort with no short-term adverse outcomes. Individual center approach to surveillance EMB will influence the utility of these findings.
Collapse
Affiliation(s)
- Brian Feingold
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Kirsten Rose-Felker
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn C West
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew D Zinn
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Pamela Berman
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Allison Moninger
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Allison Huston
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Brenda Stinner
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Qingyong Xu
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Adriana Zeevi
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Susan A Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
23
|
Alsaied T, Castrillon CD, Christopher A, Da Silva J, Morell VO, Lanford L, Goldstein BH, Feingold B, Seery T, Arora G, Hoskoppal A, Johnson JA, Tadros S, Olivieri LJ, Da Silva LDF. Cardiac MRI predictors of right ventricular dysfunction after the Da Silva cone operation for Ebstein's anomaly. International Journal of Cardiology Congenital Heart Disease 2022. [DOI: 10.1016/j.ijcchd.2022.100342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
24
|
Alsaied T, Lubert AM, Goldberg DJ, Schumacher K, Rathod R, Katz DA, Opotowsky AR, Jenkins M, Smith C, Rychik J, Amdani S, Lanford L, Cetta F, Kreutzer C, Feingold B, Goldstein BH. Protein losing enteropathy after the Fontan operation. International Journal of Cardiology Congenital Heart Disease 2022. [DOI: 10.1016/j.ijcchd.2022.100338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
25
|
Yester J, Feingold B. Extended recovery of cardiac function after severe infantile cardiomyopathy presentation of Barth syndrome. JIMD Rep 2021; 63:114-122. [PMID: 35281665 PMCID: PMC8898717 DOI: 10.1002/jmd2.12264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/05/2021] [Accepted: 11/24/2021] [Indexed: 11/20/2022] Open
Abstract
Cardiomyopathy is the most common presenting feature of Barth syndrome, often presenting in infancy with severe heart failure and cardiac dysfunction. Historically, affected infants commonly died early after presentation, sometimes before a diagnosis of Barth syndrome was made. With increases in awareness of Barth syndrome and in the care of infants with severe heart failure, survival of children with Barth syndrome and severe heart failure has improved. We describe our experience caring for five unrelated boys with Barth syndrome who presented with severe cardiomyopathy and heart failure prior to age 2 who have had marked improvement with long‐term response to medical heart failure therapy.
Collapse
Affiliation(s)
- Jessie Yester
- Heart Institute UPMC Children's Hospital of Pittsburgh Pittsburgh Pennsylvania USA
| | - Brian Feingold
- Heart Institute UPMC Children's Hospital of Pittsburgh Pittsburgh Pennsylvania USA
- Department of Pediatrics University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
- Clinical and Translational Science University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
| |
Collapse
|
26
|
Gurunathan S, Sebastian J, Baker J, Abdel-Hamid HZ, West SC, Feingold B, Peche V, Reyes-Múgica M, Madan-Khetarpal S, Field J. A homozygous CAP2 pathogenic variant in a neonate presenting with rapidly progressive cardiomyopathy and nemaline rods. Am J Med Genet A 2021; 188:970-977. [PMID: 34862840 DOI: 10.1002/ajmg.a.62590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/21/2021] [Accepted: 11/02/2021] [Indexed: 11/09/2022]
Abstract
Nemaline Myopathy (NM) is a disorder of skeletal muscles caused by mutations in sarcomere proteins and characterized by accumulation of microscopic rod or thread-like structures (nemaline bodies) in skeletal muscles. Patients diagnosed with both NM and infantile cardiomyopathy are very rare. A male infant presented, within the first few hours of life, with severe dilated cardiomyopathy, biventricular dysfunction and left ventricular noncompaction. A muscle biopsy on the 8th day of life from the right sternocleidomastoid muscle identified nemaline rods. Whole exome sequencing identified a c.1288 delT (homozygous pathogenic variant) in the CAP2 gene (NM_006366), yielding a CAP2 protein (NP_006357.1) with a p.C430fs. Both parents were heterozygous for the same variant but have no history of heart or muscle disease. Analysis of patient derived fibroblasts and cardiomyocytes derived from induced pluripotent stem cells confirmed the p.C430fs mutation (pathogenic variant), which appears to cause loss of both CAP2 protein and mRNA. The CAP2 gene encodes cyclase associated protein 2, an actin monomer binding and filament depolymerizing protein and CAP2 knockout mice develop severe dilated cardiomyopathy and muscle weakness. The patient underwent a heart transplant at 1 year of age. Heart tissue explanted at that time also showed nemaline rods and additionally disintegration of the myofibrillar structure. Other extra cardiac concerns include mild hypotonia, atrophic and widened scarring. This is the first description of a patient presenting with nemaline myopathy associated with a pathogenic variant of CAP2.
Collapse
Affiliation(s)
- Sharavana Gurunathan
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica Sebastian
- Department of Pediatrics, Division of Medical Genetics and Genomic Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer Baker
- Department of Pediatrics, Division of Medical Genetics and Genomic Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hoda Z Abdel-Hamid
- Department of Pediatrics, Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shawn C West
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Brian Feingold
- Department of Pediatrics and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Vivek Peche
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Miguel Reyes-Múgica
- Department of Pathology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Suneeta Madan-Khetarpal
- Department of Pediatrics, Division of Medical Genetics and Genomic Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeffrey Field
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
27
|
Duong SQ, Zhang Y, Hall M, Hollander SA, Thurm CW, Bernstein D, Feingold B, Godown J, Almond C. Impact of institutional routine surveillance endomyocardial biopsy frequency in the first year on rejection and graft survival in pediatric heart transplantation. Pediatr Transplant 2021; 25:e14035. [PMID: 34003559 DOI: 10.1111/petr.14035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/11/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Routine surveillance biopsy (RSB) is performed to detect asymptomatic acute rejection (AR) after heart transplantation (HT). Variation in pediatric RSB across institutions is high. We examined center-based variation in RSB and its relationship to graft loss, AR, coronary artery vasculopathy (CAV), and cost of care during the first year post-HT. METHODS We linked the Pediatric Health Information System (PHIS) and Scientific Registry of Transplant Recipients (SRTR, 2002-2016), including all primary-HT aged 0-21 years. We characterized centers by RSB frequency (defined as median biopsies performed among recipients aged ≥12 months without rejection in the first year). We adjusted for potential confounders and center effects with mixed-effects regression analysis. RESULTS We analyzed 2867 patients at 29 centers. After adjusting for patient and center differences, increasing RSB frequency was associated with diagnosed AR (OR 1.15 p = 0.004), a trend toward treated AR (OR 1.09 p = 0.083), and higher hospital-based cost (US$390 315 vs. $313 248, p < 0.001) but no difference in graft survival (HR 1.00, p = 0.970) or CAV (SHR 1.04, p = 0.757) over median follow-up 3.9 years. Center RSB-frequency threshold of ≥2/year was associated with increased unadjusted rates of treated AR, but no association was found at thresholds greater than this. CONCLUSION Center RSB frequency is positively associated with increased diagnosis of AR at 1 year post-HT. Graft survival and CAV appear similar at medium-term follow-up. We speculate that higher frequency RSB centers may have increased detection of clinically less important AR, though further study of the relationship between center RSB frequency and differences in treated AR is necessary.
Collapse
Affiliation(s)
- Son Q Duong
- Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, California, USA
| | - Yulin Zhang
- Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, California, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Seth A Hollander
- Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, California, USA
| | - Cary W Thurm
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Daniel Bernstein
- Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, California, USA
| | - Brian Feingold
- Pediatrics (Cardiology) and Clinical Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Justin Godown
- Pediatrics (Cardiology), Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Christopher Almond
- Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|
28
|
Lopez SMC, Davis A, Zinn M, Feingold B, Green M, Michaels MG. Bartonella henselae infection in the pediatric solid organ transplant recipient. Pediatr Transplant 2021; 25:e13823. [PMID: 32841466 DOI: 10.1111/petr.13823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/04/2020] [Accepted: 07/20/2020] [Indexed: 12/19/2022]
Abstract
Bartonella henselae infection can cause a wide spectrum of diseases in both the immunocompetent and immunocompromised host with BA a severe form relegated to immunocompromised hosts, including solid organ transplant population. There are established criteria for diagnosis of Bartonella infection based on clinical presentation, serologic testing, imaging studies and, when indicated, tissue sampling for histopathological evaluation, particularly for BA. However, treatment recommendations for BA are inconclusive. Furthermore, there are no studies in the pediatric solid organ transplant population for antimicrobial therapy during BA secondary to Bartonella henselae infection. A case of BA following heart transplant is presented along with a literature review of clinical presentation; diagnosis and therapy for BA in the pediatric solid organ transplant population.
Collapse
Affiliation(s)
- Santiago Manuel Cayetano Lopez
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA.,Environmental Influences on Health and Disease Group, Sanford Research, Sioux Falls, SD, USA.,Division of Infectious Disease, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amy Davis
- Division of Pathology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew Zinn
- Division of Cardiology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian Feingold
- Division of Cardiology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Green
- Division of Infectious Disease, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.,Pediatrics/Surgery and Thomas E. Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marian G Michaels
- Division of Infectious Disease, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.,Pediatrics/Surgery and Thomas E. Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
29
|
Pompa A, Feingold B, Beerman LB, Arora G. B-PO02-193 ELECTROCARDIOGRAM CHANGES IN PEDIATRIC PATIENTS WITH MYOCARDITIS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
30
|
Pompa A, Zinn M, Beerman LB, Feingold B, Arora G. B-PO03-196 ARRHYTHMIA BURDEN IN PEDIATRIC PATIENTS WITH A VENTRICULAR ASSIST DEVICE. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
31
|
Li Y, Godown J, Taylor CL, Dipchand AI, Bowen VM, Feingold B. Favorable outcomes after heart transplantation in Barth syndrome. J Heart Lung Transplant 2021; 40:1191-1198. [PMID: 34330606 DOI: 10.1016/j.healun.2021.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 05/26/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Barth Syndrome (BTHS) is a rare, X-linked disease characterized by cardioskeletal myopathy and neutropenia. Comparative outcomes after heart transplantation have not been reported. METHODS We identified BTHS recipients across 3 registries (Pediatric Heart Transplant Study Registry [PHTS], Barth Syndrome Research Registry and Repository, and Scientific Registry of Transplant Recipient-Pediatric Health Information System) and matched them 1:4 to non-BTHS, male heart transplant (HT) recipients listed with dilated cardiomyopathy in PHTS. Demographics and survival data were analyzed for all recipients, whereas post-HT infection, malignancy, allograft vasculopathy, and acute rejection were only available for analysis for individuals with PHTS data. RESULTS Forty-seven BTHS individuals with 51 listings and 43 HTs (including 2 re-transplants) were identified. Age at primary HT was 1.7 years (IQR: 0.6-4.5). Mechanical circulatory support at HT was common (ventricular assist device 29%, extracorporeal membrane oxygenation 5%). Over a median follow-up of 4.5 years (IQR 2.7-9.1), survival for BTHS HT recipients was no different than non-BTHS HT recipients (HR 0.91, 95% CI 0.40-2.12, p = 0.85). Among those with PHTS data (n = 28), BTHS HT recipients showed no difference in freedom from infection (HR 0.64, 0.34-1.22; p = 0.18), malignancy (HR 0.22, 0.02-2.01, p = 0.18), and allograft vasculopathy (HR 0.58, 0.16-2.1, p = 0.41). Freedom from acute rejection (HR 0.39, 0.17-0.86, p = 0.02) was greater for BTHS HT recipients despite similar use of induction (61 vs 73%, p = 0.20), steroids at 30-days (75 vs 62%, p = 0.27), and dual/triple drug immunosuppression at 1-year (80 vs 84%, p = 0.55). CONCLUSIONS In this largest cohort yet reported, individuals with BTHS have equivalent survival with less acute rejection and no difference in infection or malignancy after HT. When indicated, HT for individuals with BTHS is appropriate.
Collapse
Affiliation(s)
- Yu Li
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Justin Godown
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Carolyn L Taylor
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Anne I Dipchand
- Division of Cardiology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Brian Feingold
- Departments of Pediatrics and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| |
Collapse
|
32
|
Mangiola M, Marrari M, Bentlejewski C, Sadowskij J, Zern D, Feingold B, Webber S, Zeevi A. HLA Eplet Mismatch Analysis of a Large Multi-Center Pediatric Heart Transplant Cohort: Not All Transplants are Immunologically Equal. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
33
|
Capasso TL, Trucco SM, Hindes M, Schwartze T, Bloch JL, Kreutzer J, Cook SC, Hinck CS, Treggiari D, Feingold B, Hinck AP, Roman BL. In Search of "Hepatic Factor": Lack of Evidence for ALK1 Ligands BMP9 and BMP10. Am J Respir Crit Care Med 2021; 203:249-251. [PMID: 32871084 DOI: 10.1164/rccm.202005-1937le] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Stephen C Cook
- University of Pittsburgh Pittsburgh, Pennsylvania.,Spectrum Health Helen DeVos Children's Hospital Grand Rapids, Michigan and
| | | | - Davide Treggiari
- University of Pittsburgh Pittsburgh, Pennsylvania.,Azienda Ospedaliera Universitaria Integrata Verona, Italy
| | | | | | - Beth L Roman
- University of Pittsburgh Pittsburgh, Pennsylvania
| |
Collapse
|
34
|
Stidham J, Feingold B, Almond CS, Burstein DS, Krack P, Price JF, Schumacher KR, Spinner JA, Rosenthal DN, Lorts A, Godown J. Establishing Baseline Metrics of Heart Failure Medication Use in Children: A Collaborative Effort from the ACTION Network. Pediatr Cardiol 2021; 42:315-323. [PMID: 33044586 DOI: 10.1007/s00246-020-02485-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
Heart failure metrics specific to the pediatric population are required to successfully implement quality improvement initiatives in children with heart failure. Medication use at the time of discharge following admission for decompensated heart failure has been identified as a potential quality metric in this population. This study aimed to report medication use at discharge in the current era for children admitted with acute decompensated heart failure. All patients < 21 years of age with an index admission (1/1/2011-12/31/2019) for acute heart failure and a coexisting diagnosis of cardiomyopathy were identified from the Pediatric Health Information System. Medication use patterns were described and compared across age groups and centers. A total of 2288 patients were identified for inclusion. An angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker (ACEi/ARB) was prescribed in 1479 (64.6%), beta blocker in 1132 (49.5%), and mineralocorticoid receptor antagonist (MRA) in 864 (37.8%) patients at discharge. The use of ACEi/ARB at discharge has decreased over time (64.6% vs. 69.6%, p = 0.001) and the use of beta blockers has increased (49.5% vs. 36.8%, p < 0.001) compared to a historical cohort (2001-2010). There is considerable variability in medication use across centers with an overall increase in beta blocker and decrease in ACEi/ARB use over time. Collaborative efforts are needed to standardize care and define quality metrics to identify best practices in the management of pediatric heart failure.
Collapse
Affiliation(s)
- Joseph Stidham
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian Feingold
- Division of Pediatric Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christopher S Almond
- Department of Pediatrics (Pediatric Cardiology), Stanford University, Palo Alto, CA, USA
| | - Danielle S Burstein
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Paige Krack
- Division of Pediatric Cardiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Jack F Price
- Division of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA
| | - Kurt R Schumacher
- Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Joseph A Spinner
- Division of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA
| | - David N Rosenthal
- Department of Pediatrics (Pediatric Cardiology), Stanford University, Palo Alto, CA, USA
| | - Angela Lorts
- Division of Pediatric Cardiology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Justin Godown
- Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
35
|
Zimpfer D, Alexander PMA, Davies RR, Dipchand AI, Feingold B, Joong A, Lord K, Kirk R, Scales A, Shih R, Miera O. Pediatric donor management to optimize donor heart utilization. Pediatr Transplant 2020; 24:e13679. [PMID: 32198844 DOI: 10.1111/petr.13679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 12/25/2022]
Abstract
Optimal management of pediatric cardiac donors is essential in order to maximize donor heart utilization and minimize the rate of discarded organs. This review was performed after a systematic literature review and gives a detailed overview on current practices and guidelines. The review focuses on optimal monitoring of pediatric donors, donor workup, hormonal replacement, and obliterating the adverse effects of brain death. The current evidence on catecholamine support and thyroid hormone replacement is also discussed. Recognizing and addressing this shall help in a standardized approach toward donor management and optimal utilization of pediatric heart donors organs.
Collapse
Affiliation(s)
- Daniel Zimpfer
- Department of Cardiac Surgery, Pediatric Heart Center Vienna, Vienna, Austria
| | - Peta M A Alexander
- Department of Pediatric Cardiology, Boston Children's Hospital Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Brian Feingold
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anna Joong
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | | | - Richard Kirk
- Division of Pediatric Cardiology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Angie Scales
- Paediatric and Neonatal Donation and Transplantation, Organ Donation and Transplantation, NHS Blood and Transplant, London, UK
| | - Renata Shih
- Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum, Berlin, Germany
| |
Collapse
|
36
|
Bearl D, Feingold B, Lorts A, Rosenthal D, Zafar F, Conway J, Elias B, Tunuguntla H, Thurm C, Amdani S, Jaworski N, Godown J. Discharge and Readmissions after VAD Placement in US Pediatric Hospitals: A Collaboration in ACTION. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
37
|
Townsend M, Karamlou T, Boyle G, Feingold B, Daly K, Deshpande S, Auerbach S, Worley S, Liu W, Saarel E, Amdani S. Brighter Future for Children with Congenital Heart Disease Requiring Heart Transplantation? A UNOS Registry Analysis over the Last Three Decades. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
38
|
McGreevy M, Wearden P, Feingold B, Nowalk A. Fever and inflammatory markers do not predict infection in pediatric ventricular assist device recipient. Progress in Pediatric Cardiology 2020. [DOI: 10.1016/j.ppedcard.2020.101197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
39
|
Lambert AN, Weiner JG, Hall M, Thurm C, Dodd DA, Bearl DW, Soslow JH, Feingold B, Smith AH, Godown J. Rehospitalization Following Pediatric Heart Transplantation: Incidence, Indications, and Risk Factors. Pediatr Cardiol 2020; 41:584-590. [PMID: 32103290 PMCID: PMC7176534 DOI: 10.1007/s00246-020-02326-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/17/2020] [Indexed: 12/19/2022]
Abstract
Rehospitalization following pediatric heart transplantation is common. However, existing data remain somewhat limited. Using a novel linkage between administrative and clinical databases, pediatric heart transplant (HT) recipients from 29 centers who survived to discharge were retrospectively reviewed to determine the frequency, timing of, and indication for all-cause rehospitalizations in the year following transplant discharge. Of 2870 pediatric HT recipients, 1835 (63.9%) were rehospitalized in the first year post-discharge (5429 total readmissions). Rehospitalization rates varied significantly across centers (46% to 100%) and were inversely correlated to center transplant volume (r2 0.25, p < 0.01). The median number of rehospitalizations per patient was 2 (IQR 1-4) and the median time to first rehospitalization was 29 days (IQR 9-99 days). Independent risk factors for rehospitalization included younger age at HT (HR 0.99, 95% CI 0.97-0.99), congenital heart disease (HR 1.2, 95% CI 1.1-1.4), listing status 1B at transplant (HR 1.3, 95% CI 1.1-1.5), and post-transplant complications including rejection prior to discharge (HR 1.5 95% CI 1.3-1.8) and chylothorax (HR 1.3, 95% CI 1.0-1.6). Cardiac diagnoses were the most common indication for rehospitalization (n = 1600, 29.5%), followed by infection (n = 1367, 25.2%). These findings may serve to guide the development of interventions aimed at reducing post-HT hospitalizations.
Collapse
Affiliation(s)
- A. Nicole Lambert
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital At Vanderbilt, Nashville, TN, USA,Department of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital, Vanderbilt University, 2200 Children’s Way, Suite 5230 DOT, Nashville, TN 37232-9119, USA
| | - Jeffrey G. Weiner
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital At Vanderbilt, Nashville, TN, USA
| | - Matt Hall
- Children’s Hospital Association, Lenexa, KS, USA
| | - Cary Thurm
- Children’s Hospital Association, Lenexa, KS, USA
| | - Debra A. Dodd
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital At Vanderbilt, Nashville, TN, USA
| | - David W. Bearl
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital At Vanderbilt, Nashville, TN, USA
| | - Jonathan H. Soslow
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital At Vanderbilt, Nashville, TN, USA
| | - Brian Feingold
- Pediatrics and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrew H. Smith
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital At Vanderbilt, Nashville, TN, USA,Pediatric Critical Care, Monroe Carell Jr. Children’s Hospital At Vanderbilt, Nashville, TN, USA
| | - Justin Godown
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital At Vanderbilt, Nashville, TN, USA
| |
Collapse
|
40
|
Weiner JG, Lambert AN, Thurm C, Hall M, Soslow JH, Reimschisel TE, Bearl DW, Dodd DA, Feingold B, Godown J. Heart Transplantation in Children with Mitochondrial Disease. J Pediatr 2020; 217:46-51.e4. [PMID: 31711761 PMCID: PMC7012680 DOI: 10.1016/j.jpeds.2019.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/19/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To compare the outcomes and comorbidities of children with mitochondrial disease undergoing heart transplantation with children without mitochondrial disease. STUDY DESIGN Using a unique linkage between the Pediatric Health Information System and Scientific Registry of Transplant Recipients databases, pediatric heart transplantation recipients from 2002 to 2016 with a diagnosis of cardiomyopathy were included. Post heart transplantation survival and morbidities were compared between patients with and without mitochondrial disease. RESULTS A total of 1330 patients were included, including 47 (3.5%) with mitochondrial disease. Survival after heart transplantation was similar between patients with and without mitochondrial disease over a median follow-up of 4 years. Patients with mitochondrial disease were more likely to have a stroke after heart transplantation (11% vs 3%; P = .009), require a longer duration of mechanical ventilation after heart transplantation (3 days vs 1 day; P < .001), and have a longer intensive care unit stay after heart transplantation (10 vs 6 days; P = .007). The absence of a hospital readmission within the first post-transplant year was similar among patients with and without mitochondrial disease (61.7% vs 51%; P = .14). However, patients with mitochondrial disease who were readmitted demonstrated a longer length of stay compared with those without (median, 14 days vs 8 days; P = .03). CONCLUSIONS Patients with mitochondrial disease can successfully undergo heart transplantation with survival comparable with patients without mitochondrial disease. Patients with mitochondrial disease have greater risk for post-heart transplantation morbidities including stroke, prolonged mechanical ventilation, and longer intensive care unit and readmission length of stay. These results suggest that the presence of mitochondrial disease should not be an absolute contraindication to heart transplantation in the appropriate clinical setting.
Collapse
Affiliation(s)
- Jeffrey G. Weiner
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| | - Andrea N. Lambert
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| | - Cary Thurm
- Children’s Hospital Association, Lenexa, KS
| | - Matt Hall
- Children’s Hospital Association, Lenexa, KS
| | - Jonathan H. Soslow
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| | | | - David W. Bearl
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| | - Debra A. Dodd
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| | - Brian Feingold
- Pediatrics and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Justin Godown
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| |
Collapse
|
41
|
Kirk R, Dipchand AI, Davies RR, Miera O, Chapman G, Conway J, Denfield S, Gossett JG, Johnson J, McCulloch M, Schweiger M, Zimpfer D, Ablonczy L, Adachi I, Albert D, Alexander P, Amdani S, Amodeo A, Azeka E, Ballweg J, Beasley G, Böhmer J, Butler A, Camino M, Castro J, Chen S, Chrisant M, Christen U, Danziger-Isakov L, Das B, Everitt M, Feingold B, Fenton M, Garcia-Guereta L, Godown J, Gupta D, Irving C, Joong A, Kemna M, Khulbey SK, Kindel S, Knecht K, Lal AK, Lin K, Lord K, Möller T, Nandi D, Niesse O, Peng DM, Pérez-Blanco A, Punnoose A, Reinhardt Z, Rosenthal D, Scales A, Scheel J, Shih R, Smith J, Smits J, Thul J, Weintraub R, Zangwill S, Zuckerman WA. ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation. J Heart Lung Transplant 2020; 39:331-341. [PMID: 32088108 DOI: 10.1016/j.healun.2020.01.1345] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 12/14/2022] Open
Abstract
The number of potential pediatric heart transplant recipients continues to exceed the number of donors, and consequently the waitlist mortality remains significant. Despite this, around 40% of all donated organs are not used and are discarded. This document (62 authors from 53 institutions in 17 countries) evaluates factors responsible for discarding donor hearts and makes recommendations regarding donor heart acceptance. The aim of this statement is to ensure that no usable donor heart is discarded, waitlist mortality is reduced, and post-transplant survival is not adversely impacted.
Collapse
Affiliation(s)
- Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas.
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Jennifer Conway
- Department of Pediatrics, Division of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Denfield
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jeffrey G Gossett
- University of California Benioff Children's Hospitals, San Francisco, California
| | - Jonathan Johnson
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Michael McCulloch
- University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Martin Schweiger
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Vienna and Pediatric Heart Center Vienna, Vienna, Austria
| | - László Ablonczy
- Pediatric Cardiac Center, Hungarian Institute of Cardiology, Budapest, Hungary
| | - Iki Adachi
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Dimpna Albert
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Peta Alexander
- Department of Cardiology, Boston Children's Hospital Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | | | - Estela Azeka
- Heart Institute (InCor) University of São Paulo, São Paulo, Brazil
| | - Jean Ballweg
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital and Medical Center University of Nebraska Medical Center, Omaha, Nebraska
| | - Gary Beasley
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Jens Böhmer
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alison Butler
- Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Javier Castro
- Fundacion Cardiovascular de Colombia, Santander, Bucaramanga City, Colombia
| | | | - Maryanne Chrisant
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | - Urs Christen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lara Danziger-Isakov
- Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center & University of Cincinnati, Cincinnati, Ohio
| | - Bibhuti Das
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | | | - Brian Feingold
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew Fenton
- Great Ormond Street Hospital for Children Foundation Trust, London, United Kingdom
| | | | - Justin Godown
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dipankar Gupta
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Claire Irving
- Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Anna Joong
- Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | | | | | - Steven Kindel
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Kimberly Lin
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen Lord
- New England Organ Bank, Boston, Massachusetts
| | - Thomas Möller
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Deipanjan Nandi
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Oliver Niesse
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | | | | | - Ann Punnoose
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Angie Scales
- Pediatric and Neonatal Donation and Transplantation, Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | - Janet Scheel
- Washington University School of Medicine, St. Louis, Missouri
| | - Renata Shih
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | | | | | - Josef Thul
- Children's Heart Center, University of Giessen, Giessen, Germany
| | | | | | - Warren A Zuckerman
- Columbia University Medical Center, Morgan Stanley Children's Hospital of New York, New York, New York
| |
Collapse
|
42
|
Reddy S, Marino BS, Baker-Smith CM, Beaton A, Krawczeski CD, Miyake CY, Cnota JF, Glatz AC, Feingold B, Romano JC, Cabrera AG, John AS, Cohen MS. Cardiovascular Disease in the Young Council's Science and Clinical Education Lifelong Learning Committee: Year in Review. J Am Heart Assoc 2019; 7:e010617. [PMID: 30571390 PMCID: PMC6404218 DOI: 10.1161/jaha.118.010617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sushma Reddy
- 1 Department of Pediatrics Stanford University School of Medicine Palo Alto CA
| | - Bradley S Marino
- 2 Ann & Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine Chicago IL
| | | | - Andrea Beaton
- 4 Children's National Health System George Washington University Washington DC
| | | | - Christina Y Miyake
- 6 Department of Pediatrics and Molecular Physiology & Biophysics Texas Children's Hospital Baylor College of Medicine Houston TX
| | - James F Cnota
- 7 Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Andrew C Glatz
- 8 Department of Pediatrics The Children's Hospital of Philadelphia Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Brian Feingold
- 9 Pediatrics and Clinical and Translational Science University of Pittsburgh School of Medicine Pittsburgh PA
| | - Jennifer C Romano
- 10 Department of Cardiac Surgery C. S. Mott Children's Hospital University of Michigan Ann Arbor MI
| | - Antonio G Cabrera
- 11 Department of Pediatrics Texas Children's Hospital Baylor College of Medicine Houston TX
| | - Anitha S John
- 4 Children's National Health System George Washington University Washington DC
| | - Meryl S Cohen
- 8 Department of Pediatrics The Children's Hospital of Philadelphia Perelman School of Medicine University of Pennsylvania Philadelphia PA
| |
Collapse
|
43
|
Magnetta DA, Godown J, West S, Zinn M, Rose-Felker K, Miller S, Feingold B. Impact of the 2016 revision of US Pediatric Heart Allocation Policy on waitlist characteristics and outcomes. Am J Transplant 2019; 19:3276-3283. [PMID: 31544351 DOI: 10.1111/ajt.15567] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/19/2019] [Accepted: 08/04/2019] [Indexed: 01/25/2023]
Abstract
US Pediatric Heart Allocation Policy was recently revised, deprioritizing candidates with cardiomyopathy while maintaining status 1A eligibility for congenital heart disease (CHD) candidates on "high-dose" inotropes. We compared waitlist characteristics and mortality around this change. Status 1A listings decreased (70% to 56%, P < .001) and CHD representation increased among status 1A listings (48% vs 64%, P < .001). Waitlist mortality overall (subdistribution hazard ratio [SHR] 0.96, P = .63) and among status 1A candidates (SHR 1.16, P = .14) were unchanged. CHD waitlist mortality trended better (SHR 0.82, P = .06) but was unchanged for CHD candidates listed status 1A (SHR 0.92, P = .47). Status 1A listing exceptions increased 2- to 3-fold among hypertrophic and restrictive cardiomyopathy candidates and 13.5-fold among dilated cardiomyopathy (DCM) candidates. Hypertrophic (SHR 6.25, P = .004) and restrictive (SHR 3.87, P = .03) cardiomyopathy candidates without status 1A exception had increased waitlist mortality, but those with DCM did not (SHR 1.26, P = .32). Ventricular assist device (VAD) use increased only among DCM candidates ≥1 years old (26% vs 38%, P < .001). Current allocation policy has increased CHD status 1A representation but has not improved their waitlist mortality. Excessive DCM status 1A listing exceptions and continued status 1A prioritization of children on stable VADs potentially diminish the intended benefits of policy revision.
Collapse
Affiliation(s)
- Defne A Magnetta
- Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Justin Godown
- Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shawn West
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew Zinn
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kirsten Rose-Felker
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Susan Miller
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Brian Feingold
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| |
Collapse
|
44
|
Everitt MD, Wilkinson JD, Shi L, Towbin JA, Colan SD, Kantor PF, Canter CE, Webber SA, Hsu DT, Pahl E, Addonizio LJ, Dodd DA, Jefferies JL, Rossano JW, Feingold B, Ware SM, Lee TM, Godown J, Simpson KE, Sleeper LA, Czachor JD, Razoky H, Hill A, Westphal J, Molina KM, Lipshultz SE. Cardiac Biomarkers in Pediatric Cardiomyopathy: Study Design and Recruitment Results from the Pediatric Cardiomyopathy Registry. Prog Pediatr Cardiol 2019; 53:1-10. [PMID: 31745384 DOI: 10.1016/j.ppedcard.2019.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Cardiomyopathies are a rare cause of pediatric heart disease, but they are one of the leading causes of heart failure admissions, sudden death, and need for heart transplant in childhood. Reports from the Pediatric Cardiomyopathy Registry (PCMR) have shown that almost 40% of children presenting with symptomatic cardiomyopathy either die or undergo heart transplant within 2 years of presentation. Little is known regarding circulating biomarkers as predictors of outcome in pediatric cardiomyopathy. Study Design The Cardiac Biomarkers in Pediatric Cardiomyopathy (PCM Biomarkers) study is a multi-center prospective study conducted by the PCMR investigators to identify serum biomarkers for predicting outcome in children with dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM). Patients less than 21 years of age with either DCM or HCM were eligible. Those with DCM were enrolled into cohorts based on time from cardiomyopathy diagnosis: categorized as new onset or chronic. Clinical endpoints included sudden death and progressive heart failure. Results There were 288 children diagnosed at a mean age of 7.2±6.3 years who enrolled in the PCM Biomarkers Study at a median time from diagnosis to enrollment of 1.9 years. There were 80 children enrolled in the new onset DCM cohort, defined as diagnosis at or 12 months prior to enrollment. The median age at diagnosis for the new onset DCM was 1.7 years and median time from diagnosis to enrollment was 0.1 years. There were 141 children enrolled with either chronic DCM or chronic HCM, defined as children ≥2 years from diagnosis to enrollment. Among children with chronic cardiomyopathy, median age at diagnosis was 3.4 years and median time from diagnosis to enrollment was 4.8 years. Conclusion The PCM Biomarkers study is evaluating the predictive value of serum biomarkers to aid in the prognosis and management of children with DCM and HCM. The results will provide valuable information where data are lacking in children. Clinical Trial Registration NCT01873976 https://clinicaltrials.gov/ct2/show/NCT01873976?term=PCM+Biomarker&rank=1.
Collapse
Affiliation(s)
| | - James D Wilkinson
- Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, MI
| | - Ling Shi
- New England Research Institutes, Watertown, MA
| | - Jeffrey A Towbin
- University of Tennessee Health Science Center, St. Jude Children's Research Hospital and Le Bonheur Children's Hospital, Memphis, TN
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Paul F Kantor
- Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Alberta, SK
| | - Charles E Canter
- St. Louis Children's Hospital, Washington University, St. Louis, MO
| | - Steven A Webber
- Department of Pediatrics, Vanderbilt University School of Medicine and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - Daphne T Hsu
- Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Elfriede Pahl
- Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Linda J Addonizio
- Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, NY
| | - Debra A Dodd
- Department of Pediatrics, Vanderbilt University School of Medicine and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - John L Jefferies
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Brian Feingold
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - Stephanie M Ware
- Departments of Pediatrics and Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Teresa M Lee
- Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, NY
| | - Justin Godown
- Department of Pediatrics, Vanderbilt University School of Medicine and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | | | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Jason D Czachor
- Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, MI
| | - Hiedy Razoky
- Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, MI
| | - Ashley Hill
- Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, MI
| | - Joslyn Westphal
- Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, MI
| | | | - Steven E Lipshultz
- Department of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, MI
| | | |
Collapse
|
45
|
Mahle WT, Mason KL, Dipchand AI, Richmond M, Feingold B, Canter CE, Hsu DT, Singh TP, Shaddy RE, Armstrong BD, Zeevi A, Iklé DN, Diop H, Odim J, Webber SA. Hospital readmission following pediatric heart transplantation. Pediatr Transplant 2019; 23:e13561. [PMID: 31483086 PMCID: PMC8455069 DOI: 10.1111/petr.13561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 11/29/2022]
Abstract
The frequency, indications, and outcomes for readmission following pediatric heart transplantation are poorly characterized. A better understanding of this phenomenon will help guide strategies to address the causes of readmission. Data from the Clinical Trials in Organ Transplantation for Children (CTOTC-04) multi-institutional collaborative study were utilized to determine incidence of, and risk factors for, hospital readmission within 30 days and 1 year from initial hospital discharge. Among 240 transplants at 8 centers, 227 subjects were discharged and had follow-up. 129 subjects (56.8%) were readmitted within one year; 71 had two or more readmissions. The 30-day and 1-year freedom from readmission were 70.5% (CI: 64.1%, 76.0%) and 42.2% (CI: 35.7%, 48.7%), respectively. The most common indications for readmissions were infection followed by rejection and fever without confirmed infection, accounting for 25.0%, 10.6%, and 6.2% of readmissions, respectively. Factors independently associated with increased risk of first readmission within 1 year (Cox proportional hazard model) were as follows: transplant in infancy (P = .05), longer transplant hospitalization (P = .04), lower UNOS urgency status (2/IB vs 1A) at transplant (P = .04), and Hispanic ethnicity (P = .05). Hospital readmission occurs frequently in the first year following discharge after heart transplantation with highest risk in the first 30 days. Infection is more common than rejection as cause for readmission, with death during readmission being rare. A number of patient factors are associated with higher risk of readmission. A fuller understanding of these risk factors may help tailor strategies to reduce unnecessary hospital readmission.
Collapse
Affiliation(s)
- William T. Mahle
- Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | - Anne I. Dipchand
- Labatt Family Heart Center, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Marc Richmond
- Department of Pediatrics, New York-Presbyterian Morgan Stanley Children’s Hospital, New York, New York
| | - Brian Feingold
- Department of Pediatrics and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA (Feingold)
| | - Charles E. Canter
- Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Daphne T. Hsu
- Division of Pediatric Cardiology, Children’s Hospital at Montefiore, Bronx, New York
| | - Tajinder P. Singh
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
| | - Robert E. Shaddy
- Division of Pediatric Cardiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Adriana Zeevi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David N. Iklé
- Rho Federal Systems Division, Chapel Hill, North Carolina
| | - Helena Diop
- Transplantation Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jonah Odim
- Transplantation Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Steven A. Webber
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|
46
|
Lamour JM, Mason KL, Hsu DT, Feingold B, Blume ED, Canter CE, Dipchand AI, Shaddy RE, Mahle WT, Zuckerman WA, Bentlejewski C, Armstrong BD, Morrison Y, Diop H, Iklé DN, Odim J, Zeevi A, Webber SA. Early outcomes for low-risk pediatric heart transplant recipients and steroid avoidance: A multicenter cohort study (Clinical Trials in Organ Transplantation in Children - CTOTC-04). J Heart Lung Transplant 2019; 38:972-981. [PMID: 31324444 PMCID: PMC8359669 DOI: 10.1016/j.healun.2019.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/12/2019] [Accepted: 06/16/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Immunosuppression strategies have changed over time in pediatric heart transplantation. Thus, comorbidity profiles may have evolved. Clinical Trials in Organ Transplantation in Children-04 is a multicenter, prospective, cohort study assessing the impact of pre-transplant sensitization on outcomes after pediatric heart transplantation. This sub-study reports 1-year outcomes among recipients without pre-transplant donor-specific antibodies (DSAs). METHODS We recruited consecutive candidates (<21 years) at 8 centers. Sensitization status was determined by a core laboratory. Immunosuppression was standardized as follows: Thymoglobulin induction with tacrolimus and/or mycophenolate mofetil maintenance. Steroids were not used beyond 1 week. Rejection surveillance was by serial biopsy. RESULTS There were 240 transplants. Subjects for this sub-study (n = 186) were non-sensitized (n = 108) or had no DSAs (n = 78). Median age was 6 years, 48.4% were male, and 38.2% had congenital heart disease. Patient survival was 94.5% (95% confidence interval, 90.1-97.0%). Freedom from any type of rejection was 67.5%. Risk factors for rejection were older age at transplant and presence of non-DSAs pre-transplant. Freedom from infection requiring hospitalization/intravenous anti-microbials was 75.4%. Freedom from rehospitalization was 40.3%. New-onset diabetes mellitus and post-transplant lymphoproliferative disorder (PTLD) occurred in 1.6% and 1.1% of subjects, respectively. There was no decline in renal function over the first year. Corticosteroids were used in 14.5% at 1 year. CONCLUSIONS Pediatric heart transplantation recipients without DSAs at transplant and managed with a steroid avoidance regimen have excellent short-term survival and a low risk of first-year diabetes mellitus and PTLD. Rehospitalization remains common. These contemporary observations allow for improved caregiver and/or patient counseling and provide the necessary outcomes data to help design future randomized controlled trials.
Collapse
Affiliation(s)
- Jacqueline M Lamour
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, New York, New York.
| | | | - Daphne T Hsu
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, New York, New York
| | - Brian Feingold
- Departments of Pediatrics and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth D Blume
- Department of Pediatric Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Charles E Canter
- Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Anne I Dipchand
- Department of Paediatrics, Labatt Family Heart Center, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robert E Shaddy
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - William T Mahle
- Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Warren A Zuckerman
- Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York
| | - Carol Bentlejewski
- Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York
| | | | | | - Helena Diop
- Rho Federal Systems Division, Chapel Hill, North Carolina
| | - David N Iklé
- Rho Federal Systems Division, Chapel Hill, North Carolina
| | - Jonah Odim
- Transplantation Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Adriana Zeevi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Steven A Webber
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|
47
|
West C, Maul T, Feingold B, Morell VO. Right Ventricular Dominance Is Associated With Inferior Outcomes After the Extracardiac Fontan. World J Pediatr Congenit Heart Surg 2019; 10:416-423. [DOI: 10.1177/2150135119843887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Investigations of ventricular dominance and outcomes after the Fontan procedure have shown conflicting results. This may be due to the inclusion of multiple modifications of the Fontan or the omission of recently identified complications of the procedure. We examined the association between right ventricular dominance (RVD) and morbidity/mortality in a contemporary cohort following the extracardiac (EC) Fontan. Methods: We studied all pediatric patients at our center who underwent a predominantly fenestrated EC Fontan from 2004 to 2016. Outcomes assessed were freedom from (1) Fontan failure (death, takedown, listing for transplantation) and (2) complication (arrhythmia requiring medication, postoperative pacemaker, or implantable cardioverter defibrillator requirement, stroke, thrombosis in the Fontan circuit, protein losing enteropathy, plastic bronchitis, New York Heart Association class >2). We defined the perioperative period as occurring before hospital discharge or within 30 days of the Fontan. Results: A total of 137 patients (median age: 34 months, 62% male, 60% RVD) underwent the EC Fontan. Median duration of follow-up was 5.8 years (interquartile range: 2.4-9.0). Freedom from any event was 82.5% (RVD = 77%, LVD = 91%, χ2(1) = 5.03, P = .025) and RVD was associated with reduced event-free survival (hazard ratio: 2.94, P = .02). No confounders were identified. In the perioperative period, RVD was associated with reduced complication-free survival ( P = .004). After this period, RVD was associated with reduced failure-free survival ( P = .003). Conclusions: In this contemporary, single-center cohort of EC Fontan patients, RVD was associated with inferior outcomes.
Collapse
Affiliation(s)
- Caroline West
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Timothy Maul
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pediatric Cardiovascular Surgery, Nemours Children's Hospital, Orlando, Florida, USA
| | - Brian Feingold
- Departments of Pediatrics and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Victor O. Morell
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
48
|
Godown J, Bearl DW, Thurm C, Hall M, Feingold B, Soslow JH, Mettler BA, Smith AH, Profita EL, Singh TP, Dodd DA. Extracorporeal membrane oxygenation use in the first 24 hours following pediatric heart transplantation: Incidence, risk factors, and outcomes. Pediatr Transplant 2019; 23:e13414. [PMID: 30973190 PMCID: PMC6548572 DOI: 10.1111/petr.13414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/11/2019] [Indexed: 01/18/2023]
Abstract
Primary graft dysfunction following HTx is associated with significant morbidity and mortality. This study aimed to assess the incidence of, risk factors for, and outcomes of children requiring ECMO within 24 hours of HTx. This study utilized a linked PHIS/SRTR database of pediatric HTx recipients (2002-2016). Post-HTx ECMO was identified using inpatient billing data. Logistic regression assessed risk factors for post-HTx ECMO. Kaplan-Meier analyses assessed in-hospital mortality and post-discharge survival. A total of 2820 patients were included with 224 (7.9%) requiring ECMO. Independent risk factors for post-HTx ECMO include age <1 year (aOR: 2.2, 95% CI: 1.3-3.7, P = 0.006) or 1-5 years (aOR: 2.1, 95% CI: 1.3-3.4, P = 0.002), and ECMO support at HTx (aOR: 27.4, 95% CI: 15.2-49.6, P < 0.001). Survival to discharge decreased with increasing duration of post-HTx ECMO support; 89% for 1-3 days, 79.1% for 4-6 days, 63.2% for 7-9 days, and 18.8% for ≥10 days. There was no difference in long-term survival for patients requiring post-HTx ECMO who survived to hospital discharge (P = 0.434). There are identifiable risk factors associated with the need for ECMO in the post-HTx period. Length of time on ECMO post-HTx is strongly associated with the risk of in-hospital mortality. Patients who require ECMO early post-HTx and survive to discharge have comparable outcomes to patients who did not require ECMO.
Collapse
Affiliation(s)
- Justin Godown
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| | - David W. Bearl
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| | - Cary Thurm
- Children’s Hospital Association, Lenexa, KS
| | - Matt Hall
- Children’s Hospital Association, Lenexa, KS
| | - Brian Feingold
- Pediatrics and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jonathan H. Soslow
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| | - Bret A. Mettler
- Pediatric Cardiothoracic Surgery, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| | - Andrew H. Smith
- Pediatric Critical Care, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| | - Elizabeth L. Profita
- Pediatric Cardiology, Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA
| | | | - Debra A. Dodd
- Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital, Nashville, TN
| |
Collapse
|
49
|
West SC, Friedland‐Little JM, Schowengerdt KO, Naftel DC, Pruitt Freeze E, Smith KS, Urschel S, Michaels MG, Kirklin JK, Feingold B. Characteristics, risks, and outcomes of post‐transplant lymphoproliferative disease >3 years after pediatric heart transplant: A multicenter analysis. Clin Transplant 2019; 33:e13521. [DOI: 10.1111/ctr.13521] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/31/2019] [Accepted: 02/11/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Shawn C. West
- Children’s Hospital of Pittsburgh of UPMC Pittsburgh Pennsylvania
| | | | | | | | | | - Kelli S. Smith
- Children’s Hospital of Pittsburgh of UPMC Pittsburgh Pennsylvania
| | | | | | | | - Brian Feingold
- Children’s Hospital of Pittsburgh of UPMC Pittsburgh Pennsylvania
| |
Collapse
|
50
|
Godown J, Bearl D, Thurm C, Hall M, Feingold B, Soslow J, Mettler B, Smith A, Profita E, Singh T, Dodd D. Extracorporeal Membrane Oxygenation Use within 24 Hours of Heart Transplantation in Children: Incidence, Risk Factors, and Outcomes. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|