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Arthur L, Knecht K, Ferry J, Grigsby D, Spencer H, Zakaria D. Serial assessment of right ventricular function can detect acute cellular rejection in children with heart transplantation. Pediatr Transplant 2022; 26:e14231. [PMID: 35043516 PMCID: PMC9086092 DOI: 10.1111/petr.14231] [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: 08/29/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Echocardiographic markers of ACR are essential for early recognition and management. The literature's primary focus has been on the LV with little attention given to the RV. This study aimed to investigate echocardiographic right ventricular indices in the detection of ACR and to evaluate their utility as prognostic indicators of graft integrity. METHODS We performed a retrospective chart review of children with biopsy-proven ACR following orthotopic heart transplant and an echocardiogram within 24 h of biopsy. Selected echocardiographic markers were compared at baseline, during ACR, and at follow-up. RESULTS Forty-eight patients (56% male) had a total of 84 ACR episodes. Decrease in RV FAC (mean - 17.1%, p < .001) and TAPSE (mean - 8.9%, p < .001) with increase in left ventricular posterior wall thickness in diastole and systole (LVPWTd) (mean + 9.0%, p = .012) and LVPWTs (mean + 8.3%, p = .016) were found during ACR. Interestingly, these parameters improved following the episode of rejection. Additionally, these markers were compared after recovery between children with and without graft failure. RV dysfunction (FAC and TAPSE) and changes in LV posterior wall thickness were not found to have prognostic significance for graft integrity in children with heart transplantation. CONCLUSIONS RV echocardiographic functional parameters should be considered as valuable adjuncts in rejection surveillance. Further, the presence of RV dysfunction does not have prognostic significance for graft integrity but is reversible as ongoing damage was not detectable by such.
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Affiliation(s)
- Lindsay Arthur
- Arkansas Children’s Hospital, Little Rock, Arkansas, USA
| | - Kenneth Knecht
- Arkansas Children’s Hospital, Little Rock, Arkansas, USA,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jennifer Ferry
- Arkansas Children’s Hospital, Little Rock, Arkansas, USA,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Debby Grigsby
- Arkansas Children’s Hospital, Little Rock, Arkansas, USA
| | - Horace Spencer
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Dala Zakaria
- Arkansas Children’s Hospital, Little Rock, Arkansas, USA,Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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2
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Godown J, Fountain D, Bansal N, Ameduri R, Anderson S, Beasley G, Burstein D, Knecht K, Molina K, Pye S, Richmond M, Spinner JA, Watanabe K, West S, Reinhardt Z, Scheel J, Urschel S, Villa C, Hollander SA. Heart Transplantation in Children With Down Syndrome. J Am Heart Assoc 2022; 11:e024883. [PMID: 35574952 PMCID: PMC9238550 DOI: 10.1161/jaha.121.024883] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Children with Down syndrome (DS) have a high risk of cardiac disease that may prompt consideration for heart transplantation (HTx). However, transplantation in patients with DS is rarely reported. This project aimed to collect and describe waitlist and post– HTx outcomes in children with DS. Methods and Results This is a retrospective case series of children with DS listed for HTx. Pediatric HTx centers were identified by their participation in 2 international registries with centers reporting HTx in a patient with DS providing detailed demographic, medical, surgical, and posttransplant outcome data for analysis. A total of 26 patients with DS were listed for HTx from 1992 to 2020 (median age, 8.5 years; 46% male). High‐risk or failed repair of congenital heart disease was the most common indication for transplant (N=18, 69%). A total of 23 (88%) patients survived to transplant. All transplanted patients survived to hospital discharge with a median posttransplant length of stay of 22 days. At a median posttransplant follow‐up of 2.8 years, 20 (87%) patients were alive, 2 (9%) developed posttransplant lymphoproliferative disorder, and 8 (35%) were hospitalized for infection within the first year. Waitlist and posttransplant outcomes were similar in patients with and without DS (P=non‐significant for all). Conclusions Waitlist and post‐HTx outcomes in children with DS selected for transplant listing are comparable to pediatric HTx recipients overall. Given acceptable outcomes, the presence of DS alone should not be considered an absolute contraindication to HTx.
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Affiliation(s)
- Justin Godown
- Division of Pediatric Cardiology Monroe Carell Jr. Children’s Hospital at VanderbiltNashville TN
| | - Darlene Fountain
- Division of Pediatric Cardiology Monroe Carell Jr. Children’s Hospital at VanderbiltNashville TN
| | - Neha Bansal
- Division of Pediatric Cardiology Children’s Hospital at MontefioreBronx NY
| | - Rebecca Ameduri
- Division of Pediatric Cardiology University of Minnesota Minneapolis MN
| | - Susan Anderson
- Division of Pediatric Cardiology University of Minnesota Minneapolis MN
| | - Gary Beasley
- Division of Pediatric Cardiology LeBonheur Children's HospitalMemphis TN
| | - Danielle Burstein
- Division of Pediatric Cardiology Children's Hospital of PhiladelphiaPhiladelphia PA
| | - Kenneth Knecht
- Division of Pediatric Cardiology Arkansas Children's HospitalLittle Rock AR
| | - Kimberly Molina
- Division of Pediatric Cardiology Primary Children's HospitalSalt Lake City UT
| | - Sherry Pye
- Division of Pediatric Cardiology Arkansas Children's HospitalLittle Rock AR
| | - Marc Richmond
- Division of Pediatric Cardiology Columbia University Medical Center New York NY
| | - Joseph A. Spinner
- Division of Pediatric Cardiology Texas Children's HospitalHouston TX
| | - Kae Watanabe
- Division of Pediatric Cardiology Lurie Children's HospitalChicago IL
| | - Shawn West
- Division of Pediatric Cardiology Children's Hospital of PittsburghPittsburgh PA
| | - Zdenka Reinhardt
- Division of Pediatric Cardiology Freeman Hospital The Newcastle upon TyneUnited Kingdom
| | - Janet Scheel
- Division of Pediatric Cardiology Washington University St. Louis MO
| | - Simon Urschel
- Division of Pediatric Cardiology University of Alberta Edmonton AB Canada
| | - Chet Villa
- Division of Pediatric Cardiology Cincinnati Children's Hospital Medical Center Cincinnati OH
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Dykes JC, Rosenthal DN, Bernstein D, McElhinney DB, Chrisant MRK, Daly KP, Ameduri RK, Knecht K, Richmond ME, Lin KY, Urschel S, Simmonds J, Simpson KE, Albers EL, Khan A, Schumacher K, Almond CS, Chen S. Clinical and hemodynamic characteristics of the pediatric failing Fontan. J Heart Lung Transplant 2021; 40:1529-1539. [PMID: 34412962 DOI: 10.1016/j.healun.2021.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/21/2020] [Revised: 07/02/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022] Open
Abstract
AIM To describe the clinical and hemodynamic characteristics of Fontan failure in children listed for heart transplant. METHODS In a nested study of the Pediatric Heart Transplant Society, 16 centers contributed information on Fontan patients listed for heart transplant between 2005and 2013. Patients were classified into four mutually exclusive phenotypes: Fontan with abnormal lymphatics (FAL), Fontan with reduced systolic function (FRF), Fontan with preserved systolic function (FPF), and Fontan with "normal" hearts (FNH). Primary outcome was waitlist and post-transplant mortality. RESULTS 177 children listed for transplant were followed over a median 13 (IQR 4-31) months, 84 (47%) were FAL, 57 (32%) FRF, 22 (12%) FNH, and 14 (8%) FPF. Hemodynamic characteristics differed between the 4 groups: Fontan pressure (FP) was most elevated with FPF (median 22, IQR 18-23, mmHg) and lowest with FAL (16, 14-20, mmHg); cardiac index (CI) was lowest with FRF (2.8, 2.3-3.4, L/min/m2). In the entire cohort, 66% had FP >15 mmHg, 21% had FP >20 mmHg, and 10% had CI <2.2 L/min/m2. FRF had the highest risk of waitlist mortality (21%) and FNH had the highest risk of post-transplant mortality (36%). CONCLUSIONS Elevated Fontan pressure is more common than low cardiac output in pediatric failing Fontan patients listed for transplant. Subtle hemodynamic differences exist between the various phenotypes of pediatric Fontan failure. Waitlist and post-transplant mortality risks differ by phenotype.
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Affiliation(s)
- John C Dykes
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University.
| | - David N Rosenthal
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University
| | - Daniel Bernstein
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University
| | - Doff B McElhinney
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University; Department of Cardiovascular Surgery, Stanford University
| | | | - Kevin P Daly
- Boston Children's Hospital, Harvard Medical School
| | | | - Kenneth Knecht
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences
| | - Marc E Richmond
- Morgan Stanley Children's Hospital, Columbia University College of Physicians & Surgeons
| | - Kimberly Y Lin
- Children's Hospital of Philadelphia, University of Pennsylvania
| | | | | | | | - Erin L Albers
- Seattle Children's Hospital, University of Washington
| | - Asma Khan
- Ann and Robert H Lurie Children's Hospital, Northwestern University Feinberg School of Medicine
| | | | - Christopher S Almond
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University
| | - Sharon Chen
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University
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McCulloch MA, Lal AK, Knecht K, Butts RJ, Villa CR, Johnson JN, Conway J, Bock MJ, Schumacher KR, Law SP, Friedland-Little JM, Deshpande SR, West SC, Lytrivi ID, Gambetta KE, Wittlieb-Weber CA. Implantable Cardioverter Defibrillator Use in Males with Duchenne Muscular Dystrophy and Severe Left Ventricular Dysfunction. Pediatr Cardiol 2020; 41:925-931. [PMID: 32157397 DOI: 10.1007/s00246-020-02336-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/28/2020] [Indexed: 01/16/2023]
Abstract
Duchenne muscular dystrophy (DMD) is characterized by myocardial fibrosis and left ventricular (LV) dysfunction. Implantable cardioverter defibrillator (ICD) use has not been characterized in this population but is considered for symptomatic patients with severe LV dysfunction (SLVD) receiving guideline-directed medical therapy (GDMT). We evaluated ICD utilization and efficacy in patients with DMD. Retrospective cohort study of DMD patients from 17 centers across North America between January 2, 2005 and December 31, 2015. ICD use and its effect on survival were evaluated in patients with SLVD defined as ejection fraction (EF) < 35% and/ or shortening fraction (SF) < 16% on final echocardiogram. SLVD was present in 57/436 (13.1%) patients, of which 12 (21.1%) died during the study period. Of these 12, (mean EF 20.9 ± 6.2% and SF 13.7 ± 7.2%), 8 received GDMT, 5 received steroids, and none received an ICD. ICDs were placed in 9/57 (15.8%) patients with SLVD (mean EF 31.2 ± 8.5% and SF 10.3 ± 4.9%) at a mean age of 20.4 ± 6.3 years; 8/9 received GDMT, 7 received steroids, and all were alive at study end; mean ICD duration was 36.1 ± 26.2 months. Nine ICDs were implanted at six different institutions, associated with two appropriate shocks for ventricular tachycardia in two patients, no inappropriate shocks, and one lead fracture. ICD use may be associated with improved survival and minimal complications in DMD cardiomyopathy with SLVD. However, inconsistent GDMT utilization may be a significant confounder. Future studies should define optimal indications for ICD implantation in patients with DMD cardiomyopathy.
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Affiliation(s)
- Michael A McCulloch
- Division of Pediatric Cardiology, University of Virginia Children's Hospital, PO Box 800386, Charlottesville, VA, 22903, USA.
| | - Ashwin K Lal
- Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Kenneth Knecht
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ryan J Butts
- Children's Medical Center of Dallas, UT Southwestern Medical Center, Dallas, TX, USA
| | - Chet R Villa
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jennifer Conway
- Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Matthew J Bock
- Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Kurt R Schumacher
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Sabrina P Law
- Morgan Stanley Children's Hospital of New York Presbyterian, New York, NY, USA
| | | | | | - Shawn C West
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | | | - Katheryn E Gambetta
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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5
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McCulloch MA, Zuckerman WA, Möller T, Knecht K, Lin KY, Beasley GS, Peng DM, Albert DC, Miera O, Dipchand AI, Kirk R, Davies RR. Effects of donor cause of death, ischemia time, inotrope exposure, troponin values, cardiopulmonary resuscitation, electrocardiographic and echocardiographic data on recipient outcomes: A review of the literature. Pediatr Transplant 2020; 24:e13676. [PMID: 32198808 DOI: 10.1111/petr.13676] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/01/2019] [Revised: 01/12/2020] [Accepted: 01/21/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Heart transplantation has become standard of care for pediatric patients with either end-stage heart failure or inoperable congenital heart defects. Despite increasing surgical complexity and overall volume, however, annual transplant rates remain largely unchanged. Data demonstrating pediatric donor heart refusal rates of 50% suggest optimizing donor utilization is critical. This review evaluated the impact of donor characteristics surrounding the time of death on pediatric heart transplant recipient outcomes. METHODS An extensive literature review was performed to identify articles focused on donor characteristics surrounding the time of death and their impact on pediatric heart transplant recipient outcomes. RESULTS Potential pediatric heart transplant recipient institutions commonly receive data from seven different donor death-related categories with which to determine organ acceptance: cause of death, need for CPR, serum troponin, inotrope exposure, projected donor ischemia time, electrocardiographic, and echocardiographic results. Although DITs up to 8 hours have been reported with comparable recipient outcomes, most data support minimizing this period to <4 hours. CVA as a cause of death may be associated with decreased recipient survival but is rare in the pediatric population. Otherwise, however, in the setting of an acceptable donor heart with a normal echocardiogram, none of the other data categories surrounding donor death negatively impact pediatric heart transplant recipient survival. CONCLUSIONS Echocardiographic evaluation is the most important donor clinical information following declaration of brain death provided to potential recipient institutions. Considering its relative importance, every effort should be made to allow direct image visualization.
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Affiliation(s)
| | - Warren A Zuckerman
- Columbia University Medical Center, Morgan Stanley Children's Hospital of New York, New York, NY, USA
| | - Thomas Möller
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Kimberly Y Lin
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Dimpna C Albert
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum, Berlin, Germany
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Richard Kirk
- Division of Pediatric Cardiology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
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6
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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.
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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
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Greenway SC, Butts R, Naftel DC, Pruitt E, Kirklin JK, Larsen I, Urschel S, Knecht K, Law Y. Statin therapy is not associated with improved outcomes after heart transplantation in children and adolescents. J Heart Lung Transplant 2016; 35:457-65. [DOI: 10.1016/j.healun.2015.10.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 09/25/2015] [Accepted: 10/31/2015] [Indexed: 01/16/2023] Open
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8
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Butts R, Boyle G, Deshpande S, Gambetta K, Knecht K, Prada Ruiz C, Richmond M, West S, Lal A. Pediatric Myocarditis in a Contemporary Multi-Center Cohort. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1186] [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: 10/22/2022] Open
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9
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Auerbach SR, Kukreja M, Gilbert D, Bastardi H, Feingold B, Knecht K, Kaufman BD, Brown RN, Miyamoto SD. Maintenance steroid use at 30 days post-transplant and outcomes of pediatric heart transplantation: A propensity matched analysis of the Pediatric Heart Transplant Study database. J Heart Lung Transplant 2015; 34:1066-72. [DOI: 10.1016/j.healun.2015.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 02/19/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022] Open
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Affiliation(s)
- Vidya Pai
- 1University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Morrow W, Frazier E, Gossett J, Imamura M, Garcia X, Bryant J, Knecht K, Jaquiss R. 253: Black Race Is Not an Independent Risk Factor for Mortality in Pediatric Patients Listed for Heart Transplant: A Single Center Experience. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.265] [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: 10/19/2022] Open
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Knecht K, Bohrer M, Schnierstein J, Schäfer R, Bürger R. Urotheliales Karzinom des Harnleiters mit bemerkenswerter Morphologie. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1062614] [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: 10/21/2022]
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Bürger R, Knecht K, Vietsch HV, Schnierstein J. Komplikationen der retroperitonealen Lymphadenektomie bei nicht-seminomatösen Hodentumoren unter Berücksichtigung des N-Stadiums. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1062652] [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: 10/21/2022]
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16
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Bürger R, Knecht K, Schnierstein J. Diagnostik okkulter Hodentumoren. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1062763] [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: 10/21/2022]
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Laukens D, Peeters H, Cruyssen BV, Boonefaes T, Elewaut D, De Keyser F, Mielants H, Cuvelier C, Veys EM, Knecht K, Van Hummelen P, Remaut E, Steidler L, De Vos M, Rottiers P. Altered gut transcriptome in spondyloarthropathy. Ann Rheum Dis 2006; 65:1293-300. [PMID: 16476712 PMCID: PMC1798320 DOI: 10.1136/ard.2005.047738] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Intestinal inflammation is a common feature of spondyloarthropathy (SpA) and Crohn's disease. Inflammation is manifested clinically in Crohn's disease and subclinically in SpA. However, a fraction of patients with SpA develops overt Crohn's disease. AIMS To investigate whether subclinical gut lesions in patients with SpA are associated with transcriptome changes comparable to those seen in Crohn's disease and to examine global gene expression in non-inflamed colon biopsy specimens and screen patients for differentially expressed genes. METHODS Macroarray analysis was used as an initial genomewide screen for selecting a comprehensive set of genes relevant to Crohn's disease and SpA. This led to the identification of 2625 expressed sequence tags that are differentially expressed in the colon of patients with Crohn's disease or SpA. These clones, with appropriate controls (6779 in total), were used to construct a glass-based microarray, which was then used to analyse colon biopsy specimens from 15 patients with SpA, 11 patients with Crohn's disease and 10 controls. RESULTS 95 genes were identified as differentially expressed in patients with SpA having a history of subclinical chronic gut inflammation and also in patients with Crohn's disease. Principal component analysis of this filtered set of genes successfully distinguished colon biopsy specimens from the three groups studied. Patients with SpA having subclinical chronic gut inflammation cluster together and are more related to those with Crohn's disease. CONCLUSION The transcriptome in the intestine of patients with SpA differs from that of controls. Moreover, these gene changes are comparable to those seen in patients with Crohn's disease, confirming initial clinical observations. On the basis of these findings, new (genetic) markers for detection of early Crohn's disease in patients with SpA can be considered.
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Affiliation(s)
- D Laukens
- Department for Molecular Biomedical Research, Flanders Interuniversity Institute for Biotechnology, Ghent, Belgium.
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Chen F, Knecht K, Leu C, Rutledge SJ, Scafonas A, Gambone C, Vogel R, Zhang H, Kasparcova V, Bai C, Harada S, Schmidt A, Reszka A, Freedman L. Partial agonist/antagonist properties of androstenedione and 4-androsten-3beta,17beta-diol. J Steroid Biochem Mol Biol 2004; 91:247-57. [PMID: 15336702 DOI: 10.1016/j.jsbmb.2004.04.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2004] [Accepted: 04/16/2004] [Indexed: 10/26/2022]
Abstract
Androgens play important endocrine roles in development and physiology. Here, we characterize activities of two "Andro" prohormones, androstenedione (A-dione) and 4-androsten-3beta,17beta-diol (A-diol) in MDA-MB-453 (MDA) and LNCaP cells. A-dione and A-diol, like cyproterone acetate, were partial agonists of transfected mouse mammary tumor virus (MMTV) and endogenous prostate-specific antigen (PSA) promoters. Different from bicalutamide but similar to CPA, both are inducers of LNCaP cell proliferation with only mild suppression of 5alpha-dihydrotestosterone (DHT)-enhanced cell growth. Like bicalutamide and cyproterone acetate, A-dione and A-diol significantly antagonized DHT/R1881-induced PSA expression by up to 30% in LNCaP cells. Meanwhile, in MDA cells, EC(50)s for the MMTV promoter were between 10 and 100nM. Co-factor studies showed GRIP1 as most active for endogenous androgen receptor (AR), increasing MMTV transcription by up to five-fold, without substantially altering EC(50)s of DHT, A-dione or A-diol. Consistent with their transcriptional activities, A-dione and A-diol bound full-length endogenous AR from MDA or LNCaP cells with affinities of 30-70nM, although binding to expressed ligand-binding domain (LBD) was >20-fold weaker. In contrast, DHT, R1881, and bicalutamide bound similarly to LBD or aporeceptor. Together, these data suggest that A-dione and A-diol are ligands for AR with partial agonist/antagonist activities in cell-based transcription assays. Binding affinities for both are most accurately assessed by AR aporeceptor complex. In addition to being testosterone precursors in vivo, either may impart its own transcriptional regulation of AR.
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Affiliation(s)
- F Chen
- Department of Molecular Endocrinology, Merck Research Laboratory, WP26A-1000, Sumneytown Pike, West Point, PA 19486, USA
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Knecht K, Wiesmüller KH, Gnau V, Jung G, Meyermann R, Todd KG, Hamprecht B. AMP deaminase in rat brain: localization in neurons and ependymal cells. J Neurosci Res 2001; 66:941-50. [PMID: 11746422 DOI: 10.1002/jnr.10059] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purine nucleotide cycle enzyme AMP deaminase (AMPD) catalyzes the irreversible hydrolytic deamination of AMP. The physiological function of the purine nucleotide cycle in the brain is unknown. In situ hybridization and immunocytochemical studies were performed to identify the regional and cellular expression of AMPD in rat brain with the goal of elucidating the neural function of the purine nucleotide cycle. AMPD messenger RNA was detected in ventricular ependymal cells and cells of the choroid plexus and in neurons of distinct brain areas. Although only low antibody titers were obtained by immunization with the purified sheep brain AMPD, immunization of mice with synthetic lipopeptide vaccines containing oligopeptides derived from a known partial complementary DNA sequence of the enzyme yielded an antiserum suitable for immunocytochemistry. Immunostaining of cells in culture showed that neurons but not astroglial cells express appreciable amounts of the enzyme. Results of immunocytochemical staining performed on rat brain slices were in accord with the localization of AMPD messenger RNA, thus confirming the expression of AMPD in neurons of the brain stem, hippocampus, cerebellar nuclei and mesencephalic nuclei, as well as in ventricular ependymal cells and their cilia.
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Affiliation(s)
- K Knecht
- Physiologisch-chemisches Institut, der Universität Tübingen, Hoppe-Seyler-Street, 4, D-72076 Tübingen, Germany
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Mishriki YY, Knecht K. The case of the curious ripples. Felinization of the esophagus. Postgrad Med 1999; 106:255-6. [PMID: 10576015 DOI: 10.3810/pgm.1999.11.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Y Y Mishriki
- Pennsylvania State University College of Medicine, Hershey, USA
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Knecht K, Michalak A, Rose C, Rothstein JD, Butterworth RF. Decreased glutamate transporter (GLT-1) expression in frontal cortex of rats with acute liver failure. Neurosci Lett 1997; 229:201-3. [PMID: 9237493 DOI: 10.1016/s0304-3940(97)00444-8] [Citation(s) in RCA: 143] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
It has been suggested that reduced astrocytic uptake of neuronally released glutamate contributes to the pathogenesis of hepatic encephalopathy in acute liver failure. In order to further address this issue, the recently cloned and sequenced astrocytic glutamate transporter GLT-1 was studied in brain preparations from rats with ischemic liver failure induced by portacaval anastomosis followed 24 h later by hepatic artery ligation and from appropriate sham-operated controls. GLT-1 expression was studied using reverse transcriptase-polymerase chain reaction (RT-PCR). Expression of GLT-1 transcript was significantly decreased in frontal cortex at coma stages of acute liver failure. Western blotting using a polyclonal antibody to GLT-1 revealed a concomitant decrease in expression of transporter protein in the brains of rats with acute liver failure. Reduced capacity of astrocytes to reuptake neuronally released glutamate, resulting from a GLT-1 transporter deficit and the consequently compromised neuron-astrocytic trafficking of glutamate could contribute to the pathogenesis of hepatic encephalopathy and brain edema, two major complications of acute liver failure.
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Affiliation(s)
- K Knecht
- Neuroscience Research Unit, Hôpital Saint-Luc (University of Montreal), Quebec, Canada
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Affiliation(s)
- A Michalak
- Neuroscience Research Unit, Hôpital Saint-Luc (University of Montreal), Quebec, Canada
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Zinder M, Juste F, Kaczmarczyk J, Knecht K, Ribeiro L. [The coming together of 2 planets]. Rev Med Suisse Romande 1995; 115:65-70. [PMID: 7846447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- M Zinder
- Service universitaire de psychogériatrie, Hôpital psychogériatrique de Prilly
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Knecht K, Kopankiewitz F. An innovative approach to gathering functional requirements. Proc Annu Symp Comput Appl Med Care 1994:1021-2. [PMID: 7949859 PMCID: PMC2247883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Knecht K. Women in Science '93: A "Female Style"? Science 1993; 261:409. [PMID: 17770001 DOI: 10.1126/science.261.5120.409-c] [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: 11/03/2022]
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Lent V, Knecht K. [New methods of internal urine channeling]. Dtsch Med Wochenschr 1981; 106:1583-4. [PMID: 7307996 DOI: 10.1055/s-2008-1070560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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