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Borrelli G, Nittolo I, Bochicchio C, Trainelli L, Confalone V, Satta T, Cancani F, Kirk R, Amodeo A, Di Nardo M. What the pediatric nurse needs to know about the Impella cardiac assist device. Perfusion 2024; 39:95S-106S. [PMID: 38651583 PMCID: PMC11041080 DOI: 10.1177/02676591241237761] [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] [Indexed: 04/25/2024]
Abstract
Background: Cardiogenic shock in children still carries a high mortality risk despite advances in medical therapy. The use of temporary mechanical circulatory supports is an accepted strategy to bridge patients with acute heart failure to recovery, decision, transplantation or destination therapy. These devices are however limited in children and extracorporeal membrane oxygenation (ECMO) remains the most commonly used device. Veno-arterial ECMO may provide adequate oxygen delivery, but it does not significantly unload the left ventricle, and this may prevent recovery. To improve the likelihood of left ventricular recovery and minimize the invasiveness of mechanical support, the Impella axial pump has been increasingly used in children with acute heart failure in the last decade. Purpose: There are still limited data describing the Impella indications, management and outcomes in children, therefore, we aimed to provide a comprehensive narrative review useful for the pediatric nurses to be adequately trained and acquire specific competencies in Impella management.
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Affiliation(s)
- Giorgia Borrelli
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ilaria Nittolo
- Academic Department of Pediatrics (DPUO), Immune and Infectious Diseases Division, Research Unit of Primary Immunodeficiencies, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Chiara Bochicchio
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Laura Trainelli
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Valerio Confalone
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Tiziana Satta
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Federica Cancani
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Richard Kirk
- Heart Failure, Transplantation and Cardio-Respiratory Mechanical Assistance Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonio Amodeo
- Heart Failure, Transplantation and Cardio-Respiratory Mechanical Assistance Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Bano M, Hussain T, Samels MR, Butts RJ, Kirk R, Levine BD. Cardiovascular remodelling in response to exercise training in patients after the Fontan procedure: a pilot study. Cardiol Young 2024; 34:604-613. [PMID: 37664999 DOI: 10.1017/s1047951123003153] [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] [Indexed: 09/05/2023]
Abstract
BACKGROUND The cardiovascular adaptations associated with structured exercise training in Fontan patients remain unknown. We hypothesised that short-term training causes cardiac remodelling and parallel improvement in maximal exercise capacity (VO2 max) in these patients. METHODS AND RESULTS Five patients, median age 19.5 (17.6-21.3) years, with a history of Fontan operation meeting inclusion/exclusion criteria, participated in a 3-month training programme designed to improve endurance. Magnetic resonance images for assessment of cardiac function, fibrosis, cardiac output, and liver elastography to assess stiffness were obtained at baseline and after training. Maximal exercise capacity (VO2 max) and cardiac output Qc (effective pulmonary blood flow) at rest and during exercise were measured (C2H2 rebreathing) at the same interval. VO2 max increased from median (IQR) 27.2 (26-28.7) to 29.6 (28.5-32.2) ml/min/kg (p = 0.04). There was an improvement in cardiac output (Qc) during maximal exercise testing from median (IQR) 10.3 (10.1-12.3) to 12.3 (10.9-14.9) l/min, but this change was variable (p = 0.14). Improvement in VO2 max correlated with an increase in ventricular mass (r = 0.95, p = 0.01), and improvement in Quality-of-life inventory (PedsQL) Cardiac scale scores for patient-reported symptoms (r = 0.90, p = 0.03) and cognitive problems (r = 0.89, p = 0.04). The correlation between VO2 max and Qc showed a positive trend but was not significant (r = 0.8, p = 0.08). No adverse cardiac or liver adaptations were noted. CONCLUSION Short-term training improved exercise capacity in this Fontan pilot without any adverse cardiac or liver adaptations. These results warrant further study in a larger population and over a longer duration of time. TRIAL REGISTRATION NUMBER NCT03263312, Unique Protocol ID: STU 122016-037; Registration Date: 18 January, 2017.
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Affiliation(s)
- Maria Bano
- Department of Pediatrics, Division of Cardiology, UT Southwestern, Dallas, TX, USA
| | - Tarique Hussain
- Department of Pediatrics, Division of Cardiology, UT Southwestern, Dallas, TX, USA
| | - Mitchel R Samels
- Institute of Exercise and Environmental Medicine, Dallas, TX, USA
| | - Ryan J Butts
- Department of Pediatrics, Division of Cardiology, UT Southwestern, Dallas, TX, USA
| | - Richard Kirk
- Department of Pediatric Cardiology and Cardiac Surgery, Ospedale Pediatrico Bambino Gesu, Rome, Itlay
| | - Benjamin D Levine
- Institute of Exercise and Environmental Medicine, Dallas, TX, USA
- Department of Internal Medicine, Division of Cardiology, UT Southwestern, Dallas, TX, USA
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Cooper JA, Murphy S, Kirk R, O’Reilly D, Donnelly M. Record linkage studies of primary care utilisation after release from prison: A scoping review protocol. PLoS One 2023; 18:e0289218. [PMID: 37624760 PMCID: PMC10456167 DOI: 10.1371/journal.pone.0289218] [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: 03/29/2023] [Accepted: 07/13/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION There is a need to improve the implementation and provision of continuity of care between prison and community in order that people who have been in prison and have a history of low engagement with services or who are vulnerable receive appropriate and timely health care and treatment. Observational studies using record linkage have investigated continuity of care after release from prison but this type of research evidence has not been synthesised. OBJECTIVE This paper presents a protocol designed to review record linkage studies about primary care utilisation after prison release in order to inform future research and guide service organisation and delivery towards people who are at-risk following release from prison. METHODS This scoping review will follow the framework by Arksey and O'Malley (5 stages) and guidance developed by the Joanna Briggs Institute (JBI). MEDLINE, EMBASE and Web of Science Core Collection will be searched (January 2012-March 2023) using terms relating to (i) 'former prisoners' and (ii) 'primary care'. The review will focus on observational studies that have investigated this topic using linked data from two or more sources. Two authors will independently screen titles and abstracts (step 1) and full publications (step 2) using predefined eligibility criteria. Data will be extracted from included publications using a piloted data charting form. This review will map the findings in this research area by methodology, key findings and gaps in research, and current evidence will be synthesised narratively given the expected considerable heterogeneity across studies. DISCUSSION This review is part of a work programme on health in prison (Administrative Data Research Centre, Northern Ireland). This work may be used to inform future research, policy and practice. Findings will be shared with stakeholders, published in a peer-reviewed journal and presented at relevant conferences. Ethical approval is not required.
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Affiliation(s)
- Janine A. Cooper
- Centre for Public Health, Queen’s University Belfast, Royal Hospitals Site, Belfast, United Kingdom
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen’s University Belfast, Royal Hospitals Site, Belfast, United Kingdom
| | - Siobhan Murphy
- Centre for Public Health, Queen’s University Belfast, Royal Hospitals Site, Belfast, United Kingdom
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen’s University Belfast, Royal Hospitals Site, Belfast, United Kingdom
| | - Richard Kirk
- South Eastern Health and Social Care Trust, Ulster Hospital, Dundonald, United Kingdom
| | - Dermot O’Reilly
- Centre for Public Health, Queen’s University Belfast, Royal Hospitals Site, Belfast, United Kingdom
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen’s University Belfast, Royal Hospitals Site, Belfast, United Kingdom
| | - Michael Donnelly
- Centre for Public Health, Queen’s University Belfast, Royal Hospitals Site, Belfast, United Kingdom
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen’s University Belfast, Royal Hospitals Site, Belfast, United Kingdom
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Cooper JA, Onyeka I, Cardwell C, Paterson E, Kirk R, O'Reilly D, Donnelly M. Record linkage studies of drug-related deaths among adults who were released from prison to the community: a scoping review. BMC Public Health 2023; 23:826. [PMID: 37147595 PMCID: PMC10161544 DOI: 10.1186/s12889-023-15673-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/13/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND There are public health concerns about an increased risk of mortality after release from prison. The objectives of this scoping review were to investigate, map and summarise evidence from record linkage studies about drug-related deaths among former adult prisoners. METHODS MEDLINE, EMBASE, PsychINFO and Web of Science were searched for studies (January 2011- September 2021) using keywords/index headings. Two authors independently screened all titles and abstracts using inclusion and exclusion criteria and subsequently screened full publications. Discrepancies were discussed with a third author. One author extracted data from all included publications using a data charting form. A second author independently extracted data from approximately one-third of the publications. Data were entered into Microsoft Excel sheets and cleaned for analysis. Standardised mortality ratios (SMRs) were pooled (where possible) using a random-effects DerSimonian-Laird model in STATA. RESULTS A total of 3680 publications were screened by title and abstract, and 109 publications were fully screened; 45 publications were included. The pooled drug-related SMR was 27.07 (95%CI 13.32- 55.02; I 2 = 93.99%) for the first two weeks (4 studies), 10.17 (95%CI 3.74-27.66; I 2 = 83.83%) for the first 3-4 weeks (3 studies) and 15.58 (95%CI 7.05-34.40; I 2 = 97.99%) for the first 1 year after release (3 studies) and 6.99 (95%CI 4.13-11.83; I 2 = 99.14%) for any time after release (5 studies). However, the estimates varied markedly between studies. There was considerable heterogeneity in terms of study design, study size, location, methodology and findings. Only four studies reported the use of a quality assessment checklist/technique. CONCLUSIONS This scoping review found an increased risk of drug-related death after release from prison, particularly during the first two weeks after release, though drug-related mortality risk remained elevated for the first year among former prisoners. Evidence synthesis was limited as only a small number of studies were suitable for pooled analyses for SMRs due to inconsistencies in study design and methodology.
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Affiliation(s)
- Janine A Cooper
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK.
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK.
| | - Ifeoma Onyeka
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
- Present address: Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, UK
| | - Christopher Cardwell
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
| | - Euan Paterson
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
| | - Richard Kirk
- Healthcare in Prison, South Eastern Health and Social Care Trust, Dundonald, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Grosvenor Road, Belfast, UK
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Adorisio R, Ingrasciotta G, Ionata A, Cantarutti N, Bellettini E, Mencarelli E, Pilati M, Kirk R, Amodeo A. Endomyocardial Biopsy in Myocarditis Identifies Factors That Predict Outcome in Children. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1625] [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
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Adorisio R, Cantarutti N, Bellettini E, Ingrasciotta G, Mencarelli E, Grandinetti M, Kirk R, Amodeo A. Combined Strategy to Induce Myocardial Recovery in Children with Advanced Heart Failure: Single Center Retrospective Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1520] [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
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Ferrigno F, Franceschini A, Kirk R, Amodeo A. Jacobsen Syndrome with Hypoplastic Left Heart Syndrome: Outcome after Cardiac Transplantation. J Cardiovasc Dev Dis 2022; 10:jcdd10010008. [PMID: 36661903 PMCID: PMC9864704 DOI: 10.3390/jcdd10010008] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Jacobsen syndrome (JS) is a rare syndrome caused by a deletion of chromosome 11q. We report a patient with JS and hypoplastic left heart syndrome (HLHS) who required cardiac transplantation. She had many of the recognized morphological features in addition to immunological (lymphopenia) and hematological (thrombocytopenia) issues. The patient underwent a Norwood procedure with a modified Blalock-Taussig shunt (MBTS) and subsequently a Glenn procedure at six months of age. She developed desaturation, with severe tricuspid regurgitation and right ventricular dysfunction, and underwent heart transplantation at 7 months of age. After the transplant, she was hospitalized several times for severe infections. The diagnosis of Jacobsen syndrome came 2 months after transplant. Now, 5 years post-transplant, she is in relatively good health-her heart is functioning normally, her hospitalization rate is getting lower, and her immunological profile is stable.
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Affiliation(s)
- Federica Ferrigno
- The School of Pediatrics, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Correspondence: ; Tel.: +39-3286426575
| | - Alessio Franceschini
- Department of Cardiosurgery, Cardiology, Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCSS, 00165 Rome, Italy
| | - Richard Kirk
- Mechanical Circulatory Support Unit, Department of Cardiosurgery, Cardiology, Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCSS, 00165 Rome, Italy
| | - Antonio Amodeo
- Mechanical Circulatory Support Unit, Department of Cardiosurgery, Cardiology, Heart and Lung Transplant, Bambino Gesù Children’s Hospital, IRCSS, 00165 Rome, Italy
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Adorisio R, Pontrelli G, Cantarutti N, Bellettini E, Caiazza M, Mencarelli E, Limongelli G, Poli D, Drago F, Kirk R, Amodeo A. Heart rate reduction as a marker to optimize carvedilol treatment and enhance myocardial recovery in pediatric dilated cardiomyopathy. Front Physiol 2022; 13:1001752. [PMID: 36531178 PMCID: PMC9757159 DOI: 10.3389/fphys.2022.1001752] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/10/2022] [Indexed: 01/03/2024] Open
Abstract
Introduction: An elevated heart rate is associated with an increased risk of death or cardiac transplant in children with dilated cardiomyopathy (DCM). Whether heart rate is a clinical marker to address therapy, is poorly investigated in children. Aim: To investigate the relationship between heart rate reduction (HRR) and left ventricular ejection fraction (LVEF) in DCM, treated with carvedilol. Methods: This is a multi center retrospective analysis conducted on all children with DCM (aged <18 years) between 2013 and 2020, with LVEF <40% and treated with carvedilol. Carvedilol was up titrated to the maximal tolerated dose or to 1 mg/kg/day. Echocardiographic data on left ventricular function and dimension were collected. The relationship between HRR and LVEF, left ventricular end-diastolic (LVEDd) and end-systolic diameter (LVESd) was assessed before and after HRR with carvedilol, using regression analysis. Results: 100 patients were enrolled (M: 51%; age 7 ± 8 years). The mean LVEF was 30.2 ± 10% before treatment and 43.7 ± 9.6% after treatment, at the maximum therapeutic dose (p < 0.0001). There was a positive relationship between HRR and increase in LVEF (R 2 = 0.06, p = 0.014). A HRR of >20% correlated with an improvement in LVEF >13%. At 3 years follow up, HRR demonstrated a significant reduction of LVESd (R2 = 0.1, p = 0.003) LVEDd (R2 = 0.07, p = 0.008) and LVEF recovery up to 15% (p < 0.0001). No deaths or heart transplant occurred during follow-up. Conclusion: This study demonstrates that HRR is safe and improvement in LVEF is related to the degree of HRR. The magnitude of LVEF improvement was enhanced by a major reduction in HR. It provides evidence that HRR could be used as a clinical marker to treat HF in children.
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Affiliation(s)
- Rachele Adorisio
- Advanced Cardiovascular Therapies Unit- Heart Failure, Transplant and Mechanical Assist Device, Department of Cardiology, Cardiac Surgery and Heart Lung Transplant, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Giuseppe Pontrelli
- Quality Team of Clinical Study- Director, Department of Pediatrics, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Nicoletta Cantarutti
- Cardiology and Cardiac Arrhythmias Unit, Department of Cardiology, Cardiac Surgery and Heart Lung Transplant, Bambino Gesù Pediatric Hospital and Research Institute Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Elisa Bellettini
- Advanced Cardiovascular Therapies Unit- Heart Failure, Transplant and Mechanical Assist Device, Department of Cardiology, Cardiac Surgery and Heart Lung Transplant, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Martina Caiazza
- Genetic Disease and Rare Cardiovascular Disorder, Luigi Vanvitelli University, AORN Colli, Monaldi Hospital, Naples, Italy
| | - Erica Mencarelli
- Heart Failure, Transplant and Mechanical Assist Device, Department of Cardiology, Cardiac Surgery and Heart Lung Transplant, Bambino Gesù Pediatric Hospital and Research Institute Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Giuseppe Limongelli
- Genetic Disease and Rare Cardiovascular Disorder, Luigi Vanvitelli University, AORN Colli, Monaldi Hospital, Naples, Italy
| | - Daniela Poli
- Centro Cardiologico Pediatrico del Mediterraneo—Bambino Gesù Hospital—Taormina—Italia, Villagonia, Italy
| | - Fabrizio Drago
- Cardiology and Cardiac Arrhythmias Unit, Department of Cardiology, Cardiac Surgery and Heart Lung Transplant, Bambino Gesù Pediatric Hospital and Research Institute Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Richard Kirk
- Heart Failure, Transplant and Mechanical Assist Device, Department of Cardiology, Cardiac Surgery and Heart Lung Transplant, Bambino Gesù Pediatric Hospital and Research Institute Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Antonio Amodeo
- Heart Failure, Transplant and Mechanical Assist Device, Department of Cardiology, Cardiac Surgery and Heart Lung Transplant, Bambino Gesù Pediatric Hospital and Research Institute Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
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Cooper J, Onyeka I, Paterson E, O'Reilly D, Kirk R, Donnelly M. Record linkage studies of drug-related deaths among former adult prisoners who have been released to the community: a scoping review. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.2044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
ObjectivesSubstance use disorders are common in prisoners before they are admitted to prison. Epidemiological studies have demonstrated an increased risk of death following release from prison. The aim of this scoping review is to identify, map and summarise evidence from record linkage studies about drug-related deaths among former adult prisoners.
ApproachWe followed the framework for conducting scoping reviews by Arksey and O’Malley, and guidance by the Joanna Briggs Institute. MEDLINE, EMBASE, PsychINFO and Web of Science were searched for studies from January 2011 to September 2021 using keywords and index headings relating to ‘mortality’, ‘drugs’ and ‘ex-prisoner’. Two authors independently screened titles and abstracts for eligibility using pre-defined inclusion criteria. Full publication screening for inclusion was performed independently by two authors. Two authors tested the charting form and are independently extracting information from the eligible publications using this form. There were no geographical restrictions but non-English language papers were excluded.
ResultsFollowing the removal of duplicates, 3680 publications were screened using title and abstract. Full text publications were subsequently screened for eligibility. A total of 48 publications have been included in this review. Publications may be added from a search of reference lists. Two authors are performing data extraction and data will be presented and analysed in relation to answering the following scoping review questions:
What is the scope of the literature on record linkage studies of drug-related deaths among former adult prisoners who have been released to the community?
How is research conducted on this topic?
What methodologies are used?
What are the findings in relation to mortality?
Where are the knowledge gaps on this topic?
ConclusionThis review will help identify and profile at risk former prisoners, contribute to potential interventions, and inform future research and policy. Where possible, evidence will be reported about the time period to death after prison release and the specific drugs related to mortality.
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Cooper J, O'Reilly D, Kirk R, Kelly T, Gibbs R, Donnelly M. A project designed to examine, for the first time, the health records of adult prisoners in Northern Ireland and their linkage to other available health data: the test case of prisoner post-release mortality risk. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.2057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
A project designed to examine, for the first time, the health records of adult prisoners in Northern Ireland and their linkage to other available health data: the test case of prisoner post-release mortality risk
ObjectivesThe linkage of routinely collected administrative data for research purposes has the potential to improve knowledge and public benefit. We describe a novel data linkage study between the Northern Ireland (NI) Healthcare in Prisons and Business Services Organisation (BSO). This work is undertaken within the Administrative Data Research Centre-NI (ADRC-NI).
ApproachThis joint project between ADRC-NI Queen’s University Belfast and NI Healthcare in Prisons (South Eastern Health and Social Care Trust) will test linkage of prisoner health records to health data held in the BSO and the potential to generate a population-based cohort for a retrospective analysis of prisoner health (2012-2021) that will attempt to characterise prisoners according to socio-demographic, health and committal factors, compare post-release mortality rates with a reference group from the NI population using indirect standardisation and estimate post-release mortality risk using Cox proportional hazards models.
ResultsUsing novel data-linkages, a dataset will be created to examine the health of prisoners (and former prisoners) in NI. Ethics and governance approvals are in place for this data-linkage. The linkage will be undertaken via the Honest Broker Service (HBS) in NI and the dataset will be accessed in the safe setting at the BSO. The processes involved, experiences including significant delays or difficulties, and recommendations for future data-linkage studies will be discussed. In addition, a key deliverable of this project will be an assessment of access and linkage capabilities of the prisoner health data, with metadata created and made available to future researchers. In addition, we plan to present preliminary results relating to the test research question.
ConclusionWe will describe the processes involved and first-hand research experience in the development of a novel data-linkage project, in addition we will detail access and linkage capabilities in relation to this new dataset to examine health in prisoners (and former prisoners) in NI.
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Cooper JA, Onyeka I, O'Reilly D, Kirk R, Donnelly M. Record linkage studies of drug-related deaths among former adult prisoners who have been released to the community: a scoping review protocol. BMJ Open 2022; 12:e056598. [PMID: 35351720 PMCID: PMC8966574 DOI: 10.1136/bmjopen-2021-056598] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Prisoners often have a complex mix of health and care needs including needs relating to mental and physical ill-health conditions. In addition, substance use disorders are common in prisoners. The transition between prison and community poses risks in terms of a disruption to treatment and care and a deterioration in health. Studies have demonstrated an increased risk of drug-related deaths among former prisoners during the first weeks following release from custody. The aim of this scoping review is to provide an up-to-date account of evidence from record linkage studies about drug-related deaths among former adult prisoners. METHODS AND ANALYSIS This is a protocol for a scoping review. The framework for conducting scoping reviews by Arksey and O'Malley, in addition to the methodology and guidance developed by the Joanna Briggs Institute (JBI) and the JBI Collaboration will be followed. MEDLINE, EMBASE, PsychINFO and Web of Science will be searched for studies from 2011 to 2021 using search terms relating to 'mortality', 'drugs' and 'ex-prisoner'. A preliminary search in MEDLINE identified at least 473 potentially eligible papers. Two authors will independently screen all titles and abstracts for eligibility using the inclusion and exclusion criteria. There will be no geographical restrictions but non-English language papers will be excluded. Data will be extracted using a piloted customised charting form and the findings will be mapped (guided by the population, concept and context inclusion criteria) and grouped by main conceptual categories (including methodology, key findings and gaps in the research). DISCUSSION, ETHICS AND DISSEMINATION This scoping review will identify, map and summarise publicly available sources of research and therefore does not require ethical approval. The results will inform our empirical investigation of ex-prisoner mortality as well as being shared with key stakeholders, disseminated in a peer-reviewed journal and presented at relevant conferences.
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Affiliation(s)
- Janine A Cooper
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Belfast, UK
| | - Ifeoma Onyeka
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Belfast, UK
| | - Dermot O'Reilly
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Belfast, UK
| | - Richard Kirk
- South Eastern Health and Social Care Trust, Ulster Hospital, Dundonald, UK
| | - Michael Donnelly
- Administrative Data Research Centre Northern Ireland (ADRC NI), Centre for Public Health, Queen's University Belfast, Royal Hospitals Site, Belfast, UK
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Kirk R, Ratcliffe A, Noonan G, Uosis-Martin M, Lyth D, Bardell-Cox O, Massam J, Schofield P, Hindley S, Jones DR, Maclean J, Smith A, Savage V, Mohmed S, Charrier C, Salisbury AM, Moyo E, Metzger R, Chalam-Judge N, Cheung J, Stokes NR, Best S, Craighead M, Armer R, Huxley A. Rational design, synthesis and testing of novel tricyclic topoisomerase inhibitors for the treatment of bacterial infections part 1. RSC Med Chem 2020; 11:1366-1378. [PMID: 34095844 DOI: 10.1039/d0md00174k] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/07/2020] [Indexed: 12/17/2022] Open
Abstract
The alarming reduction in drug effectiveness against bacterial infections has created an urgent need for the development of new antibacterial agents that circumvent bacterial resistance mechanisms. We report here a series of DNA gyrase and topoisomerase IV inhibitors that demonstrate potent activity against a range of Gram-positive and selected Gram-negative organisms, including clinically-relevant and drug-resistant strains. In part 1, we present a detailed structure activity relationship (SAR) analysis that led to the discovery of our previously disclosed compound, REDX05931, which has a minimum inhibitory concentration (MIC) of 0.06 μg mL-1 against fluoroquinolone-resistant Staphylococcus aureus. Although in vitro hERG and CYP inhibition precluded further development, it validates a rational design approach to address this urgent unmet medical need and provides a scaffold for further optimisation, which is presented in part 2.
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Affiliation(s)
- R Kirk
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - A Ratcliffe
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - G Noonan
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - M Uosis-Martin
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - D Lyth
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - O Bardell-Cox
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - J Massam
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - P Schofield
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - S Hindley
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - D R Jones
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - J Maclean
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - A Smith
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - V Savage
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - S Mohmed
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - C Charrier
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - A-M Salisbury
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - E Moyo
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - R Metzger
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - N Chalam-Judge
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - J Cheung
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - N R Stokes
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - S Best
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - M Craighead
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - R Armer
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
| | - A Huxley
- Redx Anti-Infectives Ltd, Alderley Park, Mereside Macclesfield SK10 4TG UK
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13
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Kirk R, Ratcliffe A, Noonan G, Uosis-Martin M, Lyth D, Bardell-Cox O, Massam J, Schofield P, Lyons A, Clare D, Maclean J, Smith A, Savage V, Mohmed S, Charrier C, Salisbury AM, Moyo E, Ooi N, Chalam-Judge N, Cheung J, Stokes NR, Best S, Craighead M, Armer R, Huxley A. Rational design, synthesis and testing of novel tricyclic topoisomerase inhibitors for the treatment of bacterial infections part 2. RSC Med Chem 2020; 11:1379-1385. [PMID: 34095845 PMCID: PMC8126889 DOI: 10.1039/d0md00175a] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/07/2020] [Indexed: 11/21/2022] Open
Abstract
Building on our previously-reported novel tricyclic topoisomerase inhibitors (NTTIs), we disclose the discovery of REDX07965, which has an MIC90 of 0.5 μg mL-1 against Staphylococcus aureus, favourable in vitro pharmacokinetic properties, selectivity versus human topoisomerase II and an acceptable toxicity profile. The results herein validate a rational design approach to address the urgent unmet medical need for novel antibiotics.
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Affiliation(s)
- R Kirk
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - A Ratcliffe
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - G Noonan
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - M Uosis-Martin
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - D Lyth
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - O Bardell-Cox
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - J Massam
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - P Schofield
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - A Lyons
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - D Clare
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - J Maclean
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - A Smith
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - V Savage
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - S Mohmed
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - C Charrier
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - A-M Salisbury
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - E Moyo
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - N Ooi
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - N Chalam-Judge
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - J Cheung
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - N R Stokes
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - S Best
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - M Craighead
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - R Armer
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
| | - A Huxley
- Redx Anti-Infectives Ltd Alderley Park Macclesfield SK10 4TG Cheshire UK
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14
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Gooty VD, Dillenbeck J, Arar Y, Castellanos DA, Greil GF, Hernandez NB, Kirk R, Butts R, Hussain T. Coronary CT Angiography in Pediatric and Young Adult Coronary Allograft Vasculopathy: Single-Center Experience. JACC Cardiovasc Imaging 2020; 14:1065-1067. [PMID: 33221219 DOI: 10.1016/j.jcmg.2020.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 11/30/2022]
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15
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Baez Hernandez N, Kirk R, Davies R, Bano M, Sutcliffe D, Pirolli T, Jaquiss R, Daneman S, Butts RJ. A comprehensive strategy in donor acceptance: Impact on pediatric waitlist and heart transplant outcomes. Pediatr Transplant 2020; 24:e13764. [PMID: 32536034 DOI: 10.1111/petr.13764] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/14/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 12/12/2022]
Abstract
Significant inter- and intra-center practice variability is present in pediatric donor heart acceptability. This may contribute to variation in the donor refusal rate and may impact waitlist time, morbidity, mortality, and transplant rates. In order to reduce practice variability, our center developed and implemented a comprehensive strategy regarding donor acceptance in September 2017. The aim of this study was to assess the impact of this strategy on waitlist time and outcomes as well as early post-transplant outcomes. We performed a single-center, retrospective analysis of all pediatric (<18 years) patients listed for single-organ heart transplant at our center from September 2015 to September 2018. Patients were divided into those listed before (Group 1) and after implementation of the comprehensive strategy (Group 2). The primary end-point was waitlist time. Secondary end-points included waitlist removal due to death or clinical deterioration, donor refusals per listed patient, early post-transplant outcomes (graft failure, mechanical ventilation time, inotropic support, length of hospital stay) and 1-year post-transplant survival. Of 78 listed patients, 54 were transplanted (29 in Group 1), 9 were removed due to death or clinical deterioration (7 in Group 1) and 15 were removed due to clinical improvement (12 in Group 1). The waitlist time was significantly shorter in Group 2 (17 days, IQR 7-53) vs Group 1 (90 days, IQR 14-162); P = .006. The number of donor refusals was lower in Group 2 (1, IQR 0-2.2) vs Group 1 (4, IQR 2-19); P < .001. The percentage of refused donors with normal function (Left ventricular ejection fraction > 50%) was lower in Group 2 vs Group 1 (53% vs 84%; P < .001). Difference in removal from the waitlist for death or deterioration in Group 2 vs Group 1 (n = 2, 7% vs n = 7, 20%, P = .18) did not reach statistical significance. There was no difference in post-transplant outcomes between groups. The waitlist time and donor refusals significantly decreased after implementation of a comprehensive donor acceptance strategy without impacting transplant outcomes. This analysis supports the need for a comprehensive approach to donor organ acceptance within a pediatric transplant center.
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Affiliation(s)
| | - Richard Kirk
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ryan Davies
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Maria Bano
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David Sutcliffe
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Timothy Pirolli
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robert Jaquiss
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Susan Daneman
- Children's Health, Children's Medical Center, Dallas, TX, USA
| | - Ryan J Butts
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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16
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Baez Hernandez N, Kirk R, Davies R, Roumillat J, Sutcliffe D, Bano M, Butts R. Heart transplantation in an infant with Williams-Beuren syndrome and rapidly progressive ischemic cardiomyopathy. Pediatr Transplant 2020; 24:e13688. [PMID: 32112495 DOI: 10.1111/petr.13688] [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: 12/20/2019] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 11/30/2022]
Abstract
Ischemic cardiomyopathy with resultant refractory HF may occur in patients with WBS, often as the result of coronary involvement with SVAS. The rapid development of arteriopathy at a young age raises concerns regarding transplant candidacy due to progressive stenoses at other arterial sites with potential detrimental impact on long-term heart graft function. We report a 2-month-old male infant diagnosed with mild aortic stenosis during the neonatal period, but subsequently developed rapidly progressive supravalvar and coronary artery stenoses leading to cardiogenic shock due to myocardial ischemia. The presentation led to the diagnosis of WBS. He required prolonged CPR including ECMO therapy. He subsequently underwent LVAD implantation as bridge to transplant and 4 days later heart transplantation. His post-operative course was complicated by prolonged mechanical ventilation and extended intensive care unit and hospital stays. However, at follow-up 18 months post-transplant he continues to have normal graft function with mild, non-progressive residual coarctation of aorta and non-progressive moderately hypoplastic pulmonary arteries.
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Affiliation(s)
| | - Richard Kirk
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ryan Davies
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - David Sutcliffe
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Maria Bano
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ryan Butts
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
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17
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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.
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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
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18
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Gossett JG, Amdani S, Khulbey S, Punnoose AR, Rosenthal DN, Smith J, Smits J, Dipchand AI, Kirk R, Miera O, Davies RR. Review of interactions between high-risk pediatric heart transplant recipients and marginal donors including utilization of risk score models. Pediatr Transplant 2020; 24:e13665. [PMID: 32198806 DOI: 10.1111/petr.13665] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/29/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Donor organ acceptance practices vary among pediatric heart transplant professionals. We sought to understand what is known about the interactions between the "high-risk" recipient and the "marginal donor," and how donor risk scores can impact this discussion. METHODS A systematic review of published literature on pediatric HTx was undertaken with the assistance of a medical librarian. Two authors independently assessed search results, and papers were reviewed for inclusion. RESULTS We found that there are a large number of individual factors, and clusters of factors, that have been used to label individual recipients "high-risk" and individual donors "marginal." The terms "high-risk recipient" and "marginal donor" have been used broadly in the literature making it virtually impossible to make comparisons between publications. In general, the data support that patients who could be easily agreed to be "sicker recipients" are at more risk compared to those who are clearly "healthier," albeit still "sick enough" to need transplantation. Given this variability in the literature, we were unable to define how being a "high-risk" recipient interplays with accepting a "marginal donor." Existing risk scores are described, but none were felt to adequately predict outcomes from factors available at the time of offer acceptance. CONCLUSIONS We could not determine what makes a donor "marginal," a recipient "high-risk," or how these factors interplay within the specific recipient-donor pair to determine outcomes. Until there are better risk scores predicting outcomes at the time of organ acceptance, programs should continue to evaluate each organ and recipient individually.
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Affiliation(s)
- Jeffrey G Gossett
- University of California Benioff Children's Hospitals, San Francisco, CA, USA
| | | | | | | | | | | | - Jacqueline Smits
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - 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
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum, Berlin, Germany
| | - 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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Schweiger M, Everitt MD, Chen S, Nandi D, Castro J, Gupta D, Scheel J, Lal AK, Ablonczy L, Kirk R, Miera O, Davies RR, Dipchand AI. Review of the discard and/or refusal rate of offered donor hearts to pediatric waitlisted candidates. Pediatr Transplant 2020; 24:e13674. [PMID: 32198804 DOI: 10.1111/petr.13674] [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: 11/29/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/01/2022]
Abstract
We aimed to review current literature on the discard rate of donor hearts offered to pediatric recipients and assess geographical differences. Consequences and ways to reduce the discard rate are discussed. A systemic review on published literature on pediatric transplantation published in English since 2010 was undertaken. Additionally, a survey was sent to international OPOs with the goal of incorporating responses from around the world providing a more global picture. Based on the literature review and survey, there is a remarkably wide range of discard and/or refusal for pediatric hearts offered for transplant, ranging between 18% and 57% with great geographic variation. The data suggest that that the overall refusal rate may have decreased over the last decade. Reasons for organ discard were difficult to identify from the available data. Although the refusal rate of pediatric donor hearts seems to be lower compared to that reported in adults, it is still as high as 57% with geographic variation.
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Affiliation(s)
- Martin Schweiger
- Division of Cardiac Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | | | | | | | - Javier Castro
- Fundacion Cardiovascular de Colombia, Bucaramanga City, Colombia
| | - Dipankar Gupta
- Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Janet Scheel
- Washington University School of Medicine, St Louis, MO, USA
| | | | - Laszlo Ablonczy
- Pediatric Cardiac Center, Hungarian Institute of Cardiology, Budapest, Hungary
| | - Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX, USA
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum, Berlin, Germany
| | - 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
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20
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Conway J, Ballweg JA, Fenton M, Kindel S, Chrisant M, Weintraub RG, Danziger-Isakov L, Kirk R, Meira O, Davies RR, Dipchand AI. Review of the impact of donor characteristics on pediatric heart transplant outcomes. Pediatr Transplant 2020; 24:e13680. [PMID: 32198824 DOI: 10.1111/petr.13680] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/27/2019] [Revised: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 12/22/2022]
Abstract
Heart transplantation (HTx) is a treatment option for end-stage heart failure in children. HTx is limited by the availability and acceptability of donor hearts. Refusal of donor hearts has been reported to be common with reasons for refusal including preexisting donor characteristics. This review will focus on the impact of donor characteristics and comorbidities on outcomes following pediatric HTx. A literature review was performed to identify articles on donor characteristics and comorbidities and pediatric HTx outcomes. There are many donor characteristics to consider when accepting a donor heart. Weight-based matching is the most common form of matching in pediatric HTx with a donor-recipient weight ratio between 0.7 and 3 having limited impact on outcomes. From an age perspective, donors <50 years can be carefully considered, but the impact of ischemic time needs to be understood. To increase the donor pool, with minimal impact on outcomes, ABO-incompatible donors should be considered in patients that are eligible. Other factors to be considered when accepting an organ is donor comorbidities. Little is known about donor comorbidities in pediatric HTx, with most of the data available focusing on infections. Being aware of the potential infections in the donor, understanding the testing available and risks of transmission, and treatment options for the recipient is essential. There are a number of donor characteristics that potentially impact outcomes following pediatric HTx, but these need to be taken into consideration along with their interactions with recipient factors when interpreting the outcomes following HTx.
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Affiliation(s)
- Jennifer Conway
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Jean A Ballweg
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, Nebraska
| | - Matthew Fenton
- Great Ormond Street Hospital for Children Foundation Trust, London, UK
| | - Steve Kindel
- Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin and Herma Heart Institute and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Maryanne Chrisant
- The Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | - Robert G Weintraub
- Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia.,Department of Cardiology, The Royal Children's Hospital, Melbourne Heart Research Group, Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - Lara Danziger-Isakov
- Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center & University of Cincinnati, Cincinnati, Ohio
| | - Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas
| | - Oliver Meira
- Department of Congenital Heart Disease/Pediatric Cardiology, Berlin, Germany
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, 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, ON, Canada
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21
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Affiliation(s)
- Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX, USA
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum, Berlin, Germany
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX, USA
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22
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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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Denfield SW, Azeka E, Das B, Garcia-Guereta L, Irving C, Kemna M, Reinhardt Z, Thul J, Dipchand AI, Kirk R, Davies RR, Miera O. Pediatric cardiac waitlist mortality-Still too high. Pediatr Transplant 2020; 24:e13671. [PMID: 32198830 DOI: 10.1111/petr.13671] [Citation(s) in RCA: 24] [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: 11/29/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 12/28/2022]
Abstract
Cardiac transplantation for children with end-stage cardiac disease with no other medical or surgical options is now standard. The number of children in need of cardiac transplant continues to exceed the number of donors considered "acceptable." Therefore, there is an urgent need to understand which recipients are in greatest need of transplant before becoming "too ill" and which "marginal" donors are acceptable in order to reduce waitlist mortality. This article reviewed primarily pediatric studies reported over the last 15 years on waitlist mortality around the world for the various subgroups of children awaiting heart transplant and discusses strategies to try to reduce the cardiac waitlist mortality.
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Affiliation(s)
- Susan W Denfield
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Estela Azeka
- Division of Pediatric Cardiology, University of Sao Paolo, Sao Paolo, Brazil
| | - Bibhuti Das
- Texas Children's Hospital, Baylor College of Medicine, Austin, TX, USA
| | - Luis Garcia-Guereta
- Division of Pediatric Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Claire Irving
- Division of Pediatric Cardiology, Children's Hospital Westmead, Sydney, NSW, Australia
| | - Mariska Kemna
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Zdenka Reinhardt
- Division of Pediatric Cardiology, Freeman Hospital, New Castle upon Tyne, UK
| | - Josef Thul
- Division of Pediatric Cardiology, Children's Heart Center, University of Giessen, Giessen, 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
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum, Berlin, Germany
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24
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Butler A, Chapman G, Johnson JN, Amodeo A, Böhmer J, Camino M, Davies RR, Dipchand AI, Godown J, Miera O, Pérez-Blanco A, Rosenthal DN, Zangwill S, Kirk R. Behavioral economics-A framework for donor organ decision-making in pediatric heart transplantation. Pediatr Transplant 2020; 24:e13655. [PMID: 31985140 DOI: 10.1111/petr.13655] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/30/2019] [Accepted: 12/09/2019] [Indexed: 12/18/2022]
Abstract
The high discard rate of pediatric donor hearts presents a major challenge for children awaiting heart transplantation. Recent literature identifies several factors that contribute to the disparities in pediatric donor heart usage, including regulatory oversight, the absence of guidelines on pediatric donor heart acceptance, and variation among transplant programs. However, a likely additional contributor to this issue are the behavioral factors influencing transplant team decisions in donor offer scenarios, a topic that has not yet been studied in detail. Behavioral economics and decision psychology provide an excellent foundation for investigating decision-making in the pediatric transplant setting, offering key insights into the behavior of transplant professionals. We conducted a systematic review of published literature in pediatric heart transplant related to behavioral economics and the psychology of decision-making. In this review, we draw on paradigms from these two domains in order to examine how existing aspects of the transplant environment, including regulatory oversight, programmatic variation, and allocation systems, may precipitate potential biases surrounding donor offer decisions. Recognizing how human decision behavior influences donor acceptance is a first step toward improving utilization of potentially viable pediatric donor hearts.
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Affiliation(s)
| | | | | | | | - Jens Böhmer
- The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX, USA
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Justin Godown
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum, Berlin, Germany
| | | | | | | | - Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX, USA
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25
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Godown J, Schumacher KR, Butler A, Chapman G, Dipchand AI, Kaslow WW, Bearl DW, Kirk R. Patients and their family members prioritize post-transplant survival over waitlist survival when considering donor hearts for transplantation. Pediatr Transplant 2020; 24:e13589. [PMID: 31562687 DOI: 10.1111/petr.13589] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 07/31/2019] [Accepted: 09/01/2019] [Indexed: 10/25/2022]
Abstract
Heart transplant providers often focus on post-transplant outcomes when making donor decisions, potentially at the expense of higher waitlist mortality. This study aimed to assess public opinion regarding the selection of donor hearts and the balance between pre- and post-transplant risk. The authors generated a survey to investigate public opinion regarding donor acceptance. The survey was shared freely online across social media platforms in April-May 2019. A total of 718 individuals responded to the survey, with an equal distribution between patients and family members. Respondents consistently favored post-transplant outcomes over waitlist outcomes. About 83.9% of respondents favored a hospital with longer waitlist times, worse waitlist outcomes, but excellent post-transplant survival over a hospital with short waitlist times, a high waitlist survival, and inferior post-transplant survival. This preference was no different between pediatric and adult populations (P = .7), patient and family members (P = .935), or those with a pre- vs post-transplant perspective (P = .985). Patients and their family members consistently favor improved post-transplant survival over waitlist survival when considering the risks of accepting a donor organ. These findings suggest that current practice patterns of donor selection align with the opinions of patients and family members with heart failure or who have undergone heart transplantation.
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Affiliation(s)
- Justin Godown
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Kurt R Schumacher
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | | | | | - Anne I Dipchand
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Whitney W Kaslow
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - David W Bearl
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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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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Baez Hernandez N, Kirk R, Sutcliffe D, Davies R, Jaquiss R, Gao A, Zhang S, Butts RJ. Utilization and outcomes in biventricular assist device support in pediatrics. J Thorac Cardiovasc Surg 2019; 160:1301-1308.e2. [PMID: 31948738 DOI: 10.1016/j.jtcvs.2019.11.068] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patients with biventricular assist devices (BiVADs) have worse outcomes than those with left ventricular assist devices (LVADs). It is unclear whether these outcomes are due to device selection or patient factors. We used propensity score matching to reduce patient heterogeneity and compare outcomes in pediatric patients supported with BiVADs with a similar LVAD cohort. METHODS The Pedimacs registry was queried for patients who were supported with BiVAD or LVAD. Patients were analyzed by BiVAD or LVAD at primary implant and the 2 groups were compared before and after using propensity score matching. RESULTS Of 363 patients who met inclusion criteria, 63 (17%) underwent primary BiVAD support. After propensity score matching, differences between cohorts were reduced. Six months after implant, in the BiVAD cohort (LVAD cohort) 52.5% (42.5%) had been transplanted; 32.5% (40%) were alive with device, and 15% (10%) had died. Survival was similar between cohorts (P = .31, log-rank), but patients with BiVADs were more likely to experience a major adverse event in the form of bleeding (P = .04, log-rank). At 1 week and 1 and 3 months' postimplant, the percentage of patients on mechanical ventilation, on dialysis, or with elevated bilirubin was similar between the 2 groups. CONCLUSIONS When propensity scores were used to reduce differences in patient characteristics, there were no differences in survival but more major adverse events in the patients with BiVADs, particularly bleeding. Differences in unmatched patient outcomes between LVAD and BiVAD cohorts likely represent differences in severity of illness rather than mode of support.
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Affiliation(s)
| | - Richard Kirk
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Tex
| | - David Sutcliffe
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Ryan Davies
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Robert Jaquiss
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Ang Gao
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Song Zhang
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Ryan J Butts
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Tex
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Wigley R, Scalco RS, Gardiner AR, Godfrey R, Booth S, Kirk R, Hilton‐Jones D, Houlden H, Heales S, Quinlivan R. The need for biochemical testing in beta-enolase deficiency in the genomic era. JIMD Rep 2019; 50:40-43. [PMID: 31741825 PMCID: PMC6851005 DOI: 10.1002/jmd2.12070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 11/18/2022] Open
Abstract
Glycogen storage disease type XIII (GSDXIII) is a very rare inherited metabolic myopathy characterized by autosomal-recessive mutations in the ENO3 gene resulting in muscle β-enolase deficiency, an enzymatic defect of the distal part of glycolysis. Enzyme kinetic studies of two patients presenting with exertion intolerance and recurrent rhabdomyolysis are reported. Next generation sequencing confirmed patient 1 was homozygous for p.E187K in ENO3, while patient 2 was homozygous for p.C357Y. ENO3 variants pathogenicity was confirmed by functional studies in skeletal muscle. p.E187K caused extremely low total enolase activity. p.C357Y was associated with a higher level of residual activity but kinetic studies showed a lower maximum work rate (V max). This study illustrates that GSDXIII may be caused by either null mutations leading to β-enolase deficiency or by mutations that alter the enzyme's kinetic profile. This study highlights the importance of carrying out functional studies as part of the diagnostic process following the identification of variants with next generation sequencing.
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Affiliation(s)
- Ralph Wigley
- Enzyme Laboratory, Department of Chemical Pathology, Cameilia Botnar LaboratoriesGreat Ormond Street Hospital for Sick ChildrenLondonUK
| | - Renata S. Scalco
- MRC Centre for Neuromuscular Diseases and Department of Molecular NeuroscienceUniversity College London Institute of Neurology and National Hospital for Neurology and NeurosurgeryLondonUK
- CAPES FoundationMinistry of EducationBrazil
| | - Alice R. Gardiner
- MRC Centre for Neuromuscular Diseases and Department of Molecular NeuroscienceUniversity College London Institute of Neurology and National Hospital for Neurology and NeurosurgeryLondonUK
| | - Richard Godfrey
- MRC Centre for Neuromuscular Diseases and Department of Molecular NeuroscienceUniversity College London Institute of Neurology and National Hospital for Neurology and NeurosurgeryLondonUK
- Centre for Human Performance, Exercise and RehabilitationBrunel University LondonUxbridgeUK
| | - Suzanne Booth
- MRC Centre for Neuromuscular Diseases and Department of Molecular NeuroscienceUniversity College London Institute of Neurology and National Hospital for Neurology and NeurosurgeryLondonUK
| | - Richard Kirk
- Sheffield Diagnostic Genetic ServiceSheffield Children's NHS Foundation TrustSheffieldUK
| | - David Hilton‐Jones
- Department of Clinical NeurologyWest Wing, John Radcliffe HospitalOxfordUK
| | - Henry Houlden
- MRC Centre for Neuromuscular Diseases and Department of Molecular NeuroscienceUniversity College London Institute of Neurology and National Hospital for Neurology and NeurosurgeryLondonUK
| | - Simon Heales
- Enzyme Laboratory, Department of Chemical Pathology, Cameilia Botnar LaboratoriesGreat Ormond Street Hospital for Sick ChildrenLondonUK
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Diseases and Department of Molecular NeuroscienceUniversity College London Institute of Neurology and National Hospital for Neurology and NeurosurgeryLondonUK
- Dubowitz Neuromuscular CentreGreat Ormond Street Hospital for Children, NHS Foundation TrustLondonUK
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29
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Godown J, Kirk R, Joong A, Lal AK, McCulloch M, Peng DM, Scheel J, Davies RR, Dipchand AI, Miera O, Gossett JG. Variability in donor selection among pediatric heart transplant providers: Results from an international survey. Pediatr Transplant 2019; 23:e13417. [PMID: 31081171 DOI: 10.1111/petr.13417] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 02/19/2019] [Revised: 03/14/2019] [Accepted: 03/22/2019] [Indexed: 11/26/2022]
Abstract
There is considerable variability in donor acceptance practices among adult heart transplant providers; however, pediatric data are lacking. The aim of this study was to assess donor acceptance practices among pediatric heart transplant professionals. The authors generated a survey to investigate clinicians' donor acceptance practices. This survey was distributed to all members of the ISHLT Pediatric Council in April 2018. A total of 130 providers responded from 17 different countries. There was a wide range of acceptable criteria for potential donors. These included optimal donor-to-recipient weight ratio (lower limit: 50%-150%, upper limit: 120%-350%), maximum donor age (25-75 years), and minimum acceptable left ventricular EF (30%-60%). Non-US centers demonstrated less restrictive donor selection criteria and were willing to accept older donors (50 vs 35 years, P < 0.001), greater size discrepancy (upper limit weight ratio 250% vs 200%, P = 0.009), and donors with a lower EF (45% vs 50%, P < 0.001). Recipient factors were most influential in the decision to accept marginal donors including recipients requiring ECMO support, ventilator support, and highly sensitized patients with a negative XM. However, programmatic factors impacted the decision to decline marginal donors including recent programmatic mortalities and concerns for programmatic restrictions from regulatory bodies. There is significant variation in donor acceptance practices among pediatric heart transplant professionals. Standardization of donor acceptance practices through the development of a consensus statement may help to improve donor utilization and reduce waitlist mortality.
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Affiliation(s)
- Justin Godown
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anna Joong
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Ashwin K Lal
- Division of Pediatric Cardiology, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Michael McCulloch
- Division of Pediatric Cardiology, University of Virginia Children's Hospital, Charlottesville, Virginia
| | - David M Peng
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Janet Scheel
- Division of Pediatric Cardiology, St. Louis Children's Hospital, St. Louis, Missouri
| | - Ryan R Davies
- Department of Pediatric Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anne I Dipchand
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Oliver Miera
- Division of Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Jeffrey G Gossett
- Division of Pediatric Cardiology, UCSF Benioff Children's Hospitals, San Francisco, California
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Doyle S, O'Byrne JJ, Nesbitt M, Murphy DN, Abidin Z, Byrne N, Pastores G, Kirk R, Treacy EP. The genetic and biochemical basis of trimethylaminuria in an Irish cohort. JIMD Rep 2019; 47:35-40. [PMID: 31240165 PMCID: PMC6498825 DOI: 10.1002/jmd2.12028] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/30/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Inherited trimethylaminuria (TMAU), a rare genetic disorder of hepatic metabolism of trimethylamine (TMA) causing excessive accumulation of malodorous trimethylamine (TMA), is a socially distressing disorder. Diagnosis is made by biochemical analysis of urine, with the calculation of flavin monooxygenase trimethylamine conversion capacity. Genetic testing, sequencing the entire coding region of the FMO3 gene has been recommended for affected individuals who convert less than 90% of the total TMA load to TMAO. METHODS Genetic analysis was undertaken for 13 Irish patients with TMAU of varying phenotypic severity (three severe, six moderate, and four mild). RESULTS A genetic diagnosis was made for seven patients, including for five of the nine moderate to severely affected cases. We noted the c.913G>T;p.(Glu305*) and c.458C>T;p.(Pro153Leu) mutations in this Irish population with severe TMAU which is consistent with our earlier findings in Australian and North American families of Irish and British descent.Three individuals were noted to be homozygous for the common variant haplotype c.472G>A;923A>G;p.(Glu158Lys);(Glu308Gly). We also identified three novel variants in this population, which are likely to be pathogenic: c.682G>A;p(Gly228Ser), c.694G>T:p(Asp232Tyr), and c.989G>A;p.(Gly330Glu). CONCLUSION Urinary biochemical analysis probably remains the first line diagnostic approach to classify the various types of TMAU. FMO3 gene analysis is likely only to be informative for certain presentations of TMAU.
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Affiliation(s)
- Samantha Doyle
- National Centre for Inherited Metabolic Disorders, The Mater Misericordiae University HospitalDublinIreland
- School of Medicine and Medical Sciences, University College DublinDublinIreland
| | - James J. O'Byrne
- National Centre for Inherited Metabolic Disorders, The Mater Misericordiae University HospitalDublinIreland
| | - Mandy Nesbitt
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS TrustSheffieldUK
| | - Daniel N. Murphy
- National Rare Diseases Office, The Mater Misericordiae University HospitalDublinIreland
| | - Zaza Abidin
- National Centre for Inherited Metabolic Disorders, The Mater Misericordiae University HospitalDublinIreland
- School of Medicine and Medical Sciences, University College DublinDublinIreland
| | - Niall Byrne
- National Centre for Inherited Metabolic Disorders, The Mater Misericordiae University HospitalDublinIreland
- School of Medicine and Medical Sciences, University College DublinDublinIreland
| | - Gregory Pastores
- National Centre for Inherited Metabolic Disorders, The Mater Misericordiae University HospitalDublinIreland
- School of Medicine and Medical Sciences, University College DublinDublinIreland
| | - Richard Kirk
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS TrustSheffieldUK
| | - Eileen P. Treacy
- National Centre for Inherited Metabolic Disorders, The Mater Misericordiae University HospitalDublinIreland
- School of Medicine and Medical Sciences, University College DublinDublinIreland
- Department of Paediatrics, Trinity College Dublin, The University of DublinDublinIreland
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31
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Baez N, Kirk R, Davies R, Sutcliffe D, Bano M, Jaquiss R, Butts R. Standardized Donor Acceptance Criteria: Impact on Pediatric Waitlist and Heart Transplant Outcomes. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1200] [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: 10/27/2022] Open
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32
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Baez N, Davies R, Kirk R, Bano M, Sutcliffe D, Jaquiss R, Butts R. Transplant Center Refusal Rate and Waitlist Outcomes in Pediatric Heart Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.428] [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: 10/27/2022] Open
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Kirk R, Butts RJ, Dipchand AI. The first successful pediatric heart transplant and results from the earliest era. Pediatr Transplant 2019; 23:e13349. [PMID: 30600589 DOI: 10.1111/petr.13349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/16/2018] [Revised: 12/13/2018] [Accepted: 12/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The first pediatric heart transplant died 5 hours after transplant and the case was published by Kantrowitz. There is no report of the first successful case in the medical literature, nor indeed the outcome of children transplanted prior to 1982. However, we recently discovered that children from this period were entered retrospectively into the ISHLT Registry when it began and they form the basis of this report. METHODS A retrospective review of the ISHLT Thoracic Registry was undertaken for pediatric heart transplants prior to 1982. Demographic and descriptive data, and patient and graft survival were analyzed. RESULTS Thirty children (24 male) had a median age of 13 years (IQR 12-16) at the time of primary transplant. The underlying cardiac diagnosis was cardiomyopathy (18), congenital heart disease (7), not reported (5). The median follow-up was 2.63 years (IQR 0.1-7.2). Twenty-two patients are known to have died, and eight underwent retransplantation. Median patient survival was 3.5 years. The first patient to survive for more than one year was transplanted in 1968 and survived 6 years. CONCLUSION The definition of a successful transplant is debatable; however, the first child reported to the registry to survive beyond one year was transplanted in 1968. Survival for these early patients was considerably less than the subsequent eras and retransplantation more common; however, the experience in managing these children laid the foundation for the future.
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Kleinmahon JA, Gralla J, Kirk R, Auerbach SR, Henderson HT, Wallis GA, Ramakrishnan K, Singh RK, Caldwell RL, Savage AJ, Everitt MD. Cardiac allograft vasculopathy and graft failure in pediatric heart transplant recipients after rejection with severe hemodynamic compromise. J Heart Lung Transplant 2019; 38:277-284. [DOI: 10.1016/j.healun.2018.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/14/2018] [Accepted: 12/18/2018] [Indexed: 11/25/2022] Open
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Kirk R, Dipchand A. Center effect on posttransplant survival among currently active United States pediatric heart transplant centers. Am J Transplant 2018; 18:3079. [PMID: 30230237 DOI: 10.1111/ajt.15121] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Richard Kirk
- Department of Pediatric Cardiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Anne Dipchand
- Division of Cardiology, Hospital for Sick Children, Toronto, Canada
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Butts RJ, Dipchand AI, Sutcliffe D, Bano M, Morrow R, Kirk R. Pre-transplant amiodarone use and outcomes in children after heart transplantation. J Heart Lung Transplant 2018; 38:230-232. [PMID: 30454886 DOI: 10.1016/j.healun.2018.10.004] [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] [Received: 04/18/2018] [Revised: 10/10/2018] [Accepted: 10/17/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ryan J Butts
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Anne I Dipchand
- University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Sutcliffe
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Maria Bano
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert Morrow
- Children's Medical Center of Dallas, Dallas, Texas, USA
| | - Richard Kirk
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Dipchand AI, Kirk R, Naftel DC, Pruitt E, Blume ED, Morrow R, Rosenthal D, Auerbach S, Richmond ME, Kirklin JK. Ventricular Assist Device Support as a Bridge to Transplantation in Pediatric Patients. J Am Coll Cardiol 2018; 72:402-415. [DOI: 10.1016/j.jacc.2018.04.072] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/20/2018] [Accepted: 04/23/2018] [Indexed: 11/24/2022]
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Butts RJ, Dipchand AI, Sutcliffe D, Bano M, Dimas V, Morrow R, Das B, Kirk R. Comparison of basiliximab vs antithymocyte globulin for induction in pediatric heart transplant recipients: An analysis of the International Society for Heart and Lung Transplantation database. Pediatr Transplant 2018; 22:e13190. [PMID: 29878688 DOI: 10.1111/petr.13190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Accepted: 03/07/2018] [Indexed: 11/28/2022]
Abstract
This study aims to compare 2 common induction strategies, basiliximab and ATG. Analysis of the ISHLT transplant registry was performed. The database was queried for pediatric heart transplants from January 1, 2000, to June 30, 2015, who had received induction with basiliximab or ATG. Primary end-point was graft survival. Secondary end-points included 1-year survival and 1-year conditional survival. There were 3158 heart transplants who received induction with basiliximab or ATG. The ATG cohort was younger, more likely to have congenital heart disease or be a retransplant, have a higher PRA, longer ischemic time, and been transplanted earlier in the study period (all P<.01). There was no difference in graft loss in the basiliximab cohort compared to the ATG cohort (HR 1.18 P=.06). On conditional 1-year survival analysis, basiliximab induction was associated with graft loss (HR=1.35 95% CI 1.1-1.7, P<.01), and in the propensity-matched cohort, the basiliximab cohort was more likely to experience rejection prior to discharge (P=.04). Infection prior to discharge was more common in the antithymocyte cohort. Induction with ATG is associated with improved late graft survival compared to basiliximab.
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Affiliation(s)
- Ryan J Butts
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anne I Dipchand
- Hospital for Sick Children, University of Toronto, Toronto, ON, USA
| | - David Sutcliffe
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Maria Bano
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vivian Dimas
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robert Morrow
- Children's Medical Center of Dallas, Dallas, TX, USA
| | - Bibhuti Das
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Richard Kirk
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Dipchand A, Zuckerman W, Auerbach S, Conway J, Cherikh W, Peng D, Barnes A, Kaufman B, Thrush P, Sadavarte A, Almond C, Pahl E, Azeka E, Gajarski R, Law Y, Lorts A, VanderPluym C, Kirk R. The First Analysis of the International Pediatric Heart Failure Registry (iPHFR) - Heart Failure Hospitalizations. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.382] [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: 10/17/2022] Open
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Kleinmahon J, Gralla J, Auerbach S, Wallis G, Ramakrishnan K, Singh R, Caldwell R, Kirk R, Savage A, Henderson H, Everitt M. Earlier Cardiac Allograft Vasculopathy and Graft Failure in Pediatric Heart Transplant Recipients After Rejection with Severe Hemodynamic Compromise. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.467] [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: 11/30/2022] Open
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Davies R, Pirolli T, Bano M, Butts R, Sutcliffe D, Kirk R, Jaquiss R. Post-transplant Mortality and the Components of Donor Organ Ischemic Time in Pediatric Heart Transplantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1025] [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
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Conway J, Miera O, Adachi I, Maeda K, Eghtesady P, Henderson HT, Guleserian K, Fan CPS, Kirk R, Canter C, Pac M, VanderPluym C, Eastaugh L, Buchholz H, Zimpfer D, Turek J, Fenton M, Neibler R, Kirklin J, Padalino M, Lorts A, Hassan M, Lytrivi I, Auerbach S, Slaughter M, Schweiger M, Ueno T, Davies R, Lamour J, Schmitto J, Zinn M, Human D, Scheel J, Li Y, Parrino P, Borik Chiger S, Stiller B, Dumfarth J, Morales D. Worldwide Experience of a Durable Centrifugal Flow Pump in Pediatric Patients. Semin Thorac Cardiovasc Surg 2018; 30:327-335. [DOI: 10.1053/j.semtcvs.2018.03.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 11/11/2022]
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Aye MM, Butler AE, Kilpatrick ES, Kirk R, Vince R, Rigby AS, Sandeman D, Atkin SL. Dynamic Change in Insulin Resistance Induced by Free Fatty Acids Is Unchanged Though Insulin Sensitivity Improves Following Endurance Exercise in PCOS. Front Endocrinol (Lausanne) 2018; 9:592. [PMID: 30344510 PMCID: PMC6182066 DOI: 10.3389/fendo.2018.00592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 09/18/2018] [Indexed: 01/02/2023] Open
Abstract
Background: Insulin resistance (IR) is the hallmark of PCOS and it is known that exercise may decrease it. What is unknown is whether exercise may mechanistically alter the underlying IR, attenuating the dynamic lipid induced IR in insulin resistant subjects. Methods: 12 women with polycystic ovary syndrome (PCOS) and 10 age and body mass index matched controls completed an 8 week supervised exercise program at 60% maximal oxygen consumption. Before and after the exercise program, all participants underwent hyperinsulinaemic euglycaemic clamps with either saline or intralipid infusions. Skewed data were log transformed and expressed as mean ± SEM. Results: Before exercise, women with PCOS had a higher HOMA-IR and lower VO2 max than controls. Compared to saline, lipid infusion lowered the rate of insulin stimulated glucose disposal (M value; mg/kg/min) by 67 ± 5% (from 0.5 ± 0.03 to -0.25 ± 0.2, p = 0.01) in PCOS, and by 49 ± 7% (from 0.65 ± 0.06 to 0.3 ± 0.1, p = 0.01) in controls. The M value was significantly less in PCOS compared to controls for both saline (p < 0.01) and lipid (p < 0.05). Endurance exercise in PCOS improved VO2 max and HOMA-IR, but not weight, to those of pre-exercise control subjects. The glucose disposal rate during the lipid infusion was reduced following exercise in PCOS, indicating decreased IR (67 ± 5 vs. 50 ± 7%, p = 0.02), but IR was not altered in controls (49 ± 7 vs. 45 ± 6%, p = 0.58). The incrementally increased IR induced by the lipid infusion did not differ between controls and PCOS. Conclusion: Insulin sensitivity improved with exercise in the PCOS group alone showing that IR can be modified, though likely transiently. However, the maximal IR response to the lipid infusion did not differ within and between control and PCOS subjects, indicating that the fundamental mechanism underlying insulin resistance was unchanged with exercise. Precis: Maximal insulin resistance induced by lipid infusion determined at baseline and 8 weeks after exercise in control and PCOS women did not differ, though insulin sensitivity increased in PCOS after exercise.
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Affiliation(s)
- Myint Myint Aye
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull, United Kingdom
| | | | | | - Richard Kirk
- Department of Sport, Health and Exercise Science, Hull York Medical School, The University of Hull, Hull, United Kingdom
| | - Rebecca Vince
- Department of Sport, Health and Exercise Science, Hull York Medical School, The University of Hull, Hull, United Kingdom
| | - Alan S. Rigby
- The University of Hull, Hull York Medical School, Hull, United Kingdom
| | - Derek Sandeman
- Department of Diabetes and Endocrinology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Stephen L. Atkin
- Weill Cornell Medicine Qatar, Education City, Doha, Qatar
- *Correspondence: Stephen L. Atkin
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Kirk R, Peng E, Woods A, Flett J, Hewitt T, Griselli M, Schueler S, Wrightson N, Hasan A. Successful HeartWare Bridge to Recovery in a 3-Year Old: A Game Changer? Ann Thorac Surg 2016; 101:1984-7. [DOI: 10.1016/j.athoracsur.2015.07.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 06/30/2015] [Accepted: 07/09/2013] [Indexed: 10/21/2022]
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Peng E, Kirk R, Wrightson N, Duong P, Ferguson L, Griselli M, Butt T, O'Sullivan JJ, MacGowan GA, Crossland D, Schueler S, Hasan A. An Extended Role of Continuous Flow Device in Pediatric Mechanical Circulatory Support. Ann Thorac Surg 2016; 102:620-7. [PMID: 27130250 DOI: 10.1016/j.athoracsur.2016.02.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 09/08/2015] [Revised: 12/16/2015] [Accepted: 02/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mechanical circulatory support in the pediatric population is currently limited to pulsatile ventricular assist devices (VAD). In recent years, the use of durable, newer generation, continuous flow devices have increased substantially among adults with end-stage heart failure. We examined the extended role of this device in the pediatric population (aged less than 18 years). METHODS Between 2010 and 2015, 12 patients (median age 7.1 years; range, 3.7 to 17.0; one third of patients were aged 5 years or less) received a HeartWare ventricular assist device (HVAD; HeartWare, Framingham, MA), 11 for cardiomyopathy and 1 for posttransplant rejection. Right VAD support (n = 5; 42%) was provided by a short-term device (Levitronix, Zurich, Switzerland). RESULTS Overall, 1 patient died (day 638), 8 patients (67%) underwent transplantation, 1 patient (8.3%) recovered, and 2 patients (17%) remain on HVAD. The mean length of support was 150 days (range, 16 to 638). Four patients (33.3%) were discharged home (all left VAD). In the left VAD group (n = 7), 3 patients subsequently received transplants (days 185, 201, and 234, respectively), 1 recovered (day 149), 1 died (day 638), 1 remained on HVAD (day 198), and 1 needed conversion to biventricular assist device (BIVAD [day 73]). In the BIVAD group (n = 5), right VAD was weaned in 3 (60%), all subsequently received transplants, and 2 remained on BIVAD support until transplant (days 16 and 17, respectively). One BIVAD patient required conversion to central cannulation for longer-term support. Four BIVAD patients (80%) were in Interagency Registry for Mechanically Assisted Circulatory Support level 1 before VAD compared with 2 (29%) in the left VAD group (p = not significant). The actuarial survival rate was 100% at 1 year with no neurologic events. CONCLUSIONS The third-generation, continuous flow device can provide durable support in the pediatric population. The selection strategy for patients who benefit most from the device continues to evolve. It is anticipated that a smaller design in the future will benefit an even wider pediatric population with heart failure.
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Affiliation(s)
- Ed Peng
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Richard Kirk
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Neil Wrightson
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Phuoc Duong
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Lee Ferguson
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Massimo Griselli
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Tanveer Butt
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - John J O'Sullivan
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Guy A MacGowan
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - David Crossland
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Stephan Schueler
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Asif Hasan
- Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
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Conway J, Miera O, Henderson H, VanderPluym C, Buchholz H, Fenton M, Niebler R, Padalino M, Slaughter M, Lorts A, Schweiger M, Hassan M, Schmitto J, Scheel J, Martin B, Li Y, Parrino P, Morales D, Kirk R. Global Experience with the Heartware HVAD® in Pediatric Patients: A Preliminary Analysis. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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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Kirk R. The Non-Transmission of Abyssinian Louse-Borne Relapsing Fever by the TickOrnithodorus Savignyiand Certain Other Blood-Sucking Arthropods. Annals of Tropical Medicine & Parasitology 2016. [DOI: 10.1080/00034983.1938.11685039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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