Pediatric Heart Transplant Recipients Research Articles

Prevalence of iron deficiency and anemia in pediatric heart transplant recipients.

The prevalence of iron deficiency and anemia in the setting of modern-day maintenance immunosuppression in pediatric heart transplant (HTx) recipients is unclear. The primary aim was to determine the prevalence of iron deficiency (serum ferritin<30ng/mL±transferrin saturation<20%) and anemia per World Health Organization diagnostic criteria and associated risk factors. Single-center, cross-sectional analysis of 200 consecutive pediatric HTx recipients(<21 years old) from 2005 to 2021. Data were collected at 1-year post-HTx at the time of annual protocol biopsy. Median age at transplant was 3 years (IQR.5-12.2). The median ferritin level was 32ng/mL with 46% having ferritin<30ng/mL. Median transferrin saturation (TSAT) was 22% with 47% having TSAT<20%. Median hemoglobin was 11g/dL with 54% having anemia. Multivariable analysis revealed lower absolute lymphocyte count, TSAT<20%, and estimated glomerular filtration rate<75mL/min/1.73m2 were independently associated with anemia. Ferritin<30ng/mL in isolation was not associated with anemia. Ferritin<30ng/mL may aid in detecting absolute iron deficiency while TSAT<20% may be useful in identifying patients with functional iron deficiency±anemia in pediatric HTx recipients. Iron deficiency and anemia are highly prevalent in pediatric HTx recipients. Future studies are needed to assess the impact of iron deficiency, whether with or without anemia, on clinical outcomes in pediatric HTx recipients.

Serologic Evaluation for Severe Acute Respiratory Syndrome Coronavirus 2 in Pediatric Heart Transplantation Recipients and Patients on a Pediatric Heart Transplantation Waiting List in a Quaternary Hospital

BackgroundThe COVID-19 pandemic has been a global reality for over three years. Serological studies have great importance for the comprehension of the virus's behavior in populations, as it can suggest the status of the epidemic in a community. This cross-sectional study aimed to analyze the serological profile for COVID-19 in patients before and after pediatric heart transplant. MethodsSerologies for IgG and IgM antibodies for Sars-CoV-2 were collected in patients of the Pediatric Cardiology and Congenital Heart Diseases unit of a Brazilian hospital between January and August 2022. In total, 174 patients were recruited: 28 on waiting list and 146 recipients. Information such as demographics (age, gender, state of origin), type of heart disease (congenital or acquired) and time after transplant were analyzed. ResultsOverall, 72 patients had a positive serology for anti-N antibodies (48,0%), being 62 transplant recipients and 10 patients on transplant waiting list, with positivity rates of 48,1% and 47,6%, respectively. Positivity rates for previously infected individuals were 62,5% and 62,1%, respectively. ConclusionsWe found that approximately half of the sample has developed IgM or IgG antibodies against the Sars-CoV-2 virus Serological studies are a relevant tool to public health for health promotion of vulnerable groups, and can be useful to future studies on the antibodies’ behavior. The duration and the level of protection given by these antibodies is still a subject being studied, and can become a key information for the protection of these populations if discovered in the future.

Effect of body mass index on exercise capacity following pediatric heart transplantation.

Obesity and impaired exercise tolerance following heart transplantation increase the risk of post-transplant morbidity and mortality. The aim of this study was to evaluate the effect of body mass index on markers of exercise capacity in pediatric heart transplant recipients and compare this effect with a healthy pediatric cohort. A retrospective analysis of cardiopulmonary exercise test data between 2004 and 2022 was performed. All patients exercised on a treadmill using the Bruce protocol. Inclusion criteria included patients aged 6-21 years, history of heart transplantation (transplant cohort) or no cardiac diagnosis (control cohort) at the time of testing, and a maximal effort test. Patients were further stratified within these two cohorts as underweight, normal, overweight, and obese based on body mass index groups. Two-way analyses of variance were performed with diagnosis and body mass index category as the independent variables. A total of 250 exercise tests following heart transplant and 1963 exercise tests of healthy patients were included. Heart transplant patients across all body mass index groups had higher resting heart rate and lower maximal heart rate, heart rate recovery at 1 min, exercise duration, and peak aerobic capacity (VO2peak). Heart transplant patients in the normal and overweight body mass index categories had higher VO2peak and exercise duration when compared to underweight and obese patients. Underweight status and obesity are strongly associated with lower VO2peak and exercise duration in heart transplant patients. Normal and overweight heart transplant patients had the best markers of exercise capacity.

Approval of Mycophenolate Mofetil for Prophylaxis of Organ Rejection in Pediatric Recipients of Heart or Liver Transplants: A Regulatory Perspective.

On June 6, 2022, the FDA expanded the indications for mycophenolate mofetil (MMF) to include the prophylaxis of organ rejection in combination with other immunosuppressants in pediatric recipients of allogeneic heart or liver transplants aged 3 months and older. The approved oral dosing regimen for these patients was a starting dose of 600 mg/m2 with titration up to a maximum of 900 mg/m2 twice daily. Data to support efficacy in pediatric patients were derived from established pharmacokinetic (PK) relationships across approved populations, a PK study in pediatric liver transplant recipients, and information from the Scientific Registry of Transplant Recipients database. Information supporting safety was based on comparing mycophenolic acid (MPA) exposure with that in pediatric kidney transplant recipients, the published literature, and post-marketing safety reports. Efficacy in pediatric patients was established based on extrapolation of efficacy from studies in adult liver, adult heart, and pediatric kidney transplant populations, and similarity in MPA exposure between pediatric and adult patients. Review of the data supported an oral dosing regimen for pediatric heart transplant and liver transplant recipients consisting of a starting dose of 600 mg/m2 up to a maximum of 900 mg/m2 b.i.d. A dosage range for MMF is recommended recognizing that the MMF dose may be modified in clinical practice for myriad factors. The dosage recommendations in the labeling for pediatric liver and pediatric heart transplant patients are intended to permit individualized dosing based on clinical assessment of these factors.

A multi-centre randomised control trial of directly observed therapy to promote medication adherence in paediatric heart transplant recipients.

Medication non-adherence remains a significant challenge for adolescent heart transplant recipients. Building on the success of a pilot intervention study, herein we describe the protocol for a follow-up randomised control trial using mobile video directly observed therapy, featuring several innovations, to promote medication adherence in a multi-centre sample of adolescent heart transplant patients.

Let's get physical: Aerobic capacity, muscle strength, and muscle endurance after pediatric heart transplantation.

Pediatric heart (HTx) and kidney transplant (KTx) recipients may have lower physical fitness than healthy children. This study sought to quantify fitness levels in transplant recipients, investigate associations to clinical factors and quality of life, and identify whether a quick, simple wall-sit test is feasible as a surrogate for overall fitness for longitudinal assessment. Aerobic capacity (6-min walk test, 6MWT), normalized muscle strength, muscle endurance, physical activity questionnaire (PAQ), and quality of life (PedsQL™) were prospectively assessed in transplanted children and matched healthy controls. Twenty-two HTx were compared to 20 controls and 6 KTx. 6MWT %predicted was shorter in HTx (87.2 [69.9-118.6] %) than controls (99.9 [80.4-120] %), but similar to KTx (90.3 [78.6-115] %). Muscle strength was lower in HTx deltoids (6.15 [4.35-11.3] kg/m2) and KTx quadriceps (9.27 [8.65-19.1] kg/m2) versus controls. Similarly, muscle endurance was lower in HTx push-ups (28.6 [0-250] %predicted), KTx push-ups (8.35 [0-150] %predicted), HTx curl-ups (115 [0-450] %predicted), and KTx wall-sit time (18.5 [10.0-54.0] s) than controls. In contrast to HTx with only 9%, all KTx were receiving steroid therapy. The wall-sit test significantly correlated with other fitness parameters (normalized quadriceps strength R = .31, #push-ups R = .39, and #curl-ups R = .43) and PedsQL™ (R = .36). Compared to controls, pediatric HTx and KTx have similarly lower aerobic capacity, but different deficits in muscle strength, likely related to steroid therapy in KTx. The convenient wall-sit test correlates with fitness and reported quality of life, and thus could be a useful easy routine for longitudinal assessment.

(1318) - Pulse Wave Velocity in Pediatric Heart Transplant Recipients- A Marker of Vascular Health

(1318) - Pulse Wave Velocity in Pediatric Heart Transplant Recipients- A Marker of Vascular Health

(65) - History of Donor Drug Use and Post-Transplant Survival in Pediatric Heart Transplant Recipients: A Propensity Score Matched Analysis

(65) - History of Donor Drug Use and Post-Transplant Survival in Pediatric Heart Transplant Recipients: A Propensity Score Matched Analysis

(1345) - Socioeconomic Status and Major Adverse Transplant Events in Pediatric Heart Transplant Recipients

(1345) - Socioeconomic Status and Major Adverse Transplant Events in Pediatric Heart Transplant Recipients

(1335) - Cardiac Magnetic Resonance Imaging can Differentiate Rejection on Molecular Gene Expression Profiling in Pediatric Heart Transplant Recipients

(1335) - Cardiac Magnetic Resonance Imaging can Differentiate Rejection on Molecular Gene Expression Profiling in Pediatric Heart Transplant Recipients

(224) - Correlation of Donor-Derived Cell-Free DNA to Rejection Events in Pediatric Heart Transplant Recipients

(224) - Correlation of Donor-Derived Cell-Free DNA to Rejection Events in Pediatric Heart Transplant Recipients

(1336) - Pulmonary Vein Stenosis in Pediatric Heart Transplant Recipients: A Single-Center Case Series

(1336) - Pulmonary Vein Stenosis in Pediatric Heart Transplant Recipients: A Single-Center Case Series

(1373) - Successful Utilization of Organ Care System in Three Pediatric Heart Transplant Recipients

(1373) - Successful Utilization of Organ Care System in Three Pediatric Heart Transplant Recipients

(1355) - Effects of Fluconazole Discontinuation on the Pharmacokinetics of Immunosuppression in Pediatric Heart Transplant Recipients

(1355) - Effects of Fluconazole Discontinuation on the Pharmacokinetics of Immunosuppression in Pediatric Heart Transplant Recipients

(63) - Decreased Risk of Primary Graft Dysfunction with the SherpaPak Cardiac Transport System in Pediatric Heart Transplant Recipients

(63) - Decreased Risk of Primary Graft Dysfunction with the SherpaPak Cardiac Transport System in Pediatric Heart Transplant Recipients

(1320) - Distribution of Donor-Derived Cell-Free DNA Levels in Pediatric Heart Transplant Recipients

(1320) - Distribution of Donor-Derived Cell-Free DNA Levels in Pediatric Heart Transplant Recipients

(1346) - Panel Reactive Antibody, Crossmatch Status, and Outcomes in Pediatric Heart Transplant Recipients with Congenital Heart Disease: An Analysis of the United Network for Organ Sharing Database

(1346) - Panel Reactive Antibody, Crossmatch Status, and Outcomes in Pediatric Heart Transplant Recipients with Congenital Heart Disease: An Analysis of the United Network for Organ Sharing Database

(999) - Fibrosis and Microvessel Disease are Common Findings on Endomyocardial Biopsy in Pediatric Heart Transplant Recipients

(999) - Fibrosis and Microvessel Disease are Common Findings on Endomyocardial Biopsy in Pediatric Heart Transplant Recipients

(73) - Favorable Use of Daratumumab in Highly Sensitized Pediatric Heart Transplant Candidates and Recipients

(73) - Favorable Use of Daratumumab in Highly Sensitized Pediatric Heart Transplant Candidates and Recipients

(1380) - Donation After Circulatory Death: Changing the Timeline of Pediatric Heart Transplant Recipients

(1380) - Donation After Circulatory Death: Changing the Timeline of Pediatric Heart Transplant Recipients