Abstract:
BACKGROUND:Pediatric heart-lung transplantation (HLT) is rare, and no report has analyzed patient outcomes since time of listing. We analyzed pediatric HLTs to understand risk factors for waitlist and post-HLT mortality. METHODS:All pediatric (<18 year old) HLT candidates were identified within the UNOS database (n = 573) and grouped by age, era, and by diagnosis. Logistical regression and Cox proportional hazard modeling identified risk factors for 6-month WL and overall post-transplant mortality. RESULTS:209/573 (37%) HLT candidates were transplanted, 7% recovered, 42% died waiting, and 15% were removed for another/unknown reason. Diagnoses were primary pulmonary hypertension(n = 130), congenital heart disease(CHD) without Eisenmenger's syndrome (ES) (n = 65), CHD with ES (n = 73), and other (n = 305). Patients with a diagnosis other than CHD with ES (OR: 7.55, P = .001), on IV inotropic support (OR: 2.79, P < .001), and infants (OR: 2.20, P = .004) were associated with waitlist mortality. There has been a 56% reduction in HLTs across eras (Era 1:10.8/yr vs Era 2:4.7/yr). Risk factors for post-transplant mortality were ECMO (HR: 4.1, P = .016), and being infant (HR: 2.2, P = .04) or 1-11 years old (HR: 1.78, P = .015). ECMO patients have an 87% 2-year mortality rate with a median post-transplant survival of 64 days. Overall, post-transplant survival was unchanged (log-rank P = .067) between eras. Excluding ECMO patients, in the recent era 29 non-infant patients with primary pulmonary hypertension had 93% 1-year survival and 67% 5-year survival. CONCLUSIONS:Nearly 600 pediatric patients have been listed for HLT in UNOS, although numbers are decreasing in the current era. HLT for a patient on ECMO appears to be an ineffective strategy; however, in well-selected cohorts, HLT can provide considerable post-transplant survival.
journal_name
Pediatr Transplantjournal_title
Pediatric transplantationauthors
Riggs KW,Chapman JL,Schecter M,Towe C,Zafar F,Morales DLSdoi
10.1111/petr.13682subject
Has Abstractpub_date
2020-05-01 00:00:00pages
e13682issue
3eissn
1397-3142issn
1399-3046journal_volume
24pub_type
杂志文章abstract::Depression is common in pediatric chronic kidney disease (CKD) patients. Depression is associated with inferior long-term outcomes. There is a paucity of studies that evaluate depression and possible associated factors in children and adolescents requiring renal replacement therapy (RRT). Cross-sectional study using C...
journal_title:Pediatric transplantation
pub_type: 杂志文章
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abstract::Chronic rejection is the leading cause of graft loss following pediatric kidney transplantation. Our group and others have demonstrated an association between the development of Abs to self-antigens and chronic rejection following adult lung and heart transplantation. The goal of this study was to determine whether Ab...
journal_title:Pediatric transplantation
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journal_title:Pediatric transplantation
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doi:10.1111/j.1399-3046.2012.01648.x
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journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/petr.12313
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journal_title:Pediatric transplantation
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doi:10.1111/petr.13176
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journal_title:Pediatric transplantation
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doi:10.1111/petr.12157
更新日期:2014-02-01 00:00:00
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journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/petr.13906
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journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-3046.2009.01198.x
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abstract::In many countries, adolescents can choose to register a deceased organ donation wish when they apply for a driver's license. They often receive education about deceased organ donation in order to make an informed choice. The objective of this review was to describe the effectiveness of school-based educational program...
journal_title:Pediatric transplantation
pub_type: 杂志文章,评审
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journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/petr.13048
更新日期:2017-12-01 00:00:00
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journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-3046.2007.00855.x
更新日期:2008-08-01 00:00:00
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journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/petr.12242
更新日期:2014-06-01 00:00:00
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journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/petr.13547
更新日期:2019-11-01 00:00:00
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journal_title:Pediatric transplantation
pub_type: 杂志文章,多中心研究
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更新日期:2010-09-01 00:00:00
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journal_title:Pediatric transplantation
pub_type: 杂志文章,评审
doi:10.1111/petr.13671
更新日期:2020-05-01 00:00:00
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journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-3046.2011.01489.x
更新日期:2012-08-01 00:00:00
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journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/petr.12914
更新日期:2017-05-01 00:00:00
abstract::Heart transplantations have been performed in the Centre for Paediatric Heart Surgery at the Justus Liebig University in Giessen (Germany) since 1988. For further consultation and therapy, some affected children subsequently present at the Polyclinic for Paediatric Dentistry. In all these cases problematic oral findin...
journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-3046.2005.00429.x
更新日期:2006-03-01 00:00:00
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journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-3046.2008.01101.x
更新日期:2009-12-01 00:00:00
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journal_title:Pediatric transplantation
pub_type: 杂志文章,评审
doi:10.1111/j.1399-3046.2005.00381.x
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journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-3046.2010.01271.x
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pub_type: 杂志文章,评审
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更新日期:2017-05-01 00:00:00
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journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/petr.13346
更新日期:2019-03-01 00:00:00
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journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1046/j.1397-3142.2003.00117.x
更新日期:2003-12-01 00:00:00
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journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/petr.13733
更新日期:2020-09-01 00:00:00
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journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/petr.13296
更新日期:2018-12-01 00:00:00
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journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-3046.2006.00560.x
更新日期:2006-09-01 00:00:00
abstract::In 1999, our center implemented a policy of outpatient protocol biopsies as standard practice for the clinical management of pediatric renal allograft recipients. In order to determine the safety of this procedure, we conducted a retrospective chart audit of all outpatient renal allograft biopsies performed at our cen...
journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/j.1399-3046.2006.00659.x
更新日期:2007-03-01 00:00:00
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journal_title:Pediatric transplantation
pub_type: 杂志文章
doi:10.1111/petr.12128
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journal_title:Pediatric transplantation
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doi:10.1111/j.1399-3046.2010.01425.x
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