Blood type incompatible cardiac transplantation in young infants

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Blood type incompatible cardiac transplantation in young infants"

Transcription

1 European Journal of Cardio-thoracic Surgery 31 (2007) Blood type incompatible cardiac transplantation in young infants Sabine H. Daebritz a, *,1, Michael Schmoeckel a,1, Helmut Mair a, Rainer Kozlik-Feldmann b, Georg Wittmann c, Christian Kowalski d, Ingo Kaczmarek a, Bruno Reichart a a Department of Cardiac Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany b Department of Pediatric Cardiology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany c Department of Transfusion Medicine, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany d Department of Anesthesiology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany Received 14 June 2006; received in revised form 22 November 2006; accepted 24 November 2006; Available online 17 January 2007 Abstract Objective: Donor organ shortage in pediatric heart transplantation (HTx) is causing mortality rates of 30 50% on the waiting list. Due to immaturity of the immune system of newborns and infants, ABO-incompatible HTx may be an option to increase donor availability. We present our experience with ABO-incompatible HTx. Methods: Three infants were transplanted ABO-incompatible since 12/2004: (1) hypoplastic left heart complex, (2) restrictive hypertrophic cardiomyopathy, (3) dilative cardiomyopathy. Age at HTx was 7, 5, and 3.5 months. All recipients had blood type O, donors were A, A, and B. Informed consent was given by parents, the ethics committee, and Eurotransplant. Results: Preoperative isohemagglutinin titers were low (Patient 1: 1:4 for anti-a1, A2, B, Patient 2: 1:4, 1:1, 1:4 for anti-a1, A2, B, respectively, and Patient 3: 0 for all, but quick spin 1+ for all). Intraoperatively, plasma was separated from red blood cells and discarded up to six times until antibodies were eliminated. Immunosuppressive induction with ATG was started for 5 days. Basic immunosuppression consisted of tacrolimus, mycophenolate mofetil, and prednisone. Extubation was performed on days 15, 2, and 1, respectively. After a follow-up of 17, 16, and 12 months all patients are well, ventricular function is excellent without any acute rejection periods; Patient 1 is still on dialysis. Isohemagglutinin titers against donor blood type have disappeared in follow-up. Conclusions: ABO-incompatible cardiac transplantation shows good short-term results in young infants and seems to be a safe procedure to lower the mortality on the waiting list. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. Keywords: Pediatric heart transplantation; ABO-incompatible; Congenital heart surgery; Heart transplantation 1. Introduction Donor organ shortage causes an estimated mortality 30 50% on the waiting list for pediatric heart transplant candidates of in Germany. Recently, West et al. [1] reported a series of successful ABO-incompatible heart transplants in newborns and young infants. They noted a remarkable decline in mortality rates on the waiting list from 58% to 10%. Blood-incompatible liver [2] and kidney [3] transplantation have been performed with favorable results, if antibody titers were reduced prior to transplantation. ABO-incompatible heart transplantation (Htx) other than with blood type O donors in a grown-up population has been done only by Presented at the joint 19th Annual Meeting of the European Association for Cardio-thoracic Surgery and the 13th Annual Meeting of the European Society of Thoracic Surgeons, Barcelona, Spain, September 25 28, * Corresponding author. Address: Cardiac Surgery, University Hospital Grosshadern, D Munich, Germany. Tel ; fax: address: (S.H. Daebritz). 1 Both authors contributed equally to the manuscript. mistake and is associated with a high mortality [4]. This is in contrast to newborns and young infants, who have a relative immature immunologic system with limited production of isohemagglutinins. On the basis of this, West et al. started ABO-incompatible HTx in 1996, following a standardized protocol for preoperative antibody reduction by plasmapheresis [1]. Comparable results have been reported by Rao et al. [5]. Since December 2004, we transplanted three infants crossing the blood group compatibility barrier; during the same time, only one infant of the same age group received a donor organ compatible with the recipient s blood type. We report on our experience with these three patients. 2. Patients and methods All three patients had blood group O, isohemagglutinin titers were 1:4 or less, so that patients were amenable for ABO-incompatible heart transplantation according to the protocol defined by West et al. [West, personal communication]. Informed consent was given by the /$ see front matter # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. doi: /j.ejcts

2 340 S.H. Daebritz et al. / European Journal of Cardio-thoracic Surgery 31 (2007) parents, the ethical committee of the German Physicians Association, and the Eurotransplant International Foundation Patient 1 The first patient was referred with hypoplastic left heart complex with aortic stenosis, ASD, and endocardiofibroelastosis. Interventional ASD-closure and aortic balloon valvuloplasty to establish two-ventricle circulation failed; left ventricular function did not improve and the left ventricle did not grow due to endocardfibroelastosis. Consecutively, the patient developed congestive heart failure (CHF) and renal failure necessitating peritoneal dialysis. After 2 months on the waiting list in high-urgent status, she was listed ABO-incompatible and received a donor organ blood type A1 2 weeks later, at the age of 7 months Patient 2 The second patient had restrictive hypertrophic cardiomyopathy with congestive heart failure and several periods of medical resuscitation. He was on inotropes and had to be ventilated on the waiting list. After 2 weeks in high-urgent status, he was listed ABO-incompatible because he became borderline for mechanical circulatory support. He received a donor organ blood type A1 1 week later, at the age of 5 months Patient 3 The third patient was diagnosed with dilative cardiomyopathy at the age of 2.5 months. She was directly listed in high-urgent status of ABO-incompatible being on inotropes, but not ventilated. After 1 day she received a donor organ blood type B at the age of 3.4 months Operative management ABO-incompatible transplantation in these patients was performed according to the protocol kindly provided by Lori West (formerly Hospital for Sick Children, Toronto). The parents gave informed consent for ABO-incompatible HTx. After permission of the Review Commission of the German Medical Council, Eurotransplant International Foundation agreed to allocate a respective donor organ under certain conditions. These included that no ABOcompatible recipient of the same size was waiting in highurgent status Pretransplant recipient management Anti-A1/A2 and anti-b antibody levels were determined in weekly intervals using standard reverse blood grouping hemagglutination methods described elsewhere [6]. An urgent blood test was done just prior to transplantation. In addition, the blood bank provided a semiquantitative antibody measurement within 30 min ( quick-spin ), giving the results as negative or 1 4 positive [6]. Intraoperatively, all blood samples were taken from the cardio-pulmonary bypass circuit (CPB). Patients 1 and 2 had positive antibody titers preoperatively. Although Patient 3 had only a 1+ positive semiquantitative assessment with negative titers, all patients underwent plasma exchange intraoperatively. The CPB circuit was filled with red blood cells (2 units) of blood type O (recipient blood type) and plasma (2 units) of the donor blood type (A or B in our patients) or AB. Red blood cells were irradiated and all blood products were CMV-negative (Table 1). Immediately after commencing CPB, whole blood was withdrawn via the venous line and volume was substituted from the CPB circuit via the arterial cannula (s.a.). During surgery, plasma exchange was done by withdrawal of 2 3- fold the patient s total blood volume. The red cell fraction from the extracted blood was separated, diluted, washed, and centrifuged achieving an elimination of plasma of 99% [6,7]. Antibodies were assessed at least twice after plasma exchange. In case antibodies were elevated, plasma exchange was repeated up to six times. Red cell retransfusion and donor organ reperfusion were not started until antibodies were negative or remained 1+ positive after several runs. Orthotopic heart transplantation was performed according to the standard technique of Lower and Shumway during plasma exchange Postoperative recipient management Postoperatively, quantitative antibody titers were assessed every day for 2 weeks and subsequently weekly for 2 months and after that monthly [1]. After 6 months, patients were seen in 3-month intervals. Immunosuppression consisted of induction therapy with antithymocyte globulin (ATG; 3 mg/kg bolus, then 2 mg/kg/d), adjusted to reach a lymphocyte count of /ml until sufficient plasma levels of tacrolimus (Tac) were achieved. Intravenous methylprednisolone (30 mg/ kg) was given before release of the aortic cross-clamp, tapered down (3 mg/kg/d, 2 days, 2 mg/kg/d and Table 1 Anti-A1/A2 B antibody titers of Patients 1 and 2 Patient Recipient blood group Donor blood group Preoperative titers anti- 1-day postoperative anti- 1-week postoperative anti- Highest in follow-up Latest in follow-up A1 A2 B A1 A2 B A1 A2 B A1 A2 B A1 A2 B 1 O A 1:4 1:4 0 1: : :1 0 1: :1 2 O A 1: : :2 0 1: :1 3 O B (1+ a ) :1 0 1:1 1:1 1:1 1:1 1:1 1:1 0 a Quick-spin result.

3 S.H. Daebritz et al. / European Journal of Cardio-thoracic Surgery 31 (2007) mg/kg/d each for 2 days), and maintained with 0.5 mg/ kg/d. Maintenance immunosuppressants were Tac and mycophenolate mofetil (MMF) with through levels of and 2 5 ng/dl, respectively. Rejection monitoring included daily echocardiography, clinical signs, and cyto-immunological monitoring [8]. After discharge, patients were seen monthly in the outpatient transplant clinic, for ECG, echocardiography, and control of their immunosuppressants. Cardiac catheterization or endomyocardial biopsies are not routinely performed in pediatric patients in our institution, but these patients are scheduled for biopsy in the second year after HTx. 3. Results All three patients were positive for antibodies, two had borderline titers (1:4) for anti-a/b according to the Toronto ABO-incompatible heart transplant protocol, and the third patient had 1+ positive assessment of anti-a and anti-b antibodies. Thus, all patients underwent plasma exchange on CPB. In Patient 1, after the fourth plasma exchange, the quick spin was 1+ and the corresponding anti-a titer was 1:1. As there was no change after another two exchange runs, these antibodies were accepted without any complication. Patient 2 had negative antibodies after five exchange runs. Patient 3 underwent one plasma exchange; thereafter antibodies were negative. Surgery, reperfusion, and weaning from CPB were uneventful in all three patients. Extubation was performed on postoperative days 15, 2, and 1, respectively. Patient 1 showed only a transient increase in urine output after Htx, so that she had to stay on peritoneal dialysis with intermittent periods of hemodialysis because of peritoneal catheter problems. Immunosuppression was administered according to the protocol (s.a.) except for Patient 1. She received additional monoclonal antibodies (daclizumab 6 mg/d) to cover low Tac levels, which were slowly increased as kidney function seemed to recover. However, she had to stay on peritoneal dialysis, causing a hospitalization of 3 months post-htx. Fig. 1. Anti-graft isohemagglutinins. Anti-A antibodies are at maximum 1:1, but anti-b titers are found at rising levels (Figs. 1 and 2) during follow-up of 17 months. The patient is doing well apart from the peritoneal dialysis performed at home. She has undergone cardiac catheterization with biopsy without any pathological finding. In Patient 2, anti-a1 levels became detectable on day 3 (titer 1:1) without any obvious impairment of hemodynamic function; titers disappeared after 3 months. The patient is in excellent clinical condition after a follow-up of 16 months. He has developed low titers against blood type B (Figs. 1 and 2). In Patient 3, anti-b antibodies were detected after 1 month, but then disappeared. After a follow-up of 12 months the clinical course has been uneventful. She has no anti-b titers, but low titers against A1 and A2 (Figs. 1 and 2). Overall, titers against the respective donor blood type are not found while isohemagglutinins against the remaining blood types develop at low levels. The clinical course is uneventful without any rejection episodes and normal ventricular function in echocardiography. 4. Discussion Fig. 2. Anti-non graft isohemagglutinins (log scale). Pediatric heart transplant recipients on the waiting list have a higher mortality compared to adults [9]. First, the donor and recipient pool is much smaller, so that some organs cannot be allocated due to the unavailability of a suitable recipient despite donor shortage. Second, bridging methods are limited and carry a mortality of up to 50% [10]. On the basis of the increased knowledge of the immaturity of the immune system of the newborns and young infant, particularly with respect to carbohydrate antibody production, West et al. introduced and successfully performed ABO-incompatible heart transplantation in this age group [1]. In adults, ABO-incompatible liver and kidney transplantation has shown good results [3,11,12]. In Japan living related kidney transplantation with preoperative antibody removal by double filtration plasmapheresis (DFPP) was evaluated [3]. Long-term graft survival was 76.9 and 55.9% after 5 and 10 years and independent of preoperative anti-a/b antibody titers [13]. However, in cadaveric kidney transplantation of ABO-incompatible grafts, the 1- and 10-year survival rates of

4 342 S.H. Daebritz et al. / European Journal of Cardio-thoracic Surgery 31 (2007) and 56% still remain inferior compared with 96 and 67% of ABO-compatible grafts [12]. In contrast, heart transplantation crossing blood type barriers has only been done sporadically and mostly result from erroneous allocation of donor organs [4]. In a survey of almost 5000 heart transplants, Cooper identified only eight ABO-incompatible heart transplants [4]; five hearts were hyperacutely rejected, three patients had retransplantation, and early mortality was 50%. In other case reports urgent retransplantation with ABO-compatible grafts was performed [14,15]. Only sporadically, ABO-incompatible thoracic transplantation showed good outcome under use of additional immunosuppressants (ATG, anti-cd20, TP10), C1-esterase inhibitors, plasmapheresis, and exchange and extracorporeal immunoadsorption [16 18]. Therefore, ABO-incompatible heart transplantation is not recommended in adults [2]. Due to the immature immune system in small children which starts to mature by contact with gut bacteria after birth, isohemagglutinins are undetectable during the first months of life [19]. Thus, in 2001, West et al. reported a series of 10 infants less than 14 months of age who underwent ABO-incompatible heart transplantation in Toronto [1]. During CPB, the total body volume of recipient plasma was exchanged until circulating blood type antibodies were undetectable. No hyperacute rejection occurred; overall survival rate was 80%. Two deaths 24 and 29 days after transplant were unrelated to ABO incompatibility. A followup 3 years later revealed donor-specific B-cell tolerance in the recipients [20]. B-cells were capable of producing antibodies other than those against the donor blood type, so that the lack of donor-specific antibodies was not due to immunosuppression or dysfunction of B-cells. There is now evidence that donor-specific B-cell elimination is the mechanism of tolerance induction in recipients of ABOincompatible donor hearts [21]. All three recipients in our study had blood type O associated with a longer waiting time and mortality on the waiting list [9]. Thus, we started a program of ABOincompatible heart transplantation in infants combining intraoperative plasma exchange during CPB with our standard immunosuppressive protocol. The standard agglutination tests to determine anti-a and -B antibodies were complemented by the quick spin isohemagglutinin test which was established at our Department of Transfusion Medicine with a 24 h availability. In one of our patients, an anti-a1 titer of 1:1 remained detectable after six plasma exchange runs without any hyperacute or delayed rejection. Obviously, a remaining antibody titer of 1+ in quick spin is acceptable. The autotransfusion device used perioperatively to recover autologous red cells proved to be safe to remove all circulating isohemagglutinins during the washing procedure. Isohemagglutinin titers were undetectable in all samples that were taken from washed red cells (data not shown). The upper limit of the preoperative isohemagglutinin antibody titer and/or age for ABO-incompatible heart transplantation remains to be determined. West et al. successfully transplanted one 14-month-old child with a 1:128 anti-a titer while Rao et al. did not exceed a maximum titer of 1:8, although the oldest recipient was 21 months old. Our recipients had maximum titers of 1:4 and were under 1 year of age. In summary, isohemagglutinin titers seem to be better predictors of postoperative outcome than age. Donor-specific isohemagglutinins disappeared in all three of our patients within 4 months while the corresponding antinon-graft isohemagglutinins remained detectable at low levels. These results reflect the experience of the Toronto group that infants develop acquired B-cell tolerance most probably due to donor-specific B-cell elimination [20,21]. Our immunosuppressive protocol as well as that of the Toronto group included Tac and MMF, because MMF is supposed to have a greater effect on B-lymphocytes and thus on antibody production [1]. Shimmura et al. reported favorable results of ABO-incompatible living kidney transplantation in adults under Tac or MMF in comparison to cyclosporine and azathioprin [13]. The use of Tac and MMF may therefore have contributed to the excellent outcome even in the subset of patients beyond the neonatal period [21,22]. In conclusion, our results reconfirm that ABO-incompatible heart transplantation in the infant age group is safe provided that preoperative isohemagglutinin titers are low and intraoperative plasma exchange is performed until titers are almost undetectable. As the outcome after transplantation is not adversely altered [22] we are encouraged to proceed with the program in order to reduce mortality on the waiting list as shown by the Toronto group and others [5,22 24]. References [1] West LJ, Pollock-Barziv SM, Dipchand, Lee KJ, Cardella CJ, Benson LN, Rebeyka IM, Coles JG. ABO-incompatible heart transplantation in infants. N Engl J Med 2001;344: [2] Wu A, Bühler LH, Cooper DKC. ABO-incompatible organ and bone marrow transplantation: current status. Transpl Int 2003;16: [3] Ishida H, Koyama I, Sawada T, Utsumi K, Murakami T, Sannomiya A, Tsuji K, Yoshimura N, Tojimbara T, Nakajima I, Tanabe K, Yamaguchi Y, Fuchinoue S, Takahashi K, Teraoka S, Ito K, Toma H, Agishi T. Anti-AB titer changes in patients with ABO incompatibility after living related kidney transplantations: survey of 101 cases to determine whether splenectomies are necessary for successful transplantation. Transplantation 2000;70: [4] Cooper DKC. Clinical survey of heart transplantation between ABO blood group-incompatible recipients and donors. J Heart Transplant 1990;9: [5] Rao JN, Hasan A, Hamilton JR, Bolton D, Haynes S, Smith JH, Wallis J, Kesteven P, Khattak K, O Sullivan J, Dark JH. ABO-incompatible heart transplantation in infants: the Freeman Hospital experience. Transplantation 2004;77: [6] Schmoeckel M, Daebritz SH, Kozlik-Feldmann R, Wittmann G, Christ F, Kowalski C, Meiser BM, Netz H, Reichart B. Successful ABO-incompatible heart transplantation in two infants. Transpl Int 2005;18: [7] Shulman G. Quality of processed blood for autotransfusion. J Extracorp Technol 2000;32:11 9. [8] Schubel C, Caca K, Dirschedl P, Hammer C, Kemkes BM. Reliability of cytoimmunological monitoring after heart transplantation by consensus measurement: a multicenter study. Transplant Proc 1990;22: [9] Morrow WR, Naftel D, Chinnock R, Canter C, Boucek M, Zales V, McGiffin DC, Kirklin JK. Outcome of listing for heart transplantation in infants younger than six months: predictors of death and interval to transplantation. The Pediatric Heart Transplantation Study Group. J Heart Lung Transplant 1997;16: [10] Kaczmarek I, Sachweh J, Groetzner J, Gulbins H, Mair H, Rainer KF, Zysk S, Reichart B, Daebritz S. Mechanical circulatory support in pediatric patients with the MEDOS assist device. ASAIO J 2005;51:

5 S.H. Daebritz et al. / European Journal of Cardio-thoracic Surgery 31 (2007) [11] Alexandre GP, Squifflet JP, De Bruyere M, Latinne D, Reding R, Gianello P, Carlier M, Pirson Y. Present experiences in a series of 26 ABO-incompatible living donor renal allografts. Trans Proc 1987;19: [12] Tanabe K, Tokumoto T, Ishida H, Toma H, Nakajima I, Fuchinoue S, Teraoka S. ABO-incompatible renal transplantation at Tokyo Women s Medical University. Clin Transpl 2003; [13] Shimmura H, Tanabe K, Ishida H, Tokumoto T, Ishikawa N, Miyamoto N, Shirakawa H, Setoguchi K, Nakajima I, Fuchinoue S, Teraoka S, Toma H. Lack of correlation between results of ABO-incompatible living kidney transplantation and anti-abo blood type antibody titers under our current immunosuppression. Transplantation 2005;80: [14] Pikul FJ, Bolman RM, Saffitz JE. Anti-B-mediated rejection of an ABOincompatible cardiac allograft despite aggressive plasma exchange transfusion. Trans Proc 1987;19: [15] Albrechtsen D, Geiran O, Foerster A, Fauchald P, Flesland O, Lindberg H, Solheim BG, Vartdal F, Froysaker T. Cardiac transplantation from a blood group ABO-incompatible donor: a case report. Trans Proc 1990;22:143. [16] Banner NR, Rose ML, Cummins D, de Silva M, Pottle A, Lyster H, Doyle P, Carby M, Khaghani A. Management of an ABO-incompatible lung transplant. Am J Transplant 2004;4(7): [17] Koestner SC, Kappeler A, Schaffner T, Carrel TP, Nydegger UE, Mohasci P. Histo-blood group type change of the graft from B to O after SBO mismatched heart transplantation. Lancet 2004;363: [18] Pierson RN, Loyd JE, Goodwin A, Majors D, Dummer JS, Mohasci P, Wheeler A, Bovin N, Miller GG, Olson S, Johnson J, Rieben R, Azimzageh A. Successful management of an ABO-mismatched lung allograft using antigen-specific immunoadsorption, complement inhibition, and immunomodulatory therapy. Transplantation 2002;74(1): [19] Fong SW, Qaqundah BY, Taylor WF. Developmental patterns of ABO isohemagglutinins in normal children correlated with the effects of age, sex, and maternal isohemagglutinins. Transfusion 1974;14: [20] Fan X, Ang A, Pollock-Barziv SM, Dipchand AI, Ruiz P, Wilson G, Platt JL, West LJ. Donor specific B-cell tolerance after ABO-incompatible infant heart transplantation. Nat Med 2004;10: [21] West LJ. B-cell tolerance following ABO-incompatible infant heart transplantation. Transplantation 2006;81: [22] West LJ, Karamlou T, Dipchand AI, Pollock-BarZiv SM, Coles JG, McCrindle BW. Impact on outcomes after listing and transplantation, of a strategy to accept ABO blood group-incompatible donor hearts for neonates and infants. J Thorac Cardiovasc Surg 2006;131: [23] McMahon AM, van Doorn C, Burch M, Whitmore P, Neligan S, Rees P, Radley-Smith R, Goldman A, Brown K, Cohen G, Tsang V, Elliott M, de Leval MR. Improved early outcome for end-stage dilated cardiomyopathy in children. J Thorac Cardiovasc Surg 2003;126: [24] Rodriguez RJ, Addonizio LJ, Lamour JM, Mital S, Mosca R, West LJ, Nova JC, Hsu DT. Pediatric heart transplantation across ABO blood type barriers: a case study. Prog Transplant 2005;15: Appendix A. Conference discussion Dr S. Aharinejad (Vienna, Austria): Do you know anything about the longterm survival, overall survival, not from your studies but published in the literature? I m not in this field. It s just for my curiosity. Dr Daebritz: The longest follow-up is 8 years now in the registry. It is from the Toronto group, and, as they are running the registry, they compared ABOincompatible to ABO-compatible results. The ABO-incompatible patients are even slightly better, but this, of course, is not statistically significant. Dr S. Brann (St. Augustine, Trinidad and Tobago): Can you please tell me how your postop immunosuppression has changed, if at all? Dr Daebritz: It hasn t changed at all. We use the standard immunosuppression regimen, which is used for ABO-compatible transplantation as well. Dr C. Stremmel (Freiburg, Germany): I have a question concerning the long-run. In the literature, do these transplanted people need less immunosuppressive agents after 1 or 2 years so that they are also tolerant on the T-cell field? Dr Daebritz: There is no evidence on that. We don t have any idea what this exposure to another blood type does with the T-cell immune system. It may sensitize it, but it may also cause tolerance. This is totally unknown and both are possible. Therefore, nobody has so far reduced immunosuppression in these patients.

Transplant in Pediatric Heart Failure

Transplant in Pediatric Heart Failure Transplant in Pediatric Heart Failure Francis Fynn-Thompson, MD Co-Director, Center for Airway Disorders Surgical Director, Pediatric Mechanical Support Program Surgical Director, Heart and Lung Transplantation

More information

Surgery for Congenital Heart Disease. Improved early outcome for end-stage dilated cardiomyopathy in children

Surgery for Congenital Heart Disease. Improved early outcome for end-stage dilated cardiomyopathy in children Improved early outcome for end-stage dilated cardiomyopathy in children Anne-Marie McMahon, MRCPCH Carin van Doorn, FRCS (C/Th) Michael Burch, FRCP Pauline Whitmore, RSCN Sophie Neligan, RSCN Philip Rees,

More information

Strategies for Desensitization

Strategies for Desensitization Strategies for Desensitization Olwyn Johnston MB, MRCPI, MD, MHSc BC Nephrology Day October 8 th 2010 Pre-transplant crossmatch (CMX) with donor lymphocytes has been standard of practice Positive CDC CXM

More information

Living-donor kidney transplantation across ABO barriers: the first case in Thailand

Living-donor kidney transplantation across ABO barriers: the first case in Thailand Asian Biomedicine Vol. 3 No. 5 October 2009; 525-529 Clinical report Living-donor kidney transplantation across ABO barriers: the first case in Thailand Yingyos Avihingsanon a, Natavudh Townamchai a, Supanit

More information

Post Operative Management in Heart Transplant นพ พ ชร อ องจร ต ศ ลยศาสตร ห วใจและทรวงอก จ ฬาลงกรณ

Post Operative Management in Heart Transplant นพ พ ชร อ องจร ต ศ ลยศาสตร ห วใจและทรวงอก จ ฬาลงกรณ Post Operative Management in Heart Transplant นพ พ ชร อ องจร ต ศ ลยศาสตร ห วใจและทรวงอก จ ฬาลงกรณ Art of Good Cooking Good Ingredient Good donor + OK recipient Good technique Good team Good timing Good

More information

NAPRTCS Annual Transplant Report

NAPRTCS Annual Transplant Report North American Pediatric Renal Trials and Collaborative Studies NAPRTCS 2014 Annual Transplant Report This is a privileged communication not for publication. TABLE OF CONTENTS PAGE II TRANSPLANTATION Section

More information

Risk Factor Analysis in Pediatric Heart Transplantation

Risk Factor Analysis in Pediatric Heart Transplantation PEDIATRIC TRANSPLANTATION Risk Factor Analysis in Pediatric Heart Transplantation Yanto Sandy Tjang, MD, DSc, a,b Hans Stenlund, PhD, b Gero Tenderich, MD, PhD, a Lech Hornik, MD, a Andreas Bairaktaris,

More information

Transplantation in Australia and New Zealand

Transplantation in Australia and New Zealand Transplantation in Australia and New Zealand Matthew D. Jose MBBS (Adel), FRACP, FASN, PhD (Monash), AFRACMA Professor of Medicine, UTAS Renal Physician, Royal Hobart Hospital Overview CKD in Australia

More information

Glossary. Anesthesiologist A doctor who puts you or parts of your body to sleep during surgery.

Glossary. Anesthesiologist A doctor who puts you or parts of your body to sleep during surgery. 1-Glossary Glossary Acute rejection A type of rejection that occurs when immune cells from your body attack the transplanted organ(s). Acute rejection may occur at any time after a transplant. But it usually

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Index Note: Page numbers of article titles are in boldface type. A Ablation, radiofrequency, anesthetic considerations for, 479 489 Acute aortic syndrome, thoracic endovascular repair of, 457 462 aortic

More information

Solid Organ Transplantation 1. Chapter 55. Solid Organ Transplant, Self-Assessment Questions

Solid Organ Transplantation 1. Chapter 55. Solid Organ Transplant, Self-Assessment Questions Solid Organ Transplantation 1 Chapter 55. Solid Organ Transplant, Self-Assessment Questions Questions 1 to 9 are related to the following case: A 38-year-old white man is scheduled to receive a living-unrelated

More information

Pediatric cardiac retransplant: Differing patterns of primary graft failure by age at first transplant

Pediatric cardiac retransplant: Differing patterns of primary graft failure by age at first transplant Karamichalis et al Cardiothoracic Transplantation Pediatric cardiac retransplant: Differing patterns of primary graft failure by age at first transplant John M. Karamichalis, MD, a,b Shelley D. Miyamoto,

More information

3/15/2016. Application and Clinical Experience of Using an Adult VAD in the Pediatric Setting

3/15/2016. Application and Clinical Experience of Using an Adult VAD in the Pediatric Setting Application and Clinical Experience of Using an Adult VAD in the Pediatric Setting Bradley Kulat CCP, LP Coordinator of Perfusion Services Lurie Children s Hospital of Chicago Pediatric Perfusion Population

More information

Pharmacology notes Interleukin-2 receptor-blocking monoclonal antibodies: evaluation of 2 new agents

Pharmacology notes Interleukin-2 receptor-blocking monoclonal antibodies: evaluation of 2 new agents BUMC Proceedings 1999;12:110-112 Pharmacology notes Interleukin-2 receptor-blocking monoclonal antibodies: evaluation of 2 new agents CHERYLE GURK-TURNER, RPH Department of Pharmacy Services, BUMC wo mouse/human

More information

Pancreas and Pancreas-Kidney Transplantation By: Kay R. Brown, CLCP

Pancreas and Pancreas-Kidney Transplantation By: Kay R. Brown, CLCP Pancreas and Pancreas-Kidney Transplantation By: Kay R. Brown, CLCP Pancreas transplant recipients are usually under age 50. The majority of pancreas transplants are performed on diabetics, who are generally

More information

Oxford Transplant Centre. Live donor kidney transplantation what if we are not a match?

Oxford Transplant Centre. Live donor kidney transplantation what if we are not a match? Oxford Transplant Centre Live donor kidney transplantation what if we are not a match? page 2 You will already have been provided with information about different types of kidney transplant and the tests

More information

Takashi Yagisawa 1,2*, Makiko Mieno 1,3, Norio Yoshimura 1,4, Kenji Yuzawa 1,5 and Shiro Takahara 1,6

Takashi Yagisawa 1,2*, Makiko Mieno 1,3, Norio Yoshimura 1,4, Kenji Yuzawa 1,5 and Shiro Takahara 1,6 Yagisawa et al. Renal Replacement Therapy (2016) 2:68 DOI 10.1186/s41100-016-0080-9 POSITION STATEMENT Current status of kidney transplantation in Japan in 2015: the data of the Kidney Transplant Registry

More information

Outline. Congenital Heart Disease. Special Considerations for Special Populations: Congenital Heart Disease

Outline. Congenital Heart Disease. Special Considerations for Special Populations: Congenital Heart Disease Special Considerations for Special Populations: Congenital Heart Disease Valerie Bosco, FNP, EdD Alison Knauth Meadows, MD, PhD University of California San Francisco Adult Congenital Heart Program Outline

More information

ABO blood group-incompatible living donor kidney transplantation: a prospective, single-centre analysis including serial protocol biopsies

ABO blood group-incompatible living donor kidney transplantation: a prospective, single-centre analysis including serial protocol biopsies Nephrol Dial Transplant (2009) 24: 298 303 doi: 10.1093/ndt/gfn478 Advance Access publication 26 August 2008 Original Article ABO blood group-incompatible living donor kidney transplantation: a prospective,

More information

Pediatric Cardiac Transplantation of a Highly Sensitized Patient After Mechanical Support and Exchange Transfusions: A Case Report

Pediatric Cardiac Transplantation of a Highly Sensitized Patient After Mechanical Support and Exchange Transfusions: A Case Report Pediatric Cardiac Transplantation of a Highly Sensitized Patient After Mechanical Support and Exchange Transfusions: A Case Report Dafne Andrea Chianella, CCP Alicia Sievert, CCP, FPP; Mary McCall, CCP,FPP;

More information

NAPRTCS Annual Report

NAPRTCS Annual Report North American Pediatric Renal Trials and Collaborative Studies NAPRTCS 27 Annual Report Renal Transplantation Dialysis Chronic Renal Insufficiency This is a privileged communication not for publication.

More information

Is it safe to transplant against HLA DSA in cardiothoracic patients? development and implementation of national Guidelines

Is it safe to transplant against HLA DSA in cardiothoracic patients? development and implementation of national Guidelines Is it safe to transplant against HLA DSA in cardiothoracic patients? development and implementation of national Guidelines Dr Martin Howell. Laboratory Director. Department of H&I, NHS Blood and Transplant,

More information

Supplementary Appendix

Supplementary Appendix Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Loupy A, Lefaucheur C, Vernerey D, et al. Complement-binding

More information

Supplementary appendix

Supplementary appendix Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Lefaucheur C, Loupy A, Vernerey D, et al. Antibody-mediated

More information

Airway Management in a Patient with Klippel-Feil Syndrome Using Extracorporeal Membrane Oxygenator

Airway Management in a Patient with Klippel-Feil Syndrome Using Extracorporeal Membrane Oxygenator Airway Management in a Patient with Klippel-Feil Syndrome Using Extracorporeal Membrane Oxygenator Beckerman Z*, Cohen O, Adler Z, Segal D, Mishali D and Bolotin G Department of Cardiac Surgery, Rambam

More information

North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 2005 Annual Report. Renal Transplantation. Chronic Renal Insufficiency

North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 2005 Annual Report. Renal Transplantation. Chronic Renal Insufficiency North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 2005 Annual Report Renal Transplantation Dialysis Chronic Renal Insufficiency This is a privileged communication not for publication.

More information

Donor Recipient Race Mismatch and Graft Survival After Pediatric Heart Transplantation

Donor Recipient Race Mismatch and Graft Survival After Pediatric Heart Transplantation Donor Recipient Race Mismatch and Graft Survival After Pediatric Heart Transplantation Kirk R. Kanter, MD, Alexandria M. Berg, MSN, William T. Mahle, MD, Robert N. Vincent, MD, Patrick D. Kilgo, MS, Brian

More information

Specific Basic Standards for Osteopathic Fellowship Training in Nephrology

Specific Basic Standards for Osteopathic Fellowship Training in Nephrology Specific Basic Standards for Osteopathic Fellowship Training in Nephrology American Osteopathic Association and American College of Osteopathic Internists BOT Rev. 2/2011 These specific basic standards

More information

Less Invasive, Continuous Hemodynamic Monitoring During Minimally Invasive Coronary Surgery

Less Invasive, Continuous Hemodynamic Monitoring During Minimally Invasive Coronary Surgery Less Invasive, Continuous Hemodynamic Monitoring During Minimally Invasive Coronary Surgery Oliver Gödje, MD, Christian Thiel, MS, Peter Lamm, MD, Hermann Reichenspurner, MD, PhD, Christof Schmitz, MD,

More information

NAPRTCS Annual Report

NAPRTCS Annual Report North American Pediatric Renal Trials and Collaborative Studies NAPRTCS 2006 Annual Report Renal Transplantation Dialysis Chronic Renal Insufficiency This is a privileged communication not for publication.

More information

APHERESIS FOR DESENSITIZATION OF NON-RENAL TRANSPLANTS

APHERESIS FOR DESENSITIZATION OF NON-RENAL TRANSPLANTS APHERESIS FOR DESENSITIZATION OF NON-RENAL TRANSPLANTS GOW AREPALLY, MD MEDICAL DIRECTOR DUKE THERAPEUTIC APHERESIS SERVICE ASSOCIATE PROFESSOR, MEDICINE AMERICAN SOCIETY FOR APHERESIS MAY 25 TH 2013 OVERVIEW

More information

2012 Year In Review In Review. Number of Patients on WaitList as of Number Of Transplants Year. Number Of Patients

2012 Year In Review In Review. Number of Patients on WaitList as of Number Of Transplants Year. Number Of Patients Number Of Patients Number Of Transplants In Review In Review Kidney Kidney Pancreas Pancreas Liver Heart Number of Patients on WaitList as of.. Kidney Kidney Pancreas Liver Heart Number of Donors Number

More information

American Journal of Transplantation 2009; 9 (Suppl 3): S1 S157 Wiley Periodicals Inc.

American Journal of Transplantation 2009; 9 (Suppl 3): S1 S157 Wiley Periodicals Inc. American Journal of Transplantation 2009; 9 (Suppl 3): S1 S157 Wiley Periodicals Inc. 2009 The Authors Journal compilation 2009 The American Society of Transplantation and the American Society of Transplant

More information

2014 Year End Review

2014 Year End Review End Review Transplants Kidney Kidney Pancreas Pancreas Liver Heart Number of Patients on WaitList as of.. 99 Number Of Patients 9 Kidney Kidney Pancreas Liver Heart Organ Donor Statistics Atlantic Canada

More information

XIV. HLA AND TRANSPLANTATION MEDICINE

XIV. HLA AND TRANSPLANTATION MEDICINE XIV. HLA AND TRANSPLANTATION MEDICINE A. Introduction 1. The HLA system includes a complex array of genes and their molecular products that are involved in immune regulation and cellular differentiation.

More information

Recent advances in management of Pulmonary Vasculitis. Dr Nita MB

Recent advances in management of Pulmonary Vasculitis. Dr Nita MB Recent advances in management of Pulmonary Vasculitis Dr Nita MB 23-01-2015 Overview of the seminar Recent classification of Vasculitis What is new in present classification? Trials on remission induction

More information

Progress in Pediatric Kidney Transplantation

Progress in Pediatric Kidney Transplantation Send Orders for Reprints to reprints@benthamscience.net The Open Urology & Nephrology Journal, 214, 7, (Suppl 2: M2) 115-122 115 Progress in Pediatric Kidney Transplantation Jodi M. Smith *,1 and Vikas

More information

ASSESSMENT OF THE PAEDIATRIC NEEDS IMMUNOLOGY DISCLAIMER

ASSESSMENT OF THE PAEDIATRIC NEEDS IMMUNOLOGY DISCLAIMER European Medicines Agency Evaluation of Medicines for Human Use London, September 2006 Doc. Ref.: EMEA/381922/2006 ASSESSMENT OF THE PAEDIATRIC NEEDS IMMUNOLOGY DISCLAIMER The Paediatric Working Party

More information

New Zealand Kidney Allocation Scheme

New Zealand Kidney Allocation Scheme New Zealand Kidney Allocation Scheme The New Zealand Kidney Allocation Scheme (NZKAS) has been developed to ensure that kidney allocation in NZ is performed on an equitable, accountable and transparent

More information

Jennifer A. Brown The Cleveland Clinic School of Perfusion Cleveland, Ohio

Jennifer A. Brown The Cleveland Clinic School of Perfusion Cleveland, Ohio Biventricular Heart Failure Advanced Treatment Options at The Cleveland Clinic Jennifer A. Brown The Cleveland Clinic School of Perfusion Cleveland, Ohio I have no disclosures. Examine respiratory and

More information

AND My presentation does include discussion of off-label or investigational use (empiric therapy)

AND My presentation does include discussion of off-label or investigational use (empiric therapy) Managing Sensitized Patients Pre-Heart Transplantation Patricia P. Chang, MD MHS Associate Professor of Medicine Director, UNC Heart Failure & Transplant Program Patricia P. Chang, MD MHS Associate Professor

More information

Human Heart Transplantation: Current Status

Human Heart Transplantation: Current Status Human Heart Transplantation: Current Status Randall B. Griepp, M.D., Edward B. Stinson, M.D.," Charles P. Bieber, M.D., Bruce A. Reitz, M.D., Jack G. Copeland, M.D., Philip E. Oyer, M.D., and Norman E.

More information

Desensitization in Kidney Transplant. James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver

Desensitization in Kidney Transplant. James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Desensitization in Kidney Transplant James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Organ Shortage Currently there are >90,000 patients on the kidney

More information

Heart Transplantation is Dead

Heart Transplantation is Dead Heart Transplantation is Dead Alternatives to Transplantation in Heart Failure Sagar Damle, MD University of Colorado Health Sciences Center Grand Rounds September 8, 2008 Outline Why is there a debate?

More information

The New England Journal of Medicine

The New England Journal of Medicine The New England Journal of Medicine Copyright, 2, by the Massachusetts Medical Society VOLUME 342 M ARCH 2, 2 NUMBER 9 IMPROVED GRAFT SURVIVAL AFTER RENAL TRANSPLANTATION IN THE UNITED STATES, 1988 TO

More information

Certified Clinical Transplant Nurse (CCTN) * Detailed Content Outline

Certified Clinical Transplant Nurse (CCTN) * Detailed Content Outline I. PRETRANSPLANTATION CARE 9 11 3 23 A. Evaluate End-Stage Organ Failure 1 1 1 3 1. History and physical assessment 2. Vital signs and / or hemodynamic parameters 3. Lab values 4. Diagnostic tests B. Monitor

More information

Outcomes after liver transplantation in accordance with ABO compatibility: A systematic review and meta-analysis

Outcomes after liver transplantation in accordance with ABO compatibility: A systematic review and meta-analysis Submit a Manuscript: http://www.f6publishing.com DOI: 10.3748/wjg.v23.i35.6516 World J Gastroenterol 2017 September 21; 23(35): 6516-6533 ISSN 1007-9327 (print) ISSN 2219-2840 (online) META-ANALYSIS Outcomes

More information

Anesthesia Considerations for Pediatric Thoracic Solid Organ Transplant

Anesthesia Considerations for Pediatric Thoracic Solid Organ Transplant Anesthesiology Clin N Am 23 (2005) 709 731 Anesthesia Considerations for Pediatric Thoracic Solid Organ Transplant Glyn D. Williams, MB a,b, T, Chandra Ramamoorthy, MD a,b a Department of Anesthesia, Stanford

More information

ABO mismatched Renal Transplants

ABO mismatched Renal Transplants ABO mismatched Renal Transplants Nicos Kessaris Renal Transplant Surgeon St George s Hospital, London 7 th March 2012 Why? Protocol Risks Experience abroad Experience in UK Experience at St George s Conclusions

More information

Passenger Lymphocyte Syndrome (case presentation) Dr. Namal Bandara Kings College Hospital

Passenger Lymphocyte Syndrome (case presentation) Dr. Namal Bandara Kings College Hospital Passenger Lymphocyte Syndrome (case presentation) Dr. Namal Bandara Kings College Hospital Case history 24year Female Known Patient with Wilsons Disease DBD donor Liver Transplantation done on 15/08/2016

More information

CURRICULUM VITAE July 5, Name Chang-Kwon Oh. Date of Birth August 15, 1961

CURRICULUM VITAE July 5, Name Chang-Kwon Oh. Date of Birth August 15, 1961 CURRICULUM VITAE July 5, 2014 Name Chang-Kwon Oh Date of Birth August 15, 1961 Present Academic & Hospital Appointment Professor, Department of Surgery Ajou University, School of Medicine Chief, Department

More information

Lupus and Your Kidneys. Michael P. Madaio, MD Professor of Medicine Chairman of Medicine Medical College of Georgia Augusta, Georgia

Lupus and Your Kidneys. Michael P. Madaio, MD Professor of Medicine Chairman of Medicine Medical College of Georgia Augusta, Georgia Lupus and Your Kidneys Michael P. Madaio, MD Professor of Medicine Chairman of Medicine Medical College of Georgia Augusta, Georgia Kidney Inflammation and Abnormal Function as a Result of Lupus (Lupus

More information

Considerations for patients awaiting heart transplantation Insights from the UK experience

Considerations for patients awaiting heart transplantation Insights from the UK experience Cardiac Transplantation in Europe (Guest Editor: Martin Schweiger) Considerations for patients awaiting heart transplantation Insights from the UK experience Guy A. MacGowan 1,2, David S. Crossland 3,

More information

ABO Antibody Titer and Risk of Antibody-Mediated Rejection in ABO-Incompatible Renal Transplantation

ABO Antibody Titer and Risk of Antibody-Mediated Rejection in ABO-Incompatible Renal Transplantation American Journal of Transplantation 2010; 10: 1247 1253 Wiley Periodicals Inc. C 2010 The Authors Journal compilation C 2010 The American Society of Transplantation and the American Society of Transplant

More information

Infectious Complications in Living-Donor Kidney Transplant Recipients Undergoing Multi-Modal Desensitization

Infectious Complications in Living-Donor Kidney Transplant Recipients Undergoing Multi-Modal Desensitization SURGICAL INFECTIONS Volume 15, Number 3, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/sur.2012.231 Surgical Infection Society Articles Infectious Complications in Living-Donor Kidney Transplant Recipients

More information

MODERATOR Felix Rapaport, other members of this

MODERATOR Felix Rapaport, other members of this The First Lung Transplant in Man (1963) and the First Heart Transplant in Man (1964) J.D. Hardy MODERATOR Felix Rapaport, other members of this distinguished panel, and members of the audience, I will

More information

Acute Isolated Pulmonaw Reiection Following Transplantatich of the Heart and Both Lungs: Experimental and Clinical Observations

Acute Isolated Pulmonaw Reiection Following Transplantatich of the Heart and Both Lungs: Experimental and Clinical Observations Acute Isolated Pulmonaw Reiection Following Transplantatich of the Heart and Both Lungs: Experimental and Clinical Observations D. Novitzky, M.D., D. K. C. Cooper, Ph.D., F.R.C.S., A. G. Rose, Ch.B., M.Med.(Path),

More information

Ten yr of pediatric heart transplantation: A report from the Pediatric Heart Transplant Study

Ten yr of pediatric heart transplantation: A report from the Pediatric Heart Transplant Study Pediatr Transplantation 213: 17: 99 111 213 John Wiley & Sons A/S. Pediatric Transplantation DOI: 1.1111/petr.1238 Ten yr of pediatric heart transplantation: A report from the Pediatric Heart Transplant

More information

Pediatric Heart Transplantation after Declaration of Cardiocirculatory Death

Pediatric Heart Transplantation after Declaration of Cardiocirculatory Death The new england journal of medicine brief report Pediatric Heart Transplantation after Declaration of Cardiocirculatory Death Mark M. Boucek, M.D., Christine Mashburn, B.S.N., Susan M. Dunn, M.B.A., Rebecca

More information

KIDNEY TRANSPLANT - A TREATMENT OPTION

KIDNEY TRANSPLANT - A TREATMENT OPTION KIDNEY TRANSPLANT - A TREATMENT OPTION Page 1/5 WHAT IS A KIDNEY TRANSPLANT? When kidney failure becomes very advanced, your kidneys are so damaged they can no longer do their job. A transplant is a treatment

More information

Pediatric Cardiac Transplantation Using DCD Donors. Canadian Critical Care Forum David N. Campbell, MD

Pediatric Cardiac Transplantation Using DCD Donors. Canadian Critical Care Forum David N. Campbell, MD Pediatric Cardiac Transplantation Using DCD Donors Canadian Critical Care Forum David N. Campbell, MD No disclosures Disclosure Statement DCD: What is Old is New Again Early solid organ recoveries were

More information

DCD Heart Donation Understanding the Regulatory, Ethical and Clinical Issues. Valluvan Jeevanandam MD University of Chicago Medicine

DCD Heart Donation Understanding the Regulatory, Ethical and Clinical Issues. Valluvan Jeevanandam MD University of Chicago Medicine DCD Heart Donation Understanding the Regulatory, Ethical and Clinical Issues Valluvan Jeevanandam MD University of Chicago Medicine Disclosure Txn None MCS Scientific Advisor Thoratec/Abbott: Chairman

More information

Annual Statistics on Organ Replacement in Canada

Annual Statistics on Organ Replacement in Canada CIHI Snapshot December 2017 Annual Statistics on Organ Replacement in Canada Dialysis, Transplantation and Donation, 2007 to 2016 This summary document provides key findings from the latest annual statistics

More information

Cardiothoracic Fellow Expectations Division of Cardiac Anesthesia, Beth Israel Deaconess Medical Center

Cardiothoracic Fellow Expectations Division of Cardiac Anesthesia, Beth Israel Deaconess Medical Center The fellowship in Cardiothoracic Anesthesia at the Beth Israel Deaconess Medical Center is intended to provide the foundation for a career as either an academic cardiothoracic anesthesiologist or clinical

More information

Barriers to Transplantation

Barriers to Transplantation Barriers to Transplantation Ruth McCarrell RN BSN CNeph(C) Clinical Nurse Leader Kidney transplant Program St. Paul s Hospital Email: rmccarrell@providencehealth.bc.ca Overview Transplant Basics Living

More information

Health technology Two prophylaxis schemes against organ rejection in renal transplantation were compared in the study:

Health technology Two prophylaxis schemes against organ rejection in renal transplantation were compared in the study: An economic and quality-of-life assessment of basiliximab vs antithymocyte globulin immunoprophylaxis in renal transplantation Polsky D, Weinfurt K P, Kaplan B, Kim J, Fastenau J, Schulman K A Record Status

More information

The Heart Center. Quality Counts: Cardiothoracic Surgery and Interventional Cardiology

The Heart Center. Quality Counts: Cardiothoracic Surgery and Interventional Cardiology The Heart Center Quality Counts: Cardiothoracic Surgery and Interventional Cardiology The Cardiothoracic Surgery Program at Nationwide Children s Hospital is dedicated to the treatment of all patients,

More information

Kidney Transplantation

Kidney Transplantation Kidney Transplantation Current Kidney Transplantation Department of Surgery Yonsei University Wonju College of Medicine Kim Myoung Soo M.D. ysms91@wonju.yonsei.ac.kr http://gs.yonsei.ac.kr Current Kidney

More information

Patient Education Class

Patient Education Class Patient Education Class Slide 1: Patient Education Class This is the Patient Education Class for kidney and/or pancreas transplants. You are here today to be evaluated for a kidney and/or pancreas transplant.

More information

Transfusion & Mortality. Philippe Van der Linden MD, PhD

Transfusion & Mortality. Philippe Van der Linden MD, PhD Transfusion & Mortality Philippe Van der Linden MD, PhD Conflict of Interest Disclosure In the past 5 years, I have received honoraria or travel support for consulting or lecturing from the following companies:

More information

Ten year survival after heart transplantation: palliative procedure or successful long term treatment?

Ten year survival after heart transplantation: palliative procedure or successful long term treatment? Heart 1999;82:47 51 47 Ten year survival after heart transplantation: palliative procedure or successful long term treatment? S Fraund, K Pethig, U Franke, T Wahlers, W Harringer, J Cremer, H-G Fieguth,

More information

Derivation and Validation of a Novel Right-Sided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices: the EUROMACS-RHF Risk Score Osama I.I. Soliman, MD, PhD, FACC,

More information

U.S. changes in Kidney Allocation

U.S. changes in Kidney Allocation U.S. changes in Kidney Allocation Match kidneys with longest survival to patients with longest survival No parallel matching for kidneys with lower survival potential Decrease discard of kidneys with lower

More information

Consent and donor choice in lung and heart-lung transplantation

Consent and donor choice in lung and heart-lung transplantation Consent and donor choice in lung and heart-lung transplantation A patient s guide 1 Lung transplantation is a good option for carefully selected patients with end stage lung disease but sadly there is

More information

Records. Adult Kidney Pancreas Transplant Recipient Registration Worksheet. Recipient Information. Provider Information.

Records. Adult Kidney Pancreas Transplant Recipient Registration Worksheet. Recipient Information. Provider Information. Records Adult Kidney Pancreas Transplant Recipient Registration Worksheet FORM APPROVED: O.M.B. NO. 0915 0157 Expiration Date: 07/31/2020 Note: These worksheets are provided to function as a guide to what

More information

tients with insufficient TOR inhibitor therapy that are at risk for rejection.

tients with insufficient TOR inhibitor therapy that are at risk for rejection. Kidney International, Vol. 68 (05), pp. 2593 2598 Biochemical monitoring of mtor inhibitor based immunosuppression following kidney transplantation: A novel approach for tailored immunosuppressive therapy

More information

Chapter 4 Section 24.2

Chapter 4 Section 24.2 Surgery Chapter 4 Section 24.2 Issue Date: December 11, 1986 Authority: 32 CFR 199.4(e)(5) 1.0 CPT 1 PROCEDURE CODES 33940-33945, 33975-33980 2.0 POLICY 2.1 Benefits are allowed for heart transplantation.

More information

AORTIC COARCTATION. Synonyms: - Coarctation of the aorta

AORTIC COARCTATION. Synonyms: - Coarctation of the aorta AORTIC COARCTATION Synonyms: - Coarctation of the aorta Definition: Aortic coarctation is a congenital narrowing of the aorta, usually located after the left subclavian artery, near the ductus or the ligamentum

More information

Heart Transplantation for Patients with a Fontan Procedure

Heart Transplantation for Patients with a Fontan Procedure Heart Transplantation for Patients with a Fontan Procedure Kirk R. Kanter MD Professor of Surgery Pediatric Cardiac Surgery Emory University School of Medicine Children s Healthcare of Atlanta Atlanta,

More information

The diagnosis and treatment of cardiac rejection is

The diagnosis and treatment of cardiac rejection is ORIGINAL ARTICLES: CARDIOVASCULAR Routine Surveillance Endomyocardial Biopsy: Late Rejection After Heart Transplantation David A. Heimansohn, MD, Robert J. Robison, MD, John M. Paris III, MD, Robert G.

More information

Five years of living donor kidney transplantation at University clinical center Tuzla, Bosnia and Herzegovina, from 1999 through 2004

Five years of living donor kidney transplantation at University clinical center Tuzla, Bosnia and Herzegovina, from 1999 through 2004 Clinical Science Five years of living donor kidney transplantation at University clinical center Tuzla, Bosnia and Herzegovina, from 1999 through 2004 Senaid Trnačević 1, Goran Imamović 2, Mustafa Bazardžanović

More information

From Recovery to Transplant: One Patient's Journey

From Recovery to Transplant: One Patient's Journey From Recovery to Transplant: One Patient's Journey Tonya Elliott, RN, MSN Assist Device and Thoracic Transplant Coordinator Inova Transplant Center at Inova Fairfax Hospital Falls Church, VA Introduction

More information

Does Patient-Prosthesis Mismatch Affect Long-term Results after Mitral Valve Replacement?

Does Patient-Prosthesis Mismatch Affect Long-term Results after Mitral Valve Replacement? Original Article Does Patient-Prosthesis Mismatch Affect Long-term Results after Mitral Valve Replacement? Hiroaki Sakamoto, MD, PhD, and Yasunori Watanabe, MD, PhD Background: Recently, some articles

More information

ECMO Primer A View to the Future

ECMO Primer A View to the Future ECMO Primer A View to the Future Todd J. Kilbaugh Assistant Professor of Anesthesiology, Critical Care Medicine, and Pediatrics Director of The ECMO Center at the Children s Hospital of Philadelphia Disclosures

More information

Getting a New Kidney UHN. Information for patients and families. Is a kidney transplant right for me? Read this booklet to learn:

Getting a New Kidney UHN. Information for patients and families. Is a kidney transplant right for me? Read this booklet to learn: Getting a New Kidney UHN Information for patients and families Read this booklet to learn: about kidney transplants who can be donors how to start the transplant process how long the process might take

More information

Stabilization and Transportation guidelines for Neonates and infants with Heart disease:

Stabilization and Transportation guidelines for Neonates and infants with Heart disease: Stabilization and Transportation guidelines for Neonates and infants with Heart disease: Background: Referral Pediatric Cardiac Units, frequently receive neonates and infants referred and transported from

More information

Advanced Heart Failure and Transplant Cardiology

Advanced Heart Failure and Transplant Cardiology Advanced Heart Failure and Transplant Cardiology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills

More information

Implantable Ventricular Assist Devices and Total Artificial Hearts. Policy Specific Section: June 13, 1997 March 29, 2013

Implantable Ventricular Assist Devices and Total Artificial Hearts. Policy Specific Section: June 13, 1997 March 29, 2013 Medical Policy Implantable Ventricular Assist Devices and Total Artificial Hearts Type: Medical Necessity and Investigational / Experimental Policy Specific Section: Surgery Original Policy Date: Effective

More information

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 30 November 2011

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 30 November 2011 The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 30 November 2011 NULOJIX 250 mg, powder for concentrate for solution for infusion B/1 (CIP code: 580 415-7) B/2 (CIP

More information

Repair or Replacement

Repair or Replacement Surgical intervention post MitraClip Device: Repair or Replacement Saudi Heart Association, February 21-24 Rüdiger Lange, MD, PhD Nicolo Piazza, MD, FRCPC, FESC German Heart Center, Munich, Germany Division

More information

Management of a Recipient with a Failed Kidney Transplant. Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania

Management of a Recipient with a Failed Kidney Transplant. Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania Management of a Recipient with a Failed Kidney Transplant Simin Goral MD University of Pennsylvania Medical Center Philadelphia, Pennsylvania Objectives Epidemiology of transplant failure Timing of dialysis

More information

Prospective Psychological Evaluation of Pediatric Heart and Heart Lung Recipients

Prospective Psychological Evaluation of Pediatric Heart and Heart Lung Recipients Prospective Psychological Evaluation of Pediatric Heart and Heart Lung Recipients Jo Wray, PHD, and Rosemary Radley-Smith, FRCP Department of Paediatrics, Harefield Hospital Objective To study psychological

More information

Transplant Hepatology

Transplant Hepatology Transplant Hepatology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified

More information

Quantification of the Early Risk of Death in Elderly Kidney Transplant Recipients

Quantification of the Early Risk of Death in Elderly Kidney Transplant Recipients Wiley Periodicals Inc. C Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons Quantification of the Early Risk of Death in Elderly Kidney Transplant Recipients

More information

CASE REPORT ABSTRACT INTRODUCTION. Renal transplant was successfully performed after conversion.

CASE REPORT ABSTRACT INTRODUCTION. Renal transplant was successfully performed after conversion. CASE REPORT Port J Nephrol Hypert 2007; 21(1): 41-47 Successful live donor kidney transplant in a hypersensitised patient with positive cross-match. A case report and a review of the effectiveness of desensitisation

More information

47 studies found for: systemic lupus erythematosus AND mycophenolic acid

47 studies found for: systemic lupus erythematosus AND mycophenolic acid Recherche in auf der Webseite www.clinicaltrials.gov zuletzt am 16.02.2016 47 studies found for: systemic lupus erythematosus AND mycophenolic acid Rank Status Study 1 Terminate d Myfortic Versus Azathioprine

More information

A Guide to Better Living

A Guide to Better Living Transplantation What Is a Kidney Transplant? Kidney transplantation is placing a kidney from one person (donor) into a patient with kidney failure (recipient). This is done by surgery where the donated

More information