Impact of induction strategy change on first-year rejection in pediatric heart transplantation at a single center-From postoperative basiliximab to either postoperative anti-thymocyte globulin or preoperative basiliximab.

BACKGROUND: Our pediatric heart transplant center transitioned from post-bypass basiliximab (BAS) induction to either anti-thymocyte globulin (ATG) or pre-bypass BAS. The purpose of this study was to compare first-year rejection rates before and after this change. METHODS: A single-center retrospective analysis was conducted of pediatric heart transplant recipients from 2010 to 2019. Primary outcome was first-year rejection. Bivariate analysis, Kaplan-Meier curves, and multivariable regression were performed across eras. RESULTS: Forty-three early era patients (55%) received post-bypass BAS, and 35 late era patients (45%) received pre-bypass BAS (n = 17) or ATG (n = 18). First-year rejection decreased in the late era (31% vs 53%, p = .05). This finding was more pronounced after excluding infants (38% vs 73%, p = .006). Late era was associated with a decreased likelihood of rejection (all cohort OR 0.19, 95% CI 0.05-0.66; infants excluded OR 0.17, 95% CI 0.04-0.61). No differences in post-transplant lymphoproliferative disease, donor-specific antibody, or infection were observed. CONCLUSIONS: Fewer late era patients receiving ATG or pre-bypass BAS induction had first-year rejection compared to the early era patients receiving standard post-bypass BAS induction. This programmatic shift in induction strategy was readily achievable and potentially effective in reducing first-year rejection.

Patency of internal jugular vein following repair after ECMO stabilization prior to Berlin Heart implantation: utility of repaired vein for subsequent cardiac catheterization and biopsy.

OBJECTIVE: The objective of this study was to examine the patency and utility for subsequent vascular access of the internal jugular vein following use in short-term extracorporeal membrane oxygenation. DESIGN: Retrospective review. SETTING: Pediatric cardiac intensive care unit, pediatric cardiac catheterization laboratory, and pediatric cardiac clinic. PATIENTS: Four children, ages 7-178 months, requiring mechanical circulatory support. Interventions. Extracorporeal membrane oxygenation support, internal jugular vein repair, Berlin Heart mechanical circulatory support, heart transplantation, cardiac catheterization. OUTCOME MEASURES: Following surgical repair, the internal jugular vein was studied with bedside ultrasound for assessment of patency. When appropriate, subsequent vascular access of the vessel was attempted and the success was reported. RESULTS: Follow-up ultrasound examination demonstrated vessel patency in all cases. In patients requiring subsequent catheterization (3/4), successful vessel entry and catheterization were performed. CONCLUSIONS: Repair of the internal jugular vein following use for short-term extracorporeal membrane oxygenation support can be accomplished with success. The vessel can be used for subsequent vascular access when necessary.