B.A. Pietra

Donation after circulatory death in pediatric patients: Current utilization in the United States.

From the Cardiac Center, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Pediatrics, Division of Cardiology, University of Colorado School of Medicine, Children’s Hospital Colorado Heart Institute, Aurora, Colorado, USA; and the Congenital Heart Center, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA

End-organ recovery post-ventricular assist device can prognosticate survival

Background: This study examines our institutional ventricular assist devices (VADs) experience over two decades to understand trends towards predictors of mortality. Methods: Retrospective study of patients aged 0–21 years supported with a VAD from January 1996 to May 2015. Patient data was examined pre and post‐VAD implant among survivors and non‐survivors. Results: Thirty‐six patients identified (8 supported by Thoratec® VAD and 28 supported by EXCOR Berlin Heart®). Patients diagnosis included dilated cardiomyopathy (DCM) (n = 19,53%), congenital heart disease (CHD) (n = 12,33%), and other (n = 5,14%). Median age and body surface area (BSA) were 1.0 years[0–7 years] and 0.41[0.24–0.92], respectively. Survival to discharge was 75% with no deaths with DCM. The survival rate for patients with CHD was 42%. Univariate analysis showed diagnosis of CHD, smaller BSA and respiratory failure post‐implant (Intermacs criteria) as risk factors for mortality. Median duration of VAD support was lower in non‐survivors, 14 vs 63 days (p = 0.03). Renal function at time of transplant or death was normal/pRIFLE Risk category in 20(74%) of survivors and 2(22%) of non‐survivors (p = 0.06). Post‐implant, peak total bilirubin in the first week trended lower in survivors (p = 0.06). Conclusions: Persistent end‐organ impairment in the first 2 weeks after VAD placement could be a useful prognostic marker for survival to transplant. HighlightsEtiology of heart failure is a key determinant in VAD survival.Post‐VAD complications were similar between survivors and non‐survivors in this predominantly BiVAD subset.Persistent end‐organ impairment in the first 2 weeks after VAD placement could be a useful prognostic marker.Among the 13 patients in renal failure (pRIFLE), the longest need for RRT in a survivor was 22 days post‐VAD placement.

Anti-LFA-1 induces CD8 T-cell dependent allograft tolerance and augments suppressor phenotype CD8 cells

The induction of tolerance to transplanted organs is a major objective in transplantation immunology research. Lymphocyte function-associated antigen-1 (LFA-1) interactions have been identified as a key component of the T-cell activation process that may be interrupted to lead to allograft tolerance. In mice, αLFA-1 mAb is a potent monotherapy that leads to the induction of donor-specific transferable tolerance. By interrogating important adaptive and innate immunity pathways, we demonstrate that the induction of tolerance relies on CD8+T-cells. We further demonstrate that αLFA-1 induced tolerance is associated with CD8+CD28-T-cells with a suppressor phenotype, and that while CD8 cells are present, the effector T-cell response is abrogated. A recent publication has shown that CD8+CD28- cells are not diminished by cyclosporine or rapamycin, therefore CD8+CD28- cells represent a clinically relevant population. To our knowledge, this is the first time that a mechanism for αLFA-1 induced tolerance has been described.