Frederick Jay Fricker

Post-transplant lymphoproliferative disorder in children: recent outcomes and response to dual rituximab/low-dose chemotherapy combination.

Gupta S, Fricker FJ, González‐Peralta RP, Slayton WB, Schuler PM, Dharnidharka VR. Post‐transplant lymphoproliferative disorder in children: Recent outcomes and response to dual rituximab/low‐dose chemotherapy combination.
Pediatr Transplantation 2010: 14:896–902.

Effect of IVIG administration on complement activation and HLA antibody levels

The objective of the present study was to determine if there are changes on complement (C) activation and concentration of HLA antibodies (Abs) in patients treated with intravenous immunoglobulin (IVIG). The patients evaluated were given IVIG as treatment of Ab‐mediated rejection or desensitization. The patients’ sera obtained before and after IVIG administration were tested for their effects on the deposition of both IgG (HLA Abs) and C3b (C activation) as measured by flow cytometry on T cells. IVIG consistently inhibited C activation when measured shortly after IVIG infusion but returned to the initial levels at 2–4 weeks, when total serum IgG also returned to pre‐infusion levels. C inhibition was more pronounced with higher IVIG doses and the degree of inhibition was inversely proportional to the HLA Ab concentrations. IVIG did not block the binding of HLA Abs immediately after administration, although levels were slightly but consistently lower after several monthly IVIG infusions. The data show that C inhibition by IVIG is short‐lived and that IVIG induces only a mild reduction of HLA Abs, seen not immediately but after months of treatment. These results may explain the inconsistent results of IVIG to achieve desensitization.

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.

Effect of IVIG administration on complement activation and HLA antibody levels: ORIGINAL ARTICLE

The objective of the present study was to determine if there are changes on complement (C) activation and concentration of HLA antibodies (Abs) in patients treated with intravenous immunoglobulin (IVIG). The patients evaluated were given IVIG as treatment of Ab‐mediated rejection or desensitization. The patients’ sera obtained before and after IVIG administration were tested for their effects on the deposition of both IgG (HLA Abs) and C3b (C activation) as measured by flow cytometry on T cells. IVIG consistently inhibited C activation when measured shortly after IVIG infusion but returned to the initial levels at 2–4 weeks, when total serum IgG also returned to pre‐infusion levels. C inhibition was more pronounced with higher IVIG doses and the degree of inhibition was inversely proportional to the HLA Ab concentrations. IVIG did not block the binding of HLA Abs immediately after administration, although levels were slightly but consistently lower after several monthly IVIG infusions. The data show that C inhibition by IVIG is short‐lived and that IVIG induces only a mild reduction of HLA Abs, seen not immediately but after months of treatment. These results may explain the inconsistent results of IVIG to achieve desensitization.

Heart Transplant in Patient With Isolated Left Superior Vena Cava by Atrial Appendage Rotation

Orthotopic heart transplantation in patients with an isolated persistent left superior vena cava is extremely rare, and the anastomotic connection between a right-sided donor superior vena cava and left-sided recipient superior vena cava can be challenging to perform. We present a novel technique used in an infant female, using the left atrial appendage to extend the superior vena cava anastomosis.

Effect of IVIG administration on complement activation and HLA antibody levels: Effect of IVIG on complement and HLA antibodies

The objective of the present study was to determine if there are changes on complement (C) activation and concentration of HLA antibodies (Abs) in patients treated with intravenous immunoglobulin (IVIG). The patients evaluated were given IVIG as treatment of Ab‐mediated rejection or desensitization. The patients’ sera obtained before and after IVIG administration were tested for their effects on the deposition of both IgG (HLA Abs) and C3b (C activation) as measured by flow cytometry on T cells. IVIG consistently inhibited C activation when measured shortly after IVIG infusion but returned to the initial levels at 2–4 weeks, when total serum IgG also returned to pre‐infusion levels. C inhibition was more pronounced with higher IVIG doses and the degree of inhibition was inversely proportional to the HLA Ab concentrations. IVIG did not block the binding of HLA Abs immediately after administration, although levels were slightly but consistently lower after several monthly IVIG infusions. The data show that C inhibition by IVIG is short‐lived and that IVIG induces only a mild reduction of HLA Abs, seen not immediately but after months of treatment. These results may explain the inconsistent results of IVIG to achieve desensitization.