Susan A. Miller

Charges and resource utilization for pediatric heart transplantation across a positive virtual and/or cytotoxicity crossmatch

There is growing acceptance of transplantation across a positive crossmatch for highly allosensitized pediatric HT candidates. While survival may be similar to patients transplanted across a negative crossmatch, costs are unknown. Among 60 HT recipients at our center from 5/07 to 6/12, we analyzed hospital charges and length of stay from the day of HT to discharge and through the first year after transplant. Median age at HT was 6.2 years (15 days‐20.5 years). Charges in the first year post‐HT were greater for crossmatch‐positive patients (

Survival in Allosensitized Children After Listing for Cardiac Transplantation

907 678 vs

Impact of ELISA-detected anti-HLA antibodies on pediatric cardiac allograft outcome

549 754; P = .017), with a trend toward higher charges for the HT hospitalization (

Impact of TGFβ1 gene polymorphisms on late renal function in pediatric heart transplantation

537 640 vs

Chronic high Epstein-Barr virus load carrier state and risk for late onset PTLD/malignant lymphoma

407 374; P = .07). Plasmapheresis was more common in crossmatch‐positive patients during the HT hospitalization (80% vs 4%, P < .001). In the first year after HT, crossmatch‐positive patients had a greater number of endomyocardial biopsies (10 vs 7.5, P = .03) and episodes of treated rejection (2 vs 0, P = .004). Pediatric HT across a positive crossmatch is associated with higher first‐year costs, including increased use of plasmapheresis and care around an increased number of rejections. These novel data will help inform decision and policymaking regarding care practices for the growing population of highly sensitized pediatric HT candidates.