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Cardiothoracic transplantation in complex paediatric recipients

July 14, 2020 | Education | Heart | Lung | Webinars

WEBINAR in collaboration with IPTA

Keynote speaker: Anne Dipchand, Professor of paediatrics, University of Toronto, Canada

Chairs:  Maria Irene Bellini, Renal Transplant Surgeon, Belfast City Hospital, UK
Nicos Kessaris, Renal Unit, Guy’s Hospital, London, UK

Key topics: 
• HLA antibodies and sensitization
• Challenging cardiac anatomical considerations
• Univentricular hearts and when to transplant
• Waitlist mortality and the impact of VAD support
The small numbers of pediatric patients that approach end stage heart failure and require heart transplantation continue to challenge us with regards to acquiring the information to develop evidence-based best practices and/or to study the effect of any new diagnostic or therapeutic strategies on outcomes.  Some key evolving areas include HLA antibodies, complex cardiac anatomy, and the impact of ventricular assist device technology on our practice and on waitlist mortality.  From an antibody perspective, despite acceptable overall outcomes, it remains challenging to determine which highly-sensitized individual paediatric heart transplant patients are at highest risk transplanting across a positive crossmatch. Optimal pre-, intra- and post-operative immunosuppression protocols remain to be determined. The impact of pre-existing and newly-formed donor specific antibodies remains to be determined.  From an anatomy perspective, it is important to understand how recipient anatomy and reconstruction needs can impact donor acceptance and timing, ischemic time, intraoperative procedures, and overall outcomes. Finally, there are the challenges faced with children born with single ventricle circulations and when to consider transplantation. The goal should be to identify infants who have “suboptimal” characteristics for staged surgical palliation so that they can be considered sooner for heart transplant, ideally prior to the accrual of additional risk factors for mortality after heart transplant.

The recording is available on demand via https://www.esottransplantlive.org/

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