title: ECLS for children with late (post-discharge) rejection after heart transplantation.
abstract: Rejection with acute hemodynamic compromise after OHT is rare in children, and is associated with poor survival. We retrospectively reviewed the management, course and outcome of recipients with late (following initial hospital discharge) rejection with acute hemodynamic compromise who were supported on ECLS. Of 197 consecutive children undergoing OHT (84 male; mean [SD] age 8.3 [5.7] [range 0.1-18.8 yr]) between 2/2002 and 10/2012, 187 children survived and were discharged from hospital. Mean (SD) follow-up was 5.0 (3.1) (range 0.1-10.6) yr. During follow-up, seven presented with severe hemodynamic compromise after transplantation (of whom one patient had been transplanted elsewhere). All seven children, who presented in hemodynamic collapse with poor cardiac function refractory to inotropic support, were placed on ECLS-two following in-hospital cardiac arrest. The median duration of ECLS was 6 (range 5-15) days. All survived to decannulation, with one death from overwhelming sepsis 20 days after presentation. The median (range) duration (in days) of inotropic requirement post ECLS was 11 (5-27), the median ventilation time was 8 (7-30), median ICU length of stay was 14 (10-54), and median hospitalization was 24 (19-118). In all, ventricular function normalized (FS >28%) within 10 (7-22) days. There was significant short-term morbidity; however, over a median follow-up of 5.9 (range 0.7-9.2) yr, all survivors have good functional status with no significant apparent neurological sequelae. ECLS thus appears to be a good rescue therapy for children with severe acute rejection post OHT, refractory to conventional treatment, leading to good medium-term outcome.
authors.affiliation: Department of Paediatric Cardiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. astridlammers@gmx.de
authors.forename: Astrid E
authors.initials: AE
authors.lastname: Lammers
authors.forename: Michael
authors.initials: M
authors.lastname: Burch
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Brown
authors.forename: Johan A
authors.initials: JA
authors.lastname: Hoschtitzky
authors.forename: Tracey
authors.initials: T
authors.lastname: Lunnon-Wood
authors.forename: Jo
authors.initials: J
authors.lastname: Wray
authors.forename: Carin
authors.initials: C
authors.lastname: van Doorn
authors.forename: Allan P
authors.initials: AP
authors.lastname: Goldman
authors.forename: Aparna
authors.initials: A
authors.lastname: Hoskote
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects* / Q000379:methods*; D006439:Hemodynamics; D006760:Hospitalization; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007362:Intensive Care Units; D008297:Male; D010351:Patient Discharge; D011183:Postoperative Complications; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012306:Risk; D018805:Sepsis / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents