招請講演 VI　
Pediatric heart transplantation - UCLA experience
Associate Professor, Department of Pediatrics, Division of Cardiology,
UCLA Medical Center,
Los Angeles, California, USA
Juan Carlos Alejos
Selection criteria
Pediatric patient is defined as a patient less than or equal to 21 years of age
-Indications
-Contraindications
Absolute vs relative
-Recipient selection criteria
-Donor selection criteria
Treatment of patients with elevated PRA's
-Cellcept
-IVIG
-Rituxan
-Plasmapheresis
Maintenance
-Tacrolimus
-Mycophenolate mofetil
-Prednisone
In case of Cr > 2.0
-Zenapax is used as induction for above regimen
Mycophenolate mofetil is used for high risk transplant patients
-Previous surgery
-Assist device
-Previous exposure to blood products
-Age (> 14 years)
‘High-risk’ patients defined as those with preformed reactive antibodies, congenital heart disease and exposure to blood products and/or a VAD
Complications
-PTLD
-Rejection
-Renal insufficiency
-Infection
-Transplant coronary artery disease
Transplant coronary artery disease
-Diagnosis
Selective angiography
Intravascular ultrasound
Sestamibi
PET scan
-Therapy
PTCA with stent placement
Steroid eluting stents
Sirolimus
Renal dysfunction
-Change of immunosuppression
Sirolimus (rapamycin)
Mycophenolate mofetil (cellcept)
Discontinue tacrolimus after Rapa and cellcept levels are therapeutic
Post-transplant lymphoproliferative disease
-Felt to be related to Epstein-Barr virus
-Follow titers annually
Elevations or new infections should be treated with gancyclovir
-Surveillance for enlarged lymphatic tissue
Lymph nodes, tonsils, spleen
Therapy for PTLD
-Decrease immunosuppression
Aim for tacrolimus levels of 4 to 6. Lower if
tolerated
Use low dose prednisone in support
Tacrolimus free regimen
-Chemotherapy
Rituxan
Elevated pulmonary vascular resistance?
-Nitric oxide
-Prostacyclin
-Bosentan
-Viagra
-Continuous nebulized Flolan


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