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Aging Clin Exp Res. 2025 Jun 21;37(1):190. doi: 10.1007/s40520-025-03085-6.

NO ABSTRACT

PMID:40542187 | PMC:PMC12181121 | DOI:10.1007/s40520-025-03085-6

Transplant Cell Ther. 2025 Jun 18:S2666-6367(25)01262-X. doi: 10.1016/j.jtct.2025.06.021. Online ahead of print.

ABSTRACT

BACKGROUND: Impaired sexual health is a common long-term issue for female allogeneic hematopoietic stem cell transplant survivors.

OBJECTIVE(S): To compare sexual function among clinically stable female transplant survivors to age-matched healthy female volunteers and to explore the contribution of key post-transplant factors over time on sexual function.

STUDY DESIGN: Secondary analysis of sexual function of female transplant survivors and healthy female volunteers aged 18 to 50 years enrolled in a year-long prospective clinical trial of HPV vaccination. Clinically stable transplant survivors were at least 90 days post-transplant. The general assessment of post-transplant health included assessment for genital and systemic chronic GvHD. Gynecologists assessed for and treated genital chronic GvHD including topical, targeted therapies, assessed ovarian function, performed cervical cancer screening, provided recommendations about contraception and ovarian hormone treatments, and discussed sexual function. Participants completed the Sexual Functioning Questionnaire (SFQ) at enrollment, 7 and 12 months. Genital and systemic chronic graft-versus-host-disease (GvHD), sexual activity, ovarian hormonal status, systemic immunosuppression use, and antidepressant use were prospectively evaluated over time post-transplant and compared to sexual function and health characteristics of healthy females. Comparisons between groups were made using independent t-tests. Transplant complications of systemic or genital chronic graft-versus-host-disease (GvHD), sexual activity, ovarian hormonal status, immunosuppression, and antidepressant use were evaluated over time using linear mixed models for their association with SFQ scores.

RESULTS: Sixty-four females included 20 healthy volunteers and 44 transplant survivors, of whom 23 (52%) were receiving systemic immunosuppressive therapy. At baseline, whether participants were not currently sexually active, had low sexual function or had high sexual function significantly differed between transplant survivors (45% versus 30% versus 20% of 44 women, respectively) and volunteers (20% versus 15% versus 65% of 20 women, respectively, p=0.003). SFQ overall and subscale scores were lower in transplant survivors compared to healthy females at baseline and the difference persisted over time (all p<0.05). Baseline SFQ overall scores were similar between transplant survivors on and off immunosuppression (p=0.09). At one year, survivors had significantly higher SFQ overall and health impact scores (p=0.05 and p<0.001, respectively) and a lower problems score (p=0.04) compared to baseline, but the other subscale scores did not change. At each timepoint, females with genital chronic GvHD had lower SFQ overall scores compared to those without (p=0.04).

CONCLUSION(S): Female transplant survivors participating in an HPV vaccine trial were more likely to have sexual dysfunction at all time points compared to healthy controls and genital chronic GVHD was the most influential driver. Sexual function improved over time in transplant survivors in the context of a whole-person approach to gynecologic post-transplant care.

PMID:40541681 | DOI:10.1016/j.jtct.2025.06.021

Transplant Proc. 2025 Jun 19:S0041-1345(25)00277-5. doi: 10.1016/j.transproceed.2025.05.010. Online ahead of print.

ABSTRACT

The use of marginal kidney donors with congenital morphological anomalies, such as the "horseshoe" kidney, presents itself as a solution to expand the donor pool. The vascular and urinary anatomy of the horseshoe kidney is complex. These patients are more frequently affected by hydronephrosis, vesicoureteral reflux, urinary tract infections, and urolithiasis. The horseshoe kidney can be transplanted "en bloc" or as a single kidney after "splitting." A 54-year-old patient with end-stage renal failure, on hemodialysis for 4 years, was transplanted with a "horseshoe" graft from a deceased cardiac death (DCD) III Maastricht-type donor. The "preoperative" computed tomography (CT) documented the presence of a "horseshoe" kidney, non-divisible due to the presence of a shared lower polar renal artery between both kidneys. There were no anomalies in the collecting systems except for a slight dilation of the right renal pelvis. The distal side of the inferior vena cava was anastomosed end-to-side with the external iliac vein. The left common iliac artery of the donor was sutured end-to-side with the external iliac artery. The ureters were implanted separately after the placement of the Double J (DJ) stents. There were no perioperative complications. Immunosuppressive therapy was induced with ATG and subsequently tacrolimus and mycophenolate mofetil were introduced. In 4 months of follow-up, the patient developed a lymphocele that was drained percutaneously. The DJ stents were removed after 3 months. The donor with a horseshoe kidney, in the absence of a urological pathological history, can be considered for transplantation even in a DCD setting by planning an appropriate preoperative strategy.

PMID:40541506 | DOI:10.1016/j.transproceed.2025.05.010

Am J Respir Crit Care Med. 2025 Jun 20. doi: 10.1164/rccm.202407-1504OC. Online ahead of print.

ABSTRACT

RATIONALE: Particulate matter <=2.5um (PM2.5) adversely impacts patients with fibrotic interstitial lung disease (fILD).

OBJECTIVE: To determine whether PM2.5-associated epigenetic alterations contribute to the environmental pathogenesis of fILD.

METHODS: Retrospective two-cohort study applying satellite-derived PM2.5 and constituent exposure matching to the residential location of patients with fILD. Robust linear regressions evaluated cohort-specific epigenome-wide differential blood DNA methylation with increasing pollutant exposures (Illumina MethylationEPIC BeadChip). Cox and linear regressions evaluated associations of cytosine-phosphate-guanine (CpG) loci with transplant-free survival and lung function. Wilcoxon test evaluated cartilage-associated protein (CRTAP) levels in fILD and control lungs.

RESULTS: The University of Pittsburgh (UPitt) cohort (n=306) had 5-year median PM2.5 exposures of 12.1ug/m3 compared with 5.1ug/m3 in the University of British Columbia (UBC) cohort (n=170). Higher pollutant exposures in the UPitt cohort were associated with lower methylation at cg25354716, annotated to CRTAP, a critical extracellular matrix remodeling enzyme. Higher exposures in the UBC cohort were associated with higher methylation at cg01019301, annotated to TLN2 (talin-2), a cytoskeletal protein involved in fibroblast migration. A 10% increase in cg25354716 methylation was associated with a hazard ratio (HR) of 0.81 for death or lung transplantation in the meta-analyzed cohorts (95%CI 0.69-0.96, p=0.01), whereas the same change in cg01019301 was associated with a HR of 1.36 (95%CI 1.07-1.74, p=0.01). CRTAP protein was more abundant in lungs from patients with fILD compared with donor controls (p<0.001).

CONCLUSIONS: PM2.5 is associated with altered blood DNA methylation in fILD. This work identifies novel pollution-sensitive targets that hold potential for therapeutic modulation in fILD.

PMID:40540633 | DOI:10.1164/rccm.202407-1504OC

Am J Respir Crit Care Med. 2025 Jun 20. doi: 10.1164/rccm.202411-2146OC. Online ahead of print.

ABSTRACT

RATIONALE: Driving pressure is marker of severity and a possible target for lung protection during controlled ventilation, but its value during assisted ventilation is unknown. Inspiratory holds provide an estimate of driving pressure (quasi-static). Expiratory holds provide an estimate of the inspiratory effort, useful to estimate the transpulmonary dynamic driving pressure.

OBJECTIVES: To assess the correlation between driving pressures measured during assisted ventilation and ICU outcomes.

METHODS: Multicenter prospective observational study. Patients with acute hypoxemic respiratory failure were enrolled within 48 hours of triggering the ventilator. Respiratory mechanics were measured daily and the variables of interest averaged over the first three days of partial assistance. ICU outcomes were collected until day 90.

MEASUREMENTS AND MAIN RESULTS: Two-hundred ninety-eight patients from 16 centers were enrolled. Tidal volume, peak airway pressure, positive-end-expiratory-pressure and inspiratory effort during the first three days of assisted ventilation did not differ between survivors and non-survivors. Quasi-static driving pressure and transpulmonary dynamic driving pressure were higher in non-survivors than in survivors (13 [11,14] vs 11 [9,13] cmH2O, p<0.001 and 19 [16,23] vs 16 [13,18] cmH2O, p<0.001, respectively), while compliance normalized to predicted body weight was lower (0.65 [0.54,0.84] vs 0.79 [0.64,0.97] ml/cmH2O/kg, p<0.001). Multivariable analysis confirmed the association with outcome. Over study days, static driving pressure significantly diverged between survivors and non-survivors.

CONCLUSIONS: During assisted ventilation driving pressure and normalized compliance are associated with ICU outcome, despite some overlap. Albeit our study does not allow to estimate if driving pressure is a marker of severity, or a cause of lung injury, it highlights the potential value of monitoring and targeting it during spontaneous assisted breathing.

PMID:40540619 | DOI:10.1164/rccm.202411-2146OC

Cardiovasc Drugs Ther. 2025 Jun 20. doi: 10.1007/s10557-025-07739-5. Online ahead of print.

ABSTRACT

PURPOSE: Cardiovascular diseases (CVDs) continue to be the leading cause of death globally, driven by a complex interplay of genetic, epigenetic, and environmental factors. Traditional risk factors alone fail to explain the individual variability in disease susceptibility and progression. Recent advances in genomics and epigenomics have revealed key molecular mechanisms that regulate cardiovascular function, highlighting the importance of gene network dynamics and epigenetic regulation.

METHODS: This review systematically analyzes peer-reviewed literature from the past decade sourced from electronic databases including PubMed and Google Scholar. It compiles the multifaceted roles of DNA methylation, histone modifications, chromatin remodeling, and noncoding RNAs in regulating cardiovascular gene expression, cellular phenotypes, and disease pathogenesis.

RESULTS: DNA methylation influences the transcriptional activity of gene expression associated with atherosclerosis, myocardial infarction, and hypertension, while histone modifications and ATP-dependent chromatin remodeling regulate cardiac hypertrophy, fibrosis, and regeneration. Noncoding RNAs further act as critical regulators of angiogenesis, inflammation, and myocardial remodeling. Therapeutically, these findings have facilitated the development of epigenetic drugs and gene-editing technologies targeting specific molecular pathways involved in CVD progression. Emerging technologies such as CRISPR/Cas9, RNA-based therapies, and small-molecule inhibitors of epigenetic enzymes hold potential for correct abnormal gene expression patterns. Moreover, integrative multi-omics and systems biology approaches are advancing personalized treatment strategies, improving the accuracy and effectiveness of cardiovascular interventions.

CONCLUSION: Collectively, unraveling the complex molecular interactions among gene networks, epigenetic alterations, and targeted therapeutic mapping aims to combat CVD with better precision and efficacy.

PMID:40540082 | DOI:10.1007/s10557-025-07739-5

Adv Sci (Weinh). 2025 Jun 20:e01070. doi: 10.1002/advs.202501070. Online ahead of print.

ABSTRACT

Cardiac fibrosis, a key pathological feature of cardiac remodeling, is a major contributor to mortality in older patients with heart failure. The underlying mechanisms are complex, involving alterations in intercellular communication and chronic inflammation. This study investigates the role of indole-3-propionic acid (IPA) in aging-related myocardial fibrosis and its regulatory effects on autophagy through palmitoyl-protein thioesterase 1 (PPT1). Here, plasma levels of IPA, a tryptophan-derived metabolite, are found to be reduced in older patients with heart failure, and this reduction is associated with deteriorating cardiac function. Notably, IPA supplementation significantly attenuated aging-related myocardial fibrosis. PPT1, a lysosomal enzyme involved in autophagy, is upregulated in macrophages during aging. IPA reversed aging-induced increase in PPT1 expression. Using PPT1flox/flox Lyz2-cre mice, it is demonstrated that macrophage-specific deletion of PPT1 significantly reduced cardiac inflammation and myocardial fibrosis in aged mice. Furthermore, PPT1 silencing in macrophages reduced the expression of myocardial fibrosis markers in vitro. Mechanistically, IPA regulated PPT1 expression to modulate the PI3K-AKT-mTOR pathway, thereby restoring autophagic activity in senescent macrophages and suppressing both inflammation and aging-related myocardial fibrosis. Additionally, IPA influenced the cGAS-STING signaling pathway to regulate PPT1 expression. These findings demonstrate that IPA inhibits PPT1, activates autophagy in macrophages, and mitigates aging-related myocardial fibrosis.

PMID:40539882 | DOI:10.1002/advs.202501070

Ann Pharmacother. 2025 Jun 20:10600280251349570. doi: 10.1177/10600280251349570. Online ahead of print.

ABSTRACT

BACKGROUND: Intravenous (IV) ganciclovir is used in the management of herpesvirus infections, including cytomegalovirus (CMV). Ganciclovir is usually administered inpatient given the need for close monitoring of laboratory parameters.

OBJECTIVE: This study describes our experience with administering IV ganciclovir via an outpatient parenteral antimicrobial therapy (OPAT) program.

METHODS: This is a retrospective review of patients discharged on IV ganciclovir via OPAT at a tertiary medical center from August 2019 to August 2024. Demographics and treatment outcomes were collected.

RESULTS: Ganciclovir was the preferred agent in all patients either due to concern for gastrointestinal absorption or provider preference. Eighteen patients with a median age of 59.5 (interquartile range [IQR]: 53-65) years met criteria. The most common underlying immunocompromising condition was receipt of a transplanted organ in 16 (88.9%) patients, most commonly heart (8 patients) and kidney transplants (7 patients). Median duration of therapy after hospital discharge was 22 (IQR: 20-27) days. Fifteen (83.3%) patients transitioned to valganciclovir on completion of parenteral therapy either as secondary prophylaxis or continuation of therapy. The most common adverse event was leukopenia in 6 (33.3%) patients. One patient developed acute kidney injury (AKI) requiring dose modification and eventual discontinuation.

CONCLUSION AND RELEVANCE: Ganciclovir via OPAT is a viable option in patients requiring an extended duration of IV therapy. In our cohort of 18 patients, only one had early discontinuation of therapy due to ganciclovir-related AKI. Close monitoring of labs and an established OPAT protocol can allow for successful completion of therapy.

PMID:40539855 | DOI:10.1177/10600280251349570

Ann Surg. 2025 Jun 20. doi: 10.1097/SLA.0000000000006804. Online ahead of print.

ABSTRACT

OBJECTIVES: The Minimally Invasive Organ Transplant Consensus Conference (MIOT.CC) aimed to develop evidence-based recommendations for advancing minimally invasive techniques in organ transplantation.

BACKGROUND: Minimally invasive approaches (laparoscopic/robotic) are underutilized in transplantation compared to other specialties, despite potential advantages such as reduced morbidity and faster recovery.

METHODS: The conference Held in Riyadh, Saudi Arabia (December 2024) included international experts in minimally invasive donation and/or transplantation of the kidney, liver, pancreas, lung, heart, and uterus. Using the Danish Model of Consensus, participants reviewed current practice and evidence to formulate recommendations. The process included systematic literature reviews according to PRISMA guidelines and assessment of evidence quality using the GRADE approach.

RESULTS: Minimally invasive approaches consistently reduced postoperative pain, complications, and hospital stay. Specific recommendations were derived for each organ, with particular attention to donor safety and to the expansion of robotic techniques, if appropriately supported by locally available technology and experience.

CONCLUSION: MIOT.CC delineated a framework to disseminate minimally invasive techniques in both organ donation and transplantation. These recommendations can guide centers worldwide to first implement and subsequently optimize minimally invasive approaches through ongoing evaluation and adaptation based on emerging evidence and technological advancements.

PMID:40539268 | DOI:10.1097/SLA.0000000000006804

Front Immunol. 2025 Jun 5;16:1568988. doi: 10.3389/fimmu.2025.1568988. eCollection 2025.

ABSTRACT

BACKGROUND: Although postoperative rejection in transplant patients can be managed with immunosuppressants, their use is associated with some complications due to excessive immunosuppression. Recent animal studies in allotransplantation have suggested that certain ingredients of Chinese herbal medicine can extend transplant survival. However, their effects on transplantation have not been systematically reviewed and analyzed. The aim of this study was to evaluate the effects of herbal medicine ingredients on complications and survival of transplanted organs after heart, liver and kidney transplantation, and to explore the possible mechanism of action.

MATERIALS AND METHODS: Databases, including PubMed, EMBASE, Cochrane Library, Web of Science, Wang Fang, China National Knowledge Infrastructure (CNKI), China Science and Technological Journal Database (VIP) and Chinese Biomedical Literature Database (CBM), were searched up to January 1 2025. Animal studies reporting the effects of Chinese herbal medicine ingredients (HMIs) on postoperative complications and organ transplant survival/outcome were included. Methodological quality was assessed using the SYRCLE risk of bias tool. Meta-analysis was performed using R 4.3 software to assess levels of inflammatory factors, oxidative stress markers, apoptosis markers, indicators of liver/kidney function, median graft survival time and immune cell subsets.

RESULTS AND CONCLUSIONS: A total of 18 studies, involving 357 rodents were included. The overall quality of the included reports was moderate. We found that HMIs enhanced organ graft survival by reducing the Banff score, extending the median survival time (MST), and exerting anti-inflammatory, antioxidant and anti-apoptotic effects. HMIs can also inhibit T cell proliferation, dendritic cell (DC) maturation and increase the proportion of CD4+ regulatory T (Treg) cells. Furthermore, the improvement in liver and kidney function indicators, such as alanine aminotransferase (ALT), aspartate transaminase (AST), Serum creatinine (Scr) and blood urea nitrogen (BUN) also suggested protective effects of HMIs on liver and kidney function. However, the high heterogeneity observed in several analyses highlights the need for standardized experimental designs and further studies to confirm these findings and to explore their underlying mechanisms. Thus, our meta-analysis indicates that HMIs improve transplantation outcomes in animal models. These results lay a solid foundation for translating HMIs into clinical strategies for improving transplantation outcomes.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251002755, identifier crd420251002755.

PMID:40539066 | PMC:PMC12176545 | DOI:10.3389/fimmu.2025.1568988

Front Transplant. 2025 Jun 5;4:1594241. doi: 10.3389/frtra.2025.1594241. eCollection 2025.

ABSTRACT

Evidence for the contribution of non-HLA antibodies on long-term allograft outcome was suggested in early studies by Paul Terasaki and colleagues who showed worse 10-year allograft outcome in HLA identical kidney transplant recipients with a positive panel reactive antibody (PRA) as determined by the micro cytotoxicity assay, in which cells express other targets beside HLA. More recent reports have shown worse graft outcome when antibodies against non-HLA antigens were detected with HLA-donor specific antibodies (HLA-DSA), and even suggest that non-HLA antibodies may serve as precursor to development of HLA antibodies. Unfortunately, the recent studies lack reproducibility, which then leads to skepticism as to the relevance of non-HLA antibody in transplantation outcome. Consequently, routine testing for non-HLA antibody along with monitoring of HLA-DSA as part of a post-transplant immune surveillance protocol is not standard practice. The Sensitization in Transplantation: Assessment of Risk (STAR) workgroup summarized the current literature on this topic, citing differences in cohort characteristics, variability in study design, selection of sample and timepoints for testing and variability in the assays used to detect non-HLA antibodies, as reasons that impact the accurate assessment on the relevance of non-HLA antibodies. However, correlation between test results and outcome can only be determined if the assay in question is detecting the correct analyte. Therefore, here we will make the case for a plan that requires a systematic validation of high-throughput bead-based assays, to include appropriate sequence selection for non-HLA antigenic targets and quality control metrics as a first step to solving this puzzle.

PMID:40538429 | PMC:PMC12176821 | DOI:10.3389/frtra.2025.1594241

Interdiscip Cardiovasc Thorac Surg. 2025 Jun 4;40(6):ivaf139. doi: 10.1093/icvts/ivaf139.

NO ABSTRACT

PMID:40538181 | DOI:10.1093/icvts/ivaf139

PM R. 2025 Jun 19. doi: 10.1002/pmrj.13433. Online ahead of print.

ABSTRACT

BACKGROUND: In-reach rehabilitation is a relatively new model of care available in a small number of Australian public hospitals. These multidisciplinary teams deliver evidence-based structured rehabilitation to carefully selected patients during acute care. There are no published rehabilitation outcomes in heart and/or lung transplant recipients.

OBJECTIVE: To describe the rehabilitation outcomes of a cohort of heart and/or lung transplant recipients.

DESIGN: Retrospective cohort study.

SETTING: One metropolitan institution with the largest heart and lung transplant service in Australia.

PATIENTS: Between 2014 and 2023, a total of 957 heart and/or lung transplants were performed at this institution.

INTERVENTION: In-reach rehabilitation was delivered to selected patients during the 10-year period. However, from 2019 onwards, patients were proactively screened by the rehabilitation team for eligibility as well as referred from the acute transplant teams.

MAIN OUTCOME MEASURES: Functional independence measure (FIM) changes and percentage of patients going to inpatient rehabilitation after completion of acute care.

RESULTS: In-reach rehabilitation was received by 223 (24.3%) patients. With the exception of three patients (who died), the vast majority were able to complete an in-reach rehabilitation program and were discharged to the community (n = 98, 43.9%), inpatient rehabilitation (n = 119, 53.4%), or transferred to another hospital (n = 3, 1.3%), demonstrating feasibility. Across the cohort, the median admission and discharge FIM scores were 77.0 (interquartile range, 60-94.8) and 100 (interquartile range, 77-118), respectively, demonstrating significant functional improvements from start to finish of the in-reach rehabilitation program (p < .001). Over this period, the number of patients discharged to inpatient rehabilitation decreased as a proportion of the total number of transplants (25.7% in 2014, 47.8% in 2017, 34.7% in 2019, 26.2% in 2021, 8.0% in 2023). Proactive rehabilitation screening implemented from 2019 allowed for earlier and longer program delivery to more patients.

CONCLUSIONS: In-reach rehabilitation is feasible in acute care after heart and/or lung transplantation and was associated with functional improvements. The addition of proactive rehabilitation screening appeared to improve the effectiveness of the in-reach rehabilitation program.

PMID:40538100 | DOI:10.1002/pmrj.13433

Innovations (Phila). 2025 Jun 19:15569845251337720. doi: 10.1177/15569845251337720. Online ahead of print.

ABSTRACT

OBJECTIVE: Partial heart transplantation (PHT) is a new procedure that delivers growing heart valve implants for children. However, awareness, attitudes, and perceptions of health care professionals regarding PHT remain unexplored.

METHODS: A national survey was conducted among members of the Congenital Heart Surgical Society, pediatric cardiac intensive care unit (ICU) directors, medical students, and organ procurement organization (OPO) representatives. The survey measured their awareness, perceptions, and attitudes toward PHT. Perceptions and attitudes were measured using a 5-point Likert scale. Statistical comparisons in ranked responses between survey questions were calculated using two-way analysis of variance, with multiple comparisons assessed by a Tukey post hoc test.

RESULTS: There were responses from 95 medical students (12.1%), 32 congenital cardiac surgeons (10.26%), 21 pediatric ICU directors (16.8%), and representatives from 8 OPOs (15%). Prior to survey distribution, 20% of students were aware of PHT. In contrast, almost all congenital heart surgeons (96.88%) and pediatric cardiologists (100%) were aware of PHT. Although surgeons and cardiologists understand the concepts of PHT, cardiologists were less likely to recommend and inform their patients about the procedure if they meet the criteria (Likert scale scores of 4.68 vs 3.14, P = 0.01 and 4.38 vs 3.69, P = 0.01, respectively). Surgeon and cardiologist perceptions regarding the use of PHT for different patient age groups were significantly different (P < 0.001).

CONCLUSIONS: Even though PHT is a relatively recent innovation, it is well known among pediatric cardiac surgeons and pediatric intensive care directors.

PMID:40538051 | DOI:10.1177/15569845251337720

Sci Rep. 2025 Jun 20;15(1):20140. doi: 10.1038/s41598-025-04927-z.

ABSTRACT

Due to the increasing focus on neurodevelopment in children with congenital heart disease (CHD), early predictive markers are crucial for implementing interventions and improving neurodevelopmental outcomes. As postoperative delirium (PD) is known to have a long-term impact on neurocognitive function in adults, studies on the prevalence of and modifiable risk factors for PD offer new perspectives. We conducted a retrospective, single-centre study screening for PD using the Cornell Assessment of Pediatric Delirium (CAPD). We distinguished PD from iatrogenic withdrawal syndrome (IWS) by using the Withdrawal Assessment Tool 1 (WAT-1). A confirmatory, multivariate regression analysis was performed and included various pre-, intra-, and postoperative variables. The screening compliance rate was 95% among the 311 patients. The prevalence of PD was 40.2%, and 46.4% of the patients developed IWS. Infants were at the highest risk for PD (OR 2.9, p = 0.05). Prolonged mechanical ventilation > 100 h (OR 7.4, p = 0.003), infusion therapy with ketamine (OR 3.3, p = 0.009), IWS (mild: OR 7.7, p = < 0.001, severe: OR 17.0, p = < 0.001) and low cardiac output syndrome (LCOS) (OR 3.9, p = 0.02) were significant predictive risk factors for PD. Overall, PD and IWS are highly prevalent in paediatric cardiac intensive care units (pCICUs), especially in infants and children with prolonged ventilation durations who require multiple sedatives. This is one of the most extensive single-centre studies in the pCICU population, and the results revealed that IWS and lactatemia in the context of LCOS are novel predictors of PD.

PMID:40542017 | PMC:PMC12181358 | DOI:10.1038/s41598-025-04927-z

J Pediatr Surg. 2025 Jun 18:162420. doi: 10.1016/j.jpedsurg.2025.162420. Online ahead of print.

ABSTRACT

BACKGROUND: Currarino syndrome is a rare congenital condition characterized by a triad of anorectal malformation, sacral agenesis, and presacral mass, often a teratoma. Comparative outcomes of sacrococcygeal teratomas (SCTs) in Currarino versus non-syndromic cases are not well defined.

METHODS: A multicenter retrospective review of pediatric SCT resections from 2010-2020 was conducted across 11 institutions in the Midwest Pediatric Surgery Consortium. Patients were classified based on the presence or absence of Currarino syndrome. Demographic, surgical, pathologic, and long-term outcome data were analyzed. The primary outcome was tumor recurrence.

RESULTS: Of 203 patients, 25 (12.3%) had Currarino syndrome. Currarino patients were more often diagnosed postnatally (80% vs. 25%, p<0.001) and had predominantly Altman type IV tumors (87% vs. 17%, p<0.001). All tumors in the Currarino cohort were mature teratomas, while 27% of non-Currarino tumors were immature and 12% were malignant (p<0.001). Tumors in Currarino patients were significantly smaller in size (median 3.3 cm vs. 8.0 cm, p<0.001). Recurrence rates were low and comparable (4% Currarino vs. 10% non-Currarino, p=0.18). Currarino patients had higher rates of urinary incontinence (44% vs. 28%, p=0.048) and constipation (76% vs. 32%, p<0.001). Kaplan-Meier analysis showed a trend toward improved recurrence-free survival in Currarino patients, though not statistically significant.

CONCLUSIONS: Pediatric patients with Currarino-associated SCTs have excellent long-term outcomes, with low recurrence rates likely attributable to benign tumor histology and high rates of complete resection. These findings suggest that surveillance strategies may be tailored for Currarino patients to reduce unnecessary imaging and long-term follow-up burden.

STUDY DESIGN: Retrospective cohort study Level of Evidence: III.

PMID:40541662 | DOI:10.1016/j.jpedsurg.2025.162420

JACC Case Rep. 2025 Jun 18;30(15):103787. doi: 10.1016/j.jaccas.2025.103787.

ABSTRACT

Coronary artery fistulae (CAF) are rare aberrant connections between coronary arteries and the great vessels, coronary sinus, or cardiac chambers. Although most CAF are asymptomatic, patients with large, hemodynamically significant, or symptomatic fistulae might benefit from closure. Transcatheter occlusion is usually the preferred approach given that it avoids a sternotomy and cardiopulmonary bypass. However, there remain CAF with challenging features such as tortuous anatomy, large aneurysms, and concomitant cardiac disease that benefit from surgical ligation. We present 3 cases of CAF, all of which were treated by surgical ligation because of their hemodynamic and clinical significance, tortuosity, and massively dilated aneurysms. These cases illustrate the heterogeneous presentations of CAF and the varied open approaches to closure: epicardial versus intracardiac closure and with or without ligation of the involved coronary artery and distal revascularization. We present high-resolution 3-dimensional reconstructions of these impressively large fistulae and discuss the need for surgical consideration in similar cases.

PMID:40541346 | DOI:10.1016/j.jaccas.2025.103787

Pediatr Investig. 2025 Jan 3;9(2):181-184. doi: 10.1002/ped4.12459. eCollection 2025 Jun.

ABSTRACT

We recently came across an outbreak of parvovirus B19 related acute myocarditis in preschool children in a specific region in northern Greece. The children exhibited serious morbidity and mortality. All children had very poor left ventricular ejection fraction and required inotropic intensive care unit support.

PMID:40539004 | PMC:PMC12175628 | DOI:10.1002/ped4.12459

Ochsner J. 2025 Summer;25(2):116-118. doi: 10.31486/toj.24.0109.

ABSTRACT

BACKGROUND: The development of cardiac complications is common in patients with muscular dystrophy. However, advanced heart failure therapies such as implantation of durable ventricular assist devices and transplant are infrequently used in patients who develop cardiomyopathy, often because of comorbid impairments in mobility and respiratory function.

CASE REPORT: A 16-year-old male with limb-girdle muscular dystrophy type R4 presented with chronic decompensated heart failure. Recent worsening of his respiratory function and mobility were confounded by severe heart failure. In addition to our core advanced heart failure team, multidisciplinary assessment preoperatively included Neurology, Pulmonology, Genetics, and Physical Medicine and Rehabilitation. The patient underwent implantation of a HeartMate 3 left ventricular assist device and had an uneventful postoperative course. After intensive inpatient physical and occupational therapy, he was discharged home on postoperative day 16 with minimal residual heart failure symptoms and plans to continue robust outpatient physical therapy.

CONCLUSION: Patients with muscular dystrophy often have cardiac involvement; however, certain subtypes of muscular dystrophy are associated with an earlier presentation of severe life-limiting cardiomyopathy. Pediatric patients with muscular dystrophy should be considered for advanced heart failure therapies such as implantation of a durable left ventricular assist device at an appropriate center. Carefully selected patients may experience substantial improvements in their quality of life. Given the variable disease progression and life expectancy of patients with subtypes of muscular dystrophy, a thorough assessment by a multidisciplinary team is critical.

PMID:40538608 | PMC:PMC12175756 | DOI:10.31486/toj.24.0109

Innovations (Phila). 2025 Jun 19:15569845251337720. doi: 10.1177/15569845251337720. Online ahead of print.

ABSTRACT

OBJECTIVE: Partial heart transplantation (PHT) is a new procedure that delivers growing heart valve implants for children. However, awareness, attitudes, and perceptions of health care professionals regarding PHT remain unexplored.

METHODS: A national survey was conducted among members of the Congenital Heart Surgical Society, pediatric cardiac intensive care unit (ICU) directors, medical students, and organ procurement organization (OPO) representatives. The survey measured their awareness, perceptions, and attitudes toward PHT. Perceptions and attitudes were measured using a 5-point Likert scale. Statistical comparisons in ranked responses between survey questions were calculated using two-way analysis of variance, with multiple comparisons assessed by a Tukey post hoc test.

RESULTS: There were responses from 95 medical students (12.1%), 32 congenital cardiac surgeons (10.26%), 21 pediatric ICU directors (16.8%), and representatives from 8 OPOs (15%). Prior to survey distribution, 20% of students were aware of PHT. In contrast, almost all congenital heart surgeons (96.88%) and pediatric cardiologists (100%) were aware of PHT. Although surgeons and cardiologists understand the concepts of PHT, cardiologists were less likely to recommend and inform their patients about the procedure if they meet the criteria (Likert scale scores of 4.68 vs 3.14, P = 0.01 and 4.38 vs 3.69, P = 0.01, respectively). Surgeon and cardiologist perceptions regarding the use of PHT for different patient age groups were significantly different (P < 0.001).

CONCLUSIONS: Even though PHT is a relatively recent innovation, it is well known among pediatric cardiac surgeons and pediatric intensive care directors.

PMID:40538051 | DOI:10.1177/15569845251337720