Nadeen Wu, Stephen J. Foulkes, Nathan R. Weeldreyer, Calvin Kruger, Corey R. Tomczak, Michael Khoury, Jennifer L. Conway, Mark J. Haykowsky
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引用次数: 0
Abstract
Pediatric heart transplant (PHTR) recipients have reduced cardiorespiratory fitness (VO2peak); however, the magnitude of this impairment and its underlying central hemodynamic mechanisms remain poorly characterized. This systematic review and meta-analysis quantified differences in VO2peak and peak exercise central hemodynamics between PHTR recipients and age-matched healthy controls (CON). MEDLINE (PubMed) was searched for studies comparing VO2peak in PHTR recipients and CON. Pooled effect sizes were expressed as weighted mean differences (WMD) using a DerSimonian–Laird random-effects model, and weighted least-squares meta-regression assessed the moderating effects of age and time post-transplant. Seven unique studies (PHTR n = 90; CON n = 118) reported VO2peak and peak HR. PHTR had significantly lower VO2peak (WMD = −9.5 mL/kg/min), peak HR (WMD: −30 bpm), and CO (n = 3 studies, WMD: −2.5 L/min), with no difference in peak SBP (n = 3 studies). Meta-regression revealed no significant moderating effect of age or time post-transplant on the VO2peak deficit. The markedly reduced VO2peak in PHTR recipients is driven primarily by impaired peak CO and persistent chronotropic incompetence, consistent with cardiac allograft sympathetic denervation.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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