Clinical practice patterns are relatively uniform between pediatric heart transplant centers: A survey-based assessment

Chesney Castleberry*, Sonja Ziniel, Christopher Almond, Scott Auerbach, Seth A. Hollander, Ashwin K. Lal, Matthew Fenton, Elfriede Pahl, Joseph W. Rossano, Melanie D. Everitt, Kevin P. Daly

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Clinical practice variations are a barrier to the study of pediatric heart transplants and coordination of multicenter RCTs in this patient population. We surveyed centers to describe practice patterns, understand areas of variation, and willingness to modify protocol. Pediatric heart transplant centers were identified, and one survey was completed per center. Simple descriptive statistics were used. The response rate was 77% (40 responses from 52 contacted centers, 37 with complete responses). Median center volume of respondents was eight transplants/year (IQR 3-19). Most centers reported tacrolimus (36/38, 95%) and mycophenolate mofetil (36/38, 95%) as maintenance immunosuppression. Other immunosuppression agents reported were cyclosporine (7/38, 18%), everolimus or sirolimus (3/38, 8%), and azathioprine (2/38, 5%). Overall, respondents answered similarly for questions regarding clinical practices including induction therapy, maintenance immunosuppression, and rejection treatment threshold (>85% agreement for all). Additionally, willingness to change clinical practices was over 70% for all practices surveyed (35 total respondents), and 97% of centers (36/37) were willing to participate in a RCT of maintenance immunosuppression. In conclusion, we found many similar clinical practice protocols. Most centers are willing to collaborate on a common protocol in order to participate in a RCT and support a trial investigating maintenance immunosuppression.

Original languageEnglish (US)
Article numbere13013
JournalPediatric transplantation
Volume21
Issue number5
DOIs
StatePublished - Aug 2017

Keywords

  • heart transplantation
  • immunosuppression
  • pediatric heart transplant
  • survey of practices

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

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