Outcome of Antibody‐Mediated Fetal Heart Disease With Standardized Anti‐Inflammatory Transplacental Treatment

Background Transplacental fetal treatment of immune‐mediated fetal heart disease, including third‐degree atrioventricular block (AVB III) and endocardial fibroelastosis, is controversial. Methods and Results To study the impact of routine transplacental fetal treatment, we reviewed 130 consecutive cases, including 108 with AVB III and 22 with other diagnoses (first‐degree/second‐degree atrioventricular block [n=10]; isolated endocardial fibroelastosis [n=9]; atrial bradycardia [n=3]). Dexamethasone was started at a median of 22.4 gestational weeks. Additional treatment for AVB III included the use of a β‐agonist (n=47) and intravenous immune globulin (n=34). Fetal, neonatal, and 1‐year survival rates with AVB III were 95%, 93%, and 89%, respectively. Variables present at diagnosis that were associated with perinatal death included an atrial rate <90 beats per minute (odds ratio [OR], 258.4; 95% CI, 11.5–5798.9; P <0.001), endocardial fibroelastosis (OR, 28.9; 95% CI, 1.6–521.7; P <0.001), fetal hydrops (OR, 25.5; 95% CI, 4.4–145.3; P <0.001), ventricular dysfunction (OR, 7.6; 95% CI, 1.5–39.4; P =0.03), and a ventricular rate <45 beats per minute (OR, 12.9; 95% CI, 1.75–95.8; P =0.034). At a median follow‐up of 5.9 years, 85 of 100 neonatal survivors were paced, and 1 required a heart transplant for dilated cardiomyopathy. Cotreatment with intravenous immune globulin was used in 16 of 22 fetuses with diagnoses other than AVB III. Neonatal and 1‐year survival rates of this cohort were 100% and 95%, respectively. At a median age of 3.1 years, 5 of 21 children were paced, and all had normal ventricular function. Conclusions Our findings reveal a low risk of perinatal mortality and postnatal cardiomyopathy in fetuses that received transplacental dexamethasone±other treatment from the time of a new diagnosis of immune‐mediated heart disease.

Pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 symptoms in Iran

Aim: We report two cases of pediatric patients diagnosed and treated for pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS) symptoms. Materials & methods: Two previously healthy 3- and 4-year-old boys were referred to the hospital after 5 days of 39°C fever, with symptoms such as erythema multiform in the lower extremities, irritability, refusal to eat, restlessness, lymphadenopathy, conjunctivitis and abnormal echocardiography. Results: After 8 days of hospitalization, the patients showed normal laboratory tests, improvement of clinical condition and were discharged from the hospital. Conclusion: This study raised several issues for physicians about SARS-CoV-2, its complications, diagnosis and treatment. Based on our results, pediatrics with PIMS-TS should be first screened for SARS-CoV-2, then treated with a combination of antivirals, anti-inflammatories, antibiotics and intravenous immune globulin.

Natural Antibodies and Alloreactive T Cells Long after Kidney Transplantation

Background. The relationship between circulating effector memory T and B cells long after transplantation and their susceptibility to immunosuppression are unknown. To investigate the impact of antirejection therapy on T cell-B cell coordinated immune responses, we assessed IFN-γ-producing memory cells and natural antibodies (nAbs) that potentially bind to autoantigens on the graft. Methods. Plasma levels of IgG nAbs to malondialdehyde (MDA) were measured in 145 kidney transplant recipients at 5–7 years after transplantation. In 54 of these patients, the number of donor-reactive IFN-γ-producing cells was determined. 35/145 patients experienced rejection, 18 of which occurred within 1 year after transplantation. Results. The number of donor-reactive IFN-γ-producing cells and the levels of nAbs were comparable between rejectors and nonrejectors. The nAbs levels were positively correlated with the number of donor-reactive IFN-γ-producing cells (rs = 0.39, p = 0.004 ). The positive correlation was only observed in rejectors (rs = 0.53, p = 0.003 ; nonrejectors: rs = 0.24, p = 0.23 ). Moreover, we observed that intravenous immune globulin treatment affected the level of nAbs and this effect was found in patients who experienced a late ca-ABMR compared to nonrejectors ( p = 0.008 ). Conclusion. The positive correlation found between alloreactive T cells and nAbs in rejectors suggests an intricate role for both components of the immune response in the rejection process. Treatment with intravenous immune globulin impacted nAbs.