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We sought to develop and validate a quantitative risk‐prediction model for predicting the risk of posttransplant in‐hospital mortality in pediatric heart transplantation (HT). Children <18 years of age who underwent primary HT in the United States during 1999–2008 (n = 2707) were identified using Organ Procurement and Transplant Network data. A risk‐prediction model was developed using two‐thirds of the cohort (random sample), internally validated in the remaining one‐third, and independently validated in a cohort of 338 children transplanted during 2009–2010. The best predictive model had four categorical variables: hemodynamic support (ECMO, ventilator support, VAD support vs. medical therapy), cardiac diagnosis (repaired congenital heart disease [CHD], unrepaired CHD vs. cardiomyopathy), renal dysfunction (severe, mild‐moderate vs. normal) and total bilirubin (≥ 2.0, 0.6 to <2.0 vs. <0.6 mg/dL). The C‐statistic (0.78) and the Hosmer–Lemeshow goodness‐of‐fit (p = 0.89) in the model‐development cohort were replicated in the internal validation and independent validation cohorts (C‐statistic 0.75, 0.81 and the Hosmer–Lemeshow goodness‐of‐fit p = 0.49, 0.53, respectively) suggesting acceptable prediction for posttransplant in‐hospital mortality. We conclude that this risk‐prediction model using four factors at the time of transplant has good prediction characteristics for posttransplant in‐hospital mortality in children and may be useful to guide decision‐making around patient listing for transplant and timing of mechanical support.

Macular edema (ME) secondary to retinal vein occlusion (RVO) is an important cause of vision loss resulting in substantial morbidity in terms of reduced health-related quality of life and functioning. Until recently, no approved pharmacological treatment options were available.

We sought to evaluate trends in overall and race‐specific pediatric heart transplant (HT) wait‐list mortality in the United States (US) during the last 20 years. We identified all children <18 years old listed for primary HT in the US during 1989–2009 (N = 8096, 62% White, 19% Black, 13% Hispanic and 6% Other) using the Organ Procurement and Transplant Network database. Wait‐list mortality was assessed in four successive eras (1989–1994, 1995–1999, 2000–2004 and 2005–2009). Overall wait‐list mortality declined in successive eras (26%, 23%, 18% and 13%, respectively). The decline across eras remained significant in adjusted analysis (hazard ratio [HR] 0.70 in successive eras, 95% confidence interval [CI], 0.67–0.74) and was 67% lower for children listed during 2005–2009 versus those listed during 1989–1994 (HR 0.33; CI, 0.28–0.39). In models stratified by race, wait‐list mortality decreased in all racial groups in successive eras. In models stratified by era, minority children were not at higher risk of wait‐list mortality in the most recent era. We conclude that the risk of wait‐list mortality among US children listed for HT has decreased by two‐thirds during the last 20 years. Racial gaps in wait‐list mortality present variably in the past are not present in the current era.

We assessed whether the improvement in posttransplant survival in pediatric heart transplant (HT) recipients during the last two decades has benefited the major racial groups in the United States equally. We analyzed all children <18 years of age who underwent their first HT in the US during 1987–2008. We compared trends in graft loss (death or retransplant) in white, black and Hispanic children in five successive cohorts (1987–1992, 1993–1996, 1997–2000, 2001–2004, 2005–2008). The primary endpoint was early graft loss within 6 months posttransplant. Longer‐term survival was assessed in recipients who survived the first 6 months. The improvement in early posttransplant survival was similar (hazard ratio [HR] for successive eras 0.80, 95% confidence interval [CI] 0.7, 0.9, p = 0.24 for black‐era interaction, p = 0.22 for Hispanic‐era interaction) in adjusted analysis. Longer‐term survival was worse in black children (HR 2.2, CI 1.9, 2.5) and did not improve in any group with time (HR 1.0 for successive eras, CI 0.9, 1.1, p = 0.57; p = 0.19 for black‐era interaction, p = 0.21 for Hispanic‐era interaction). Thus, the improvement in early post‐HT survival during the last two decades has benefited white, black and Hispanic children equally. Disparities in longer‐term survival have not narrowed with time; the survival remains worse in black recipients.

Racial differences in outcomes are well known in children after heart transplant (HT) but not in children awaiting HT. We assessed racial and ethnic differences in wait-list mortality in children <18 years old listed for primary HT in the United States during 1999-2006 using multivariable Cox models. Of 3299 listed children, 58 were listed as white, 20 as black, 16 as Hispanic, 3 as Asian and 3 were defined as 'Other'. Mortality on the wait-list was 14, 19, 21, 17 and 27 for white, black, Hispanic, Asian and Other children, respectively. Black (hazard ratio HR 1.6, 95 confidence interval CI 1.3, 1.9), Hispanic (HR 1.5, CI 1.2, 1.9), Asian (HR, 2.0, CI 1.3, 3.3) and Other children (HR 2.3, CI 1.5, 3.4) were all at higher risk of wait-list death compared to white children after controlling for age, listing status, cardiac diagnosis, hemodyamic support, renal function and blood group. After adjusting additionally for medical insurance and area household income, the risk remained higher for all minorities. We conclude that minority children listed for HT have significantly higher wait-list mortality compared to white children. Socioeconomic variables appear to explain a small fraction of this increased risk.

Feline hyperthyroidism is a common endocrine disorder in older cats for which homeopathic treatment has been advocated. A double‐blinded, placebo‐controlled randomised trial was performed to look for evidence of efficacy for the use of individualised homeopathy in the treatment of this disease. Using a case definition of a concentration of the thyroid hormone T4 >66 nmol/l, cats were randomised into two treatment arms. Either a placebo or a homeopathic treatment was given to each cat blindly. After 21 days, the T4 levels, weight (Wt) and heart rate (HR) were compared with pretreatment values. There were no statistically significant differences in the changes seen between the two treatment arms following placebo or homeopathic treatment (T4 P=0.96, Wt P=0.16, HR P=0.36) or between the means of each parameter for either treatment arm before and after placebo or homeopathic treatment (all P values >0.13). In a second phase of the study, patients in both treatment arms were given methimazole treatment for 21 days and T4, Wt and HR determined again. Again there were no statistically significant differences between the groups, but there were statistically significant reductions in T4 (P<0.0001) and HR (P=0.02), and a statistically significant increase in Wt (P=0.004) in both groups compared with their pre‐methimazole treatment levels. The results of this study failed to provide any evidence of the efficacy of homeopathic treatment of feline hyperthyroidism.