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Rejection with heart failure after pediatric cardiac transplantation
M J Flippin1, D T Balzer, P R Murphy
1Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA. flippin-m@a1.kids.wustl.edu
Background:
Rejection associated with heart failure or death occurs after pediatric cardiac transplantation but has had limited analysis.
Methods:
We analyzed the records of 96 consecutive pediatric cardiac transplant recipients who survived to hospital discharge.
Results:
Eighteen patients (19%) experienced 23 episodes of heart failure or death associated with rejection. Univariate analysis demonstrated black race (p = 0.041), transplantation after 12 months of age (p = 0.032), later time after transplantation (p = 0.037), rejection episode in the first year after transplantation (p = 0.001), and history of two or more rejection episodes (p < 0.001) were significantly associated with rejection seen with heart failure. A multivariate regression analysis identified two or more rejection episodes to be the only independent risk factor for the development of rejection with heart failure (odds ratio 20; 95% confidence limits, 4-104; p < 0.0001).
Conclusions:
This study identified pediatric heart transplant recipients with a history of previous rejection episodes to be at a higher risk for symptomatic or fatal rejection. Further studies are needed to determine if intensification of maintenance immunosuppression, long-term rejection surveillance, or both in patients with multiple rejection episodes could reduce morbidity and mortality from rejection.