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Updated: Aug 10, 2026
Murine Heterotopic Heart Transplant Technique
Published on: July 8, 2014
Late rejection is a predictor of transplant coronary artery disease in children
N F Mulla1, J K Johnston, L Vander Dussen
1Department of Pediatrics, Loma Linda University Children's Hospital, California, USA. Nmulla@ahs.llumc.edu
Insights
Late rejection significantly predicts posttransplant coronary artery disease (TxCAD) in pediatric heart transplant recipients. Early retransplantation (re-Tx) is recommended upon diagnosis to improve survival rates.
Area of Science:
- Pediatric Cardiology
- Transplant Immunology
- Cardiovascular Research
Background:
- Posttransplant coronary artery disease (TxCAD) is a major limitation to long-term survival after pediatric heart transplantation (Tx).
- Retransplantation (re-Tx) is the primary treatment for TxCAD, but data on risk factors and optimal timing for re-Tx in children are scarce.
Purpose of the Study:
- To determine the incidence of TxCAD in pediatric heart transplant recipients.
- To identify predisposing factors for TxCAD development.
- To establish optimal timing for retransplantation (re-Tx) in pediatric heart transplant recipients.
Main Methods:
- Retrospective review of pediatric heart transplant recipients surviving over one year at Loma Linda University.
- Analysis of nonimmune and immune risk factors associated with TxCAD development.
- Statistical analysis, including univariate and multivariate models, to identify independent predictors of TxCAD.
Main Results:
- TxCAD was diagnosed in 24 of 210 pediatric heart transplant recipients, with freedom from TxCAD at 5 and 10 years being 92% and 75%, respectively.
- Late rejection (>1 year posttransplant), particularly severe and hemodynamically compromising episodes, was identified as an independent predictor of TxCAD development (p=0.025 for frequency, p<0.01 for severity).
- Patients experiencing severe late rejection developed TxCAD rapidly, with freedom from TxCAD one and two years postevent at 78% and 55%, respectively. Eleven patients underwent re-Tx within seven months of diagnosis, with nine surviving.
Conclusions:
- Late rejection is a significant independent predictor of TxCAD in pediatric heart transplant recipients.
- Severe late rejection leads to rapid development of angiographically apparent TxCAD, necessitating aggressive monitoring.
- Given the early onset of TxCAD mortality and morbidity, immediate listing for re-Tx upon diagnosis is recommended.
Objective:
The study objectives were to determine posttransplant coronary artery disease (TxCAD) incidence, predisposing factors and optimal timing for retransplantation (re-Tx) in pediatric heart transplantation (Tx) recipients.
Background:
The TxCAD limits long-term survival following heart Tx, with re-Tx being the primary therapy. Information on risk factors and timing of listing for re-Tx is limited in children.
Methods:
The records of children who survived >1 year post-Tx at Loma Linda University were reviewed. Nonimmune and immune risk factors were analyzed.
Results:
TxCAD was documented in 24 of 210 children. Freedom from TxCAD was 92 +/- 2% and 75 +/- 5% at 5 and 10 years' post-Tx, respectively. The TxCAD diagnosis was established at autopsy in 10 asymptomatic patients who died suddenly within nine months following the most recent negative angiograms. The remaining 14 children had angiographic diagnoses of TxCAD and had symptoms and/or graft dysfunction (n = 10) or positive stress studies (n = 4). Three of 14 died within three months after the diagnosis was made. Eleven patients underwent re-Tx within seven months of diagnosis; nine survived. Univariate and multivariate analyses showed that only late rejection (>1 year posttransplant) frequency (p = 0.025) and severity (hemodynamically compromising) (p < 0.01) were independent predictors of TxCAD development. Freedom from TxCAD after severe late rejection was 78 +/- 8% one year postevent and 55 +/- 10% by two years.
Conclusions:
Late rejection is an independent predictor of TxCAD. Patients suffering severe late rejection develop angiographically apparent TxCAD rapidly and must be monitored aggressively. Both TxCAD mortality and morbidity occur early; therefore, we recommend immediate listing for re-Tx upon diagnosis.
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