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Updated: Aug 5, 2026
Murine Heterotopic Heart Transplant Technique
Published on: July 8, 2014
Nonadherence is associated with late rejection in pediatric heart transplant recipients
J M Ringewald1, S S Gidding, S E Crawford
1Department of Cardiology, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois, USA.
Insights
Nonadherence significantly impacts late rejection in pediatric heart transplant recipients, particularly during adolescence, leading to poor outcomes. Addressing adherence is crucial for improving graft survival post-transplant.
Area of Science:
- Pediatric Cardiology
- Transplantation Immunology
- Adherence Research
Background:
- Pediatric heart transplantation outcomes are influenced by various factors.
- Late rejection remains a significant challenge in long-term graft survival.
- Understanding nonadherence is critical for optimizing post-transplant care.
Purpose of the Study:
- To investigate the association between nonadherence and late rejection in pediatric heart transplant recipients.
- To identify risk factors contributing to late rejection episodes.
- To evaluate the impact of nonadherence on patient outcomes.
Main Methods:
- Retrospective cohort study of 50 pediatric heart transplant recipients surviving over 6 months.
- Stratification of patients based on episodes of late rejection.
- Assessment of cyclosporine A (CSA) levels, CSA level variability, and self-reported nonadherence.
Main Results:
- 49 episodes of late rejection occurred in 15 patients, with 76% linked to nonadherence.
- Nonadherence was associated with increased mortality (7/15 deaths) and transplant coronary artery disease (3/15).
- Risk factors for rejection included single-parent households, non-white ethnicity, older age, and higher CSA variability.
Conclusions:
- Late rejection in pediatric heart transplantation is strongly associated with nonadherence.
- Nonadherence and subsequent rejection are common during adolescence.
- Nonadherence significantly contributes to poor outcomes, including mortality and graft loss.
Objectives:
The objective was to study the impact of nonadherence on late rejection after pediatric heart transplantation.
Study Design:
This was a retrospective cohort study of cardiac transplant recipients surviving >6 months (n = 50). Patients were stratified by episodes of late rejection. End points were defined by cyclosporin A (CSA) level, CSA level variability, and patient admission of nonadherence.
Results:
In 15 patients there were 49 episodes of late rejection, and 37 (76%) were associated with nonadherence. Of these patients, 7 of 15 died, and 3 of 15 had transplant coronary artery disease. Risk factors for the rejection were single-parent home, non-white, older age, and higher CSA level variability. In 35 nonrejectors there were 4 deaths from sepsis, post-transplant lymphoproliferative disease, renal failure, and encephalomyelitis.
Conclusion:
Late rejection after pediatric heart transplantation is associated with nonadherence, is common during adolescence, and is associated with poor outcome.
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