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Updated: Sep 22, 2026
A Porcine Heterotopic Heart Transplantation Protocol for Delivery of Therapeutics to a Cardiac Allograft
Published on: February 14, 2022
Treatment of hyperhomocysteinemia in pediatric heart transplant recipients
Francesco Parisi1, Hélène Danesi, Vincenzo Di Ciommo
1Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy. parisi@opbg.net
Insights
Vitamin supplementation significantly reduced homocysteine levels in pediatric heart transplant recipients, potentially normalizing levels and mitigating risks associated with graft coronary artery vasculopathy. This study highlights the benefits of vitamin B12, E, A, and folic acid.
Area of Science:
- Pediatric Cardiology
- Transplantation Immunology
- Nutritional Biochemistry
Background:
- Graft coronary artery vasculopathy is a major cause of late morbidity and mortality in pediatric cardiac allograft recipients.
- Elevated plasma homocysteine levels are increasingly linked to cardiac allograft vasculopathy post-heart transplantation.
Purpose of the Study:
- To assess the efficacy of vitamin supplementation in reducing homocysteine levels in pediatric heart transplant recipients.
- To investigate the role of creatinine levels as potential determinants of post-transplant plasma homocysteine concentration.
Main Methods:
- A study involving 27 pediatric heart transplant patients with elevated homocysteine levels.
- Administration of vitamin B12, vitamin E, vitamin A, and folic acid supplementation.
- Monitoring of homocysteine, vitamin, and creatinine levels at 3, 6, 9, and 12 months post-treatment.
Main Results:
- A significant reduction in homocysteine levels was observed across all measurement points.
- Marked increase in vitamin B12 serum levels, with moderate increases in folic acid, vitamin E, and vitamin A.
- No significant change in creatinine levels; a correlation between homocysteine and creatinine existed, but not a direct causal link for homocysteine reduction.
Conclusions:
- Vitamin supplementation effectively reduces and may normalize homocysteine serum levels in pediatric heart transplant recipients.
- The study confirms the impact of vitamin supplementation on homocysteine levels, suggesting a potential therapeutic strategy.
- Creatinine levels did not directly correlate with the reduction in homocysteine achieved through vitamin supplementation.
Background:
Graft coronary artery vasculopathy is the main cause of late morbidity and mortality in pediatric cardiac allograft recipients. Growing evidence suggests that elevated plasma homocysteine levels are associated with cardiac allograft vasculopathy following heart transplantation. The purpose of this study was to evaluate the effect of vitamin supplementation as a potential strategy for reducing homocysteine levels in pediatric heart transplant recipients and examine creatinine levels as potential determinants of plasma homocysteine concentration after transplantation.
Methods:
We studied 27 pediatric heart transplant patients with homocysteine levels higher than normal. All children received vitamin supplementation (vitamin B(12), vitamin E, vitamin A and folic acid). During treatment, levels of homocysteine, vitamins and creatinine were evaluated after 3, 6, 9 and 12 months.
Results:
We observed a significant homocysteine concentration decrease after treatment at every determination, whereas no significant change occurred for creatinine. Vitamin B(12) serum level increased markedly, whereas folic acid, vitamin E and vitamin A serum levels showed only minor increases.
Conclusions:
We observed a significant increase of mean levels of vitamin B(12) and a moderate increase in the other 3 vitamins. We also observed a significant reduction in homocysteine levels, which returned to normal levels for age. In our patients, there was a correlation, before and after treatment, between homocysteine and creatinine levels, but there was no a direct correlation between creatinine serum levels and homocysteine reduction. We conclude that vitamin supplementation reduces and may normalize homocysteine serum level after pediatric heart transplantation.
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