Related Experiment Video
Updated: Jul 9, 2026
Mouse Heterotopic Cervical Cardiac Transplantation Utilizing Vascular Cuffs
Published on: June 23, 2022
Use of mechanical circulatory support in pediatric patients with acute cardiac graft rejection
David L S Morales1, Brandi E Braud, Jack F Price
1Michael E. DeBakey Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine, Houston, Texas, USA.
Insights
Mechanical circulatory support (MCS) offers a viable option for pediatric heart transplant patients experiencing acute graft rejection and hemodynamic instability. While weaning and discharge rates are promising, long-term survival remains a significant challenge for this critical patient group.
Area of Science:
- Cardiology
- Transplantation Immunology
- Pediatric Critical Care
Background:
- Acute cardiac graft rejection can lead to life-threatening hemodynamic collapse.
- Pediatric data on mechanical circulatory support (MCS) for acute rejection with hemodynamic instability is limited.
Purpose of the Study:
- To review the experience of using MCS in pediatric patients with severe acute allograft rejection and cardiogenic shock.
- To evaluate the efficacy and outcomes of MCS in this high-risk population.
Main Methods:
- Retrospective review of 7 pediatric heart transplant recipients (8 cases) requiring MCS between 1995 and 2006 for acute graft rejection and hemodynamic instability.
- Analysis of devices used, duration of support, concurrent medical therapies, and patient outcomes including weaning, discharge, and survival.
- Devices included BioMedicus, Thoratec, and extracorporeal membrane oxygenation.
Main Results:
- 88% of patients were successfully weaned from MCS.
- 5 patients recovered, and 2 were bridged to retransplantation.
- 71% of weaned patients were discharged with normal left ventricular function.
- One-year and 3-year survival rates were 50% and 38%, respectively.
Conclusions:
- MCS can be effectively implemented in pediatric heart transplant recipients with acute graft rejection and hemodynamic instability.
- Acceptable rates of weaning and discharge were achieved.
- Despite initial success, long-term survival for this cohort remains poor, highlighting the need for improved post-transplant management strategies.
Abstract:
Patients suffering from acute cardiac graft rejection can die because of hemodynamic collapse while being treated with vigorous immunosuppressive therapies. There is little pediatric data on the use of mechanical circulatory support (MCS) in patients with acute cardiac graft rejection accompanied by hemodynamic instability. This report reviews our experience using MCS in patients with severe acute allograft rejection and cardiogenic shock. Between July 1995 and December 2006, 7 of 117 heart transplant recipients (6%) had MCS placed in 8 cases of acute graft rejection with hemodynamic instability. Devices used were BioMedicus (five), Thoratec (two), and extracorporeal membrane oxygenation machine (one). Mean age was 12 +/- 6.6 years. Median duration of support was 7.5 days (range, 3-28 days). Medical therapy applied included pulse steroids (eight), antithymocyte globulin (five), intravenous immunoglobulins (five), and plasmapheresis (five). Eighty-eight percent (seven of eight cases) weaned from MCS. Five patients weaned to recovery and two were bridged to retransplant. Five of the seven patients weaned (71%) were discharged home, all with normal left ventricular function. Median follow-up was 3.0 years (4.5 months to 3.5 years). One-year survival is 50% and 3 year survival is 38%. Mechanical circulatory support can be applied in patients with acute cardiac graft rejection causing hemodynamic instability with acceptable weaning and discharge rates. Unfortunately, late survival for this cohort remains poor.
