Acute rejection after paediatric heart transplantation: far less common and less severe

Area of Science:

• Pediatric Cardiology
• Transplantation Immunology
• Immunosuppression Therapy

Background:

• Rejection remains a significant cause of morbidity and mortality in pediatric heart transplant recipients.
• Despite advancements in immunosuppression, understanding risk factors for rejection is crucial.

Purpose of the Study:

• To determine the incidence and outcomes of rejection in children post-heart transplantation.
• To identify risk factors associated with significant rejection episodes.

Main Methods:

• Retrospective analysis of 105 children undergoing heart transplantation between 2002 and 2007.
• Multivariate modeling to assess risk factors for rejection.
• Analysis of patient-years of follow-up and rejection episodes (grade >=3A).

Main Results:

• Twenty-three episodes of significant rejection occurred in 21 patients (20%) over 271.9 patient-years.
• Rejection was more common in older children, boys, and those treated with sirolimus.
• Tacrolimus-containing immunosuppression was associated with a significantly lower risk of rejection (P < 0.002).
• None of the patients with severe rejection requiring extracorporeal membrane oxygenation support were on mycophenolate mofetil.

Conclusions:

• Rejection is a serious complication after pediatric heart transplantation, although incidence may be lower than registry data.
• Sirolimus monotherapy was associated with increased rejection episodes.
• Tacrolimus and mycophenolate mofetil appear to offer the most effective protective profile against rejection.