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Rejection and infection after pediatric cardiac transplantation
E A Braunlin1, C E Canter, M T Olivari
1Department of Pediatrics, University of Minnesota Hospital and Clinic, Minneapolis.
Insights
Pediatric heart transplantation shows promising survival rates, but careful management of immunosuppression is crucial to prevent rejection and ensure long-term success in young patients.
Area of Science:
- Pediatric Cardiology
- Immunosuppression Therapy
- Transplant Medicine
Background:
- Cardiac transplantation is an emerging therapy for pediatric end-stage cardiomyopathy.
- Long-term outcomes, including rejection and infection rates, require further definition.
Purpose of the Study:
- To evaluate the outcomes of cardiac transplantation in children and adolescents.
- To assess the incidence of rejection and infection in this population.
Main Methods:
- Retrospective analysis of 21 pediatric cardiac transplant recipients (1985-1989).
- All survivors received triple-drug immunosuppression: cyclosporine, azathioprine, and prednisone.
- Follow-up included monitoring for rejection via endomyocardial biopsy and infection surveillance.
Main Results:
- 18 of 21 patients survived the operative period with a mean follow-up of 24 months.
- 12 rejection episodes occurred in 7 patients; 67% were associated with subtherapeutic cyclosporine levels.
- Actuarial 1- and 3-year survival rates were 94% and 78%, respectively. No deaths from infection.
- 73% of patients were rejection-free and 83% infection-free within 7 months post-transplant.
Conclusions:
- Pediatric cardiac transplantation offers favorable survival rates.
- Maintaining adequate cyclosporine levels is critical for preventing rejection.
- Infection remains a manageable complication with no reported mortality in this cohort.
Abstract:
Cardiac transplantation has only recently become an accepted therapeutic modality for children and adolescents with end-stage cardiomyopathy. Long-term survival, the incidence of rejection, and the incidence of infection are still being defined. From 1985 to 1989, 21 children aged 6 months to 19 years (average age, 11.2 years) underwent cardiac transplantation at our institutions. Eighteen survived the operative period and have been followed for 5 to 49 months (average follow-up, 24 months). All operative survivors have received triple-drug immunosuppression consisting of cyclosporine, azathioprine, and prednisone. During follow-up, 7 patients have been treated on 12 occasions for rejection as documented by endomyocardial biopsy. Eight (67%) of the 12 episodes of rejection occurred in the presence of subtherapeutic cyclosporine levels. Two of the 7 patients treated for rejection have subsequently died of ongoing cardiac rejection and arrhythmia. There have been no perioperative or late deaths from infection. Bacterial sepsis was identified and treated twice during follow-up, viral infections on five occasions, and fungal infection once. Actuarial 1-year survival and 3-year survival of the 18 operative survivors are 94% and 78%, respectively. In the first 7 months after cardiac transplantation, 73% of patients were free from rejection and 83% were free from serious bloodborne infection.(ABSTRACT TRUNCATED AT 250 WORDS)