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Has late rejection decreased in pediatric heart transplantation in the current era? A multi-institutional study

Rebecca K Ameduri1, Jie Zheng, Kenneth B Schechtman

  • 1Division of Pediatric Cardiology, University of Minnesota Amplatz Children's Hospital, Minneapolis, MN 55454, USA. amedu001@umn.edu

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|August 14, 2012
PubMed

Insights

Late rejection after pediatric heart transplantation has decreased but still significantly increases mortality and coronary vasculopathy risk. Improved prevention strategies are crucial for long-term outcomes in these young patients.

Area of Science:

  • Pediatric Cardiology
  • Transplantation Immunology
  • Cardiovascular Research

Background:

  • Late rejection (LR), occurring over a year post-transplant, is a significant risk factor for mortality and morbidity in pediatric heart transplant recipients.
  • While early rejection rates have declined in recent years, the impact of LR remains a concern.
  • This study investigates whether the incidence of LR has also decreased in the current era.

Purpose of the Study:

  • To analyze trends in the prevalence of late rejection (LR) after pediatric heart transplantation (HTx) between different eras.
  • To examine the relationship between LR and key adverse outcomes, including mortality, coronary artery vasculopathy (CAV), and retransplantation.
  • To identify independent risk factors associated with LR in pediatric HTx recipients.

Main Methods:

  • Utilized the Pediatric Heart Transplant Study database for comprehensive analysis.
  • Compared data from two distinct eras: 1993-1998 (earlier) and 1999-2007 (current).
  • Assessed the effects of era and other factors on LR prevalence and its association with mortality, CAV, and retransplantation.

Main Results:

  • Freedom from first and recurrent LR was significantly lower in the current era compared to the earlier era (5-year post-HTx: 69% vs 59%).
  • LR was strongly associated with early rejection (ER) in both eras.
  • Independent risk factors for LR included: earlier era, non-white race, older recipient age, recipient Status 2, and male donor.

Conclusions:

  • Late rejection has decreased in pediatric heart transplant recipients in the recent era.
  • The detrimental effects of LR on mortality and the development of moderate-severe CAV or retransplantation have remained consistent over time.
  • Enhanced primary prevention strategies are essential to mitigate the ongoing risks associated with LR.
Abstract

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