Less Is More in Post Pediatric Heart Transplant Care

Historically, steroids and endomyocardial biopsies have, respectively, been part of standard immunosuppression for preventing cardiac transplant rejection and monitoring for rejection. However, these treatments come with numerous adverse effects. Some transplant programs have questioned whether the risks and costs outweigh the benefits or whether they may interfere with patient outcomes.

Pediatric cardiac transplantations over 15 years (n = 49) were examined in a single-center retrospective study. Two groups of patients were formed: group 1 received induction steroids and underwent routine protocol biopsy (n = 18), and group 2 neither received steroids nor underwent routine biopsy (n = 13).

The 1-year survival rate was similar between the two approaches: group 1 survival was 94% and group 2 survival was 92%. However, differences between the two groups were observed for comorbidities. Group 1 had 11 patients that exhibited rejection, and group 2 had only 1 patient (p = 0.003). Group 2 had fewer cases of posttransplant hypertension (p = 0.001) and insulin dependence (p = 0.02).

This study suggests a less-invasive posttransplant approach that avoids biopsies and steroids was safely implemented in this single center. Both groups had similar survival. However, group 2 had statistically significant less posttransplant rejection, hypertension, and diabetes. Overall, this study shows no increased risk associated with steroid and biopsy avoidance in posttransplant patients, but with some clear benefits.