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Early results after pediatric cardiac transplantation with triple immunosuppression therapy
C E Canter1, J E Saffitz, S Moorhead
1Department of Pediatrics, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
Insights
Pediatric heart transplantation using triple immunosuppression therapy shows high survival rates and low rejection in infants and children. This study confirms its efficacy for young heart transplant recipients.
Area of Science:
- Cardiology
- Pediatric Surgery
- Immunosuppression Therapy
Background:
- Pediatric heart transplant recipients historically face higher mortality and morbidity than adults on triple immunosuppression.
- Triple immunosuppression involves steroids, azathioprine, and cyclosporine.
Purpose of the Study:
- To evaluate the efficacy and safety of triple immunosuppression therapy in pediatric heart transplantation.
- To assess survival rates, rejection episodes, and complications in infants and older children post-transplant.
Main Methods:
- Nineteen pediatric patients (11 infants, 8 older children) received orthotopic heart transplants with triple immunosuppression.
- Surveillance included endomyocardial biopsy, coronary angiography, and monitoring for hypertension and infection.
- Follow-up data analyzed survival, rejection, coronary arteriopathy, infection, and hypertension.
Main Results:
- High survival rate of 89% (17/19 patients) with a median follow-up of 29 months.
- Actuarial freedom from rejection was 65% at 3 months and 54% at 12 months.
- Infants experienced longer postoperative stays due to noninfectious complications; severe coronary arteriopathy occurred in one infant.
Conclusions:
- Triple immunosuppression therapy is associated with high survival rates in pediatric heart transplantation.
- Low rates of rejection and serious infection were observed in infants, children, and adolescents.
- While effective, careful monitoring for complications, particularly in infants, is crucial.
Abstract:
Pediatric heart transplant recipients were previously reported to have higher early mortality and morbidity than do adult patients treated with triple immunosuppression therapy (steroids, azathioprine and cyclosporine). Nineteen patients (11 infants and 8 older children) underwent orthotopic transplantation using triple immunosuppression therapy. Surveillance for cellular rejection and coronary arteriopathy was performed with endomyocardial biopsy and selective coronary angiography in all patients, with continuous monitoring for hypertension and serious infection. Seventeen of 19 patients (89%; 10 infants and 7 older children) are current survivors, with a median follow-up of 29 months (range 17 to 94). There were 5 and 7 episodes of rejection in the first 12 months after transplantation in the infant and older groups, respectively, for actuarial freedom-from-rejection rates of 65% at 3 months and 54% at 12 months. Severe coronary arteriopathy was detected in 1 infant 11 months after transplantation. In the first 12 months after transplantation, there were 3 hospitalizations for infection, and 2 patients needed treatment for hypertension in the infant group, compared with 1 hospitalization for infection, and 4 patients on antihypertensives in the older group. An increased prevalence of noninfectious complications in the infant group led to significantly longer postoperative stays than in the older group (mean 27.3 vs 19.4 days; p < 0.05). The results indicate that cardiac transplantation using triple immunosuppression therapy in infants, children and adolescents is associated with a high survival rate, and low rates of rejection and serious infection.