Aspirin Use and the Development of Cardiac Allograft Vasculopathy in Pediatric Heart Transplant Recipients

Abstract

<h3>Purpose</h3> Cardiac allograft vasculopathy (CAV) has limited treatment options and results in significant mortality. Data in adult heart transplant (HTx) recipients suggests that aspirin (ASA) use may reduce the risk of CAV. However, there are limited pediatric data on this topic. This study aimed to assess the use of ASA in pediatric HTx recipients and its association with CAV. <h3>Methods</h3> All patients in the Pediatric Heart Transplant Society database < 17 years of age who underwent primary HTx and had > 3 years of follow up were included. ASA use during the first 3 years post-transplant was defined as continuous, intermittent, or no ASA use. Time to CAV and graft loss was compared across groups using the Kaplan Meier method. A multivariable survival model was constructed for each outcome to assess the impact of early post-HTx ASA use. <h3>Results</h3> A total of 3,011 patients were identified for inclusion with 387 (13%) continuous, 676 (22%) intermittent, and 1948 (65%) with no ASA use. ASA use was more common in older patients (p<0.001). Patients receiving continuous ASA were less likely to receive induction therapy at HTx compared to other groups (p<0.001). ASA use was highly variable across centers, ranging from 0% to 100% (Figure 1a). Patients receiving continuous ASA therapy demonstrated worse freedom from CAV (p= 0.002) and inferior graft survival (p<0.001) (Figures 1b-c). In multivariable analyses, early ASA use was not associated with improvements in freedom from CAV or graft survival. <h3>Conclusion</h3> ASA use varies widely across pediatric HTx centers. Early ASA use did not reduce the risk of CAV or graft loss.