Abstract
Since the 1980s a steadily increasing number of children have undergone cardiac transplantation. Although graft rejection and complications of immunosuppressive therapy are the leading causes of death in children and adults after cardiac transplantation, coronary atherosclerosis is a significant cause of late mortality. 1,2 Our first pediatric heart transplant patient died suddenly 17 months after transplantation at 3 years of age with severe coronary atherosclerosis. Transplant coronary atherosclerosis may be the result of immune endothelial injury, with a response characterized by proliferation of myointimal cells, thrombus formation, and ultimate intraarterial deposition of lipid material. 3–5 The development of atherosclerosis in transplanted hearts may be enhanced by the presence of hyperlipidemia, both hypertriglyceridemia and hypercholesterolemia. We measured serial lipid levels in 14 children after heart transplantation to assess the prevalence of lipid abnormalities and the usefulness of niacin therapy in children with significant hypercholesterolemia after transplantation.
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