Recurrent Rejection in Pediatric Cardiac Transplantation 110

Abstract

Cardiac transplantation has become an accepted therapy for end-stage pediatric cardiac disease. While acute rejection is a major cause of morbidity and mortality, recurrent (≥ 2 episodes) rejection in pediatric recipients has had limited analysis. We characterized recurrent rejection in 95 consecutive pediatric (0-18 years) heart transplant recipients treated with the same triple immunosuppression protocol (cyclosporine, azathioprine, steroids). Median follow-up for the population was 24 months (range 6-132 months) and 53 (56%) were infant (≤1 year) recipients. Rejection was diagnosed by endomyocardial biopsy (ISHLT Grade 3A or greater). Of all patients, 27 (28%) had more than 1 rejection episode (median of 2, range 2-5). Furthermore, 7/27 (26%) patients with recurrent rejection have died any time after transplant compared to 5/68 (7%) without recurrent rejection(p 12 months of age (p 12 months (Odds Ratio 3.6, p<0.005, 70%CI 2.4-5.4) and non-white race (Odds Ratio 3.4, p<0.002, 70%CI 2.6-4.6) to be risk factors for recurrent rejection. These results indicate that recurrent rejection is less likely to occur in infant and white recipients. This implies that immunosuppression and rejection surveillance protocols should be tailored for specific populations of recipients. Further studies are needed to determine if these differences are a result of biologic or non-biologic(compliance) phenomena.