Pediatric Cardiology

, Volume 32, Issue 1, pp 1–7

Outcome of Acute Graft Rejection Associated with Hemodynamic Compromise in Pediatric Heart Transplant Recipients

Authors

    • Children’s Hospital of Denver
  • Cecile Tissot
    • Children’s Hospital of Denver
  • Shannon Buckvold
    • Children’s Hospital of Denver
  • Jane Gralla
    • Children’s Hospital of Denver
  • D. Dunbar Ivy
    • Children’s Hospital of Denver
  • Biagio A. Pietra
    • Children’s Hospital of Denver
  • Shelley D. Miyamoto
    • Children’s Hospital of Denver
Original Article

DOI: 10.1007/s00246-010-9795-5

Cite this article as:
Phelps, C.M., Tissot, C., Buckvold, S. et al. Pediatr Cardiol (2011) 32: 1. doi:10.1007/s00246-010-9795-5

Abstract

We sought to analyze the outcome of hemodynamically significant acute graft rejection in pediatric heart transplant recipients from a single-center experience. Acute graft rejection remains a major cause of morbidity and mortality for patients who undergo orthotopic heart transplantation and has been associated with the severity of the rejection episode. A retrospective review of all children experiencing a hemodynamically significant rejection episode after orthotopic heart transplantation was performed. Fifty-three patients with 54 grafts had 70 rejection episodes requiring intravenous inotropic support. Forty-one percent of these patients required high-dose inotropic support, with the remaining 59% of patients requiring less inotropic support. Overall graft survival to hospital discharge was 41% for patients in the high-dose group compared to 94% in the low-dose group. Six-month graft survival in patients who required high-dose inotropes remained at 41% compared to 44% in the low-dose group. Hemodynamically significant acute graft rejection in pediatric heart transplant recipients is a devastating problem with poor short- and long-term outcomes. Survival to hospital discharge is dismal in patients who require high-dose inotropic support. In contrast, survival to discharge is quite good in patients who require only low-dose inotropic support; however, six-month graft survival in this group is low secondary to a high incidence of graft failure related to worsening or aggressive transplant coronary artery disease.

Keywords

Acute graft rejectionPediatric heart transplant

Copyright information

© Springer Science+Business Media, LLC 2010