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.
Similar content being viewed by others
References
Boucek MM, Aurora P et al (2007) Registry of the International Society for Heart and Lung Transplantation: tenth official pediatric heart transplantation report-2007. J Heart Lung Transplant 26(8):796–807
Boucek MM, Mathis CM et al (1993) Serial echocardiographic evaluation of cardiac graft rejection after infant heart transplantation. J Heart Lung Transpl 12(5):824–831
Chin C, Naftel DC et al (2004) Risk factors for recurrent rejection in pediatric heart transplantation: a multicenter experience. J Heart Lung Transpl 23(2):178–185
Cooley DA, Frazier OH et al (1986) Cardiac transplantation in an 8-month-old female infant with subendocardial fibroelastosis. JAMA 256(10):1326–1329
Flippin MJ, Balzer DT et al (1999) Rejection with heart failure after pediatric cardiac transplantation. Ann Thorac Surg 68(1):176–180
Kantrowitz A, Haller JD et al (1968) Transplantation of the heart in an infant and an adult. Am J Cardiol 22(6):782–790
Kirk R, Edwards LB et al (2008) Registry of the International Society for Heart and Lung Transplantation: eleventh official pediatric heart transplantation report-2008. J Heart Lung Transpl 27(9):970–977
Mills RM, Naftel DC et al (1997) Heart transplant rejection with hemodynamic compromise: a multiinstitutional study of the role of endomyocardial cellular infiltrate. Cardiac Transplant Research Database. J Heart Lung Transpl 16(8):813–821
Morales DL, Braud BE et al (2007) Use of mechanical circulatory support in pediatric patients with acute cardiac graft rejection. Asaio J 53(6):701–705
Morales DL, Dreyer WJ et al (2007) Over two decades of pediatric heart transplantation: how has survival changed?”. J Thorac Cardiovasc Surg 133(3):632–639
Mulla NF, Johnston JK et al (2001) Late rejection is a predictor of transplant coronary artery disease in children. J Am Coll Cardiol 37(1):243–250
Pahl E, Naftel DC et al (2001) Death after rejection with severe hemodynamic compromise in pediatric heart transplant recipients: a multi-institutional study. J Heart Lung Transpl 20(3):279–287
Shaddy RE, Naftel DC et al (1996) Outcome of cardiac transplantation in children. Survival in a contemporary multi-institutional experience. Pediatric Heart Transplant Study. Circulation 94(9 Suppl):II69–II73
Smith RR, Wray J et al (2005) Ten year survival after paediatric heart transplantation: a single centre experience. Eur J Cardiothorac Surg 27(5):790–794
Tantengco MV, Dodd D et al (1993) Echocardiographic abnormalities with acute cardiac allograft rejection in children: correlation with endomyocardial biopsy. J Heart Lung Transpl 12(6 Pt 2):S203–S210
Webber SA, Naftel DC et al (2003) Late rejection episodes more than 1 year after pediatric heart transplantation: risk factors and outcomes. J Heart Lung Transpl 22(8):869–875
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Phelps, C.M., Tissot, C., Buckvold, S. et al. Outcome of Acute Graft Rejection Associated with Hemodynamic Compromise in Pediatric Heart Transplant Recipients. Pediatr Cardiol 32, 1–7 (2011). https://doi.org/10.1007/s00246-010-9795-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-010-9795-5