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. 2001 Jul;139(1):75-8.
doi: 10.1067/mpd.2001.115067.

Nonadherence is associated with late rejection in pediatric heart transplant recipients

J M Ringewald  1 , S S Gidding, S E Crawford, C L Backer, C Mavroudis, E Pahl
Affiliations

Nonadherence is associated with late rejection in pediatric heart transplant recipients

J M Ringewald et al. J Pediatr. 2001 Jul.

Abstract

Objectives: The objective was to study the impact of nonadherence on late rejection after pediatric heart transplantation.

Study design: This was a retrospective cohort study of cardiac transplant recipients surviving >6 months (n = 50). Patients were stratified by episodes of late rejection. End points were defined by cyclosporin A (CSA) level, CSA level variability, and patient admission of nonadherence.

Results: In 15 patients there were 49 episodes of late rejection, and 37 (76%) were associated with nonadherence. Of these patients, 7 of 15 died, and 3 of 15 had transplant coronary artery disease. Risk factors for the rejection were single-parent home, non-white, older age, and higher CSA level variability. In 35 nonrejectors there were 4 deaths from sepsis, post-transplant lymphoproliferative disease, renal failure, and encephalomyelitis.

Conclusion: Late rejection after pediatric heart transplantation is associated with nonadherence, is common during adolescence, and is associated with poor outcome.

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