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Comparative Study
. 2011 Jan;32(1):1-7.
doi: 10.1007/s00246-010-9795-5. Epub 2010 Oct 21.

Outcome of acute graft rejection associated with hemodynamic compromise in pediatric heart transplant recipients

Christina M Phelps  1 , Cecile Tissot, Shannon Buckvold, Jane Gralla, D Dunbar Ivy, Biagio A Pietra, Shelley D Miyamoto
Affiliations
Comparative Study

Outcome of acute graft rejection associated with hemodynamic compromise in pediatric heart transplant recipients

Christina M Phelps et al. Pediatr Cardiol. 2011 Jan.

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.

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Figures

Fig. 1
Fig. 1
All rejection episodes to next rejection (p = 0.913)
Fig. 2
Fig. 2
From first rejection treatment to graft failure (no ECMO) (p = 0.316)
See this image and copyright information in PMC

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