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. 2017 Apr;36(4):451-456.
doi: 10.1016/j.healun.2016.09.017. Epub 2016 Oct 7.

Impact of age on incidence and prevalence of moderate-to-severe cellular rejection detected by routine surveillance biopsy in pediatric heart transplantation

Matthew D Zinn  1 , Michael J Wallendorf  2 , Kathleen E Simpson  3 , Ashley D Osborne  4 , James K Kirklin  5 , Charles E Canter  3
Affiliations

Impact of age on incidence and prevalence of moderate-to-severe cellular rejection detected by routine surveillance biopsy in pediatric heart transplantation

Matthew D Zinn et al. J Heart Lung Transplant. 2017 Apr.

Abstract

Background: The effect of age at transplant on rejection detected by routine surveillance biopsy (RSB) in pediatric heart transplant (HT) recipients is unknown. We hypothesized there would be low diagnostic yield and decreased prevalence of rejection detected on RSB in infants (age <1 year) when compared with children (age 1 to 9 years) and adolescents (age 10 to 18 years).

Methods: We utilized Pediatric Heart Transplant Study (PHTS) data from 2010 to 2013 to analyze moderate-to-severe (ISHLT Grade 2R/3R) cellular rejection (MSR) detected only on RSB (RSBMSR).

Results: RSB detected 280 of 343 (81.6%) episodes of MSR. RSBMSR was detected in all age groups even >5 years after HT. Infant RSBMSR had a greater proportion (p = 0.0025) occurring >5 years after HT (39.2 vs 18.4 vs 10.8%) and a lower proportion (p = 0.0009) occurring in the first year after HT (25.5 vs 60.6 vs 51.7%) compared with children and adolescents, respectively. Freedom from RSBMSR was 87 ± 7% in infants, 76 ± 6% in children and 73 ± 7% in adolescents 4 years after HT. In 1-year survivors who had RSBMSR in the first year after HT, the risk of RSBMSR occurring in Years 2 to 4 was significantly (p < 0.0001) greater than patients without RSBMSR in the first year (hazard ratio 21.28, 95% confidence interval 10.87 to 41.66), regardless of recipient age.

Conclusions: RSBMSR exists in all age groups after pediatric HT with long-term follow-up. The prevalence in infant recipients is highest >5 years after HT. Those with RSBMSR in the first year after HT are at a high risk for recurrent rejection regardless of age at HT.

Keywords: biopsy; pediatric heart transplantation; rejection.

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Conflict of interest statement

Disclosure statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Patient inclusion algorithm.
Figure 2
Figure 2
Freedom from routine surveillance biopsy-diagnosed moderate-to-severe cellular rejection (RSBMSR) by age and time after heart transplantation (HT).
Figure 3
Figure 3
Hazard function of routine surveillance biopsy-diagnosed moderate-to-severe cellular rejection (RSBMSR) by age and time after heart transplantation (HT).
Figure 4
Figure 4
Freedom from subsequent routine surveillance biopsy-diagnosed moderate-to-severe cellular rejection (RSBMSR) with 1-year conditional survival of RSBMSR.
See this image and copyright information in PMC

References

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