Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 1;108(1):e8-e14.
doi: 10.1097/TP.0000000000004820. Epub 2023 Oct 2.

Medium-term Outcomes in Pediatric Heart Transplant Recipients Managed Using a Steroid Avoidance Immune Suppression Protocol

Christina Hartje-Dunn  1 , Elizabeth D Blume  1   2 , Heather Bastardi  1 , Kevin P Daly  1   2 , Francis Fynn-Thompson  3 , Kimberlee Gauvreau  1   4 , Tajinder P Singh  1   2
Affiliations

Medium-term Outcomes in Pediatric Heart Transplant Recipients Managed Using a Steroid Avoidance Immune Suppression Protocol

Christina Hartje-Dunn et al. Transplantation. .

Abstract

Background: Short-term outcomes using steroid avoidance immune suppression are encouraging in pediatric heart transplant (HT) recipients at low risk of antibody-mediated rejection. We assessed medium-term outcomes in pediatric HT recipients initiated on a steroid avoidance protocol at our institution using surveillance biopsies.

Methods: All primary HT recipients during 2006-2020 who did not have a donor-specific antibody were eligible for immune suppression consisting of 5-d Thymoglobulin/steroid induction followed by a tacrolimus-based, steroid-free regimen. We assessed freedom from graft failure (death or retransplant), acute rejection, posttransplant lymphoproliferative disease, and cardiac allograft vasculopathy.

Results: Overall, 150 of 181 primary HT recipients were eligible for steroid avoidance regimen. Their median age was 8.7 y, 41% had congenital heart disease, 23% were sensitized, and 35% were on a mechanical support. The median follow-up was 6.1 y. Eleven patients (8%) were on maintenance steroids at discharge and 13% at 1 y. Graft survival was 94% at 1 y and 87% at 5 y. Freedom from rejection was 73% at 1 y and 64% at 5 y. Freedom from posttransplant lymphoproliferative disease was 96% at 1 y and 95% at 5 y. Freedom from moderate cardiac allograft vasculopathy was 94% at 5 y. Eight patients developed diabetes. Estimated glomerular filtration rate was <60 mL/min/1.73 m 2 in 5% of the cohort at 5 y.

Conclusions: Pediatric HT recipients at low risk of antibody-mediated rejection have excellent medium-term survival and relatively low incidence of posttransplant morbidities when managed using a steroid avoidance immune suppression protocol.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Comment in

References

    1. Aljebab F, Choonara I, Conroy S. Systematic review of the toxicity of long-course oral corticosteroids in children. PLoS One. 2017;12:e0170259.
    1. Lamour JM, Mason KL, Hsu DT, et al.; CTOTC-04 Investigators. Early outcomes for low-risk pediatric heart transplant recipients and steroid avoidance: a multicenter cohort study (Clinical Trials in Organ Transplantation in Children—CTOTC-04). J Heart Lung Transplant. 2019;38:972–981.
    1. Singh TP, Faber C, Blume ED, et al. Safety and early outcomes using a corticosteroid-avoidance immunosuppression protocol in pediatric heart transplant recipients. J Heart Lung Transplant. 2010;29:517–522.
    1. Pahl E, Naftel DC, Canter CE, et al.; Pediatric Heart Transplant Study. Death after rejection with severe hemodynamic compromise in pediatric heart transplant recipients: a multi-institutional study. J Heart Lung Transplant. 2001;20:279–287.
    1. Webber S, Zeevi A, Mason K, et al.; CTOTC-04 Investigators. Pediatric heart transplantation across a positive crossmatch: First year results from the CTOTC-04 multi-institutional study. Am J Transplant. 2018;18:2148–2162.

LinkOut - more resources