Rejection is reduced in thoracic organ recipients when transplanted in the first year of life

Ibrahim, Jill E; Sweet, Stuart C; Flippin, Mindee; Dent, Catherine; Mendelhoff, Eric; Huddleston, Charles B; Trinkhaus, Kathryn; Canter, Charles E

« Previous Next »The Journal of Heart and Lung Transplantation
Volume 21, Issue 3 , Pages 311-318, March 2002

Rejection is reduced in thoracic organ recipients when transplanted in the first year of life

Jill E Ibrahim, MD
- Department of Pediatrics, Division of Pediatric Cardiology, St Louis, Missouri, USA
- Reprint requests: Jill E. Ibrahim, MD, Department of Pediatrics, Washington University School of Medicine, St Louis Children’s Hospital, One Children’s Place, 5S30, St Louis, Missouri 63110, USA. Telephone: 314-454-6095. Fax: 314-454-2561.
Stuart C Sweet, MD
- Department of Pediatrics, Division of Pulmonary Medicine, St Louis, Missouri, USA
Mindee Flippin, MD
- Department of Pediatrics, Division of Pediatric Cardiology, St Louis, Missouri, USA
Catherine Dent, MD
- Department of Pediatrics, Division of Pediatric Cardiology, St Louis, Missouri, USA
Eric Mendelhoff, MD
- Department of Surgery, Division of Cardiothoracic Surgery, St Louis, Missouri, USA
Charles B Huddleston, MD
- Department of Surgery, Division of Cardiothoracic Surgery, St Louis, Missouri, USA
Kathryn Trinkhaus, PhD
- Division of Biostatistics, Washington University School of Medicine, St Louis Children’s Hospital, St Louis, Missouri, USA
Charles E Canter, MD
- Department of Pediatrics, Division of Pediatric Cardiology, St Louis, Missouri, USA

Received 30 April 2001; received in revised form 23 May 2001; accepted 28 August 2001.

Abstract

Background:

Infant heart transplant recipients have been reported to have decreased rates of rejection when clinical criteria are used for diagnosis. This study compares the rates of acute episodes of rejection in heart and lung transplant recipients transplanted in the first year of life to those of older recipients utilizing pathologic criteria.

Methods:

Records of 100 consecutive lung transplant recipients (cystic fibrosis patients excluded) and 107 consecutive heart transplant recipients were reviewed with respect to: time to first rejection; total number; single versus multiple; and early (<90 days) versus late (>180 days) biopsy-proven rejection episodes. Rejection was defined as ISHLT biopsy Grade 3A or A2 for heart and lung transplant recipients, respectively. Biopsy and immunosuppression protocols were similar between groups.

Results:

Kaplan–Meier analysis for freedom from rejection showed infant heart recipients were more often rejection-free (p = 0.004) as were infant lung recipients (p = 0.0001). Multivariate analysis revealed age at transplant as the most significant factor in predicting time to first rejection (age <1 year: risk ratio 0.19 [0.068–0.54] for lung transplant recipients and risk ratio 0.46 [0.27–0.78] for heart transplant recipients). Early rejection episodes occurred with less frequency in both the infant heart (19 of 63 [30%] versus 24 of 44 [50%]; p = 0.016) and lung (3 of 26 [12%] versus 63 of 74 [85%]; p = 0.001) groups. Late episodes of rejection were also less frequent in infant heart (4 of 53 [8%] versus 10 of 36 [28%], p = 0.016) and lung (0 of 23 [0%] versus 29 of 65 [45%]; p = 0.001) recipients. Multiple (≥2) rejection episodes occurred less in infant heart (4 of 63 [6%] versus 9 of 41 [22%]; p = 0.037) and lung recipients (0 of 26 [0%] versus 17 of 74 [23%]; p = 0.003).

Conclusions:

These results demonstrate that age of <1 at time of thoracic transplantation confers significant protection from early, late and multiple episodes of acute rejection, as well as significantly greater freedom from rejection and time to first rejection.