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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.
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Pediatric transplantation| Volume 20, ISSUE 3, P279-287, March 2001

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Death after rejection with severe hemodynamic compromise in pediatric heart transplant recipients: a multi-institutional study

DOI:https://doi.org/10.1016/S1053-2498(00)00228-X
Death after rejection with severe hemodynamic compromise in pediatric heart transplant recipients: a multi-institutional study
Next ArticleNutritional assessment of the lung transplant patient: body mass index as a predictor of 90–day mortality following transplantation

      Abstract

      Background: Rejection with severe hemodynamic compromise results in high mortality in adult transplant patients. This study determines the incidence, outcome and risk factors for rejection with severe hemodynamic compromise in a multi-institutional study of pediatric heart transplant recipients.

      Methods

      Data from 847 patients transplanted between 1/1/93 and 12/31/98 at 18 centers in the Pediatric Heart Transplant Study were analyzed. Rejection with severe hemodynamic compromise was defined as a clinical event occurring beyond 1 week postoperatively, which led to augmentation of immunosuppression and use of inotropic therapy. Actuarial freedom from such rejection and death after rejection were determined and risk factors sought.

      Results

      Among 1,033 rejection episodes in 532 patients, 113 (11%) episodes were associated with severe hemodynamic compromise in 95 patients. The highest risk for severe rejection was in the first year. Risk factors were older recipient age (p >.05) and non-white race (p >.001). Survival after an episode was poor (60%), and biopsy score did not affect outcome. Deaths were due to rejection (n = 14), other cardiac causes (n = 17), infection (n = 5), lymphoma (n = 2), pulmonary causes (n = 2), and thrombosis (n = 1).

      Conclusions

      Rejection with severe hemodynamic compromise occurs in 11% of pediatric patients, irrespective of age, sex or biopsy score, and mortality is high. Non-white race and older recipient age are independent risk factors for rejection with severe hemodynamic compromise. Aggressive treatment and close surveillance should be crucial components of protocols aimed at reducing the high mortality.
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      Article info

      Publication history

      Accepted: October 12, 2000
      Received in revised form: September 20, 2000
      Received: June 29, 2000

      Identification

      DOI: https://doi.org/10.1016/S1053-2498(00)00228-X

      Copyright

      © 2001 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

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