Late heart rejection is in decline in children, mortality the same

By Sarah Guy, MedWire Reporter

The rate of heart transplant rejection after 1 year has decreased in pediatric patients in recent years compared with the early 1990s, report researchers who add that, despite this, mortality rates in these patients have stayed the same.

Children who experience late rejection (LR) after a heart transplant continue to have a higher risk for mortality, development of moderate-to-severe coronary vasculopathy or need for retransplantation compared with their peers who do not experience LR, show the study findings.

The results suggest the need for strategies that will primarily prevent LR, say Rebecca Ameduri (University of Minnesota Amplatz Children's Hospital, USA) and colleagues in the Journal of Heart and Lung Transplantation.

Further analysis is needed "to identify some of the influences on LR, including social/behavioral environment, genetic polymorphisms that may present higher risk, and pharmacologic changes that could be targeted to specific patients over time," they add.

The findings add to previous research showing that early rejection (ER) in the first year after transplant has decreased in the years since 1999. This was replicated in Ameduri et al's study of LR rates in the same period (1999-2007), with significantly more (69% of 1333) recipients free from LR at 5 years post-transplant compared with their counterparts treated in the early era (1993-1998).

Indeed, after multivariate adjusted analysis, being treated in the earlier era was associated with a significant 1.47-fold increase in risk for LR compared with being treated in the later period.

LR was frequent in the study cohort overall, occurring in 663 (33.5%) of the total 1977 patients aged under 18 years and followed up for a median 5.2 years, report the authors.

Patients who experienced LR and were treated in either era had a significantly higher risk for mortality and moderate-to-severe coronary vasculopathy or retransplantation than those who remained rejection-free, with odds ratios of 4.20 and 2.63.

However, mortality rates for patients who survived beyond a year without rejection were low, with only 5.0% of patients dying during follow up. By contrast, 18.7% of those with LR died during the same period.

Ameduri and co-workers remark that institutional differences in surveillance strategies after heart transplant to assess for rejection could have the potential to confound their results.

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