title: Eight-year experience of pediatric heart transplantation: clinical outcome using non-invasive methods for the evaluation of acute rejection.
abstract: Combined immunosuppression therapy and acute rejection surveillance after heart transplantation may influence clinical outcome. This prospective, longitudinal study investigated 27 pediatric patients (12 days to 12 yr of age; mean 3.0 yr) who underwent a post-operative regimen that included long-term treatment with cyclosporin A and azathioprine (double immunosuppression) and polyclonal anti-thymocyte serum induction therapy. Non-invasive parameters were used to diagnose acute rejection. The actuarial survival, clinical outcomes, and complications were analyzed. The actuarial survival after double immunosuppression and induction therapy with polyclonal anti-thymocyte serum was 89%, 73%, and 57% at 1, 4, and 8 yr, respectively. The rejection frequency was 2.6 episodes/patient and the infection frequency, 3.7 episodes/patient. One year after transplantation, systemic arterial hypertension was detected in 21% of patients. Hence, double immunosuppression with polyclonal anti-thymocyte serum induction therapy combined with surveillance of acute rejection with non-invasive tests may provide promising clinical outcome in pediatric heart transplant recipients.
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, Brazil.
authors.forename: Estela
authors.initials: E
authors.lastname: Azeka
authors.forename: Miguel Barbero
authors.initials: MB
authors.lastname: Marcial
authors.forename: Marcelo
authors.initials: M
authors.lastname: Jatene
authors.forename: José Otávio Costa
authors.initials: JO
authors.lastname: Auler
authors.forename: José Antônio Franchini
authors.initials: JA
authors.lastname: Ramires
mesh_terms: D000206:Actuarial Analysis; D002311:Cardiomyopathy, Dilated / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000517:prevention & control*; D006330:Heart Defects, Congenital / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents