title: Moderate acute rejection detected during annual catheterization in pediatric heart transplant recipients.
abstract: BACKGROUND
  Acute rejection commonly occurs within the first year after heart transplantation, and then decreases in frequency with time. Recently, the long-term utility of endomyocardial biopsy during routine annual catheterization has been questioned. The purpose of this study was to retrospectively review the prevalence of biopsy-proven rejection during routine annual catheterization in our patient population, determine whether biopsies late after transplant are useful, and identify factors that correlate with late unsuspected rejection.
  
  
  METHODS
  Biopsy results from the annual catheterization were evaluated from 1986 to August 2000. The prevalence of moderate rejection was evaluated and compared with the patient's immunosuppressive regimen; the prevalence of late rejection; and how late rejection correlated with recipient age, number of first-year rejections and presence of sub-therapeutic cyclosporine.
  
  
  RESULTS
  A total of 1108 biopsies were performed in 269 children with a mean follow-up of 5 +/- 3 years (median 5 years, range 1 to 11 years). Three-drug immunosuppressive therapy, including steroids, was used in 93 patients. There was a persistent 8% to 10% prevalence of moderate rejection at up to 10 years post-transplantation. Moderate rejection was more likely in patients: (1). on 3-drug immunosuppressive therapy; (2). with a recipient age >1 year; and (3). with a relatively lower cyclosporine level.
  
  
  CONCLUSIONS
  These data suggest that continued surveillance of pediatric transplant patients for acute rejection is indicated for long-term follow-up.
authors.affiliation: Division of Pediatric Cardiology, Loma Linda University Children's Hospital and Medical Center, Loma Linda, California 92354, USA. mkuhn@ahs.llumc.edu
authors.forename: Micheal A
authors.initials: MA
authors.lastname: Kuhn
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Deming
authors.forename: Constance E
authors.initials: CE
authors.lastname: Cephus
authors.forename: Neda F
authors.initials: NF
authors.lastname: Mulla
authors.forename: Richard E
authors.initials: RE
authors.lastname: Chinnock
authors.forename: Anees J
authors.initials: AJ
authors.lastname: Razzouk
authors.forename: Ranae L
authors.initials: RL
authors.lastname: Larsen
mesh_terms: D000208:Acute Disease; D001706:Biopsy; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis* / Q000453:epidemiology; D016027:Heart Transplantation / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D009206:Myocardium / Q000473:pathology; D015995:Prevalence; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents