Treatment of hyperhomocysteinemia in pediatric heart transplant recipients.
BACKGROUND
Graft coronary artery vasculopathy is the main cause of late morbidity and mortality in pediatric cardiac allograft recipients. Growing evidence suggests that elevated plasma homocysteine levels are associated with cardiac allograft vasculopathy following heart transplantation. The purpose of this study was to evaluate the effect of vitamin supplementation as a potential strategy for reducing homocysteine levels in pediatric heart transplant recipients and examine creatinine levels as potential determinants of plasma homocysteine concentration after transplantation.


METHODS
We studied 27 pediatric heart transplant patients with homocysteine levels higher than normal. All children received vitamin supplementation (vitamin B(12), vitamin E, vitamin A and folic acid). During treatment, levels of homocysteine, vitamins and creatinine were evaluated after 3, 6, 9 and 12 months.


RESULTS
We observed a significant homocysteine concentration decrease after treatment at every determination, whereas no significant change occurred for creatinine. Vitamin B(12) serum level increased markedly, whereas folic acid, vitamin E and vitamin A serum levels showed only minor increases.


CONCLUSIONS
We observed a significant increase of mean levels of vitamin B(12) and a moderate increase in the other 3 vitamins. We also observed a significant reduction in homocysteine levels, which returned to normal levels for age. In our patients, there was a correlation, before and after treatment, between homocysteine and creatinine levels, but there was no a direct correlation between creatinine serum levels and homocysteine reduction. We conclude that vitamin supplementation reduces and may normalize homocysteine serum level after pediatric heart transplantation.
Parisi
Francesco
F
Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Pediatric Hospital, Rome, Italy. parisi@opbg.net
Danesi
Hélène
H
Di Ciommo
Vincenzo
V
Fina
Francesca
F
Giannone
Germana
G
Colistro
Franco
F
Di Donato
Roberto M
RM
Catena
Glauco
G
D000293:Adolescent; D000975:Antioxidants / Q000378:metabolism / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003404:Creatinine / Q000097:blood; D005260:Female; D005492:Folic Acid / Q000097:blood / Q000627:therapeutic use; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006397:Hematinics / Q000097:blood / Q000627:therapeutic use; D006710:Homocysteine / Q000097:blood / Q000187:drug effects; D006801:Humans; D020138:Hyperhomocysteinemia / Q000378:metabolism* / Q000601:surgery*; D007223:Infant; D007229:Infant Welfare; D008297:Male; D013223:Statistics as Topic; D016896:Treatment Outcome; D014801:Vitamin A / Q000097:blood / Q000627:therapeutic use; D014805:Vitamin B 12 / Q000097:blood / Q000627:therapeutic use; D014810:Vitamin E / Q000097:blood / Q000627:therapeutic use
D000975:Antioxidants; D015415:Biomarkers; D006397:Hematinics; D006710:Homocysteine; D014801:Vitamin A; D014810:Vitamin E; D005492:Folic Acid; D003404:Creatinine; D014805:Vitamin B 12