Risk factors for recurrent rejection in pediatric heart transplantation: a multicenter experience.
BACKGROUND
Cardiac allograft rejection remains as a primary cause of death in the first 3 years after pediatric heart transplantation. Multiple episode of acute rejection in adult heart transplant recipients may accelerate the development of graft vasculopathy. We sought to quantify the time-related probability of recurrent rejection and identify risk factors for the development of recurrent rejection.


METHODS
We analyzed data from 847 pediatric recipients who underwent transplantation between January 1, 1993 and December 31, 1998 at 22 centers in the Pediatric Heart Transplant Study (PHTS). Recurrent rejection and risk factors were evaluated using univariate and multivariate analyses.


RESULTS
Five hundred fifty two patients had 1,072 rejection events and were the subject of the analyses. The highest risk of recurrent rejection occurs within 1 month after resolution of a previous rejection episode. Risk factors for recurrent rejection include the number of previous rejection events, the elapsed time since a previous rejection episode, and subjects of either Hispanic or African-American descent. Rejection associated with hemodynamic compromise and late rejection is associated with higher mortality.


CONCLUSIONS
Recurrent rejection is a risk factor for mortality, especially in the presence of hemodynamic compromise. This association appears independent of the time post-transplantation. Use of surveillance biopsies appears warranted throughout the life of the transplant individual. Retransplantation should be considered among these subjects with recurrent rejection.
Chin
Clifford
C
Division of Pediatric Cardiology, Stanford University, Palo Alto, California 94304, USA. clifford@stanford.edu
Naftel
David C
DC
Singh
Tajinder P
TP
Blume
Elizabeth D
ED
Luikart
Helen
H
Bernstein
Daniel
D
Gamberg
Pat
P
Kirklin
James K
JK
Morrow
W Robert
WR
D000328:Adult; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D016027:Heart Transplantation / Q000276:immunology / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors