Cardiac allograft vasculopathy in pediatric heart transplant recipients.
Metabolic parameters for coronary allograft vasculopathy (CAV) have not been well defined in children. CAV (by angiography or autopsy) was studied in 337 heart recipients on a cyclosporine-based steroid-sparing regimen. Freedom from CAV for all was 79% at 10 years. Fifty-nine patients (18%) developed CAV at a mean of 6.5 +/- 3 years post-transplant. First year rejections were significantly higher in CAV, mean 2.3 vs. 1.4, P = 0.003, odds ratio (OR) 1.8. Rejection with hemodynamic compromise beyond 1 year post-transplant was associated with CAV, P < 0.001, OR 8.4. There was no significant correlation among human leukocyte antigen DR (HLA DR) mismatch, pacemaker use or homocysteine levels and the development of CAV. Maximum cholesterol and low density lipoprotein (LDL) levels were not significantly different. Neither diabetes nor hypertension was significant predictors of CAV on multivariate logistic regression analysis. In conclusion, frequent and severe rejection episodes may predict pediatric CAV. Neither glucose intolerance nor lipid abnormalities appeared to alter risk for CAV in this population.
Hathout
Eba
E
Department of Pediatrics, Loma Linda University School of Medicine, CA, USA.
Beeson
W Lawrence
WL
Kuhn
Micheal
M
Johnston
Joyce
J
Fitts
James
J
Razzouk
Anees
A
Bailey
Leonard
L
Chinnock
Richard E
RE
D000293:Adolescent; D000792:Angiography; D001344:Autopsy; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000378:metabolism; D016572:Cyclosporine / Q000494:pharmacology; D005260:Female; D005947:Glucose / Q000378:metabolism; D006085:Graft Survival; D006684:HLA-DR Antigens / Q000378:metabolism; D016027:Heart Transplantation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D007223:Infant; D007231:Infant, Newborn; D008055:Lipids / Q000737:chemistry; D008077:Lipoproteins, LDL / Q000737:chemistry / Q000378:metabolism; D016015:Logistic Models; D008297:Male; D015233:Models, Statistical; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012044:Regression Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000473:pathology*
D006684:HLA-DR Antigens; D007166:Immunosuppressive Agents; D008055:Lipids; D008077:Lipoproteins, LDL; D016572:Cyclosporine; D002784:Cholesterol; D005947:Glucose