title: Cardiac allograft vasculopathy in pediatric heart transplant recipients.
abstract: 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.
authors.affiliation: Department of Pediatrics, Loma Linda University School of Medicine, CA, USA.
authors.forename: Eba
authors.initials: E
authors.lastname: Hathout
authors.forename: W Lawrence
authors.initials: WL
authors.lastname: Beeson
authors.forename: Micheal
authors.initials: M
authors.lastname: Kuhn
authors.forename: Joyce
authors.initials: J
authors.lastname: Johnston
authors.forename: James
authors.initials: J
authors.lastname: Fitts
authors.forename: Anees
authors.initials: A
authors.lastname: Razzouk
authors.forename: Leonard
authors.initials: L
authors.lastname: Bailey
authors.forename: Richard E
authors.initials: RE
authors.lastname: Chinnock
mesh_terms: 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*
chemical_list: D006684:HLA-DR Antigens; D007166:Immunosuppressive Agents; D008055:Lipids; D008077:Lipoproteins, LDL; D016572:Cyclosporine; D002784:Cholesterol; D005947:Glucose