Infectious, malignant, and autoimmune complications in pediatric heart transplant recipients.
OBJECTIVE
To review clinical courses of pediatric heart transplant survivors after 5 years from transplantation for infections, lymphoproliferative, and autoimmune diseases.


METHODS
A total of 71 patients were examined in 2 groups, infant recipients (underwent transplant <1 year of age, n = 38) and older recipients (underwent transplant >1 year, n = 33). All patients received comparable immunosuppression. Calculated occurrence rates were reported as means per 10 years of follow-up with SEs. Differences were examined by using Poisson regression.


RESULTS
Infant recipients had significantly higher (P < .001) occurrence rates of severe (mean, 2.04 +/- 0.5) and chronic infections (mean, 4.58 +/- 0.67) compared with older recipients (means, 0.37 +/- 0.19 and 1.87 +/- 0.70, respectively). Types of infections were similar to those in the general population with extremely rare opportunistic infections; however, they were more severe and resistant to treatment. Autoimmune disorders occurred at a frequency comparable with lymphoproliferative diseases and were observed in 7 of 38 infants (18%). Most common were autoimmune cytopenias.


CONCLUSIONS
Infant heart transplant recipients who survive in the long term have higher occurrence rates of infections compared with older recipients. Autoimmune disorders are a previously unrecognized morbidity in pediatric heart transplantation.
Kulikowska
Agnieszka
A
Department of Pediatrics, Washington University, St. Louis, MO 63110, USA. kulikowska_a@kids.wustl.edu
Boslaugh
Sarah E
SE
Huddleston
Charles B
CB
Gandhi
Sanjiv K
SK
Gumbiner
Carl
C
Canter
Charles E
CE
D000367:Age Factors; D001327:Autoimmune Diseases / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007239:Infections / Q000453:epidemiology*; D008232:Lymphoproliferative Disorders / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome