title: Clinical predictors of autoimmune and severe atopic disease in pediatric heart transplant recipients.
abstract: Autoimmune and allergic diseases cause morbidity and diminished quality of life in pediatric organ transplant recipients. We hypothesize that younger age at transplantation and immunosuppression regimen play a role in the development of immune-mediated disease following heart transplant. A single institution retrospective review identified all patients undergoing heart transplant at ≤18 yr of age from 1987 to 2010 who survived ≥1 yr. Using medical record and database review, patients were evaluated for development of autoimmune or severe allergic disease. Of 129 patients who met criteria, seven patients (5.4%) with autoimmune or severe atopic disease were identified. Immune-mediated diseases included inflammatory bowel disease (n = 3), eosinophilic esophagitis/colitis (n = 4), and chronic bullous disease of childhood (n = 1). Patients <1 yr of age at transplant were at greater risk of developing autoimmune disease than patients 1-18 yr at transplant (OR = 9.3, 95% CI 1.1-79.2, p = 0.02). All affected patients underwent thymectomy at <1 yr of age (7/71 vs. 0/58, p = 0.02). In our experience, heart transplantation in infancy is associated with the development of immune-mediated gastrointestinal and dermatologic diseases. Further study is needed to determine risk factors for the development of immune-mediated disease to identify best practices to decrease incidence.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Jessica H
authors.initials: JH
authors.lastname: Mouledoux
authors.forename: Erin L
authors.initials: EL
authors.lastname: Albers
authors.forename: Zengqi
authors.initials: Z
authors.lastname: Lu
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Saville
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Moore
authors.forename: Debra A
authors.initials: DA
authors.lastname: Dodd
mesh_terms: D000293:Adolescent; D001327:Autoimmune Diseases / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006333:Heart Failure / Q000276:immunology* / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000175:diagnosis*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008969:Molecular Sequence Data; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D007166:Immunosuppressive Agents
keywords: atopic disease; autoimmune disease; immunosuppression; infant heart transplantation; pediatric heart transplantation; thymectomy