title: Eosinophilic esophagitis in children following cardiac transplantation: association with post-transplant lymphoproliferative disorder and other transplant outcomes.
abstract: Although cardiac transplantation is life-saving, morbidities from immunosuppression are significant. EoE is a complication of calcineurin inhibitors following liver transplant causing feeding intolerance, weight loss, vomiting, and dysphagia. There are limited reports of EoE following heart transplantation. We performed a retrospective single-center review of pediatric cardiac transplant patients from 2000 to 2010. A case-control analysis of patients with and without EoE was performed evaluating heart transplantation outcomes such as rates of rejection, CAV, PTLD, and graft loss. Eighty-six transplants were performed in 84 patients; 34 (40%) underwent diagnostic endoscopy, and 10 (12%) had EoE. Median time to diagnosis of EoE was 3.7 yr (IQR: 2.0-5.2). There were no differences in demographics or use of induction medications between patients with or without EoE. Patients with EoE had fewer episodes of treated rejection (1.0 vs. 2.5; p = 0.04). Four of 10 (40%) EoE patients had PTLD compared with only 2/24 (8%) of those without EoE (p = 0.048; OR 7.33 [95% CI: 1.1-50.2]). There were no differences in CAV or graft loss between groups. EoE should be considered as a cause of GI symptoms in children after cardiac transplantation and may be associated with fewer rejection episodes and increased rates of PTLD, thus representing a marker of over-immunosuppression.
authors.affiliation: Division of Cardiology, Children's Hospital & Medical Center, Omaha, NE, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kindel
authors.forename: Brian F
authors.initials: BF
authors.lastname: Joy
authors.forename: Elfriede
authors.initials: E
authors.lastname: Pahl
authors.forename: Eric L
authors.initials: EL
authors.lastname: Wald
mesh_terms: D001706:Biopsy; D065095:Calcineurin Inhibitors / Q000737:chemistry; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D057765:Eosinophilic Esophagitis / Q000209:etiology*; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007223:Infant; D016031:Liver Transplantation; D008232:Lymphoproliferative Disorders / Q000209:etiology*; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents
keywords: calcineurin inhibitors; eosinophilic esophagitis; pediatric cardiac transplant; post-transplant lymphoproliferative disease