Document Detail


Leukocyte suppression is associated with improved clinical outcomes in children's status after orthotopic heart transplantation.
MedLine Citation:
PMID:  16446220     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Leukocyte suppression is a sequela of immunosuppressive therapy after orthotopic heart transplantation and may result in discontinuation of anti-proliferative agents. Clinical outcomes in this patient population have not been well delineated. METHODS: This study was a retrospective review of children who underwent orthotopic heart transplantation at our institution from 1986 to 2003. Leukocyte suppression was defined as a white blood cell count <5,000, prompting the withdrawal of anti-proliferative agents. The population was divided into 2 groups, leukosuppressed (LS) and non-leukosuppressed (NLS), and their clinical outcomes were compared. RESULTS: The study included 109 patients, of which 44 (40%) became leukosuppressed. The 2 groups were similar regarding demographic data and initial management. The LS Group had a significantly decreased incidence of rejection, being 7 times less likely to have recurrent rejection (p = 0.001). The median time to rejection was 0.8 +/- 0.6 years for the NLS Group, whereas the median time to rejection was not yet reached at 17 years for the LS Group. The LS Group also tended toward a decreased incidence of retransplantation or death (p = 0.06). The organ "half-life" in the NLS Group was 7.5 years vs 12.5 years in the LS Group. There was no difference between the 2 groups in regards to other adverse effects of immunosuppression. CONCLUSIONS: Children who have undergone orthotopic heart transplantation and subsequently become leukosuppressed have a lower incidence of rejection and a tendency toward less organ loss than children who do not become leukosuppressed, without having an increased incidence of adverse side effects.
Authors:
Jeffrey J Kim; William J Dreyer; E O'Brian Smith; Jack F Price; Sarah Clunie; V Vasiliki Dimas; John L Jefferies; Howard Rosenblatt; Branislav Radovancevic; Jeffrey A Towbin; Susan W Denfield
Publication Detail:
Type:  Journal Article     Date:  2005-12-15
Journal Detail:
Title:  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation     Volume:  25     ISSN:  1557-3117     ISO Abbreviation:  J. Heart Lung Transplant.     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-31     Completed Date:  2006-08-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9102703     Medline TA:  J Heart Lung Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  195-9     Citation Subset:  IM    
Affiliation:
Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas 77030, USA. jjkim@texaschildrenshospital.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Cell Proliferation / drug effects
Child
Child, Preschool
Female
Graft Rejection / etiology,  physiopathology,  prevention & control
Heart Transplantation / immunology*,  methods,  pathology
Humans
Immunosuppression / adverse effects
Immunosuppressive Agents / adverse effects,  pharmacology*,  therapeutic use
Infant
Leukocytes / drug effects*,  pathology*,  physiology
Leukopenia* / chemically induced
Male
Multivariate Analysis
Postoperative Complications / immunology,  pathology
Retrospective Studies
Risk Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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