Document Detail


Pediatric cardiac retransplant: differing patterns of primary graft failure by age at first transplant.
MedLine Citation:
PMID:  21047651     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This study compared graft failure leading to retransplant in infants versus older children at initial heart transplant.
METHODS: Twenty-six retransplant recipients were compared by age at first transplant: infant group (<1 year) and pediatric group (≥1 year).
RESULTS: Early retransplant survival was 92%. Retransplant survivals at 1, 3, and 5 years were 83%, 74%, and 67%. There were 15 infant and 11 pediatric patients. First transplant ages were 0.4 ± 0.3 vs. 8.5 ± 5.7 years in infant and pediatric groups, respectively (P < .01). First graft rejection episodes were more common in pediatric group (4.8 ± 2.5 vs 3.1 ± 2.1, P = .032), and rejection rate was higher (1.5 ± 1.1 vs 0.4 ± 0.4, P = .0024). Median first graft survival was longer in infant group (10.7 years vs 3.9 years, P < .001). Recurrent cellular rejection was retransplant indication in 40% of infant group versus 91% of pediatric group (P < .05). Cardiac allograft vasculopathy was more prevalent in infant group (73% vs 20% in pediatric group, P = .032).
CONCLUSIONS: Infant heart transplant recipients had longer primary graft survival, fewer cellular rejection episodes, and higher incidence of cardiac allograft vasculopathy relative to older graft recipients requiring retransplant. Advantages in adaptive immunity in infant heart recipients confer improved primary graft survival, but longer graft life in these patients is limited by cardiac allograft vasculopathy. Older recipient first graft failure was rejection related, and shorter graft life probably limited development of cardiac allograft vasculopathy.
Authors:
John M Karamichalis; Shelley D Miyamoto; David N Campbell; Jilayne Smith; Kim K McFann; Sydne Clark; Biagio Pietra; Max B Mitchell
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-11-03
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  141     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-20     Completed Date:  2011-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  223-30     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
The Children's Hospital Heart Institute, Aurora, Colo 80045, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adaptive Immunity
Adolescent
Age Factors
Chi-Square Distribution
Child
Child, Preschool
Colorado
Coronary Artery Disease / immunology,  surgery*
Graft Rejection / immunology,  surgery*
Graft Survival*
Heart Transplantation / adverse effects*
Humans
Infant
Kaplan-Meier Estimate
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Transplantation, Homologous
Treatment Failure

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


Previous Document:  Giant bronchogenic cyst within the aortic wall mimicking symptoms of acute type A aortic dissection.
Next Document:  [Emergency contraception and stroke. A new case report].