Nonadherence is associated with late rejection in pediatric heart transplant recipients

Ringewald, Jeremy M.; Gidding, Samuel S.; Crawford, Susan E.; Backer, Carl L.; Mavroudis, Constantine; Pahl, Elfriede

doi:10.1067/mpd.2001.115067

Cited by 75 publications

(56 citation statements)

References 11 publications

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“…157,199 Substance abuse, noncompliance, and psychological problems have been associated with increased morbidity and mortality after heart transplantation in adults. 200 -203 Limited studies in pediatric heart transplant recipients 204,205 have shown correlations between difficulties with family adjustment issues and functioning with noncompliance and late rejection.…”

Section: Psychosocial Evaluationmentioning

confidence: 99%

Indications for Heart Transplantation in Pediatric Heart Disease

Canter¹,

Shaddy²,

Bernstein³

et al. 2007

Circulation

252

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Background— Since the initial utilization of heart transplantation as therapy for end-stage pediatric heart disease, improvements have occurred in outcomes with heart transplantation and surgical therapies for congenital heart disease along with the application of medical therapies to pediatric heart failure that have improved outcomes in adults. These events justify a reevaluation of the indications for heart transplantation in congenital heart disease and other causes of pediatric heart failure. Methods and Results— A working group was commissioned to review accumulated experience with pediatric heart transplantation and its use in patients with unrepaired and/or previously repaired or palliated congenital heart disease (children and adults), in patients with pediatric cardiomyopathies, and in pediatric patients with prior heart transplantation. Evidence-based guidelines for the indications for heart transplantation or retransplantation for these conditions were developed. Conclusions— This evaluation has led to the development and refinement of indications for heart transplantation for patients with congenital heart disease and pediatric cardiomyopathies in addition to indications for pediatric heart retransplantation.

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Section: Psychosocial Evaluationmentioning

confidence: 99%

Indications for Heart Transplantation in Pediatric Heart Disease

Canter¹,

Shaddy²,

Bernstein³

et al. 2007

Circulation

252

View full text Add to dashboard Cite

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“…A small single center study of pediatric heart transplant recipients undergoing transition to adult care showed a higher risk of death among older adolescents and young adults than other age groups; it was not clear if this study adjusted for time since transplant (39). Previous work in the kidney transplant population suggested that irrespective of time since transplant, emerging adults (age [17][18][19][20][21][22][23][24] have the highest risk of graft failure (13). The present study demonstrates that a similar relationship exists in heart transplant recipients, with graft failure rates peaking at 21-24 years old, regardless of time since transplant.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, even in studies of prevalent solid organ transplant recipients with more objective adherence assessments, poor adherence was more common in adolescents and emerging adults regardless of age at transplant (20,21). Poor adherence has been shown to be associated with late acute rejection and death in both pediatric and adult heart transplant recipients (22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

High Risk of Graft Failure in Emerging Adult Heart Transplant Recipients

Foster

Dahhou

Zhang

et al. 2015

American Journal of Transplantation

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Emerging adulthood (17-24 years) is a period of high risk for graft failure in kidney transplant. Whether a similar association exists in heart transplant recipients is unknown. We sought to estimate the relative hazards of graft failure at different current ages, compared with patients between 20 and 24 years old. We evaluated 11 473 patients recorded in the Scientific Registry of Transplant Recipients who received a first transplant at <40 years old and had at least 6 months of graft function. Timedependent Cox models were used to estimate the association between current age (time-dependent) and failure risk, adjusted for time since transplant and other potential confounders. Failure was defined as death following graft failure or retransplant; observation was censored at death with graft function. There were 2567 failures. Crude age-specific graft failure rates were highest in 21-24 year olds (4.2 per 100 person-years). Compared to individuals with the same time since transplant, 21-24 year olds had significantly higher failure rates than all other age periods except 17-20 years (HR 0.92 [95%CI 0.77, 1.09]) and 25-29 years (0.86 [0.73, 1.03]). Among young first heart transplant recipients, graft failure risks are highest in the period from 17 to 29 years of age.Abbreviations: HLA, human leukocyte antigen; HR, hazard ratio; IQR, interquartile range; SES, socioeconomic status; SRTR, Scientific Registry of Transplant Recipients

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“…Immature recipients such as juveniles or elderly patients with poor compliance would have more frequent LR. 30,31) Our results cannot be adapted in such recipients, who should be carefully surveyed for recurrence of LR. 5) We could not obtain data for DSA or HLA-matching between donors and recipients.…”

Section: )mentioning

confidence: 99%

Late Rejection Occurred in Recipients Who Experienced Acute Cellular Rejection Within the First Year After Heart Transplantation

et al. 2015

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SummarySerial endomyocardial biopsies (EMBs) are scheduled even several years after heart transplantation (HTx) to monitor for late rejection (LR). However, repeated EMBs are associated with an increased risk for fatal complications and decrease the quality of life of the recipient. We retrospectively analyzed clinical data from 42 adult recipients who had received HTx and were followed > 1 year at the University of Tokyo Hospital. Five recipients experienced LR at 1130 ± 157 days after HTx, and all 5 had experienced acute cellular rejection (ACR) with ISHLT grade ≥ 2R within the first year, which was treated with methylprednisolone pulse therapy (sensitivity, 1.000; specificity, 0.7027). Logistic regression analyses demonstrated that positive panel reactive antibody (PRA) was the only significant predictor for LR among all parameters at 1 year after HTx (P = 0.020, odds ratio 24.00). Among the 5 recipients with LR, LR occurred earlier in the two PRA positive recipients than in those with a negative PRA (981 ± 12 versus 1230 ± 110 days, P = 0.042). Among the perioperative parameters, gender mismatch [n = 13 (31%)] was the only significant predictor for ACR within the first year in logistic regression analyses (P = 0.042, odds ratio 4.200). In conclusion, the current schedule of serial EMBs should perhaps be reconsidered for recipients without any history of ACR within the first year due to their lower risk of LR. (Int Heart J 2015; 56: 174-179)

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Nonadherence is associated with late rejection in pediatric heart transplant recipients

Cited by 75 publications

References 11 publications

Indications for Heart Transplantation in Pediatric Heart Disease

Indications for Heart Transplantation in Pediatric Heart Disease

High Risk of Graft Failure in Emerging Adult Heart Transplant Recipients

Late Rejection Occurred in Recipients Who Experienced Acute Cellular Rejection Within the First Year After Heart Transplantation

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