Surveillance for Transplant Coronary Artery Disease in Infant, Child and Adolescent Heart Transplant Recipients: An Intravascular Ultrasound Study

Coronary Flow Reserve Measurement Detects Transplant Coronary Artery Disease in Pediatric Heart Transplant Patients

“…13,[21][22][23] Evaluation of epicardial CAV may alternatively be done using intravascular ultrasound (IVUS) studies, although the use of IVUS is limited, especially in smaller pediatric patients, due to the size of the probe. 24,25 Fearon et al showed a good correlation of CFR with IVUS findings, but CFR was, interestingly, abnormal in asymptomatic cardiac transplant patients with normal angiograms, in whom one might speculate about microvasculopathy, which was not evaluated in their study. 26 In contrast, Klauss et al showed in adults that the degree of epicardial intimal thickening, as quantified by IVUS, did not predict the adenosine vasodilator response, which may be explained by adequate remodeling of flow velocity in the larger and epicardial vessels.…”

Biopsy-diagnosed antibody-mediated rejection based on the proposed International Society for Heart and Lung Transplantation working formulation is associated with adverse cardiovascular outcomes after pediatric heart transplant

“…This is consistent with previously published age-related differences after HT in childhood, which include an increased risk of rejection within the first year, increased risk of rejection with severe hemodynamic compromise, greater prevalence of CAV, and shorter transplant half-life in older vs younger HT recipients. [23][24][25][26][27] Likewise, other investigators have found a trend toward younger transplant age and the presence of donor-specific antibodies (DSA) in pediatric HT recipients with a significant association between older donor age and the prevalence of DSA. 28 Future studies on the immunologic changes that occur with age may be important to understanding the pathophysiology of AMR.…”

Outcomes after listing for primary transplantation for infants with unoperated-on non-hypoplastic left heart syndrome congenital heart disease: A multi-institutional study

“…2 Infant heart transplant recipients have had the longest graft survival times of any heart transplant recipient 3 and are at lower risk for rejection 4 and transplant coronary arteriopathy. 5 The use of primary heart transplantation for HLHS has diminished over time due to a limited donor pool 6 and considerable improvement in outcomes with staged, palliative surgery. 7 However, single-center reports continue to document heart transplantation as the primary therapy for CHD other than HLHS (non-HLHS-CHD), such as asplenia syndromes 8 or pulmonary atresia/intact ventricular septum with severe coronary anomalies, 9 which are associated with relatively poor outcomes with conventional palliative surgery.…”