Rejection with heart failure after pediatric cardiac transplantation

Background. Rejection associated with heart failure or death occurs after p ediatric cardiac transplantation but has had limited analysis. Methods. We analyzed the records of 96 consecutive pediatric cardiac transp lant recipients who survived to hospital discharge. Results. Eighteen patients (19%) experienced 23 episodes of heart failure o r death associated with rejection. Univariate analysis demonstrated black r ace (p = 0.041), transplantation after 12 months of age (p = 0.032), later time after transplantation (p = 0.037), rejection episode in the first year after transplantation (p = 0.001), and history of two or more rejection ep isodes (p < 0.001) were significantly associated with rejection seen with h eart failure. A multivariate regression analysis identified two or more rej ection episodes to be the only independent risk factor for the development of rejection with heart failure (odds ratio 20; 95% confidence limits, 4-10 4; p < 0.0001). Conclusions. This study identified pediatric heart transplant recipients wi th a history of previous rejection episodes to be at a higher risk for symp tomatic or fatal rejection. Further studies are needed to determine if inte nsification of maintenance immunosuppression, long-term rejection surveilla nce, or both in patients with multiple rejection episodes could reduce morb idity and mortality from rejection. (C) 1999 by The Society of Thoracic Sur geons.