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Canadian Journal of Cardiology

CARDIAC ALLOGRAFT VASCULOPATHY AND SURVIVAL IN PEDIATRIC HEART TRANSPLANT RECIPIENTS TRANSITIONED TO ADULT CARE

      Background

      Cardiac allograft vasculopathy (CAV) is an important cause of mortality after pediatric heart transplantation (HT) but there is a paucity of data regarding its incidence and impact on survival in children once they reach adulthood. Differences in outcomes according to transplant era are also not well characterized. Our objectives were to describe the incidence of CAV overall and according to transplant era and to evaluate the impact of CAV on mortality in pediatric HT recipients transitioned to adult care.

      Methods and Results

      We included consecutive HT recipients transplanted between 1989-2014 who were transitioned from Sick Kids Hospital to Toronto General Hospital. We determined the incidence of CAV according to transplant era (earlier era 1989-2001 vs. recent era 2002-2014). We used Kaplan Meier methods to evaluate all-cause mortality stratified by CAV and transplant era. There were 73 patients transitioned to adult care: 26 (38%) were transplanted between 1989-2001 and 42 (62%) were transplanted between 2002-2014. Patients transplanted between 2002-2014 were older (13 vs 9 years old, p< 0.001). Of the 68 patients with a coronary angiogram at any timepoint after HT, 34 (50%) patients had CAV. Of the 34 patients with CAV, 35 (68%) developed CAV ≥10 years after HT. Age at the time of HT was associated with CAV ≥10 years after HT (OR 1.15, 95%CI 1.02 – 1.30). Transplant era was not significantly associated with the incidence of CAV (age-adjusted HR=1.37, 95%CI 0.58–3.20). There was a significant interaction between transplant era and CAV (p=0.028; Figure) on all-cause mortality. CAV was associated with increased mortality in patients transplanted between 1989-2001 (HR=6.41, 95%CI 1.35–30.36) but not in patients transplanted in the more recent era between 2002-2014 (HR=0.59, 95%CI 0.14–2.53).

      Conclusion

      Pediatric HT recipients in the recent era who are transitioned to adult care are older and have similar age-adjusted rates of CAV compared to recipients transplanted in the earlier era. In the recent era, the development of CAV in pediatric HT recipients does not appear to negatively impact on survival.
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