Moderate acute rejection detected during annual catheterization in pediatric heart transplant recipients

J Heart Lung Transplant. 2003 Mar;22(3):276-80. doi: 10.1016/s1053-2498(02)00551-x.


Background: Acute rejection commonly occurs within the first year after heart transplantation, and then decreases in frequency with time. Recently, the long-term utility of endomyocardial biopsy during routine annual catheterization has been questioned. The purpose of this study was to retrospectively review the prevalence of biopsy-proven rejection during routine annual catheterization in our patient population, determine whether biopsies late after transplant are useful, and identify factors that correlate with late unsuspected rejection.

Methods: Biopsy results from the annual catheterization were evaluated from 1986 to August 2000. The prevalence of moderate rejection was evaluated and compared with the patient's immunosuppressive regimen; the prevalence of late rejection; and how late rejection correlated with recipient age, number of first-year rejections and presence of sub-therapeutic cyclosporine.

Results: A total of 1108 biopsies were performed in 269 children with a mean follow-up of 5 +/- 3 years (median 5 years, range 1 to 11 years). Three-drug immunosuppressive therapy, including steroids, was used in 93 patients. There was a persistent 8% to 10% prevalence of moderate rejection at up to 10 years post-transplantation. Moderate rejection was more likely in patients: (1). on 3-drug immunosuppressive therapy; (2). with a recipient age >1 year; and (3). with a relatively lower cyclosporine level.

Conclusions: These data suggest that continued surveillance of pediatric transplant patients for acute rejection is indicated for long-term follow-up.

MeSH terms

  • Acute Disease
  • Biopsy
  • Cardiac Catheterization*
  • Child
  • Child, Preschool
  • Follow-Up Studies
  • Graft Rejection / diagnosis*
  • Graft Rejection / epidemiology
  • Heart Transplantation* / immunology
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Myocardium / pathology
  • Prevalence
  • Retrospective Studies
  • Time Factors


  • Immunosuppressive Agents