Serial assessment of right ventricular function can detect acute cellular rejection in children with heart transplantation

Pediatr Transplant. 2022 Jun;26(4):e14231. doi: 10.1111/petr.14231. Epub 2022 Jan 18.

Abstract

Background: Echocardiographic markers of ACR are essential for early recognition and management. The literature's primary focus has been on the LV with little attention given to the RV. This study aimed to investigate echocardiographic right ventricular indices in the detection of ACR and to evaluate their utility as prognostic indicators of graft integrity.

Methods: We performed a retrospective chart review of children with biopsy-proven ACR following orthotopic heart transplant and an echocardiogram within 24 h of biopsy. Selected echocardiographic markers were compared at baseline, during ACR, and at follow-up.

Results: Forty-eight patients (56% male) had a total of 84 ACR episodes. Decrease in RV FAC (mean - 17.1%, p < .001) and TAPSE (mean - 8.9%, p < .001) with increase in left ventricular posterior wall thickness in diastole and systole (LVPWTd) (mean + 9.0%, p = .012) and LVPWTs (mean + 8.3%, p = .016) were found during ACR. Interestingly, these parameters improved following the episode of rejection. Additionally, these markers were compared after recovery between children with and without graft failure. RV dysfunction (FAC and TAPSE) and changes in LV posterior wall thickness were not found to have prognostic significance for graft integrity in children with heart transplantation.

Conclusions: RV echocardiographic functional parameters should be considered as valuable adjuncts in rejection surveillance. Further, the presence of RV dysfunction does not have prognostic significance for graft integrity but is reversible as ongoing damage was not detectable by such.

Keywords: acute cellular rejection; cardiac transplantation; fractional area change; right ventricular dysfunction; tricuspid annular plane systolic excursion.

MeSH terms

  • Child
  • Echocardiography
  • Female
  • Graft Rejection / diagnosis
  • Heart Transplantation*
  • Humans
  • Male
  • Retrospective Studies
  • Ventricular Dysfunction, Right* / diagnosis
  • Ventricular Function, Right