ANALYSIS of recurrent rejection (RR) in pediatric heart transplant recipients revealed that 17% of the population studied experienced RR, with a significant impact on graft survival rates.
The investigation focused on evaluating the prevalence and clinical outcomes associated with RR, which poses risks for graft loss and cardiac allograft vasculopathy (CAV) in children. Given the limited research on RR in pediatric heart transplant (HT) recipients, this study aimed to assess the impact of RR, defined as two or more rejection episodes, by analysing a large dataset from the Pediatric Heart Transplant Society. The study examined prevalence trends and the influence of different rejection types, aiming to inform clinical practice on improving outcomes for this vulnerable population.
The study utilised data from 6,342 pediatric HT recipients listed in the Pediatric Heart Transplant Society database, spanning from 2000 to 2020. Rejection trends were compared across two eras (2000-2009 and 2010-2020), with a focus on types of RR: antibody-mediated rejection (AMR), acute cellular rejection (ACR), and mixed rejection (ACR/AMR). Statistical analyses examined freedom from CAV and graft loss among patients experiencing varying rejection frequencies and types. Findings showed that while RR prevalence was lower in the current era (P < 0.001), children with RR had a significantly reduced freedom from graft loss compared to those with 0 or 1 rejection episodes (56.3% vs 72.3% vs 82.3%). Notably, freedom from CAV was similar across patients regardless of rejection frequency (96.6% for RR patients vs 95.3% and 96.6% for those with 0 or 1 episode) and type (65.5% for AMR, 82.9% for ACR, and 100% for mixed rejection) (P > 0.05).
In conclusion, although RR prevalence has declined, its occurrence remains a strong predictor of graft loss, especially in cases of recurrent AMR and mixed rejection. These findings highlight the need for targeted strategies in clinical practice to mitigate RR’s impact, particularly among higher-risk groups, such as Black children who demonstrated poorer outcomes in terms of freedom from CAV and graft survival. Future studies should explore tailored immunosuppressive regimens to reduce rejection episodes and improve long-term outcomes in pediatric HT patients.
Reference
Amdani S et al. Prevalence and impact of recurrent rejection on pediatric heart transplant recipients: a PHTS multi-institutional analysis. J Am Coll Cardiol. 2024;DOI:10.1016/j.jacc.2024.08.010.
