LONG-TERM RESULTS OF TRIPLE-DRUG-BASED IMMUNOSUPPRESSION IN NONNEONATAL PEDIATRIC HEART TRANSPLANT RECIPIENTS
| Autor: | O.H. Frazier, J.A. Towbin, Robert J. Gajarski, Debra L. Kearney, Branislav Radovancevic, E.O. Smith, Naomi J. Kertesz, Howard M. Rosenblatt, Susan W. Denfield, J K Price |
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| Rok vydání: | 1998 |
| Předmět: |
Adult
Graft Rejection Male medicine.medical_specialty Adolescent Heart disease medicine.medical_treatment Cardiomyopathy Coronary Disease Azathioprine Infections Coronary artery disease Postoperative Complications Maintenance therapy Risk Factors medicine Humans Longitudinal Studies Child Postoperative Care Heart transplantation Transplantation business.industry Incidence Infant Immunosuppression medicine.disease Survival Analysis Surgery Child Preschool Cyclosporine Heart Transplantation Prednisone Drug Therapy Combination Female business Immunosuppressive Agents medicine.drug |
| Zdroj: | Transplantation. 65:1470-1476 |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/00007890-199806150-00011 |
| Popis: | Background Few reports document long-term results of pediatric cardiac transplantation in which triple therapy (cyclosporine, azathioprine, and corticosteroids) was the mainstay of immunosuppression. This report details a single center's pediatric transplant experience and analyzes the relative contributions of selected pre/posttransplant risk factors on long-term morbidity and mortality. Methods Retrospective data were collected for all non-neonatal pediatric transplant recipients including: presenting diagnosis, cardiac hemodynamics (particularly pulmonary vascular resistance index), donor ischemic time, occurrence of postoperative infections, episodes of allograft rejection, incidence of posttransplant lymphoproliferative disease or coronary artery disease (CAD), and overall survival. Analysis of single variables and a Cox-proportional hazards model were utilized to determine the impact of pre/posttransplant risk factors on long-term survival. Results From 1984 to 1995, 64 patients (mean age, 8.3 years), 46 of whom had cardiomyopathy and 18 who had inoperable complex congenital heart disease, underwent cardiac transplantation and received triple-drug immunosuppression. Orthotopic transplantation was performed unless the pulmonary vascular resistance index remained >6 um2 (despite use of pulmonary vasodilator). One patient required heterotopic transplantation. Average donor ischemic time was 217 min. An average of 1.2 rejection episodes/patient occurred (average follow-up period: 50 months). No patient developed posttransplant lymphoproliferative disease, but 22 patients (34%) developed CAD. Overall survival was 80%, 60%, and 57% at 1, 5, and 10 years, respectively. Of outcome variables analyzed, rejection frequency was significantly increased in patients who subsequently developed CAD, but the presence of CAD was not significantly correlated with mortality. Conclusion Triple-drug-based immunosuppressive maintenance therapy in pediatric heart transplant recipients results in good long-term graft survival. |
| Databáze: | OpenAIRE |
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