Vascular endothelial growth factor A is associated with the subsequent development of moderate or severe cardiac allograft vasculopathy in pediatric heart transplant recipients
| Autor: | John F. Keane, David Zurakowski, Kevin P. Daly, Elizabeth D. Blume, David M. Briscoe, Maria P. Stack, Michele F Eisenga |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male Vascular Endothelial Growth Factor A medicine.medical_specialty Adolescent medicine.medical_treatment Coronary Disease 030204 cardiovascular system & hematology 030230 surgery Article Coronary artery disease 03 medical and health sciences Young Adult 0302 clinical medicine Postoperative Complications Prednisone Predictive Value of Tests Internal medicine medicine Clinical endpoint Humans Myocardial infarction Young adult Child Proportional Hazards Models Heart transplantation Heart Failure Transplantation medicine.diagnostic_test business.industry medicine.disease Allografts ROC Curve Heart failure Child Preschool Angiography Cardiology cardiovascular system Heart Transplantation Surgery Female Cardiology and Cardiovascular Medicine business Biomarkers medicine.drug |
| Zdroj: | The Journal of Heart and Lung Transplantation, 36(4), 434-442. ELSEVIER SCIENCE INC |
| ISSN: | 1053-2498 |
| Popis: | BACKGROUND: Cardiac allograft vasculopathy (CAV) is the leading cause of chronic allograft loss after pediatric heart transplantation. We hypothesized that biomarkers of endothelial injury and repair would predict CAV development in pediatric heart transplant recipients. METHODS: Blood was collected from pediatric heart transplant recipients at the time of routine annual coronary angiography, and the concentrations of 13 angiogenesis-related molecules were determined. The primary end point was the presence of moderate or severe CAV by angiography during a 5-year follow-up period. RESULTS: The study enrolled 48 recipients (57% male) with a median age of 15.5 years (range, 2-22 years) and median time post-transplant of 5.8 years (range, 2-15 years). Eight recipients developed moderate/severe CAV at a median follow-up of 4.7 years, of whom 3 died, 3 underwent retransplantation, 1 had a myocardial infarction, and 1 was listed for retransplantation. Clinical characteristics associated with the development of moderate/severe CAV included prednisone use at enrollment (p = 0.03) and positive recipient cytomegalovirus immunoglobulin G at the time of transplant (p = < 0.01). Multivariable Cox proportional hazards regression identified plasma vascular endothelial growth factor (VEGF)-A concentration greater than 90 pg/ml at the time of blood draw as a significant predictor of time to moderate or severe CAV (hazard ratio, 14.3; 95% confidence interval, 1.3-163). Receiver operating characteristic curve analysis demonstrated that VEGF-A shows moderate performance for association with the subsequent development of CAV (area under the curve, 0.77; 95% confidence interval, 0.61-0.92). CONCLUSIONS: VEGF-A levels in pediatric heart transplant recipients are associated with clinically important CAV progression within the subsequent 5 years. |
| Databáze: | OpenAIRE |
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