Heart Retransplantation for Coronary Allograft Vasculopathy in Children: 25 Years of Single-Center Experience

Pediatric end-stage heart disease is surgically managed by heart transplantation. A major complication of primary transplantation (PTx) is coronary allograft vasculopathy (CAV), a form of accelerated atherosclerosis. Retransplantation (RTx) has been the management of CAV; however, there is limited c...

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Published in:Transplantation proceedings 2020-06, Vol.52 (5), p.1394-1396
Main Authors: Azeka, Estela, Walker, Thomas, Siqueira, Adailson Wagner da Silva, Penha, Juliano, Miana, Leonardo, Caneo, Luiz Fernando, Massoti, Maria Raquel, Tanamati, Carla, Miura, Nana, Jatene, Marcelo Biscegli
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cited_by cdi_FETCH-LOGICAL-c380t-82a136d4964a67bba692a171ed69dd269ddc7eb4205a0a464dd9f4b9d1c8f7983
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container_title Transplantation proceedings
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creator Azeka, Estela
Walker, Thomas
Siqueira, Adailson Wagner da Silva
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Miura, Nana
Jatene, Marcelo Biscegli
description Pediatric end-stage heart disease is surgically managed by heart transplantation. A major complication of primary transplantation (PTx) is coronary allograft vasculopathy (CAV), a form of accelerated atherosclerosis. Retransplantation (RTx) has been the management of CAV; however, there is limited comprehensive literature on this subject. Here we report 25 years of single-center experience in managing CAV with RTx and place it in the context of recent studies. A retrospective cohort study was undertaken on patients who underwent PTx 
doi_str_mv 10.1016/j.transproceed.2020.03.012
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A major complication of primary transplantation (PTx) is coronary allograft vasculopathy (CAV), a form of accelerated atherosclerosis. Retransplantation (RTx) has been the management of CAV; however, there is limited comprehensive literature on this subject. Here we report 25 years of single-center experience in managing CAV with RTx and place it in the context of recent studies. A retrospective cohort study was undertaken on patients who underwent PTx &lt;18 years old and subsequent RTx due to CAV at the Heart Institute (InCor) University of São Paulo Medical School between 1992 and 2018. The maintenance immunosuppression protocol was double immunosuppression. For both PTx and RTx, quantitative and qualitative analyses were conducted for transplantation indication, donor/recipient demographics, post-transplant survival, rejection, infection, and immunosuppression. Between 1992 and 2018, 200 children underwent heart transplantation. Ten re-transplantations were performed, for which 7 (70%) were for CAV. Ages at RTx ranged from 11.5 to 29.3 years (19.1 ± 5.68 years; median 18.2 years). The mean time between PTx and RTx was 12.9 ± 3.4 years (median 13.4 years). The Kaplan-Meier survival rate at 1 month, 3 years, and 5 years was 85.7%, 71.5%, and 47.6%, respectively. Cardiac RTx can be a management option for CAV in patients who have undergone PTx in childhood with double immunosuppression therapy.</description><identifier>ISSN: 0041-1345</identifier><identifier>EISSN: 1873-2623</identifier><identifier>DOI: 10.1016/j.transproceed.2020.03.012</identifier><identifier>PMID: 32387081</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><ispartof>Transplantation proceedings, 2020-06, Vol.52 (5), p.1394-1396</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. 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title Heart Retransplantation for Coronary Allograft Vasculopathy in Children: 25 Years of Single-Center Experience
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