Prevalence of graft vessel disease after paediatric heart transplantation: a single centre study of 54 patients

• Published in: Interactive cardiovascular and thoracic surgery 2005-10, Vol.4 (5), p.434-439
• Main Authors: Hiemann, Nicola Erika, Wellnhofer, Ernst, Meyer, Rudolf, Abdul-Khaliq, Hashim, Dandel, Michael, Grauhan, Onnen, Hummel, Manfred, Hetzer, Roland
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1510/icvts.2004.103978

a Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany b Department of Cardiology, Deutsches Herzzentrum Berlin, 13353 Berlin, Germany c Department for Congenital Heart Defects and Paediatric Cardiology, Deutsches Herzzentrum Berlin, 13353 Berlin, Germany *Corresponding author. Tel.: [phone]; fax: [phone]. E-mail address : hiemann{at}dhzb.de (N.E. Hiemann). The study tested the prevalence of graft vessel disease (GVD) in 54 paediatric heart transplant (HTx) patients (32 male, age 0–17 years) who underwent coronary angiographic investigations ( N =117). These were evaluated according to the Stanford classification and additional criteria (peripheral obliterations, diameter fluctuations, pathologic tapering) were applied for risk assessment (no GVD/minimal lesions, GVD without Stanford lesions, accelerated GVD). In H&E stainings from right ventricular endomyocardial biopsies (EMB=169) diagnosis of acute cellular rejection (ACR, ISHLT) and microvasculopathy were performed. Mild rejection was found in 43% ( N =44) and severe rejection in 7% ( N =7) of EMB early (1st year) and mild rejection in 31% ( N =32) and severe in 8% ( N =9) late (>3 years) after HTx. Microvasculopathy was present in 22% of EMB. Risk assessment of coronary angiographies showed no GVD/minimal disease in 25% ( N =29), GVD without Stanford lesions in 12% ( N =14) and different grades of accelerated GVD in 74% ( N =74) of studies. All patients dying due to cardiac related causes of death ( N =6, 3–12 years after HTx) had evidence of GVD. The data show GVD to be an important cause of late cardiac related deaths in this population. Key Words: Children; Diagnosis; Coronary angiography; Endomyocardial biopsy; Heart transplantation; Vasculopathy