Eight-year experience of pediatric heart transplantation: clinical outcome using non-invasive methods for the evaluation of acute rejection

Combined immunosuppression therapy and acute rejection surveillance after heart transplantation may influence clinical outcome. This prospective, longitudinal study investigated 27 pediatric patients (12 days to 12 yr of age; mean 3.0 yr) who underwent a post-operative regimen that included long-term treatment with cyclosporin A and azathioprine (double immunosuppression) and polyclonal anti-thymocyte serum induction therapy. Non-invasive parameters were used to diagnose acute rejection. The actuarial survival, clinical outcomes, and complications were analyzed. The actuarial survival after double immunosuppression and induction therapy with polyclonal anti-thymocyte serum was 89%, 73%, and 57% at 1, 4, and 8 yr, respectively. The rejection frequency was 2.6 episodes/patient and the infection frequency, 3.7 episodes/patient. One year after transplantation, systemic arterial hypertension was detected in 21% of patients. Hence, double immunosuppression with polyclonal anti-thymocyte serum induction therapy combined with surveillance of acute rejection with non-invasive tests may provide promising clinical outcome in pediatric heart transplant recipients.