Rejection is reduced in thoracic organ recipients when transplanted in the first year of life

Ibrahim, Jill; Sweet, Stuart C.; Flippin, Mindee J; Dent, Catherine L.; Mendelhoff, Eric; Huddleston, Charles B.; Trinkhaus, K.; Canter, Charles E.

doi:10.1016/s1053-2498(01)00395-3

Cited by 77 publications

(19 citation statements)

References 15 publications

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“…This finding, along with the prevalence trend just presented, seemingly negates the presumed protective effect against long-term rejection in infant recipients. 15 …”

Section: Discussionmentioning

confidence: 99%

Impact of age on incidence and prevalence of moderate-to-severe cellular rejection detected by routine surveillance biopsy in pediatric heart transplantation

Zinn

Wallendorf

Simpson

et al. 2017

The Journal of Heart and Lung Transplantation

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BACKGROUND The effect of age at transplant on rejection detected by routine surveillance biopsy (RSB) in pediatric heart transplant (HT) recipients is unknown. We hypothesized there would be low diagnostic yield and decreased prevalence of rejection detected on RSB in infants (age <1 year) when compared with children (age 1 to 9 years) and adolescents (age 10 to 18 years). METHODS We utilized Pediatric Heart Transplant Study (PHTS) data from 2010 to 2013 to analyze moderate to severe (ISHLT Grade 2R/3R) cellular rejection (MSR) detected only on RSB (RSBMSR). RESULTS RSB detected 280 of 343 (81.6%) episodes of MSR. RSBMSR was detected in all age groups even >5 years after HT. Infant RSBMSR had a greater proportion (p = 0.0025) occurring >5 years after HT (39.2 vs 18.4 vs 10.8%) and a lower proportion (p = 0.0009) occurring in the first year after HT (25.5 vs 60.6 vs 51.7%) compared with children and adolescents, respectively. Freedom from RSBMSR was 87 ± 7% in infants, 76 ± 6% in children and 73 ± 7% in adolescents 4 years after HT. In 1-year survivors who had RSBMSR in the first year after HT, the risk of RSBMSR occurring in Years 2 to 4 was significantly (p < 0.0001) greater than patients without RSBMSR in the first year (hazard ratio 21.28, 95% confidence interval 10.87 to 41.66), regardless of recipient age. CONCLUSIONS RSBMSR exists in all age groups after pediatric HT with long-term follow-up. The prevalence in infant recipients is highest >5 years after HT. Those with RSBMSR in the first year after HT are at a high risk for recurrent rejection regardless of age at HT.

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“…This finding, along with the prevalence trend just presented, seemingly negates the presumed protective effect against long-term rejection in infant recipients. 15 …”

Section: Discussionmentioning

confidence: 99%

Impact of age on incidence and prevalence of moderate-to-severe cellular rejection detected by routine surveillance biopsy in pediatric heart transplantation

Zinn

Wallendorf

Simpson

et al. 2017

The Journal of Heart and Lung Transplantation

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“…Infants also remain a challenging population, with higher waiting list mortality and poorer outcomes. However, evidence that long-term complications in infants may be lower (6,47), raises the question whether outcomes for these patients could be improved by shortening time to transplant.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Transplantation in the United States,1995–2004

Sweet

Wong

Webber

et al. 2006

American Journal of Transplantation

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This article reviews trends in pediatric solid organ transplantation over the last decade, as reflected in OPTN/SRTR data. In 2004, children younger than 18 years made up nearly 3% of the 86 378 candidates for organ transplantation and nearly 7% of the 27 031 organ transplant recipients. Children accounted for nearly 14% of the 7152 deceased organ donors. The transplant community recognizes important differences between pediatric and adult organ transplant recipients, including different etiologies of organ failure, surgical procedures that are more complex or technically challenging, effects of development on the pharmacokinetic properties of common immunosuppressants, unique immunological aspects of transplant in the developing immune system and increased susceptibility to posttransplant complications, particularly infectious diseases. For these reasons, and be- Tables 1.3, 1.4, 1.5, 1.7, 1.8, 1.10, 1.11a and b, 1.12a and b, 2.1-2.7, 5.1a, 5.3-5. 5, 5.9a-c, 5.12a, 5.12c, 5.14, 7.14, 9.1a and b, 9.3-9.5, 9.7a, 9.9a and b, 9.12a and b, 9.14, 10.1-10.7, 10.9, 10.12, 10.14, 10.15, 11.1b, 11.3-11.5, 11.9, 11.12, 11.14, 12.1-12.7, 12.9a and b, 12.14, 13.1b, 13.2, 13.4 and 15.3. All of these tables may be found online at http://www.ustransplant.org.cause of the impact of end-stage organ failure on growth and development, the transplant community has generally provided pediatric candidates with special consideration in the allocation of deceased donor organs. Outcomes following kidney, liver and heart transplantation in children often rank among the best. This article emphasizes that the prospects for solid organ transplantation in children, especially those aged 1-10 years are excellent. It also identifies themes warranting further consideration, including organ availability, adolescent survival and challenges facing pediatric transplant clinical research.

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“…Despite this higher mortality in the first year following transplant in infant recipients, at 5 years following transplantation, the survival is similar to that seen in all other age groups ( Figure 16). This equilibration in survival that occurs by 5 years following the transplant may be related to emerging evidence that rejection is reduced in thoracic organ recipients when transplanted in the first year of life (45). Transplantation performed in infancy may confer some type of immunologic tolerance that, as of yet, is not well understood.…”

Section: Transplantation and Survivalmentioning

confidence: 99%