Zinn Matthew D, Wallendorf Michael J, Simpson Kathleen E, Osborne Ashley D, Kirklin James K, Canter Charles E
Department of Pediatrics, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Pediatric Cardiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA.
J Heart Lung Transplant. 2017 Apr;36(4):451-456. doi: 10.1016/j.healun.2016.09.017. Epub 2016 Oct 7.
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).
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).
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.
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.
在小儿心脏移植（HT）受者中，移植时的年龄对通过常规监测活检（RSB）检测到的排斥反应的影响尚不清楚。我们假设，与儿童（1至9岁）和青少年（10至18岁）相比，婴儿（年龄<1岁）通过RSB检测到的排斥反应的诊断率较低且发生率降低。
我们利用2010年至2013年的小儿心脏移植研究（PHTS）数据，分析仅通过RSB检测到的中度至重度（国际心脏和肺移植学会2R/3R级）细胞排斥反应（MSR）。
RSB检测到343次MSR发作中的280次（81.6%）。即使在HT后>5年，所有年龄组均检测到RSBMSR。与儿童和青少年相比，婴儿RSBMSR在HT后>5年发生的比例更高（p = 0.0025）（39.2%对18.4%对10.8%），而在HT后第一年发生的比例更低（p = 0.0009）（25.5%对60.6%对51.7%）。HT后4年，婴儿免于RSBMSR的比例为87±7%，儿童为76±6%，青少年为73±7%。在HT后第一年发生RSBMSR的1年幸存者中，第2至4年发生RSBMSR的风险显著高于第一年未发生RSBMSR的患者（p < 0.0001）（风险比21.28，95%置信区间10.87至41.66），与受者年龄无关。
小儿HT后长期随访，所有年龄组均存在RSBMSR。婴儿受者在HT后>5年的发生率最高。HT后第一年发生RSBMSR的患者，无论HT时的年龄如何，复发排斥反应的风险都很高。
