Gunderman Lauren, Lancki Nicola, Madden Brian, Ahmed Aisha
Division of Allergy and Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Pediatr Transplant. 2025 Mar;29(2):e70052. doi: 10.1111/petr.70052.
Pediatric heart transplant recipients are at risk for complications from prolonged exposure to immunosuppressive drugs, possibly worsened due to over-immune suppression in patients with pre-existing immune abnormalities.
This was a retrospective, single-center pediatric cohort study and review of baseline immune evaluation in patients referred for heart transplant. Referrals included were from January 1, 2021, to June 31, 2022.
Fifty-one patients were referred during the time period with a median age of 5 years (ranging 1 month-20 years). Twenty-seven total patients were transplanted. Given a lack of standardized immune evaluation, results were focused on lymphocyte quantitation, functional testing when available, and T-cell subsets. Outcome measures focused on the number of infections and episodes of rejection requiring treatment. In total, 44.4% of patients experienced rejection, and the mean number of infections in the first 12 months post-heart transplant was 2.1 (range 0-7 total infections).
Baseline immune evaluation showed general T and B cell lymphopenia, without a clear connection between outcome differences for the number of infections or episodes of rejection requiring treatment. This small study demonstrated some differences in immune function in patients prior to heart transplant but was inadequately powered to draw conclusions about the effects of immunosuppression on post-transplant outcomes.
小儿心脏移植受者因长期暴露于免疫抑制药物而有发生并发症的风险，对于已有免疫异常的患者，可能由于免疫抑制过度而使情况恶化。
这是一项回顾性单中心小儿队列研究，并对转诊进行心脏移植的患者的基线免疫评估进行了回顾。纳入的转诊患者为2021年1月1日至2022年6月31日期间的患者。
在此期间转诊了51例患者，中位年龄为5岁（范围为1个月至20岁）。共有27例患者接受了移植。由于缺乏标准化的免疫评估，结果主要集中在淋巴细胞定量、可用时的功能测试以及T细胞亚群。结果指标集中在感染次数和需要治疗的排斥反应发作次数。总共有44.4%的患者发生了排斥反应，心脏移植后前12个月的平均感染次数为2.1次（总感染次数范围为0至7次）。
基线免疫评估显示总体T和B细胞淋巴细胞减少，感染次数或需要治疗的排斥反应发作次数的结果差异之间没有明确联系。这项小型研究显示了心脏移植前患者免疫功能的一些差异，但样本量不足以就免疫抑制对移植后结果的影响得出结论。
