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OBJECTIVESThe study objectives were to determine posttransplant coronary artery disease (TxCAD) incidence, predisposing factors and optimal timing for retransplantation (re-Tx) in pediatric heart transplantation (Tx) recipients.BACKGROUNDThe TxCAD limits long-term survival following heart Tx, with re-Tx being the primary therapy. Information on risk factors and timing of listing for re-Tx is limited in children.METHODSThe records of children who survived >1 year post-Tx at Loma Linda University were reviewed. Nonimmune and immune risk factors were analyzed.RESULTSTxCAD was documented in 24 of 210 children. Freedom from TxCAD was 92 ± 2% and 75 ± 5% at 5 and 10 years’ post-Tx, respectively. The TxCAD diagnosis was established at autopsy in 10 asymptomatic patients who died suddenly within nine months following the most recent negative angiograms. The remaining 14 children had angiographic diagnoses of TxCAD and had symptoms and/or graft dysfunction (n = 10) or positive stress studies (n = 4). Three of 14 died within three months after the diagnosis was made. Eleven patients underwent re-Tx within seven months of diagnosis; nine survived. Univariate and multivariate analyses showed that only late rejection (>1 year posttransplant) frequency (p = 0.025) and severity (hemodynamically compromising) (p < 0.01) were independent predictors of TxCAD development. Freedom from TxCAD after severe late rejection was 78 ± 8% one year postevent and 55 ± 10% by two years.CONCLUSIONSLate rejection is an independent predictor of TxCAD. Patients suffering severe late rejection develop angiographically apparent TxCAD rapidly and must be monitored aggressively. Both TxCAD mortality and morbidity occur early; therefore, we recommend immediate listing for re-Tx upon diagnosis.

Objectives. This study was undertaken to investigate the incidence of posttransplant recoarctation of the aorta, delineate the mode of presentation, identify risk factors that predict recoarctation and examine the results of intervention for posttransplant recoarctation.Background. Patients with aortic arch hypoplasia require extended arch reconstruction at transplant, with an inherent possibility of subsequent recoarctation of the aorta.Methods. This was a retrospective review of all children (age

Limited data are available on exercise performance after infant cardiac transplantation (CTX). Purpose: The aim of this study was to compare the cardiorespiratory response to exercise in children who had undergone CTX for hypoplastic left heart syndrome in infancy with normal (NML) subjects. Procedure: Subjects (24 CTX; 25 NML) were exercised on a treadmill using pediatric ramp protocols. Heart rate (HR), blood pressure (BP), oxygen consumption (VO2), CO2 production and ventilatory anaerobic threshold (VAT) were measured. Mean age at CTX was 32±26 days. Age of CTX subjects at time of exercise was 9.7±2.3 years and 10.5±1.4 years in NML subjects (p=NS). All subjects in both groups were NYHA Class I. Results: Exercise duration was similar (p=NS) in both groups (10.3±2.0 minutes(CTX) versus 11.1±1.5 minutes (NML). HR at rest was greater in CTX patients (94±15 BPM versus 85±11 BPM (p=0.02). Peak HR was also less in the CTX group (158 BPM±15 BPM versus 189 BPM±12 BPM (p Conclusions: 1) Overall, children receiving cardiac transplantation in infancy have an exercise capacity within the normal range. 2) Subjects undergoing cardiac transplantation in early infancy have decreased heart rate reserve that may account for the differences in peak oxygen consumption compared to normal subjects.