Pediatric transplantationIdentifying cardiac transplant rejection in children: diagnostic utility of echocardiography, right heart catheterization and endomyocardial biopsy data
Section snippets
Patients
A prospective, blinded evaluation was performed at Stanford University, with data collection from January 1, 1999 to June 30, 2000. During this time period, data were collected on all pediatric patients (≤18 years of age) undergoing endomyocardial biopsy after cardiac transplantation. The routine biopsy schedule for noninfant patients was: weekly for 4 weeks; bi-weekly for 4 weeks; monthly for months 3 to 6; and every third month thereafter, until 3 years post-transplant. After the third year,
Results
A total of 49 patients underwent a total of 281 biopsies, all of which were included in the study. Patient characteristics are summarized in Table I. There were 177 biopsies (63%) in patients taking cyclosporine, 105 biopsies (37%) in patients taking tacrolimus, and 196 biopsies (70%) in patients taking prednisone.
Discussion
Surveillance for pediatric patients who have undergone cardiac transplantation includes echocardiography and endomyocardial biopsy at routine intervals, with marked interinstitutional variability in specific protocol and practice. Multiple studies have examined the sensitivity and specificity of various echocardiographic measurements with inconsistent results.2, 3, 7 These studies have demonstrated for the most part that echocardiography does not have sufficient predictive value to completely
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Native T1 mapping detects both acute clinical rejection and graft dysfunction in pediatric heart transplant patients
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2019, Journal of the American Society of EchocardiographyMultimodality Noninvasive Imaging in the Monitoring of Pediatric Heart Transplantation
2017, Journal of the American Society of EchocardiographyCardiac dysfunction in children and young adults with heart transplantation: A comprehensive echocardiography study
2017, Journal of Heart and Lung TransplantationCitation Excerpt :Previous studies have reported a high prevalence of cardiac dysfunction in adults with heart transplant of both the right ventricle and the left ventricle,32–34 although more recent studies have also described normal cardiac mechanics in this population,35 suggesting that sub-clinical cardiac mechanical dysfunction might not represent a part of the physiologic adaptation of the transplanted heart, but rather may be an early marker of cardiac impairment. In younger populations with heart transplants, some studies have focused on the analysis of cardiac function to identify early markers of acute rejection.36–39 It has been shown that abnormalities in RV function as well as changes in tissue Doppler indices are able to identify patients at risk of developing acute rejection.