TY - JOUR
T1 - A comparison of traditional versus contemporary immunosuppressive regimens in pediatric heart recipients
AU - Marshall, Clement D.
AU - Richmond, Marc E.
AU - Singh, Rakesh K.
AU - Gilmore, Lisa
AU - Beddows, Kim
AU - Chen, Jonathan M.
AU - Addonizio, Linda J.
N1 - Funding Information:
C.M. is funded by the Columbia University Weinstein Research Fellowship . The authors declare no conflicts of interest.
PY - 2013
Y1 - 2013
N2 - Objectives: To assess the differences in rejection and infection complications between the most common contemporary immunosuppression regimen in pediatric heart transplantation (cytolytic induction, tacrolimus based) and classic triple-therapy (cyclosporine based without induction). Study design: We performed a retrospective, historical-control, observational study comparing outcomes in patients who underwent traditional immunosuppression (control group, n = 64) with those for whom the contemporary protocol was used (n = 39). Episodes of rejection, viremia (cytomegalovirus or Epstein-Barr virus), serious bacterial or fungal infections, anemia or neutropenia requiring treatment in the first year after heart transplantation, and 1-year survival were compared between traditional and contemporary immunosuppression groups. Results: The 2 groups were similar with respect to baseline demographics. There were no differences in risk of cytomegalovirus, Epstein-Barr virus, or bacterial or fungal infections in the first year post-transplantation. Patients in the contemporary group were more likely to need therapy for anemia (51% vs 14%, P <.001) or neutropenia (10% vs 0%, P =.019). However, more contemporary protocol patients were rejection-free in the first year post-transplantation (63% vs 41%, P =.03). Overall graft survival was similar between groups (P =.15). Conclusions: A contemporary immunosuppression regimen using tacrolimus, mycophenolate mofetil, and induction was associated with less rejection in the first year, with no difference in the risk of infection but greater risk of anemia and neutropenia requiring treatment. Long-term follow-up on these patients will evaluate the impact of the immunosuppression regimen on survival.
AB - Objectives: To assess the differences in rejection and infection complications between the most common contemporary immunosuppression regimen in pediatric heart transplantation (cytolytic induction, tacrolimus based) and classic triple-therapy (cyclosporine based without induction). Study design: We performed a retrospective, historical-control, observational study comparing outcomes in patients who underwent traditional immunosuppression (control group, n = 64) with those for whom the contemporary protocol was used (n = 39). Episodes of rejection, viremia (cytomegalovirus or Epstein-Barr virus), serious bacterial or fungal infections, anemia or neutropenia requiring treatment in the first year after heart transplantation, and 1-year survival were compared between traditional and contemporary immunosuppression groups. Results: The 2 groups were similar with respect to baseline demographics. There were no differences in risk of cytomegalovirus, Epstein-Barr virus, or bacterial or fungal infections in the first year post-transplantation. Patients in the contemporary group were more likely to need therapy for anemia (51% vs 14%, P <.001) or neutropenia (10% vs 0%, P =.019). However, more contemporary protocol patients were rejection-free in the first year post-transplantation (63% vs 41%, P =.03). Overall graft survival was similar between groups (P =.15). Conclusions: A contemporary immunosuppression regimen using tacrolimus, mycophenolate mofetil, and induction was associated with less rejection in the first year, with no difference in the risk of infection but greater risk of anemia and neutropenia requiring treatment. Long-term follow-up on these patients will evaluate the impact of the immunosuppression regimen on survival.
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U2 - 10.1016/j.jpeds.2012.12.075
DO - 10.1016/j.jpeds.2012.12.075
M3 - Article
C2 - 23391044
AN - SCOPUS:84879413634
SN - 0022-3476
VL - 163
SP - 132
EP - 136
JO - Journal of Pediatrics
JF - Journal of Pediatrics
IS - 1
ER -