Clinical predictors of autoimmune and severe atopic disease in pediatric heart transplant recipients.

Mouledoux JH, Albers EL, Lu Z, Saville BR, Moore DJ, Dodd DA
Pediatr Transplant. 2014 18 (2): 197-203

PMID: 24372990 · PMCID: PMC3988248 · DOI:10.1111/petr.12205

Autoimmune and allergic diseases cause morbidity and diminished quality of life in pediatric organ transplant recipients. We hypothesize that younger age at transplantation and immunosuppression regimen play a role in the development of immune-mediated disease following heart transplant. A single institution retrospective review identified all patients undergoing heart transplant at ≤18 yr of age from 1987 to 2010 who survived ≥1 yr. Using medical record and database review, patients were evaluated for development of autoimmune or severe allergic disease. Of 129 patients who met criteria, seven patients (5.4%) with autoimmune or severe atopic disease were identified. Immune-mediated diseases included inflammatory bowel disease (n = 3), eosinophilic esophagitis/colitis (n = 4), and chronic bullous disease of childhood (n = 1). Patients <1 yr of age at transplant were at greater risk of developing autoimmune disease than patients 1-18 yr at transplant (OR = 9.3, 95% CI 1.1-79.2, p = 0.02). All affected patients underwent thymectomy at <1 yr of age (7/71 vs. 0/58, p = 0.02). In our experience, heart transplantation in infancy is associated with the development of immune-mediated gastrointestinal and dermatologic diseases. Further study is needed to determine risk factors for the development of immune-mediated disease to identify best practices to decrease incidence.

© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

MeSH Terms (16)

Adolescent Autoimmune Diseases Child Child, Preschool Female Heart Failure Heart Transplantation Humans Hypersensitivity, Immediate Immunosuppressive Agents Infant Infant, Newborn Male Molecular Sequence Data Retrospective Studies Risk Factors

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