Cardiac allograft vasculopathy in pediatric heart transplant recipients does early-onset portend a worse prognosis?

PURPOSE: We sought to evaluate the association between timing of cardiac allograft vasculopathy (CAV) occurrence post-heart transplant (HT) with graft survival and progression of CAV severity in pediatric HT recipients. METHODS: Data from the Pediatric Heart Transplant Society for pediatric (< 18 years old) HT recipients between 1993-2019 with available angiographic data were obtained (N = 5,075). The timing of CAV diagnosis (< 3; 3-< 5; 5-< 10; and > 10 years post-HT) and severity of disease at each assessment (CAV 1-3) was determined. Associations between CAV timing, graft survival, and CAV progression were evaluated using Kaplan-Meier survival curves, multivariable COX proportional hazard regression anal-yses, and competing risk analyses. RESULTS: Over a median follow-up period of 4.1 (IQR 1.3-8.3) years, CAV was identified in 17% (885/ 5,075), 28% (252/885) of which were early-onset CAV. Compared with late onset CAV > 10 years post-HT, patients with early CAV were older at the time of transplant (8.3 +/- 6.2 vs. 3.8 +/- 4.8 years, p <.0001). While the five-year graft-survival in the > 10-year group (79.2%, p = 0.03) was significantly higher than the < 3, 3-< 5, and 5-< 10 years post-HT groups (65.0%-67%) (p = 0.03), overall post-CAV graft survival was not significantly different across the CAV time-points. CAV disease progression did not vary with CAV timing post-HT, with an overall five-year freedom from CAV > 2 of 75.4% (73.1%-77.6%). CONCLUSION: Later onset CAV (> 10-years post-HT) was associated with improved five-year graft sur-vival compared with CAV onset at earlier time-points, but similar and poor long-term outcomes. CAV timing post-HT was not associated with progression of CAV disease severity. J Heart Lung Transplant 2022;41:578-588 (c) 2022 International Society for Heart and Lung Transplantation. All rights reserved.

Automated summary

This study aimed to evaluate the association between the timing of cardiac allograft vasculopathy (CAV) occurrence post-heart transplant (HT) and graft survival and progression of CAV severity in pediatric HT recipients. The study found that later onset CAV (> 10 years post-HT) was associated with improved five-year graft survival compared to CAV onset at earlier time-points, but the long-term outcomes were similar and poor. The timing of CAV post-HT was not associated with progression of CAV disease severity.