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J Heart Lung Transplant. 2014 Jun;33(6):624-8. doi: 10.1016/j.healun.2014.01.863. Epub 2014 Jan 29.

Single-center experience with extracorporeal photopheresis in pediatric heart transplantation.

Author information

  • 1Divisions of Pediatric Cardiology, The University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: wfcarlo@peds.uab.edu.
  • 2Divisions of Pediatric Cardiology, The University of Alabama at Birmingham, Birmingham, Alabama.
  • 3Divisions of Cardiothoracic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama.
  • 4Divisions of Cardiovascular Diseases, The University of Alabama at Birmingham, Birmingham, Alabama.
  • 5Divisions of Laboratory Medicine, The University of Alabama at Birmingham, Birmingham, Alabama.
  • 6Department of Laboratory Medicine and Pathology, Mayo Clinic, Arizona.

Abstract

BACKGROUND:

The pediatric heart transplant literature contains little information regarding extracorporeal photopheresis (ECP), despite International Society for Heart and Lung Transplantation guidelines recommending it for recurrent/recalcitrant rejection. We report our experience with ECP in pediatric heart transplantation.

METHODS:

Data were obtained on heart transplant patients who were aged ≤ 18 years at the time of transplantation and received ECP between 1990 and 2012 at our institution.

RESULTS:

Twenty heart transplant patients underwent 22 courses of ECP. Median ages were 12.7 years (range, 0.3-18.5 years) at transplant and 15.3 years (range, 7.3-31 years) at initial ECP. Median time from transplant to ECP was 1.4 years (range, 0.1-12.6 years). The median ECP duration was 5.8 months (range, 1.9-16.1 months). Indications for ECP included rejection with hemodynamic compromise (HC) in 4 patients, rejection without HC in 12, and prophylaxis in 2. Eleven patients died at a median time of 3.1 years after the start of ECP. Survival after ECP was 84% at 1 year and 53% at 3 years. Eleven patients were considered non-compliant and had a trend toward lower survival of 75% at 1 year and 18% at 3 years (p = 0.06 compared with compliant patients). One patient developed Pneumocystis carinii pneumonia during ECP and post-transplant lymphoproliferative disease 21 months after finishing ECP. No other adverse effects or infectious complications associated with ECP were noted.

CONCLUSIONS:

This case series represents the largest reported experience with ECP in pediatric heart transplantation. ECP can be safely applied in this patient group. Despite EPC, non-compliant patients showed a trend toward lower survival than compliant patients.

Copyright © 2014 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

extracorporeal photopheresis; hemodynamic compromise; pediatric heart transplant; rejection

PMID:
24661684
[PubMed - indexed for MEDLINE]
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