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Early Statin Therapy Is Not Associated With Improved Outcomes After Heart Transplantation in Children
Abstracts S79
1( 95) Comparison of Segmental Versus Longitudinal Intravascular Ultrasound Analysis for Pediatric Cardiac Allograft Vasculopathy M.A. Kuhn ,1 R.E. Chinnock,1 M. Burch,2 M.J. Fenton.2 1Pediatrics, Loma Linda Univ, Loma Linda, CA; 2Pediatrics, Great Ormond Street Hospital, London, United Kingdom. Purpose: Intravascular ultrasound (IVUS) has been used routinely in some centers to investigate cardiac allograft vasculopathy (CAV) in pediatric heart transplant patients. The established standard method is based on analyzing 10 operator selected cross-sectional segments within each study. We present an alternative method, using a more sophisticated imaging software, to analyze regular images along the entire imaged coronary segment. This study presents a comparison of the methods using IVUS studies over 1 year. Methods: All patients who had IVUS performed at our institution in 2012 were retrospectively evaluated. Each IVUS study had morphometric analysis of 10 operator selected segments along the vessel. Each study was reevaluated using a longitudinal technique, taken at every 3rd cardiac cycle, along the entire vessel. Semi- automatic edge detection software was used to detect vessel imaging planes (QIVUS, Medis, NL). Measurements using either method included outer (OD) and inner (ID) diameter, total (TA) and luminal (LA) area, maximal intimal thickness (MIT) and intimal index (II). Each IVUS was graded for severity of intimal thickening using the Stanford grading (SG). All results are given as mean ± SD. Groups were compared using Student’s t-test. A p-value less than 0.05 was considered significant. Results: There were 59 IVUS studies performed on 58 patients with a patient age of 15 ± 3 years. The table shows the differences between the two methods of analysis. There was a significantly lower LA, and higher MIT and II in the longitudinal group. Using the longitudinal technique, there was no change in SG in 33 patients, a decrease in SG in 6 patients, and an increase in SG in 20 patients. Conclusion: The longitudinal technique appeared to be more sensitive in assessing the degree of CAV by IVUS in pediatric patients, and may play a role in the increase in the degree of thickening seen. It may offer an alternative way of grading severity of CAV in pediatric heart transplant recipients.
Purpose: Although used routinely the pleiotropic benefits of statins remain understudied in children after heart transplantation. We hypothesized that statin therapy would reduce the incidence of rejection, cardiac allograft vasculopathy (CAV) and post-transplant lymphoproliferative disease (PTLD). Methods: This was a retrospective review of 1,020 pediatric (age 5-18 years) heart transplant recipients in the multicentre Pediatric Heart Transplant Study registry from 2001-2012. Data were missing for 56 patients. Patients with previous PTLD, undergoing re-transplantation, survival < 1 year or with missing data regarding statin use were excluded from the analysis. Early statin use was defined as initiation prior to 1 year post-transplant. The effects of statins beyond the first year were estimated by Kaplan-Meier and Cox regression multivariate analysis for freedom from PTLD, rejection requiring treatment, any severity of CAV, and survival. Results: Statin-treated children (average age at transplant 13.2 ± 3.3 years) had significantly earlier rejection (HR 1.44, 95% CI 1.11-1.85, p= 0.0056) compared to untreated children (transplanted at 12 ± 3.6 years) after the first year post-transplant (see Figure- unadjusted freedom from rejection) after adjusting for conventional risk factors for rejection. Freedom from PTLD and CAV and overall survival up to 6 years post-transplant were not affected by statin use (multivariable analyses not performed), however, the number of events was small. Conclusion: In our cohort, early statin therapy did not confer an early survival benefit and was not associated with delayed onset of rejection, PTLD or CAV. Only a third of the cohort were started on a statin within 1 year of transplant. These statin-treated patients may be a pre-selected, high-risk rejection subgroup. Additional studies are needed to better define treated patients and their outcome from statin use.
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Lymphoproliferative Disorders Late After Pediatric Heart Transplantation: A Multicenter Analysis S.C. West ,1 J.M. Friedland-Little,2 K. Schowengerdt,3 D. Naftel,4 E. Pruitt,4 K.S. Smith,1 S. Urschel,5 M. Michaels,6 J.K. Kirklin,4 B. Feingold.1 1Pediatric Cardiology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA; 2Pediatric Cardiology, University of Michigan, CS Mott Children’s Hospital, Ann Arbor, MI; 3Pediatric Cardiology, Saint Louis University, Cardinal Glennon Children’s Medical Center, St Louis, MO; 4Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL; 5Pediatric Cardiology, University of Alberta, Edmonton, AB; 6Infectious Disease, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
Early Statin Therapy Is Not Associated With Improved Outcomes After Heart Transplantation in Children S.C. Greenway ,1 R. Butts,2 D.C. Naftel,3 E. Pruitt,3 J.K. Kirklin,3 S. Urschel,1 K.R. Knecht,4 Y. Law.5 1University of Alberta, Edmonton, AB, Canada; 2Medical University of South Carolina, Charleston, SC; 3University of Alabama at Birmingham, Birmingham, AL; 4Arkansas Children’s Hospital, Little Rock, AR; 5Seattle Children’s Hospital, Seattle, WA.
Purpose: PTLD is a significant complication after heart transplantation (HT), occurring in 5-15% of children within 3 years of HT. However, there is limited data about the development of PTLD late after HT. We sought to describe the prevalence, range of pathology, risk factors, and outcomes of PTLD occurring late (> 3 yrs) after pediatric HT. Methods: We identified all cases of PTLD in the Pediatric Heart Transplant Study from 1993 to 2013. Cases were categorized with respect to timing,
Table 1 OD (mm) Standard technique
ID (mm)
TA (mm3)
LA (mm3)
MIT (mm)
II
3.06 ± 0.40 2.87 ± 0.37 7.55 ± 2.03 6.91 ± 1.81 0.22 ± 0.16 0.08 ± 0.07
Longitudinal 3.08 ± 0.44 2.83 ± 0.39 7.85 ± 2.20 6.60 ± 1.78 0.32 ± 0.19 0.15 ± 0.07 technique P- value NS NS NS 0.029 < 0.001 < 0.001
1( 95) Comparison of Segmental Versus Longitudinal Intravascular Ultrasound Analysis for Pediatric Cardiac Allograft Vasculopathy M.A. Kuhn ,1 R.E. Chinnock,1 M. Burch,2 M.J. Fenton.2 1Pediatrics, Loma Linda Univ, Loma Linda, CA; 2Pediatrics, Great Ormond Street Hospital, London, United Kingdom. Purpose: Intravascular ultrasound (IVUS) has been used routinely in some centers to investigate cardiac allograft vasculopathy (CAV) in pediatric heart transplant patients. The established standard method is based on analyzing 10 operator selected cross-sectional segments within each study. We present an alternative method, using a more sophisticated imaging software, to analyze regular images along the entire imaged coronary segment. This study presents a comparison of the methods using IVUS studies over 1 year. Methods: All patients who had IVUS performed at our institution in 2012 were retrospectively evaluated. Each IVUS study had morphometric analysis of 10 operator selected segments along the vessel. Each study was reevaluated using a longitudinal technique, taken at every 3rd cardiac cycle, along the entire vessel. Semi- automatic edge detection software was used to detect vessel imaging planes (QIVUS, Medis, NL). Measurements using either method included outer (OD) and inner (ID) diameter, total (TA) and luminal (LA) area, maximal intimal thickness (MIT) and intimal index (II). Each IVUS was graded for severity of intimal thickening using the Stanford grading (SG). All results are given as mean ± SD. Groups were compared using Student’s t-test. A p-value less than 0.05 was considered significant. Results: There were 59 IVUS studies performed on 58 patients with a patient age of 15 ± 3 years. The table shows the differences between the two methods of analysis. There was a significantly lower LA, and higher MIT and II in the longitudinal group. Using the longitudinal technique, there was no change in SG in 33 patients, a decrease in SG in 6 patients, and an increase in SG in 20 patients. Conclusion: The longitudinal technique appeared to be more sensitive in assessing the degree of CAV by IVUS in pediatric patients, and may play a role in the increase in the degree of thickening seen. It may offer an alternative way of grading severity of CAV in pediatric heart transplant recipients.
Purpose: Although used routinely the pleiotropic benefits of statins remain understudied in children after heart transplantation. We hypothesized that statin therapy would reduce the incidence of rejection, cardiac allograft vasculopathy (CAV) and post-transplant lymphoproliferative disease (PTLD). Methods: This was a retrospective review of 1,020 pediatric (age 5-18 years) heart transplant recipients in the multicentre Pediatric Heart Transplant Study registry from 2001-2012. Data were missing for 56 patients. Patients with previous PTLD, undergoing re-transplantation, survival < 1 year or with missing data regarding statin use were excluded from the analysis. Early statin use was defined as initiation prior to 1 year post-transplant. The effects of statins beyond the first year were estimated by Kaplan-Meier and Cox regression multivariate analysis for freedom from PTLD, rejection requiring treatment, any severity of CAV, and survival. Results: Statin-treated children (average age at transplant 13.2 ± 3.3 years) had significantly earlier rejection (HR 1.44, 95% CI 1.11-1.85, p= 0.0056) compared to untreated children (transplanted at 12 ± 3.6 years) after the first year post-transplant (see Figure- unadjusted freedom from rejection) after adjusting for conventional risk factors for rejection. Freedom from PTLD and CAV and overall survival up to 6 years post-transplant were not affected by statin use (multivariable analyses not performed), however, the number of events was small. Conclusion: In our cohort, early statin therapy did not confer an early survival benefit and was not associated with delayed onset of rejection, PTLD or CAV. Only a third of the cohort were started on a statin within 1 year of transplant. These statin-treated patients may be a pre-selected, high-risk rejection subgroup. Additional studies are needed to better define treated patients and their outcome from statin use.
1( 97)
1 ( 96)
Lymphoproliferative Disorders Late After Pediatric Heart Transplantation: A Multicenter Analysis S.C. West ,1 J.M. Friedland-Little,2 K. Schowengerdt,3 D. Naftel,4 E. Pruitt,4 K.S. Smith,1 S. Urschel,5 M. Michaels,6 J.K. Kirklin,4 B. Feingold.1 1Pediatric Cardiology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA; 2Pediatric Cardiology, University of Michigan, CS Mott Children’s Hospital, Ann Arbor, MI; 3Pediatric Cardiology, Saint Louis University, Cardinal Glennon Children’s Medical Center, St Louis, MO; 4Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL; 5Pediatric Cardiology, University of Alberta, Edmonton, AB; 6Infectious Disease, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
Early Statin Therapy Is Not Associated With Improved Outcomes After Heart Transplantation in Children S.C. Greenway ,1 R. Butts,2 D.C. Naftel,3 E. Pruitt,3 J.K. Kirklin,3 S. Urschel,1 K.R. Knecht,4 Y. Law.5 1University of Alberta, Edmonton, AB, Canada; 2Medical University of South Carolina, Charleston, SC; 3University of Alabama at Birmingham, Birmingham, AL; 4Arkansas Children’s Hospital, Little Rock, AR; 5Seattle Children’s Hospital, Seattle, WA.
Purpose: PTLD is a significant complication after heart transplantation (HT), occurring in 5-15% of children within 3 years of HT. However, there is limited data about the development of PTLD late after HT. We sought to describe the prevalence, range of pathology, risk factors, and outcomes of PTLD occurring late (> 3 yrs) after pediatric HT. Methods: We identified all cases of PTLD in the Pediatric Heart Transplant Study from 1993 to 2013. Cases were categorized with respect to timing,
Table 1 OD (mm) Standard technique
ID (mm)
TA (mm3)
LA (mm3)
MIT (mm)
II
3.06 ± 0.40 2.87 ± 0.37 7.55 ± 2.03 6.91 ± 1.81 0.22 ± 0.16 0.08 ± 0.07
Longitudinal 3.08 ± 0.44 2.83 ± 0.39 7.85 ± 2.20 6.60 ± 1.78 0.32 ± 0.19 0.15 ± 0.07 technique P- value NS NS NS 0.029 < 0.001 < 0.001