The occurrence of depression in pediatric patients before and one year after heart or heart-lung transplantation (tx)

The Journal of Heart and Lung Transplantation Volume 21, Number 1 group differences in systolic (p⫽.46) or diastolic (p⫽.77) B/P. Although creatinine was elevated, there were no differences across groups (p⫽.86). %ideal body weight was⬎1.00 in all groups. Pairwise comparisons revealed differences between Grps 3 (mean⫽1.30; SD⫽.23) and 4 (mean⫽1.14; SD⫽.12; p⫽.03). HDL was ⱖ42mg/dL in all groups. There were differences across groups in LDL (p⫽.003). Grps 1 (mean⫽139.2; SD⫽38.5) and 2 (mean⫽141.0; SD⫽47.8) were different than Grp 4 (mean⫽106.1; SD⫽28.2; p⫽.01), and Grp 2 was different than Grp 5 (mean⫽112.9; SD⫽36.1; p⫽.05). There were group differences in cholesterol levels (p⫽.002) with lower levels in Groups 4 (mean⫽190.5; SD⫽38.6) and 5 (mean⫽186.3; SD⫽37.7) as compared to Group 2 (mean⫽230.8; SD⫽66.5). In conclusion, identifying post-TX time periods in which healthy behaviors and HS may be vulnerable to decline is important if clinicians are to provide on-going education and psychosocial support to CTRs who manage a complex regimen. 155 THE OCCURRENCE OF DEPRESSION IN PEDIATRIC PATIENTS BEFORE AND ONE YEAR AFTER HEART OR HEART-LUNG TRANSPLANTATION (tx) J. Wray, R. Radley-Smith, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom Depression is a significant psychiatric condition of childhood and adolescence and the presence of a chronic medical problem increases the risk for its development, but the prevalence of depression in children and adolescents undergoing heart and heart-lung tx has not been addressed. However, the role of psychosocial factors such as mood state in determining outcome is being increasingly acknowledged, particularly with regard to adherence. Fifty-eight children (26 girls, 32 boys; mean age:12.5 years, range:8.1-16.8 years) and parents were seen pre-tx and 46 children (23 girls, 23 boys; mean age:13.2 years) and parents were seen 12 months after tx, with 24 completing both assessments. On both occasions the Mood and Feelings Questionnaire (MFQ) was completed, a 33 item rating scale of depressive symptoms for children of 8-18 years, based on DSM-III-R criteria. A child (MFQ-C)and parent (MFQ-P) version with corresponding items was completed. Pre-tx, the mean score on the MFQ-C (18.96; S.D.10.93) was significantly higher (p⬍.001) than that on the MFQ-P (13.71; S.D.9.71) but there were no significant differences between mean scores for boys and girls. On the MFQ-C, 24% obtained scores indicative of significant depression, compared with 21% on the MFQ-P. There were no differences in child ratings of depression according to diagnosis, but parents of children with cardiomyopathy rated their children as having significantly more depressive symptoms than parents of children with congenital heart disease or cystic fibrosis. Post-tx, mean scores on both the MFQ-P (8.79; S.D.9.01) and MFQ-C (10.61; S.D.10.83) were lower than pre-tx scores, with no significant differences between parent and child mean scores or between mean scores for different diagnostic groups. On the MFQ-C, 9% obtained scores indicative of significant depression, compared with 11% on the MFQ-P. It is concluded that whilst tx is associated with a reduction in the prevalence of depression, the post-tx prevalence is still higher than that of the healthy population. Underlying diagnosis is a salient factor in pre-tx functioning. There are important implications for targeting psychosocial interventions.

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156 THE DECREASING INCIDENCE OF CARDIAC ALLOGRAFT REJECTION AND ITS IMPACT ON CLINICAL TRIALS S. Subherwal,1 M.L. Espejo,1 M.C. Fishbein,3 J. Patel,1 H. Laks,2 J.A. Kobashigawa,1 1Medicine, UCLA, Los Angeles, CA; 2Surgery, UCLA, Los Angeles, CA; 3Pathology, UCLA, Los Angeles, CA The endomyocardial biopsy (Embx) has been the standard to detect rejection in cardiac transplant patients and has been used as a primary endpoint in many immunosuppression trials. The incidence of rejections in the first year after transplant has been reported as decreasing but this trend has not been well established due to differences in Embx interpretation (reading) and different Embx protocols after transplantation among the various cardiac transplant programs. During the past decade in our single center experience, Embx interpretation has been consistent (one predominant reviewer) and the Embx protocol has been the same. All Embxs in the first year after transplant were assigned International Society of Heart/Lung Transplant (ISHLT) grades and reviewed from 1990 through 2000 to assess the incidence of biopsy-proven rejection. A total of 6892 Embxs were performed in 536 cardiac transplant patients in the first year after transplant. Cyclosporine based immunosuppression (no cytolytic induction) was used in greater than 95% during the time of the Embx with the remainder under tacrolimus based immunosuppression. Since 1998, mycophenolate mofetil has replaced azathioprine as part of a triple drug regimen (prednisone as the third agent). From 1990 to 2000, the number of biopsy-proven rejections in the first year after transplant (defined as ISHLT grade 3A or worse) per patient has decreased (p ⬍ 0.001 for ‘90-’91 through 2000). Conclusion: The incidence of biopsy-proven rejection has decreased through the 90’s decade in cardiac transplant patients concomitant with improved immunosuppressive therapies. This will impact future immunosuppression trials that use biopsyproven rejection as an endpoint as more study patients will be needed to show differences. Year

’90–’91

’92–’93

’94–’95

’96–’97

’98–’99

20 00

# of Patients % Pts with BPR (ⱖISHLT 3A)

97 51.5

67 38.8

94 32.9

127 29.9

107 20.6

62 3.2

157 DOES CMV STATUS INFLUENCE ACUTE AND CHRONIC REJECTION IN HEART TRANSPLANTATION DURING THE GANCICLOVIR PROPHYLAXIS ERA? H. Luckraz,1 J. Parameshwar,1 T. Wreghitt,2 J. Wallwork,1 S. Large,1 1Transplant Unit, Papworth Hospital, Cambridge, United Kingdom; 2Public Health Laboratory Service, Addenbrooke’s Hospital, Cambridge, United Kingdom The effect of CMV status on acute rejection in heart transplantation is not well understood. Furthermore, there is some evidence to suggest that CMV antibody positivity is associated with cardiac allograft vasculopathy (CAV). Aim: This study compared the effect of CMV status in heart transplant donors (D) and recipients (R) on acute and chronic rejection episodes during the ganciclovir prophylaxis era. Methods and Results: All heart transplant recipients at Papworth Hospital during the ganciclovir prophylaxis era are included (n⫽