Leukocyte suppression is associated with improved clinical outcomes in children's status after orthotopic heart transplantation

Authors

• Jeffrey J. Kim, Texas Children's Hospital
• William J. Dreyer, Texas Children's Hospital
• E. O'Brian Smith, Texas Children's Hospital
• Jack F. Price, Texas Children's Hospital
• Sarah Clunie, Texas Children's Hospital
• V. Vasiliki Dimas, Texas Children's Hospital
• John L. Jefferies, Texas Children's Hospital
• Howard Rosenblatt, Texas Children's Hospital
• Branislav Radovancevic, Texas Children's Hospital
• Jeffrey A. Towbin, Texas Children's Hospital
• Susan W. Denfield, Texas Children's Hospital

Abstract

Background: Leukocyte suppression is a sequela of immunosuppressive therapy after orthotopic heart transplantation and may result in discontinuation of anti-proliferative agents. Clinical outcomes in this patient population have not been well delineated. Methods: This study was a retrospective review of children who underwent orthotopic heart transplantation at our institution from 1986 to 2003. Leukocyte suppression was defined as a white blood cell count <5,000, prompting the withdrawal of anti-proliferative agents. The population was divided into 2 groups, leukosuppressed (LS) and non-leukosuppressed (NLS), and their clinical outcomes were compared. Results: The study included 109 patients, of which 44 (40%) became leukosuppressed. The 2 groups were similar regarding demographic data and initial management. The LS Group had a significantly decreased incidence of rejection, being 7 times less likely to have recurrent rejection (p = 0.001). The median time to rejection was 0.8 ± 0.6 years for the NLS Group, whereas the median time to rejection was not yet reached at 17 years for the LS Group. The LS Group also tended toward a decreased incidence of retransplantation or death (p = 0.06). The organ "half-life" in the NLS Group was 7.5 years vs 12.5 years in the LS Group. There was no difference between the 2 groups in regards to other adverse effects of immunosuppression. Conclusions: Children who have undergone orthotopic heart transplantation and subsequently become leukosuppressed have a lower incidence of rejection and a tendency toward less organ loss than children who do not become leukosuppressed, without having an increased incidence of adverse side effects. Copyright © 2006 by the International Society for Heart and Lung Transplantation.

Publication Title

Journal of Heart and Lung Transplantation

Recommended Citation

Kim, J., Dreyer, W., O'Brian Smith, E., Price, J., Clunie, S., Dimas, V., Jefferies, J., Rosenblatt, H., Radovancevic, B., Towbin, J., & Denfield, S. (2006). Leukocyte suppression is associated with improved clinical outcomes in children's status after orthotopic heart transplantation. Journal of Heart and Lung Transplantation, 25 (2), 195-199. https://doi.org/10.1016/j.healun.2005.09.005