Predictors of cardiac allograft vasculopathy in pediatric heart transplant recipients

CAV remains a leading cause of late graft loss and mortality among survivors of pediatric heart transplantation. We sought to define the incidence of CAV and identify its predictors in pediatric heart transplant recipients. The OPTN/UNOS database was analyzed for pediatric recipients who underwent heart transplant between 1987 and 2011. The primary end-point is time from heart transplantation to development of CAV (CAV-free survival). To identify predictors of CAV-free survival, demographic and transplant data were analyzed by the Kaplan-Meier survival method and Cox proportional hazards regression. Of 5211 pediatric heart transplant recipients with at least one-yr follow-up, the incidence of CAV at five, 10, and 15yr was 13%, 25%, and 54%, respectively. Multivariate analysis found that risk of CAV was associated with the following variables: Recipient age 1-4yr (HR 1.25), 5-9yr (1.45), 10-18yr (1.83), donor age >18yr (1.34), re-transplantation (2.14), recipient black race (1.55), and donor cigarette use (1.54). Older recipient and donor age, recipient black race, donor cigarette use, and re-transplantation were highly associated with shorter CAV-free survival.