Background

Freedom from rejection in pediatric heart transplant recipients is highly variable across centers. This study aimed to assess the center variation in methods used to diagnose rejection in the first-year post-transplant and determine the impact of this variation on patient outcomes.

Methods

The PHTS registry was queried for all rejection episodes in the first-year post-transplant (2010-2019). The primary method for rejection diagnosis was determined for each event as surveillance biopsy, echo diagnosis, or clinical. The percentage of first-year rejection events diagnosed by surveillance biopsy was used to approximate the surveillance strategy across centers. Methods of rejection diagnosis were described and patient outcomes were assessed based on surveillance biopsy utilization among centers.

Results

A total of 3985 patients from 56 centers were included. Of this group, 873 (22%) developed rejection within the first-year post-transplant. Surveillance biopsy was the most common method of rejection diagnosis (71.7%), but practices were highly variable across centers. The majority (73.6%) of first rejection events occurred within 3-months of transplantation. Diagnosis modality in the first-year was not independently associated with freedom from rejection, freedom from rejection with hemodynamic compromise, or overall graft survival.

Conclusions

Rejection in the first-year after pediatric heart transplant occurs in 22% of patients and most commonly in the first 3 months post-transplant. Significant variation exists across centers in the methods used to diagnose rejection in pediatric heart transplant recipients, however, these variable strategies are not independently associated with freedom from rejection, rejection with hemodynamic compromise, or overall graft survival.

中文翻译：

---

儿科心脏移植中心急性排斥反应诊断的实践差异：儿科心脏移植协会 (PHTS) 登记的分析

背景

儿科心脏移植受者的排斥反应因中心而异。本研究旨在评估移植后第一年用于诊断排斥反应的方法的中心变异，并确定这种变异对患者预后的影响。

方法

移植后第一年（2010-2019）的所有排斥事件都向 PHTS 登记处查询。对于每个事件，确定排斥诊断的主要方法是监测活检、回声诊断或临床。监测活检诊断出的第一年排斥事件的百分比被用来估计各中心的监测策略。描述了排斥诊断的方法，并根据中心之间的监测活检利用情况评估了患者的结果。

结果

共纳入来自 56 个中心的 3985 名患者。在该组中，873 人（22%）在移植后第一年内出现排斥反应。监测活检是最常见的排斥诊断方法（71.7%），但不同中心的做法差异很大。大多数 (73.6%) 首次排斥事件发生在移植后 3 个月内。第一年的诊断方式与免排斥反应、免因血流动力学受损的排斥反应或移植物总生存率无关。

结论

22% 的患者在小儿心脏移植后的第一年出现排斥反应，最常见于移植后的前 3 个月。在用于诊断儿科心脏移植受者排斥反应的方法中，各中心之间存在显着差异，但是，这些可变策略与无排斥反应、血流动力学受损的排斥反应或移植物总存活率无关。