Clinical approach to acute cellular rejection from the pediatric heart transplant society - PubMed (original) (raw)

Case Reports

Clinical approach to acute cellular rejection from the pediatric heart transplant society

Neha Bansal et al. Pediatr Transplant. 2022 Dec.

Abstract

Background: Early detection of cardiac allograft rejection is crucial for post-transplant graft survival. Despite the progress made in immunosuppression strategies, acute cellular rejection remains a serious complication during and after the first post-transplant year, and there is a continued lack of consensus regarding its treatment, especially in pediatric transplant patients.

Methods: An open request was placed via the listserv to the membership of the Pediatric Heart Transplant Society (PHTS). Along with a broad literature search, numerous institutional protocols were pooled, analyzed and consolidated. A clinical approach document was generated highlighting areas of consensus and practice variation.

Results: The clinical approach document divides cellular rejection by International Society for Heart and Lung Transplantation grades and provides management strategies for each, including persistent cellular rejection.

Conclusions: Cellular rejection treatment can be tailored to the clinical status, graft function, and the grade of cellular rejection. A case of mild and asymptomatic rejection may not require treatment, whereas a higher-grade rejection or rejection with graft dysfunction or hemodynamic compromise may require aggressive intravenous therapies, changes to maintenance immunosuppression therapy and augmented surveillance.

Keywords: heart transplant; pediatric; rejection.

© 2022 Wiley Periodicals LLC.

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References

REFERENCES

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