Abstract 11572: Use of Sirolimus in Pediatric Heart Transplant Patients: A Multi-Institutional Study From the Pediatric Heart Transplant Study Group
Introduction: Proliferation signal inhibitors such as sirolimus are increasingly utilized in solid-organ transplantation and are associated with improved outcomes in adults in some studies. Only small single center studies, however, exist on the use and outcomes of sirolimus treated pediatric patients.
Hypothesis: The use of sirolimus has increased over time, is more common in patients with renal dysfunction, and is associated with improved outcomes.
Methods: A retrospective review and propensity matched analysis of the Pediatric Heart Transplant Registry was performed on primary heart transplant patients in two cohorts, patients with the opportunity for 1-year follow-up (Cohort 1) and for 5-year follow-up (Cohort 2).
Results: There were 2,085 patients who underwent transplant between 2004 and 2010 and 1,117 had a one year-follow completed (Cohort 1), mean age at transplant was 6.5 years ± 6.1, 43% congenital heart disease, 67% status IA. Overall 18% of patients were on sirolimus at some point, 8% at 30 days post-transplant, 10% at 1-year, and 16% at 5 years. The use of sirolimus has increased over time, 13% in 2005 and 17% in 2011 (p=0.02). Among patients on sirolimus at 1-year post-transplant, tacrolimus was used in 71%, mycophenolate mofetil in 34%, steroids in 23%, and sirolimus monotherapy in 13%. Factors associated with sirolimus use at 1-year included use of sirolimus at discharge, later year of listing, history of renal insufficiency, longer donor ischemic time, and history of rejection during the first year post transplant (p<0.05 for all). Sirolimus treated patients had similar overall survival, 1-year conditional survival (Cohort 1), and 5-year conditional survival (Cohort 2) in both the overall cohorts and in the propensity matched analysis. Sirolimus use by 30-days post-transplant was associated with a decreased freedom from rejection (p=0.02) and freedom from infection (p=0.02).
Conclusions: The use of sirolimus is increasing in pediatric heart transplant patients and is more common among patients with a history of renal insufficiency and rejection. While the overall outcomes were similar in sirolimus treated and non-treated patients, early use of sirolimus may be associated with an increased risk of rejection and infections.
- © 2013 by American Heart Association, Inc.