Although triple-
drug immunosuppression (
cyclosporine,
azathioprine, and
prednisone) has reduced the incidence of acute rejection after pediatric
cardiac transplantation, its effect on the development of
coronary artery disease, which may be the major determinant of long-term survival in these patients, is not well defined. We reviewed 42 coronary angiograms obtained annually in 17 cardiac transplant recipients, aged 6 months to 18 years (mean, 12.4 years) at the time of
transplantation, who had been maintained on triple-
drug immunosuppression and had survived at least 1 year after
transplantation. Each angiogram was reviewed for
luminal irregularities or discrete
stenoses, for the loss of third-order branching, and for the presence of
myocardial bridging or calcification of vessels. Patient files were reviewed for donor and recipient age, sex, and
ABO blood group, for postoperative episodes of rejection or
cytomegalovirus infection, for
hypertension, and for
cholesterol and
triglyceride values. No recipient in our series has died or undergone retransplantation because of
coronary artery disease. Six of 17 (35%) patients have developed angiographically identifiable coronary artery abnormalities: four by the first year and two additional recipients by the second and third years, respectively, after
transplantation. Development of coronary artery abnormalities approached a significant correlation when related to posttransplantation
cytomegalovirus infection (p = 0.11) and older recipient age (p = 0.056) but not to any other factors studied, including episodes of rejection (p = 1.0). Angiographically identifiable coronary artery abnormalities can occur in pediatric recipients within the first year after
cardiac transplantation in spite of a low incidence of acute rejection. Although the abnormalities may be mild initially, they can progress and require intervention.(ABSTRACT TRUNCATED AT 250 WORDS)