Eosinophilic esophagitis in children following cardiac transplantation: association with post-transplant lymphoproliferative disorder and other transplant outcomes.

Abstract

Although cardiac transplantation is life-saving, morbidities from immunosuppression are significant. EoE is a complication of calcineurin inhibitors following liver transplant causing feeding intolerance, weight loss, vomiting, and dysphagia. There are limited reports of EoE following heart transplantation. We performed a retrospective single-center review of pediatric cardiac transplant patients from 2000 to 2010. A case-control analysis of patients with and without EoE was performed evaluating heart transplantation outcomes such as rates of rejection, CAV, PTLD, and graft loss. Eighty-six transplants were performed in 84 patients; 34 (40%) underwent diagnostic endoscopy, and 10 (12%) had EoE. Median time to diagnosis of EoE was 3.7 yr (IQR: 2.0-5.2). There were no differences in demographics or use of induction medications between patients with or without EoE. Patients with EoE had fewer episodes of treated rejection (1.0 vs. 2.5; p = 0.04). Four of 10 (40%) EoE patients had PTLD compared with only 2/24 (8%) of those without EoE (p = 0.048; OR 7.33 [95% CI: 1.1-50.2]). There were no differences in CAV or graft loss between groups. EoE should be considered as a cause of GI symptoms in children after cardiac transplantation and may be associated with fewer rejection episodes and increased rates of PTLD, thus representing a marker of over-immunosuppression.

• Authors: Steven J Kindel, Brian F Joy, Elfriede Pahl, Eric L Wald
• Journal: Pediatric transplantation (Pediatr Transplant) Vol. 18 Issue 5 Pg. 491-6 (Aug 2014) ISSN: 1399-3046 [Electronic] Denmark
• PMID: 24931365 (Publication Type: Journal Article)
• Copyright: © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Calcineurin Inhibitors
• Immunosuppressive Agents

Topics

• Biopsy
• Calcineurin Inhibitors (chemistry)
• Case-Control Studies
• Child
• Child, Preschool
• Eosinophilic Esophagitis (etiology)
• Female
• Graft Rejection
• Heart Transplantation (adverse effects)
• Humans
• Immunosuppression Therapy
• Immunosuppressive Agents (adverse effects)
• Infant
• Liver Transplantation
• Lymphoproliferative Disorders (etiology)
• Male
• Postoperative Complications
• Retrospective Studies
• Treatment Outcome