Nonadherence is associated with late rejection in pediatric heart transplant recipients

Objectives: The objective was to study the impact of nonadherence on late rejection after pediatric heart transplantation. Study design: This was a retrospective cohort study of cardiac transplant recipients surviving >6 months (n = 50). Patients were stratified by episodes of late rejection. End points were defined by cyclosporin A (CSA) level, CSA level variability, and patient admission of nonadherence. Results: In 15 patients there were 49 episodes of late rejection, and 37 (76%) were associated with nonadherence. Of these patients, 7 of 15 died, and 3 of 15 had transplant coronary artery disease. Risk factors for the rejection were single-parent home, non-white, older age, and higher CSA level variability. In 35 nonrejectors there were 4 deaths from sepsis, posttransplant lymphoproliferative disease, renal failure, and encephalomyelitis. Conclusion: Late rejection after pediatric heart transplantation is associated with nonadherence, is common during adolescence, and is associated with poor outcome.