Journal
JOURNAL OF HEART AND LUNG TRANSPLANTATION
Volume 36, Issue 4, Pages 434-442Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.healun.2016.09.013
Keywords
heart transplantation; coronary artery disease; allograft vasculopathy; VEGF; biomarkers
Funding
- National Institutes of Health [UL1RR025758, 3ROIA104675610S1, T32-HL-07572, K 1 2HD052896-06]
- Casey Lee Ball Foundation
- Boston Children's Hospital Cardiac Transplant and Education Fund
Ask authors/readers for more resources
BACKGROUND: Cardiac allograft vasculopathy (CAV) is the leading cause of chronic allograft loss after pediatric heart transplantation. We hypothesized that biomarkers of endothelial injury and repair would predict CAV development in pediatric heart transplant recipients. METHODS: Blood was collected from pediatric heart transplant recipients at the time of routine annual coronary angiography, and the concentrations of 13 angiogenesis-related molecules were determined. The primary end point was the presence of moderate or severe CAV by angiography during a 5 -year follow-up period. RESULTS: The study enrolled 48 recipients (57% male) with a median age of 15.5 years (range, 2-22 years) and median time post -transplant of 5.8 years (range, 2-15 years). Eight recipients developed moderate/severe CAV at a median follow-up of 4.7 years, of whom 3 died, 3 underwent retransplantation, 1 had a myocardial infarction, and 1 was listed for retransplantation. Clinical characteristics associated with the development of moderate/severe CAV included prednisone use at enrollment (p = 0.03) and positive recipient cytomegalovirus immunoglobulin G at the time of transplant (p = < 0.01). Multivariable Cox proportional hazards regression identified plasma vascular endothelial growth factor (VEGF)-A concentration greater than 90 pg/ml at the time of blood draw as a significant predictor of time to moderate or severe CAV (hazard ratio, 14.3; 95% confidence interval, 1.3-163). Receiver operating characteristic curve analysis demonstrated that VEGF-A shows moderate performance for association with the subsequent development of CAV (area under the curve, 0.77; 95% confidence interval, 0.61-0.92). CONCLUSIONS: VEGF-A levels in pediatric heart transplant recipients are associated with clinically important CAV progression within the subsequent 5 years. J Heart Lung Transplant 2017;36:434-442 (C) 2017 International Society for Heart and Lung Transplantation. All rights reserved.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available