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Practice variation in the diagnosis of acute rejection among pediatric heart transplant centers: An analysis of the pediatric heart transplant society (PHTS) registry. J Heart Lung Transplant 2021 Dec;40(12):1550-1559



Pubmed ID




Scopus ID

2-s2.0-85115950242 (requires institutional sign-in at Scopus site)   2 Citations


BACKGROUND: Freedom from rejection in pediatric heart transplant recipients is highly variable across centers. This study aimed to assess the center variation in methods used to diagnose rejection in the first-year post-transplant and determine the impact of this variation on patient outcomes.

METHODS: The PHTS registry was queried for all rejection episodes in the first-year post-transplant (2010-2019). The primary method for rejection diagnosis was determined for each event as surveillance biopsy, echo diagnosis, or clinical. The percentage of first-year rejection events diagnosed by surveillance biopsy was used to approximate the surveillance strategy across centers. Methods of rejection diagnosis were described and patient outcomes were assessed based on surveillance biopsy utilization among centers.

RESULTS: A total of 3985 patients from 56 centers were included. Of this group, 873 (22%) developed rejection within the first-year post-transplant. Surveillance biopsy was the most common method of rejection diagnosis (71.7%), but practices were highly variable across centers. The majority (73.6%) of first rejection events occurred within 3-months of transplantation. Diagnosis modality in the first-year was not independently associated with freedom from rejection, freedom from rejection with hemodynamic compromise, or overall graft survival.

CONCLUSIONS: Rejection in the first-year after pediatric heart transplant occurs in 22% of patients and most commonly in the first 3 months post-transplant. Significant variation exists across centers in the methods used to diagnose rejection in pediatric heart transplant recipients, however, these variable strategies are not independently associated with freedom from rejection, rejection with hemodynamic compromise, or overall graft survival.

Author List

Godown J, Cantor R, Koehl D, Cummings E, Vo JB, Dodd DA, Lytrivi I, Boyle GJ, Sutcliffe DL, Kleinmahon JA, Shih R, Urschel S, Das B, Carlo WF, Zuckerman WA, West SC, McCulloch MA, Zinn MD, Simpson KE, Kindel SJ, Szmuszkovicz JR, Chrisant M, Auerbach SR, Carboni MP, Kirklin JK, Hsu DT


Steven J. Kindel MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Factors
Graft Rejection
Heart Transplantation
Practice Patterns, Physicians'
Retrospective Studies
Risk Factors
Time Factors