Children s/p Heart Transplantation – Rejection

• Children need heart transplantation for complex congenital heart defects (hypoplastic left heart syndrome is most common) or dilated cardiomyopathies.

• Signs of Acute rejection
  • Chest Pain is uncommon
  • Common presentions: fever, myalgias, and vomiting.
    • ECG may show a decreased R wave amplitude and an increased QRS duration.
  • Labs are most often NOT diagnostic in acute rejection.
    • Troponin and CK levels may or may not be elevated.
    • Elevated LFTs are concerning for right heart failure.
  • Echo – Diastolic dysfunction is the earliest change seen in acute rejection
• Signs of Chronic Rejection
  • Clinical symptoms often related to the accelerated atherosclerosis
  • “Silent” ischemia or infarction – decreased exercise tolerance or malaise
  • Syncope

Woods, WA. Care of the Acutely Ill Pediatric Heart Transplant Recipient. Pediatric Emergency Care. 23(10):721-724, October 2007.