Copyright
©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 24, 2016; 6(4): 751-758
Published online Dec 24, 2016. doi: 10.5500/wjt.v6.i4.751
Magnetic resonance imaging of the transplanted pediatric heart as a potential predictor of rejection
Steven C Greenway, Frederic Dallaire, Paul F Kantor, Anne I Dipchand, Rajiv R Chaturvedi, Monali Warade, Eugenie Riesenkampff, Shi-Joon Yoo, Lars Grosse-Wortmann
Steven C Greenway, Department of Paediatrics, University of Calgary, Calgary, AB T2N 1N4, Canada
Steven C Greenway, Frederic Dallaire, Paul F Kantor, Anne I Dipchand, Rajiv R Chaturvedi, Eugenie Riesenkampff, Shi-Joon Yoo, Lars Grosse-Wortmann, Labatt Family Heart Centre, the Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
Frederic Dallaire, Division of Pediatric Cardiology, University of Sherbrooke and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
Paul F Kantor, Department of Pediatric Cardiology, Stollery Children’s Hospital, Edmonton, AB T6G 2B7, Canada
Monali Warade, Shi-Joon Yoo, Lars Grosse-Wortmann, Department of Diagnostic Imaging, the Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
Author contributions: Kantor PF and Grosse-Wortmann L designed the study and recruited the patients; Chaturvedi RR, Yoo SJ and Grosse-Wortmann L performed the magnetic resonance imaging and cardiac catheterization; Greenway SC, Warade M and Riesenkampff E performed the data collection, analysis and writing of the manuscript; Dallaire F performed the statistical analysis; all authors contributed to the review of the manuscript.
Institutional review board statement: The study was reviewed and approved by the institutional review board at The Hospital for Sick Children (Toronto, Ontario, Canada).
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lars Grosse-Wortmann, MD, Labatt Family Heart Centre, the Hospital for Sick Children, Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
lars.grosse-wortmann@sickkids.ca
Telephone: +1-416-8137326 Fax: +1-416-8137591
Received: July 19, 2016
Peer-review started: July 21, 2016
First decision: September 5, 2016
Revised: November 4, 2016
Accepted: November 27, 2016
Article in press: November 29, 2016
Published online: December 24, 2016
Processing time: 148 Days and 12.5 Hours
AIM
To evaluate cardiac magnetic resonance imaging (CMR) as a non-invasive tool to detect acute cellular rejection (ACR) in children after heart transplant (HT).
METHODS
Thirty pediatric HT recipients underwent CMR at the time of surveillance endomyocardial biopsy (EMB) and results were compared to 14 non-transplant controls. Biventricular volumes, ejection fractions (EFs), T2-weighted signal intensities, native T1 times, extracellular volumes (ECVs) and presence of late gadolinium enhancement (LGE) were compared between patients and controls and between patients with International Society of Heart and Lung Transplantation (ISHLT) grade ≥ 2R rejection and those with grade 0/1R. Heart rate (HR) and brain natriuretic peptide (BNP) were assessed as potential biomarkers.
RESULTS
Significant ACR (ISHLT grade ≥ 2R) was an infrequent event in our population (5/30, 17%). Ventricular volumes, EFs, LGE prevalence, ECVs, native T1 times, T2 signal intensity ratios, HR and BNP were not associated with the presence of ≥ 2R ACR.
CONCLUSION
In this pilot study CMR did not reliably identify ACR-related changes in pediatric HT patients.
Core tip: After heart transplantation the diagnosis of significant acute cellular rejection (ACR) changes management. It is associated with adverse outcome. Endomyocardial biopsy is the gold standard for the detection of ACR but has important limitations. This prospective trial examined the use of cardiac magnetic resonance imaging (CMR) for the diagnosis of ACR in pediatric heart transplant recipients. Significant rejection was a rare event in our cohort and was not associated with changes in CMR parameters in this pilot study.
