Clinical approach to acute cellular rejection from the pediatric heart transplant society

Neha Bansal, Melanie D. Everitt, Deipanjan Nandi, Joseph Spinner, Jennifer Conway*, Defne A. Magnetta, Elizabeth L. Profita, Madeleine Townsend, Juan Carlos Alejos, Shriprasad R. Deshpande

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Early detection of cardiac allograft rejection is crucial for post-transplant graft survival. Despite the progress made in immunosuppression strategies, acute cellular rejection remains a serious complication during and after the first post-transplant year, and there is a continued lack of consensus regarding its treatment, especially in pediatric transplant patients. Methods: An open request was placed via the listserv to the membership of the Pediatric Heart Transplant Society (PHTS). Along with a broad literature search, numerous institutional protocols were pooled, analyzed and consolidated. A clinical approach document was generated highlighting areas of consensus and practice variation. Results: The clinical approach document divides cellular rejection by International Society for Heart and Lung Transplantation grades and provides management strategies for each, including persistent cellular rejection. Conclusions: Cellular rejection treatment can be tailored to the clinical status, graft function, and the grade of cellular rejection. A case of mild and asymptomatic rejection may not require treatment, whereas a higher-grade rejection or rejection with graft dysfunction or hemodynamic compromise may require aggressive intravenous therapies, changes to maintenance immunosuppression therapy and augmented surveillance.

Original languageEnglish (US)
Article numbere14393
JournalPediatric transplantation
Issue number8
StatePublished - Dec 2022


  • heart transplant
  • pediatric
  • rejection

ASJC Scopus subject areas

  • Transplantation
  • Pediatrics, Perinatology, and Child Health


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