Rejection is reduced in thoracic organ recipients when transplanted in the first year of life

Infant heart transplant recipients have been reported to have decreased rates of rejection when clinical criteria are used for diagnosis. This study compares the rates of acute episodes of rejection in heart and lung transplant recipients transplanted in the first year of life to those of older recipients utilizing pathologic criteria. Records of 100 consecutive lung transplant recipients (cystic fibrosis patients excluded) and 107 consecutive heart transplant recipients were reviewed with respect to: time to first rejection; total number; single versus multiple; and early (180 days) biopsy-proven rejection episodes. Rejection was defined as ISHLT biopsy Grade 3A or A2 for heart and lung transplant recipients, respectively. Biopsy and immunosuppression protocols were similar between groups. Kaplan–Meier analysis for freedom from rejection showed infant heart recipients were more often rejection-free ( p = 0.004) as were infant lung recipients ( p = 0.0001). Multivariate analysis revealed age at transplant as the most significant factor in predicting time to first rejection (age