Comparison of Segmental Versus Longitudinal Intravascular Ultrasound Analysis for Pediatric Cardiac Allograft Vasculopathy

s S79 Purpose: Although used routinely the pleiotropic benefits of statins remain understudied in children after heart transplantation. We hypothesized that statin therapy would reduce the incidence of rejection, cardiac allograft vasculopathy (CAV) and post-transplant lymphoproliferative disease (PTLD). Methods: This was a retrospective review of 1,020 pediatric (age 5-18 years) heart transplant recipients in the multicentre Pediatric Heart Transplant Study registry from 2001-2012. Data were missing for 56 patients. Patients with previous PTLD, undergoing re-transplantation, survival < 1 year or with missing data regarding statin use were excluded from the analysis. Early statin use was defined as initiation prior to 1 year post-transplant. The effects of statins beyond the first year were estimated by Kaplan-Meier and Cox regression multivariate analysis for freedom from PTLD, rejection requiring treatment, any severity of CAV, and survival. Results: Statin-treated children (average age at transplant 13.2 ± 3.3 years) had significantly earlier rejection (HR 1.44, 95% CI 1.11-1.85, p= 0.0056) compared to untreated children (transplanted at 12 ± 3.6 years) after the first year post-transplant (see Figureunadjusted freedom from rejection) after adjusting for conventional risk factors for rejection. Freedom from PTLD and CAV and overall survival up to 6 years post-transplant were not affected by statin use (multivariable analyses not performed), however, the number of events was small. Conclusion: In our cohort, early statin therapy did not confer an early survival benefit and was not associated with delayed onset of rejection, PTLD or CAV. Only a third of the cohort were started on a statin within 1 year of transplant. These statin-treated patients may be a pre-selected, high-risk rejection subgroup. Additional studies are needed to better define treated patients and their outcome from statin use.