Abstract
BACKGROUND: Cardiac allograft vasculopathy (CAV) remains a leading cause of graft loss in pediatric heart transplant (HTx) recipients. Adult literature suggests that aspirin (ASA) use in the early post-HTx period may reduce the risk of CAV. This study aimed to determine the impact of early ASA use on the development of CAV in pediatric HTx recipients. METHODS: All subjects <17 years of age at time of primary htx who survived ≥3 years without evidence of cav were identified for inclusion from the pediatric heart transplant society database (1996-2019). early asa use was defined as asa started within the first 3 years post-htx and was classified as continuous or intermittent. frequency of asa use was described across centers. kaplan-meier method assessed freedom from cav and overall graft survival. multiphase parametric hazard analyses and propensity score matched analysis were used to identify independent risk factors. results: 3,011 patients were included with 387 (13%) receiving continuous asa, 676 (22%) receiving intermittent asa, and 1,948 (65%) receiving no asa. asa use was highly variable across centers (0%-100%). at baseline patients receiving continuous asa therapy demonstrated inferior graft survival (p>< 0.001) and worse freedom from CAV (p = 0.002), but with lower CAV grades (p = 0.05). In multiphase parametric hazard modeling continuous ASA use was not independently associated with CAV, but remained associated with inferior graft survival. Propensity-matched sub-analysis between continuous and no ASA groups demonstrated no difference in freedom from CAV or overall graft loss. CONCLUSIONS: ASA use varies widely across pediatric HTx centers. Early ASA use did not reduce the risk of CAV or graft loss in pediatric heart transplant recipients.
