Safe and Effective Early Use of Betablockers after Pediatric Heart Transplantation

Safe and Effective Early Use of Betablockers after Pediatric Heart Transplantation https://doi.org/10.1016/j.healun.2023.02.1366   Purpose:  Beta-blockers (BBs) have been increasingly incorporated into the management of heart transplant recipients, with data supporting decreased mortality in adult recipients. However, very few studies have evaluated the use of BBs in pediatric recipients, and early use after pediatric heart transplantation (HTx) is still associated with hesitancy among providers. We sought to evaluate the safety and effectiveness of early use of BBs after pediatric HTx. Methods: We performed a single center retrospective review of pediatric patients (< 18 years of age) who have undergone HTx (or heart re-transplantation) from 1991 to 2022. Patients were included if they received any oral BBs within the first 6 months after HTx. Patients who received only intravenous BBs were excluded. Results: Out of 75 HTx performed, 22 patients (29.3%) were identified, with 25 courses of BB therapy. Median age at HTx was 11.2 years (28 days - 17.9 years). The most common indication for HTx was cardiomyopathy in 17/22 cases (77.3%). BBs were most frequently started for stable atrial tachyarrhythmias in 12 cases (48%), either as monotherapy or in combination with other medications. Other indications included arterial hypertension or afterload reduction, ventricular arrhythmias, and diastolic heart failure. In 2 patients, more than one course of BBs was given. BBs were started at a median time after HTx of 21 days (5-180d). Metoprolol was the most frequently used (12/25, 48%) and other agents included propranolol, carvedilol, atenolol and sotalol. Median duration of therapy was 170 days (1-1444 d). Adverse effects (symptomatic bradycardia) occurred in 2 patients; treatment had to be stopped in 1 patient due to profound bradycardia, with full recovery after discontinuation. There were no other associated complications. Early discontinuation also occurred in 4 patients due to unsuccessful BB therapy (16%). At median follow-up of 4.5 years after HTx (32d - 12.3 yrs), 7 patients (31.8%) continued to receive BB therapy. There were 2 deaths (9.1%) during this follow-up period, both unrelated to BB effects.