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Evaluation and treatment of pericardial effusion in paediatric patients post-haematopoietic cell transplantation

Published online by Cambridge University Press:  18 July 2025

Josaura V. Fernandez Sanchez Open the ORCID record for Josaura V. Fernandez Sanchez [Opens in a new window] ,
Saleh Bhar ,
Kristen Shaver ,
Christian Lilje ,
Tami John ,
Brian Friend ,
Nino Rainusso ,
Anitha Parthiban ,
Athar Qureshi Open the ORCID record for Athar Qureshi [Opens in a new window]  and
Tao Wang
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Josaura V. Fernandez Sanchez*
Affiliation:
Division of Pediatric Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA
Saleh Bhar
Affiliation:
Division of Pediatric Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA Division of Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
Kristen Shaver
Affiliation:
Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
Christian Lilje
Affiliation:
Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
Tami John
Affiliation:
Division of Pediatric Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA
Brian Friend
Affiliation:
Division of Pediatric Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA
Nino Rainusso
Affiliation:
Division of Pediatric Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
Anitha Parthiban
Affiliation:
Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
Athar Qureshi
Affiliation:
Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
Tao Wang
Affiliation:
Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
Mengfen Wu
Affiliation:
Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
Baheyeldin Salem
Affiliation:
Division of Pediatric Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA
*
Corresponding author: Josaura V. Fernandez Sanchez; Email: jvfernan@texaschildrens.org
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Abstract

Background:

Cardiac complications after haematopoietic cell transplantation in paediatric patients are significant yet under-recognised. Pericardial effusion has been associated with worse outcomes and transplant-related mortality.

Objectives:

We aimed to evaluate the incidence, risk factors, and clinical course of pericardial effusion after paediatric allogeneic haematopoietic cell transplantation. We identified transplantation recipients “at risk” for clinically significant pericardial effusion based on our definition, described our clinical experience and provided recommendations for screening and management.

Study Design:

Clinical data of children who underwent allogeneic haematopoietic cell transplantation at Texas Children’s Hospital from January 2010 to April 2021 were analyzed retrospectively. Factors potentially contributing to time to pericardial effusion, time to pericardial effusion resolution, and overall survival were evaluated.

Results:

We included 629 haematopoietic cell transplantation recipients with a median age at transplantation of 8.5 years (0.1–24.3). Seventy-three patients (11.6%) developed pericardial effusion within a median time of 102 days (1–403) post-haematopoietic cell transplantation, and 50 (68.5%) had resolution of pericardial effusion at the time of last evaluation. Older age at the time of haematopoietic cell transplantation, transplant-associated thrombotic microangiopathy, and cytomegalovirus diagnoses independently increased the risk of pericardial effusion development, while cytomegalovirus diagnosis decreased the likelihood of pericardial effusion resolution. Both non-significant pericardial effusion development and clinically significant effusion development were significantly associated with post-haematopoietic cell transplantation mortality, compared to no pericardial effusion development.

Conclusions:

Paediatric haematopoietic cell transplantation recipients with malignant diseases, older age at the time of transplantation, cytomegalovirus infection, or transplant-associated thrombotic microangiopathy are at higher risk for pericardial effusion development, which in turn predicts worse outcomes with increased risk of death. We propose a model for improved detection, evaluation, and management of pericardial effusion post-haematopoietic cell transplantation.

Keywords

Cardio-oncologypericardial effusiontransplant complicationshaematopoietic cell transplant

Information

Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 10
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Copyright
© The Author(s), 2025. Published by Cambridge University Press

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Footnotes

Tweet: Pericardial effusion can be a seriously overlooked complication following haematopoietic cell transplant in children, potentially leading to cardiac tamponade. In our cohort, pericardial effusion is a marker for worse outcomes and patients with inflammatory conditions (such as transplant-associated thrombotic microangiopathy) and Cytomegalovirus infection are at increased risk of pericardial effusion development. We present a clinical algorithm for early detection and management. #PericardialEffusion #HCTOutcomes Twitter handle: @JosieFernandezS

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