Mark Randall


Post transplant coronary artery disease influences short and long-term survival of pediatric heart transplant recipients. Associated cardiovascular disease risk factors among non-heart transplant adult and pediatric heart populations for development of coronary artery disease have been documented. Little is known about these typical cardiovascular disease risk factors as well as other possible risk factors in the development of post transplant coronary artery disease. Objective: The purpose of this research was to examine children/adolescents (n=194), 5-18 years old, at least one-year post heart transplant. This study also investigated if there were physiological and psychological/behavioral differences between recipients with (n = 28) and without post transplant coronary artery disease (n = 166). Method: Archival (physiological) data were collected from the Loma Linda Heart Institute computer database, and behavioral prospective data were obtained from a mailed survey of parents (n = 173) (Child Behavior Checklist and Demographic Information Form). Results: Total number of rejection episodes (4.88 vs 2.88) and mean triglyceride levels (115.50 vs 85.90) were higher for recipients with post transplant coronary artery disease. Parents reported psychological variables of anxiety/depression (50.67 vs 54.58), aggression (51.33 vs 54.26), and thought problems (50.00 vs 55.32) were higher for recipients without post transplant coronary artery disease. Recipients whose parents smoked in the past or currently smoke had a greater total number of rejection episodes (4.82 vs 2.58) than recipients with parents who did not smoke in the past or currently.

Conclusions: The results indicate that rejection episodes, triglyceride levels, and parental smoking behavior generate a greater risk for developing post transplant coronary artery disease. Addressing the implications of these results for pediatric heart transplant recipients, parents, and transplant programs should be accomplished by professionals who hold the skill and experience in the fields of preventive care and mental health. Focal point to lifestyle wellness dynamics such as nutrition, smoking cessation, and successful long term behavior change in conjunction with transplant medical care will offer recipients the best chance for a long and improved quality of life.


School of Public Health

First Advisor

Helen Hopp Marshak

Second Advisor

Kiti Freier

Third Advisor

Gray Hopkins

Degree Name

Doctor of Public Health (DrPH)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Heart Transplantation -- in infancy & childhood; Adolescent; Child; Coronary Disease; Coronary Arteriosclerosis; Transplantation -- complications.



Page Count

vii; 78

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website


Loma Linda University. Del E. Webb Memorial Library. University Archives