title: Multiple risk factors before pediatric cardiac transplantation are associated with increased graft loss.
abstract: Identification of heart transplant recipients at highest risk for a poor outcome could lead to improved posttransplantation survival. A chart review of primary heart transplantations from 1993 to 2006 was performed. Analysis was performed to evaluate the risk of graft loss for those with a transplantation age less than 1 year, congenital heart disease (CHD), elevated pulmonary vascular resistance (index > 6), positive panel reactive antibody or crossmatch, liver or renal dysfunction, mechanical ventilation, or mechanical circulatory support (MCS). Primary transplantation was performed for 189 patients. Among these patients, 37% had CHD, 23% had mechanical ventilation, and 6% had renal dysfunction. Overall graft survival was 82% at 1 year and 68% at 5 years. The univariate risk factors for graft loss included mechanical ventilation (hazard ratio [HR], 1.9; 95% confidence interval [CI], 1.15-3.18), CHD (HR, 1.68; 95% CI, 1.04-2.70), and renal dysfunction (HR, 3.05; 95% CI, 1.34-6.70). The multivariate predictors of graft loss were CHD (HR, 1.8; 95% CI, 1.02-2.64), mechanical ventilation (HR, 1.9; 95% CI, 1.13-3.10), and the presence of two or more statistically significant univariate risk factors (SRF) (HR, 3.8; 95% CI, 2.00-7.32). Mechanical ventilation, CHD, and the presence of two or more SRFs identify pediatric patients at higher risk for graft loss and should be considered in the management of children with end-stage heart failure.
authors: Department of Pediatric Cardiology, University of Colorado, Children's Hospital Colorado, Denver, CO, USA.
authors: Scott R
authors: SR
authors: Auerbach
authors: Marc E
authors: ME
authors: Richmond
authors: Jonathan M
authors: JM
authors: Chen
authors: Ralph S
authors: RS
authors: Mosca
authors: Jan M
authors: JM
authors: Quaegebeur
authors: Linda J
authors: LJ
authors: Addonizio
authors: Daphne T
authors: DT
authors: Hsu
authors: Jacqueline M
authors: JM
authors: Lamour
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006330:Heart Defects, Congenital / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult