title: Perioperative factors associated with in-hospital mortality or retransplantation in pediatric heart transplant recipients.
abstract: OBJECTIVE
  Despite improved long-term survival after pediatric heart transplantation, perioperative mortality has remained high. We sought to understand the factors associated with perioperative graft loss after pediatric heart transplantation.
  
  
  METHODS
  The factors associated with primary heart transplant mortality and retransplantation before hospital discharge in 226 pediatric heart transplant recipients (1995-2010) at a single-center institution were analyzed using multivariable logistic regression models adjusted for age at surgery and year of surgery.
  
  
  RESULTS
  A total of 26 patients died (n = 21) or underwent retransplantion (n = 5) before hospital discharge secondary to primary graft failure (n = 10), multisystem organ failure (n = 5), infection (n = 4), rejection (n = 2), and perioperative complications (n = 5). United Network for Organ Sharing status 1 (vs status 2) at transplantation was associated with an increased odds of death from noncardiac causes (odd ratio [OR], 4.7; 95% confidence level [CI], 1.2-22.3; P = .002). The factors associated with increased odds of perioperative mortality or retransplant were pre- and post-transplant extracorporeal membrane oxygenation (OR, 5.3; 95% CI, 1.5-18.7; P = .01; and OR, 25.9; 95% CI, 7.0-95.9; P < .001), longer ischemic times (OR, 1.4 per 30 minutes; 95% CI, 1.0-2.0; P = .04), reoperation after transplantation (OR, 3.5; 95% CI, 1.2-10.4; P = .02), and transplantation before 2002 (OR, 4.5; 95% CI, 1.4-14.9; P = .01), respectively.
  
  
  CONCLUSIONS
  The use of extracorporeal membrane oxygenation (both before and after transplantation), a longer ischemic time, and reoperation were key factors associated with perioperative graft loss, with noncardiac mortality closely related to United Network for Organ Sharing status at heart transplantation. Knowledge of the perioperative risk factors and how they affect graft survival will help guide difficult decisions around eligibility, timing of primary listing, and appropriateness for retransplantation, and potentially affect long-term survival.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rachel D
authors.initials: RD
authors.lastname: Vanderlaan
authors.affiliation: Labatt Family Heart Centre, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
authors.affiliation: Labatt Family Heart Centre, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Conway
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Labatt Family Heart Centre, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Osami
authors.initials: O
authors.lastname: Honjo
authors.affiliation: Labatt Family Heart Centre, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.affiliation: Labatt Family Heart Centre, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: anne.dipchand@sickkids.ca.
authors.forename: Anne I
authors.initials: AI
authors.lastname: Dipchand
mesh_terms: D000367:Age Factors; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D009864:Ontario; D011183:Postoperative Complications / Q000401:mortality* / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome