title: Pulmonary vascular resistance index and mortality after paediatric heart transplant.
abstract: BACKGROUND
  Although some prior studies have provided evidence to question the historical belief that pulmonary vascular resistance index ⩾6 Wood Units×m2 should be a contraindication to heart transplantation in children, no national analyses specific to the modern area have addressed this question.
  
  
  METHODS
  Data were analysed for paediatric heart transplant recipients from 1 January, 2002 to 1 September, 2012 (n=699). The relationship between pulmonary vascular resistance and all-cause 30-day mortality was evaluated using univariate and multivariate analyses.
  
  
  RESULTS
  The 30-day mortality included 10 patients (1.43%), which is lower than in the previous analyses. Receiver operating curve analysis of pulmonary vascular resistance index as a predictor of mortality yielded a cut-off value of 3.37 Wood Units×m2, but the area under the curve and specificity of this threshold was weaker than in previous analyses. Whereas pulmonary vascular resistance index treated as a dichotomised variable was a significant predictor of mortality in univariate (odds ratio 4.92, 95% confidence interval 1.04-23.33, p=0.045) and multivariate (odds ratio 5.26, 95% confidence interval 1.07-25.80, p=0.041) analyses, pulmonary vascular resistance index treated as a continuous variable was not a significant predictor of mortality in univariate (p=0.12) or multivariate (p=0.11) analyses.
  
  
  CONCLUSIONS
  The relationship between pulmonary vascular resistance and post-heart transplant mortality in children is less convincing in this analysis of a comprehensive, contemporary database than in previous series. This suggests the possibility that modern improvements in the management of post-transplant right ventricular dysfunction have mitigated the contribution of pulmonary hypertension to early mortality.
authors.affiliation: 1Department of Anesthesiology and Critical Care Medicine,Johns Hopkins University School of Medicine,Baltimore,MarylandUnited States of America.
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Maxwell
authors.affiliation: 2Department of Cardiothoracic Surgery,Stanford University School of Medicine,Stanford,CaliforniaUnited States of America.
authors.forename: Ahmad Y
authors.initials: AY
authors.lastname: Sheikh
authors.affiliation: 1Department of Anesthesiology and Critical Care Medicine,Johns Hopkins University School of Medicine,Baltimore,MarylandUnited States of America.
authors.forename: Chinwe C
authors.initials: CC
authors.lastname: Ajuba-Iwuji
authors.affiliation: 1Department of Anesthesiology and Critical Care Medicine,Johns Hopkins University School of Medicine,Baltimore,MarylandUnited States of America.
authors.forename: Eugenie S
authors.initials: ES
authors.lastname: Heitmiller
authors.affiliation: 3Department of Cardiothoracic Surgery,Johns Hopkins University School of Medicine,Baltimore,Maryland,United States of America.
authors.forename: Luca A
authors.initials: LA
authors.lastname: Vricella
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology*; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D012720:Severity of Illness Index; D014655:Vascular Resistance
keywords: Heart transplantation; paediatric heart transplantation; pulmonary hypertension; pulmonary vascular resistance