title: Elevated pretransplant pulmonary vascular resistance index does not predict mortality after isolated orthotopic heart transplantation in children: A retrospective analysis of the UNOS database.
abstract: OHT is the definitive therapy in end-stage heart failure. Elevated PVRI is considered a relative contraindication to isolated OHT; this assumption is re-evaluated using data from the UNOS database. A retrospective review of de-identified data from the UNOS dataset was performed. There were 1943 pediatric OHT recipients between 10/87 and 12/11 with sufficient data for analysis. Cox regression was performed to examine the effect of baseline characteristics on post-transplant survival. Patients were propensity matched, and Kaplan-Meier survival analysis was performed comparing cohorts of patients using thresholds of 6 and 9 WU × m(2) . PVRI was not a significant predictor of post-transplant outcomes in either univariate or multivariate Cox regression. Kaplan-Meier analysis revealed no difference in survival between both unmatched and propensity-matched OHT recipients. In conclusion, elevated PVRI was not associated with post-transplant mortality in pediatric OHT recipients. A prospective study assessing the current use of PVRI ≥6 as a threshold to contraindicate isolated OHT should be undertaken. Removing this potentially unnecessary restriction on transplant candidacy may make this life-saving therapy available to a greater number of patients.
authors.affiliation: Department of Cardiothoracic Surgery, Stanford Hospital and Clinics, Stanford, CA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Chiu
authors.affiliation: Department of Cardiothoracic Surgery, Stanford Hospital and Clinics, Stanford, CA, USA.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Schaffer
authors.affiliation: Department of Cardiothoracic Surgery, Stanford Hospital and Clinics, Stanford, CA, USA.
authors.forename: Ahmad Y
authors.initials: AY
authors.lastname: Sheikh
authors.affiliation: Department of Cardiothoracic Surgery, Stanford Hospital and Clinics, Stanford, CA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Ha
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucille Packard Children's Hospital, Stanford, CA, USA.
authors.forename: Olaf
authors.initials: O
authors.lastname: Reinhartz
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucille Packard Children's Hospital, Stanford, CA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Mainwaring
authors.affiliation: Department of Cardiothoracic Surgery, Stanford Hospital and Clinics, Stanford, CA, USA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Reitz
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D007223:Infant; D008297:Male; D057234:Preoperative Period; D011379:Prognosis; D057216:Propensity Score; D011652:Pulmonary Circulation / Q000502:physiology*; D012189:Retrospective Studies; D016019:Survival Analysis; D014184:Transplantation, Homologous; D014655:Vascular Resistance
keywords: adolescent; child; heart transplantation/mortality; infant; pediatric; pulmonary hypertension; pulmonary vascular resistance index; survival analysis