title: Impact of Heart Transplantation on the Functional Status of US Children With End-Stage Heart Failure.
abstract: BACKGROUND
  There are limited data describing the functional status (FS) of children after heart transplant (HT). We sought to describe the FS of children surviving at least 1 year after HT, to evaluate the impact of HT on FS, and to identify factors associated with abnormal FS post-HT.
  
  
  METHODS
  Organ Procurement and Transplantation Network data were used to identify all US children <21 years of age surviving ≥1 year post-HT from 2005 to 2014 with a functional status score (FSS) available at 3 time points (listing, transplant, ≥1 year post-HT). Logistic regression and generalized estimating equations were used to identify factors associated with abnormal FS (FSS≤8) post-HT.
  
  
  RESULTS
  A total of 1633 children met study criteria. At the 1-year assessment, 64% were "fully active/no limitations" (FSS=10), 21% had "minor limitations with strenuous activity" (FSS=9); and 15% scored ≤8. In comparison with listing FS, FS at 1 year post-HT increased in 91% and declined/remained unchanged in 9%. A stepwise regression procedure selected the following variables for association with abnormal FS at 1 year post-HT: ≥18 years of age (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2-2.7), black race (OR, 1.5; 95% CI, 1.1-2.0), support with ≥inotropes at HT (OR, 1.7; 95% CI, 1.2-2.5), hospitalization status at HT (OR, 1.5; 95% CI, 1.0-2.19), chronic steroid use at HT (OR, 1.5; 95% CI, 1.0-2.2), and treatment for early rejection (OR, 2.0; 95% CI, 1.5-2.7).
  
  
  CONCLUSIONS
  Among US children who survive at least 1 year after HT, FS is excellent for the majority of patients. HT is associated with substantial improvement in FS for most children. Early rejection, older age, black race, chronic steroid use, hemodynamic support at HT, and being hospitalized at HT are associated with abnormal FS post-HT.
authors.affiliation: From Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, and the Department of Pediatrics, Stanford University, Palo Alto, CA (D.M.P., D.N.R., S.C., B.D.K., S.A.H., N.M., D.B., C.S.A.); the Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (Y.Z., M.P.); and Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, MA (L.B.S.).
authors.forename: David M
authors.initials: DM
authors.lastname: Peng
authors.affiliation: From Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, and the Department of Pediatrics, Stanford University, Palo Alto, CA (D.M.P., D.N.R., S.C., B.D.K., S.A.H., N.M., D.B., C.S.A.); the Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (Y.Z., M.P.); and Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, MA (L.B.S.).
authors.forename: Yulin
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: From Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, and the Department of Pediatrics, Stanford University, Palo Alto, CA (D.M.P., D.N.R., S.C., B.D.K., S.A.H., N.M., D.B., C.S.A.); the Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (Y.Z., M.P.); and Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, MA (L.B.S.).
authors.forename: David N
authors.initials: DN
authors.lastname: Rosenthal
authors.affiliation: From Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, and the Department of Pediatrics, Stanford University, Palo Alto, CA (D.M.P., D.N.R., S.C., B.D.K., S.A.H., N.M., D.B., C.S.A.); the Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (Y.Z., M.P.); and Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, MA (L.B.S.).
authors.forename: Michal
authors.initials: M
authors.lastname: Palmon
authors.affiliation: From Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, and the Department of Pediatrics, Stanford University, Palo Alto, CA (D.M.P., D.N.R., S.C., B.D.K., S.A.H., N.M., D.B., C.S.A.); the Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (Y.Z., M.P.); and Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, MA (L.B.S.).
authors.forename: Sharon
authors.initials: S
authors.lastname: Chen
authors.affiliation: From Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, and the Department of Pediatrics, Stanford University, Palo Alto, CA (D.M.P., D.N.R., S.C., B.D.K., S.A.H., N.M., D.B., C.S.A.); the Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (Y.Z., M.P.); and Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, MA (L.B.S.).
authors.forename: Beth D
authors.initials: BD
authors.lastname: Kaufman
authors.affiliation: From Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, and the Department of Pediatrics, Stanford University, Palo Alto, CA (D.M.P., D.N.R., S.C., B.D.K., S.A.H., N.M., D.B., C.S.A.); the Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (Y.Z., M.P.); and Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, MA (L.B.S.).
authors.forename: Katsuhide
authors.initials: K
authors.lastname: Maeda
authors.affiliation: From Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, and the Department of Pediatrics, Stanford University, Palo Alto, CA (D.M.P., D.N.R., S.C., B.D.K., S.A.H., N.M., D.B., C.S.A.); the Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (Y.Z., M.P.); and Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, MA (L.B.S.).
authors.forename: Seth A
authors.initials: SA
authors.lastname: Hollander
authors.affiliation: From Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, and the Department of Pediatrics, Stanford University, Palo Alto, CA (D.M.P., D.N.R., S.C., B.D.K., S.A.H., N.M., D.B., C.S.A.); the Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (Y.Z., M.P.); and Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, MA (L.B.S.).
authors.forename: Nancy
authors.initials: N
authors.lastname: McDonald
authors.affiliation: From Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, and the Department of Pediatrics, Stanford University, Palo Alto, CA (D.M.P., D.N.R., S.C., B.D.K., S.A.H., N.M., D.B., C.S.A.); the Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (Y.Z., M.P.); and Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, MA (L.B.S.).
authors.forename: Leslie B
authors.initials: LB
authors.lastname: Smoot
authors.affiliation: From Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, and the Department of Pediatrics, Stanford University, Palo Alto, CA (D.M.P., D.N.R., S.C., B.D.K., S.A.H., N.M., D.B., C.S.A.); the Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (Y.Z., M.P.); and Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, MA (L.B.S.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Bernstein
authors.affiliation: From Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, and the Department of Pediatrics, Stanford University, Palo Alto, CA (D.M.P., D.N.R., S.C., B.D.K., S.A.H., N.M., D.B., C.S.A.); the Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (Y.Z., M.P.); and Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, MA (L.B.S.). christopher.almond@stanford.edu.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Almond
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation; D006760:Hospitalization; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D015996:Survival Rate; D014481:United States; D055815:Young Adult
keywords: functional capacity impairment; functional status; heart failure; heart transplantation; pediatrics; quality of life