TY - JOUR
T1 - Multiple risk factors before pediatric cardiac transplantation are associated with increased graft loss
AU - Auerbach, Scott R.
AU - Richmond, Marc E.
AU - Chen, Jonathan M.
AU - Mosca, Ralph S.
AU - Quaegebeur, Jan M.
AU - Addonizio, Linda J.
AU - Hsu, Daphne T.
AU - Lamour, Jacqueline M.
PY - 2012/1
Y1 - 2012/1
N2 - 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% hadCHD, 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.
AB - 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% hadCHD, 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.
KW - Alternate listing
KW - Cardiac transplantation
KW - Congenital heart disease
KW - Graft survival
KW - Pediatrics
KW - Risk factors
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U2 - 10.1007/s00246-011-0077-7
DO - 10.1007/s00246-011-0077-7
M3 - Review article
C2 - 21892650
AN - SCOPUS:84859051872
SN - 0172-0643
VL - 33
SP - 49
EP - 54
JO - Pediatric Cardiology
JF - Pediatric Cardiology
IS - 1
ER -