Pediatric Cardiology

, Volume 33, Issue 1, pp 49–54

Multiple Risk Factors Before Pediatric Cardiac Transplantation Are Associated With Increased Graft Loss

  • Scott R. Auerbach
  • Marc E. Richmond
  • Jonathan M. Chen
  • Ralph S. Mosca
  • Jan M. Quaegebeur
  • Linda J. Addonizio
  • Daphne T. Hsu
  • Jacqueline M. Lamour
Original Article

DOI: 10.1007/s00246-011-0077-7

Cite this article as:
Auerbach, S.R., Richmond, M.E., Chen, J.M. et al. Pediatr Cardiol (2012) 33: 49. doi:10.1007/s00246-011-0077-7

Abstract

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% had CHD, 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.

Keywords

Alternate listing Cardiac transplantation Congenital heart disease Graft survival Pediatrics Risk factors 

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Scott R. Auerbach
    • 1
  • Marc E. Richmond
    • 2
  • Jonathan M. Chen
    • 3
  • Ralph S. Mosca
    • 4
  • Jan M. Quaegebeur
    • 3
  • Linda J. Addonizio
    • 2
  • Daphne T. Hsu
    • 5
  • Jacqueline M. Lamour
    • 5
  1. 1.Department of Pediatric CardiologyUniversity of Colorado, Children’s Hospital ColoradoDenverUSA
  2. 2.Division of Pediatric CardiologyColumbia University, Morgan Stanley Children’s Hospital of New York at the Columbia University Medical CenterNew YorkUSA
  3. 3.Division of Pediatric Cardiac SurgeryColumbia University, Morgan Stanley Children’s Hospital of New York at the Columbia University Medical CenterNew YorkUSA
  4. 4.Division of Cardiovascular SurgeryNew York University, NYU Langone Medical CenterNew YorkUSA
  5. 5.Division of Pediatric CardiologyAlbert Einstein College of Medicine, Children’s Hospital at MontefioreBronxUSA