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

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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.

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Authors and Affiliations

  1. Department of Pediatric Cardiology, University of Colorado, Children’s Hospital Colorado, Denver, CO, USA

    Scott R. Auerbach

  2. Division of Pediatric Cardiology, Columbia University, Morgan Stanley Children’s Hospital of New York at the Columbia University Medical Center, New York, NY, USA

    Marc E. Richmond & Linda J. Addonizio

  3. Division of Pediatric Cardiac Surgery, Columbia University, Morgan Stanley Children’s Hospital of New York at the Columbia University Medical Center, New York, NY, USA

    Jonathan M. Chen & Jan M. Quaegebeur

  4. Division of Cardiovascular Surgery, New York University, NYU Langone Medical Center, New York, NY, USA

    Ralph S. Mosca

  5. Division of Pediatric Cardiology, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, R3, 3415 Bainbridge Avenue, Bronx, NY, 10467-2490, USA

    Daphne T. Hsu & Jacqueline M. Lamour

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  1. Scott R. Auerbach
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  2. Marc E. Richmond
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  3. Jonathan M. Chen
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  5. Jan M. Quaegebeur
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  6. Linda J. Addonizio
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  7. Daphne T. Hsu
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Correspondence to Jacqueline M. Lamour.

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Auerbach, S.R., Richmond, M.E., Chen, J.M. et al. Multiple Risk Factors Before Pediatric Cardiac Transplantation Are Associated With Increased Graft Loss. Pediatr Cardiol 33, 49–54 (2012). https://doi.org/10.1007/s00246-011-0077-7

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  • DOI: https://doi.org/10.1007/s00246-011-0077-7

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