Andersons pediatric cardiology 1779

FIG 67.13 Kaplan-Meier survival in children with transplanted hearts by mechanical circulatory support usage ECMO, Extracorporeal membrane oxygenation; LVAD, left ventricular assist device; RVAD, right ventricular assist device; TAH, total artifical heart; VAD, ventricular assist device (From the registry of the International Society of Heart and Lung Transplantation J Heart Lung Transplant 2016;35(10):1185–1195.) Risk Factors for Death The risk factors for death in the first year following heart transplantation during childhood are outlined in Table 67.1 They include a diagnosis of congenital heart disease, need for dialysis or extracorporeal mechanical support, mechanical ventilation before transplantation, infection, and retransplantation Continuous variables that incur risk include ischemic time, donor weight, estimated glomerular filtration rate, and pediatric center volume.2 Owing to the longevity of the registry, risk factors for mortality at 5, 10, and 15 years can now be determined in a large number of childhood heart transplant patients and are summarized in Table 67.2.2 Data from the PHTS were used to identify pretransplant factors by cardiac diagnosis (cardiomyopathy vs congenital heart disease) to model risks of graft loss.10 Risk factors common to both diagnostic groups included markers of renal function and elevated panel reactive antibodies (PRAs, see further on) Independent risk factors for patients with congenital heart disease only included ventilator dependency and low recipient body surface area The resultant risk prediction model for cardiomyopathy performed well, but that for congenital heart disease had limited ability to predict outcomes Table 67.1 Categoric Risk Factors for 1-Year Mortality in Children After Heart Transplantation (N = 5646) Risk Factor Infection requiring IV drug therapy within 2 weeks of Tx Ventilator Donor cause of death: cerebrovascular vs trauma Diagnosis: CHD vs DCM Diagnosis: ReTx vs DCM Recipient dialysis ECMO: ECMO/CHD vs no ECMO N 681 826 396 1979 304 146 145 Hazard Ratio (95% CI) 1.36 (1.10–1.68) 1.41 (1.1.3–1.76) 1.59 (1.20–2.09) 1.91 (1.46–2.52) 2.23 (1.53–3.25) 2.36 (1.57–3.57) 2.42 (2.42–3.35) P value 005 002 001