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Updated: Jul 1, 2026
Cardiac Loading using Passive Left Atrial Pressurization and Passive Afterload for Graft Assessment
Published on: August 2, 2024
Elevated filling pressures are associated with poor long-term graft survival after pediatric heart transplantation
Ezgi Yavasca1,2,3, Lisa-Maria Rosenthal1,2,3, Regina Stegherr4
1Deutsches Herzzentrum der Charite Klinik für Angeborene Herzfehler - Kinderkardiologie, Berlin, Germany.
Insights
Elevated filling pressures (EFP) after pediatric heart transplantation (HT) are linked to significantly worse long-term graft survival. Monitoring EFP early post-transplant is crucial for identifying patients at high risk for graft loss.
Area of Science:
- Cardiology
- Transplantation Medicine
- Pediatric Critical Care
Background:
- Pediatric heart transplantation (HT) survival has improved.
- Long-term outcomes beyond 10 years, particularly the impact of elevated filling pressures (EFP), are not well understood.
- EFP is defined as pulmonary capillary wedge pressure (PCWP) > 15 mmHg and/or right atrial pressure (RAP) > 12 mmHg without biopsy-proven rejection.
Purpose of the Study:
- To assess the association between early EFP and long-term graft survival in pediatric HT recipients.
- To investigate the relationship between EFP and cardiovascular adverse events (AE) post-transplant.
Main Methods:
- Retrospective analysis of 114 pediatric HT cases from 1986-2020.
- Included patients with PCWP and/or RAP measurements between 7 months and 5 years post-transplant (landmark cohort).
- Evaluated associations of EFP with graft survival and AE using survival analysis.
Main Results:
- 12% of grafts (14/114) exhibited EFP during the follow-up period.
- Grafts with EFP showed significantly worse 10-year survival (44% vs. 85%, p < 0.001) and a higher risk of graft loss (HR 6.04).
- The incidence of AE was numerically higher in the EFP group, though this finding is exploratory.
Conclusions:
- Early elevated filling pressures in pediatric heart transplant recipients are associated with poor long-term graft survival.
- EFP may serve as an indicator for potential cardiovascular complications after HT.
- Further research is warranted to explore the implications of EFP on cardiovascular adverse events.
Abstract:
Long-term survival has improved in the current era of pediatric heart transplantation (HT). The impact of elevated filling pressures [EFP; defined as pulmonary capillary wedge pressure (PCWP) > 15 mmHg and/or right atrial pressure (RAP) > 12 mmHg in the absence of biopsy-confirmed rejection] on long-term outcomes beyond 10 years remains poorly characterized. We assessed whether EFP during the early years after HT are associated with poor graft survival and cardiovascular adverse events (AE). We retrospectively analyzed 114 pediatric HT grafts (1986-2020) with available PCWP and/or RAP measurements 7 months to 5 years post-transplant (grouping period), representing a landmark cohort of 5-year survivors. Associations of EFP with graft survival and AE were evaluated. Fourteen grafts (12%) had EFP during the grouping period. Grafts with EFP had significantly worse long-term survival (44% vs. 85% at 10 years; log-rank p < 0.001), and higher risk of graft loss (overall HR 6.04, 95% CI [2.01-16.85]). The incidence of AE was numerically higher in grafts with EFP (26.6 [15.2-43.2] vs. 11.9 [9.4-14.9] per 100 person-years), but should be interpreted as exploratory. EFP within the early years post-transplant are associated with poor graft survival and may indicate cardiovascular complications.
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