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Risk factors for graft failure associated with pulmonary hypertension after pediatric heart transplantation
N Fukushima1, S R Gundry, A J Razzouk
1Loma Linda University Medical Center, Department of Surgery, CA 92354.
Insights
Pediatric heart transplant recipients older than one year face higher mortality from pulmonary hypertension. Early heart transplantation in infants prevents deaths related to pulmonary hypertension, especially in those with congenital heart disease.
Area of Science:
- Pediatric Cardiology
- Transplantation Medicine
- Pulmonary Hypertension Research
Background:
- Postoperative pulmonary hypertension is a significant cause of early mortality in pediatric heart transplant recipients.
- Understanding predictive risk factors is crucial for improving outcomes in this vulnerable population.
Purpose of the Study:
- To identify predictive risk factors for the development of pulmonary hypertension after heart transplantation in pediatric patients.
- To compare outcomes between infant and older pediatric heart transplant recipients.
Main Methods:
- Retrospective analysis of 194 pediatric heart transplant recipients (1987-1992).
- Patients divided into two groups: infants (<1 year) and older children (≥1 year).
- Evaluation of risk factors including underlying heart condition, donor factors, and graft ischemic time.
Main Results:
- Infants had a significantly lower mortality rate from pulmonary hypertension compared to older children (2/152 vs. 4/42).
- Mortality from pulmonary hypertension was lower in infants with congenital heart disease compared to older children with congenital heart disease (0/44 vs. 4/24).
- Prolonged graft ischemic time (>6 hours) was associated with higher pulmonary hypertension mortality in older children but not in infants.
Conclusions:
- Older pediatric heart transplant recipients, particularly those with congenital heart disease, have a higher risk of mortality from pulmonary hypertension.
- Early heart transplantation in infancy offers a protective benefit against death from pulmonary hypertension.
- Graft ischemic time is a critical factor for older recipients, especially those with congenital heart disease.
Abstract:
Postoperative pulmonary hypertension can be a major cause of early death after heart transplantation in children. To identify predictive risk factors of pulmonary hypertension after heart transplantation, we performed a retrospective analysis of our 194 infant and pediatric recipients who underwent heart transplantation between 1987 and 1992. Because the response of pulmonary vasculature may change during growth, the patients were divided into two groups: age less than 1 year in group I (n = 152) and 1 year or older in group C (n = 43). The following risk factors were evaluated: cardiomyopathy, congenital heart disease and hypoplastic left heart syndrome, pretransplant pulmonary hypertension, history of operation, oversized donor (donor/recipient weight ratio greater than 2), donor's history of cardiopulmonary resuscitation, and prolonged graft ischemic time (graft ischemic time 360 minutes or longer). Though there was no significant difference between group I and group C in overall early mortality including early graft loss (19 of 152 versus 5 of 42), the mortality rate from pulmonary hypertension in group I was significantly lower than that in group C (2 of 152 versus 4 of 42; p < 0.05). The mortality rate from pulmonary hypertension in patients with congenital heart disease in group I was significantly lower than that in group C (0 of 44 versus 4 of 24; p < 0.05). In group I, there was no significant difference in the early mortality rate or the mortality rate from pulmonary hypertension from any factors studied. The mortality rate from pulmonary hypertension in association with prolonged graft ischemic time in group C was significantly higher than when no prolonged graft ischemic time was present in group C and with either prolonged graft ischemic time or no prolonged graft ischemic time in group I (4 of 16 versus 0 of 26, 0 of 37, and 2 of 115). In conclusion, older patients had a higher mortality rate from pulmonary hypertension after heart transplantation, especially in patients with congenital heart disease who received a graft preserved more than 6 hours. This study demonstrates another benefit of early heart transplantation in infancy, that is, prevention of death from pulmonary hypertension.