Moderate‐severe primary graft dysfunction after pediatric heart transplantation

Abstract

Background PGD is a complication after heart transplantation (OHT) and a significant cause of mortality, particularly in infant recipients. Lack of standardized definition of PGD in the pediatric population makes the prevalence and magnitude of impact unclear. Methods ISHLT PGD consensus guidelines, which include inotrope scores and need for MCS, were applied retrospectively to 208 pediatric OHT recipients from a single institution from 1/2005‐5/2016. PGD was defined as: moderate PGD—inotrope score >10 on postoperative day 1 (24‐48 hours), and severe PGD—MCS within 24 hours (in the absence of detectable rejection). Results PGD occurred in 34 patients (16.3%); 14 of which had severe PGD (6.7%). Multivariate risk factors for PGD included CPB time (OR 10.3/10 min, 95% 10.05, 10.2, P = 0.03), Fontan palliation (OR 1.9, 95% 1.2, 3.97), and PCM (OR 5.65, 95% 1.52, 22.4); but not age, weight, ischemic time, or donor characteristics. Upon sub‐analysis excluding patients with PCM, increased CPB was a significant multivariate risk factor (OR 10.09, 95% 9.89, 10.12, P = 0.003). Patients with PGD had decreased discharge survival compared to those without PGD (85% vs 96%, P < 0.01). Severe PGD was associated with the poorest 1‐year survival (57% vs 91% without PGD, P = 0.04). Conclusion Patients with prolonged CPB are potentially at risk for developing PGD. Neither infant recipients nor donor characteristics were associated with an increased risk of PGD in the current era.

Clinical approach to mechanical circulatory support in the transplant patient from the Pediatric Heart Transplant Society

“…In cases where retransplantation with MCS occurred >1 year after primary transplant, 1‐ and 5‐year survival nearly matched that of retransplantation without MCS (64% and 56%, respectively) 7 . Other single‐center studies have shown similar difficulties supporting this patient population in children 1,8,9 and adults 10,11 . In a review of Organ Procurement and Transplantation Network (OPTN) data, any MCS (ECMO or VAD) prior to retransplantation predicted increased mortality during transplantation (HR 2.5 [95% CI 1.6–4.1], p < .01) 12 …”

Pediatric Heart Transplantation

“…Perioperative management consists of some topics that are listed in Table 6 [11][12][13][14][15][16].…”

Current opinion in pediatric heart transplantation

“…No difference in donor-specific factors (age mismatch, size mismatch, sex mismatch, need for cardiopulmonary resuscitation, ejection fraction, or inotrope need) was observed between patients with and without PGD. Occurrence of moderate/severe PGD correlated with significantly worse survival at both discharge (85% vs 96%, P < 0.01) and one-year posttransplant (57% vs 91%, P ¼ 0.04) [14]. A chart summarizing the findings of all pediatric studies to investigate the impact of donor-specific factors on pediatric heart transplant outcomes is included (Fig.…”