Risk factors for primary graft failure after pediatric cardiac transplantation: importance of recipient and donor characteristics

Indications for Heart Transplantation in Pediatric Heart Disease

“…Partial or complete reversibility of elevations of pulmonary vascular resistance and transpulmonary gradient can be observed in patients acutely tested with pulmonary vasodilators such as nitroprusside, prostaglandins, and nitric oxide. 180,[185][186][187][188] Prolonged administration of inotropic agents has also been associated with pulmonary resistance reduction. 185 In these studies, heart transplantation was performed successfully in patients with baseline elevated pulmonary vascular resistance that demonstrated reversibility to a pulmonary vascular resistance index Ͻ6 Woods units/m 2 or transpulmonary gradient Ͻ15 mm Hg.…”

Risk Factor Analysis in Pediatric Heart Transplantation

“…This could partly explain the high specific cause of early mortality due to primary graft failure. 15 Previously, we showed that undersize mismatching in pediatric heart transplantation increased the early mortality risk, especially for congenital heart disease. 16 Our current results reflect the common practice of pediatric heart transplant centers outside North America, where dilated cardiomyopathy is more predominant than congenital heart disease.…”

Changing Indications for Pediatric Heart Transplantation

“…These include renal failure, the need for extracorporeal membrane oxygenator support, mechanical ventilation, the presence of anti-HLA antibodies, and infection within 2 weeks of transplantation. 17,19,[78][79][80][81][82] The use of extracorporeal membrane oxygenation before transplantation had a hazard ratio of 2.65, and 1-year posttransplantation survival was 64%. 19 Mortality on the wait list for sensitized patients who express anti-HLA antibodies is reported to range between 19% and 22% because a negative prospective HLA cross-match is often a prerequisite to accepting the donor heart.…”