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J Heart Lung Transplant. 2008 Apr;27(4):408-15. doi: 10.1016/j.healun.2008.01.007.

Risk factor analysis in pediatric heart transplantation.

Author information

  • 1Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine Westphalia, University Hospital of Bochum, Bad Oeynhausen, Germany. ystjang@hotmail.com

Abstract

BACKGROUND:

Steady assessment of risk factors will enable identification of patients at higher risk for post-transplant death, and may thus improve organ utilization and outcomes. In this study we aimed to identify the risk factors of mortality in pediatric heart transplantation.

METHODS:

Between November 1989 and February 2004, there were 116 orthotopic heart transplantations performed in patients <18 years of age at our institution.

RESULTS:

The 30-day mortality risk was 12% (dilated cardiomyopathy 7%, congenital heart disease 26%; univariate analysis: p = 0.023). The main cause of 30-day mortality was primary graft failure (36%). The late mortality rate was 31 per 1,000 person-years. The main causes of late mortality were acute rejection (44%) and cardiac allograft vasculopathy (26%). The 1-, 5-, 10- and 15-year survival rates were 85%, 77%, 65% and 53%, respectively. Male donor (odds ratio [OR] 6.33, 95% confidence interval [CI] 1.11 to 36.01) and cardiopulmonary bypass >210 minutes (OR 43.05, 95% CI 1.11 to 1,669) were risk factors for 30-day mortality. Risk factors for 1- and 5-year mortality were body weight ratio <0.8 (OR 40.36, 95% CI 3.04 to 536.47) and male donor (OR 3.36, 95% CI 1.05 to 10.75), respectively. Recipient age <1 year (OR 64.65, 95% CI 1.69 to 2,466.77) and donor-recipient body surface area mismatch of <0.9 (OR 10.58, 95% CI 1.03 to 108.25) were risk factors for 10-year mortality.

CONCLUSIONS:

Pediatric heart transplantation can be performed with an expectation of excellent results. Certain risk factors suggest poorer outcomes.

PMID:
18374877
[PubMed - indexed for MEDLINE]
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