Elevated pre-transplant pulmonary vascular resistance is not associated with mortality in children without congenital heart disease: A multicenter study

Marc E. Richmond, Yuk M. Law, Bibhuti B. Das, Melanie D. Everitt, Manisha Kukreja, David C. Naftel, Mariska S. Kemna, Heather T. Henderson, Kimberly Beddows, F. Jay Fricker, William T. Mahle

Research output: Contribution to journalArticle

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Abstract

Background Traditionally, an elevated pulmonary vascular resistance index (PVRI) has been a relative contraindication to pediatric orthotopic heart transplantation. This study examined the risk of elevated pre-transplant PVRI on early (30-day) and intermediate-term mortality in pediatric heart transplant recipients without congenital heart disease (CHD). Methods A review of the prospective multicenter Pediatric Heart Transplant Study registry identified all patients without CHD in whom a pre-transplant PVRI was recorded. Of 35 participating centers, 29 reported heart transplants in children with a markedly elevated PVRI (> 5 WU × m2, corresponding to the highest quartile). Multiphase parametric analysis was performed, adjusting for potential risk factors to assess the association of PVRI with early and intermediate-term mortality. Results Between 1993 and 2011, 1,909 children without CHD underwent heart transplantation at a median age of 9.7 years (range, 1.6 months-18 years). Of those, 795 (42%) had a recorded or calculable pre-transplant PVRI, and PVRI > 5 WU × m2 was present in 193 patients (24%). For all recipients, median pre-transplant PVRI was 3.15 WU × m2 (range, 0.4-23 WU × m2); 2.8 WU × m2 in infants < 1 year, 3.5 WU × m2 in patients aged 1 to 10 years, and 3.0 WU × m2 in patients aged > 10 years (p = 0.03). Multivariable hazard analysis controlling for graft ischemic time and pre-transplant ventilation showed no association of elevated PVRI with early mortality (relative risk, 1.2; p = 0.66), nor with intermediate mortality when controlled for year of transplant, age, race, and pre-sensitization (relative risk, 0.7; p = 0.27). Conclusions Elevation of PVRI did not affect post-transplant survival in this large, multicenter cohort of pediatric heart transplant recipients without CHD, suggesting that the barrier of elevated PVRI can be successfully overcome in this population.

Original languageEnglish (US)
Pages (from-to)448-456
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume34
Issue number3
DOIs
StatePublished - Mar 1 2015

Fingerprint

Child Mortality
Vascular Resistance
Multicenter Studies
Heart Diseases
Transplants
Pediatrics
Mortality
Heart Transplantation
Ventilation
Registries

Keywords

  • cardiomyopathy
  • heart transplant outcome
  • mortality
  • pediatric
  • pulmonary vascular resistance index

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Elevated pre-transplant pulmonary vascular resistance is not associated with mortality in children without congenital heart disease : A multicenter study. / Richmond, Marc E.; Law, Yuk M.; Das, Bibhuti B.; Everitt, Melanie D.; Kukreja, Manisha; Naftel, David C.; Kemna, Mariska S.; Henderson, Heather T.; Beddows, Kimberly; Fricker, F. Jay; Mahle, William T.

In: Journal of Heart and Lung Transplantation, Vol. 34, No. 3, 01.03.2015, p. 448-456.

Research output: Contribution to journalArticle

Richmond, Marc E. ; Law, Yuk M. ; Das, Bibhuti B. ; Everitt, Melanie D. ; Kukreja, Manisha ; Naftel, David C. ; Kemna, Mariska S. ; Henderson, Heather T. ; Beddows, Kimberly ; Fricker, F. Jay ; Mahle, William T. / Elevated pre-transplant pulmonary vascular resistance is not associated with mortality in children without congenital heart disease : A multicenter study. In: Journal of Heart and Lung Transplantation. 2015 ; Vol. 34, No. 3. pp. 448-456.
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abstract = "Background Traditionally, an elevated pulmonary vascular resistance index (PVRI) has been a relative contraindication to pediatric orthotopic heart transplantation. This study examined the risk of elevated pre-transplant PVRI on early (30-day) and intermediate-term mortality in pediatric heart transplant recipients without congenital heart disease (CHD). Methods A review of the prospective multicenter Pediatric Heart Transplant Study registry identified all patients without CHD in whom a pre-transplant PVRI was recorded. Of 35 participating centers, 29 reported heart transplants in children with a markedly elevated PVRI (> 5 WU × m2, corresponding to the highest quartile). Multiphase parametric analysis was performed, adjusting for potential risk factors to assess the association of PVRI with early and intermediate-term mortality. Results Between 1993 and 2011, 1,909 children without CHD underwent heart transplantation at a median age of 9.7 years (range, 1.6 months-18 years). Of those, 795 (42{\%}) had a recorded or calculable pre-transplant PVRI, and PVRI > 5 WU × m2 was present in 193 patients (24{\%}). For all recipients, median pre-transplant PVRI was 3.15 WU × m2 (range, 0.4-23 WU × m2); 2.8 WU × m2 in infants < 1 year, 3.5 WU × m2 in patients aged 1 to 10 years, and 3.0 WU × m2 in patients aged > 10 years (p = 0.03). Multivariable hazard analysis controlling for graft ischemic time and pre-transplant ventilation showed no association of elevated PVRI with early mortality (relative risk, 1.2; p = 0.66), nor with intermediate mortality when controlled for year of transplant, age, race, and pre-sensitization (relative risk, 0.7; p = 0.27). Conclusions Elevation of PVRI did not affect post-transplant survival in this large, multicenter cohort of pediatric heart transplant recipients without CHD, suggesting that the barrier of elevated PVRI can be successfully overcome in this population.",
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T2 - A multicenter study

AU - Richmond, Marc E.

AU - Law, Yuk M.

AU - Das, Bibhuti B.

AU - Everitt, Melanie D.

AU - Kukreja, Manisha

AU - Naftel, David C.

AU - Kemna, Mariska S.

AU - Henderson, Heather T.

AU - Beddows, Kimberly

AU - Fricker, F. Jay

AU - Mahle, William T.

PY - 2015/3/1

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N2 - Background Traditionally, an elevated pulmonary vascular resistance index (PVRI) has been a relative contraindication to pediatric orthotopic heart transplantation. This study examined the risk of elevated pre-transplant PVRI on early (30-day) and intermediate-term mortality in pediatric heart transplant recipients without congenital heart disease (CHD). Methods A review of the prospective multicenter Pediatric Heart Transplant Study registry identified all patients without CHD in whom a pre-transplant PVRI was recorded. Of 35 participating centers, 29 reported heart transplants in children with a markedly elevated PVRI (> 5 WU × m2, corresponding to the highest quartile). Multiphase parametric analysis was performed, adjusting for potential risk factors to assess the association of PVRI with early and intermediate-term mortality. Results Between 1993 and 2011, 1,909 children without CHD underwent heart transplantation at a median age of 9.7 years (range, 1.6 months-18 years). Of those, 795 (42%) had a recorded or calculable pre-transplant PVRI, and PVRI > 5 WU × m2 was present in 193 patients (24%). For all recipients, median pre-transplant PVRI was 3.15 WU × m2 (range, 0.4-23 WU × m2); 2.8 WU × m2 in infants < 1 year, 3.5 WU × m2 in patients aged 1 to 10 years, and 3.0 WU × m2 in patients aged > 10 years (p = 0.03). Multivariable hazard analysis controlling for graft ischemic time and pre-transplant ventilation showed no association of elevated PVRI with early mortality (relative risk, 1.2; p = 0.66), nor with intermediate mortality when controlled for year of transplant, age, race, and pre-sensitization (relative risk, 0.7; p = 0.27). Conclusions Elevation of PVRI did not affect post-transplant survival in this large, multicenter cohort of pediatric heart transplant recipients without CHD, suggesting that the barrier of elevated PVRI can be successfully overcome in this population.

AB - Background Traditionally, an elevated pulmonary vascular resistance index (PVRI) has been a relative contraindication to pediatric orthotopic heart transplantation. This study examined the risk of elevated pre-transplant PVRI on early (30-day) and intermediate-term mortality in pediatric heart transplant recipients without congenital heart disease (CHD). Methods A review of the prospective multicenter Pediatric Heart Transplant Study registry identified all patients without CHD in whom a pre-transplant PVRI was recorded. Of 35 participating centers, 29 reported heart transplants in children with a markedly elevated PVRI (> 5 WU × m2, corresponding to the highest quartile). Multiphase parametric analysis was performed, adjusting for potential risk factors to assess the association of PVRI with early and intermediate-term mortality. Results Between 1993 and 2011, 1,909 children without CHD underwent heart transplantation at a median age of 9.7 years (range, 1.6 months-18 years). Of those, 795 (42%) had a recorded or calculable pre-transplant PVRI, and PVRI > 5 WU × m2 was present in 193 patients (24%). For all recipients, median pre-transplant PVRI was 3.15 WU × m2 (range, 0.4-23 WU × m2); 2.8 WU × m2 in infants < 1 year, 3.5 WU × m2 in patients aged 1 to 10 years, and 3.0 WU × m2 in patients aged > 10 years (p = 0.03). Multivariable hazard analysis controlling for graft ischemic time and pre-transplant ventilation showed no association of elevated PVRI with early mortality (relative risk, 1.2; p = 0.66), nor with intermediate mortality when controlled for year of transplant, age, race, and pre-sensitization (relative risk, 0.7; p = 0.27). Conclusions Elevation of PVRI did not affect post-transplant survival in this large, multicenter cohort of pediatric heart transplant recipients without CHD, suggesting that the barrier of elevated PVRI can be successfully overcome in this population.

KW - cardiomyopathy

KW - heart transplant outcome

KW - mortality

KW - pediatric

KW - pulmonary vascular resistance index

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