No abstract

PurposeWe sought to determine whether the presence of a systemic SA with potential complicating factors affects waitlist and post–HT outcomes in pediatric patients.MethodsThis is a single‐center retrospective review of pediatric patients listed for HT between January 1, 2009, and July 1, 2018. Patients were selected based on the presence of any underlying syndromes, which included chromosomal anomalies, skeletal myopathies, connective tissue disorders, mitochondrial disease,and other systemic disorders. Waitlist and post–HT outcomes were compared to those without SA.ResultsA total of 243 patients were listed for HT, of which 21 (9%) patients had associated SA. Of those, 16 (76%) survived to transplant, 3 (14%) died while on the waitlist, 1 (5%) improved and was removed from the waitlist, and 1 (5%) patient is currently listed. Waitlist survival was not different between those with/without an associated syndrome (P = 1.0). Among those who survived to HT, there was no difference in listing days (70 vs 90, P = .8), survival to hospital discharge [14 (93%) vs 150 (95%), P = .6], post‐HT intubation days (2 vs 2 days, P = .6), or post‐HT hospital length of stay (18 vs 18 days, P = .8). Overall survival during the study period post‐HT was not different between groups (P = .8).ConclusionA SA was present in 9% of pediatric patients wait‐listed for HT, but was not associated with an increased waitlist mortality or post‐HT hospital morbidity or long‐term survival. For several anomalies, HT is safe and feasible.

BackgroundIdeal "cardiovascular health" (CVH)-optimal diet, exercise, nonsmoking, BMI, BP, lipids, and glucose-is associated with healthy longevity in adults. Pediatric heart transplant (HT) patients may be at risk for suboptimal CVH. MethodsSingle-center retrospective study of HT patients 2003HT patients -2014 who survived 1 year post-transplant. Five CVH metrics were collected at listing, 1, 3 and 5 years post-transplant (diet and exercise were unavailable). CVH was scored by summing individual metrics: ideal = 2, intermediate = 1, and poor = 0 points; total scores of 8-10 points were considered high (favorable). CVH was compared between HT patients and the US pediatric population (GP) utilizing NHANES 2007-2016. Logistic regression was performed to examine the association of CVH 1 year posttransplant with a composite adverse outcome (death, re-listing, coronary vasculopathy, or chronic kidney disease) 3 years post-transplant. ResultsWe included 110 HT patients (median age at HT: 6 years [range 0.1-21]) and 19,081 NHANES participants. CVH scores among HT patients were generally high at listing (75%), 1 (74%), 3 (87%) and 5 (76%) years post-transplant and similar to GP, but some metrics (e.g., glucose) were worse among HT patients. Among HT patients, CVH was poorer with older age and non-Caucasian race/ethnicity. Per 1-point higher CVH score, the demographic-adjusted OR for adverse outcomes was 0.95 (95% CI, 0.7-1.4). ConclusionsHT patients had generally favorable CVH, but some metrics were unfavorable and CVH varied by age and race/ethnicity. No signi cant association was detected between CVH and adverse outcomes in this small sample, but study in a larger sample is warranted. BackgroundSurvival after pediatric heart transplant (HT) has improved over time, with more than half of recipients now living at least 17 years after HT (1, 2). Two of the main factors limiting long-term survival among pediatric HT recipients are coronary allograft vasculopathy (CAV) (3) and chronic kidney disease (CKD) (1). Evidence-based preventive strategies are elusive, but observational data in pediatric and adult HT recipients suggest that traditional cardiovascular risk factors, such as dyslipidemia and obesity, are associated with increased risk for these complications (4-6). Previous studies have shown that pediatric HT recipients have elevated levels of total cholesterol (TC) and triglycerides and lower levels of high density lipoprotein (HDL-C) when compared to the general pediatric population (7-10). As dyslipidemia is associated with CAV development in adult HT recipients, a icted patients may be at increased cardiovascular risk (4,5,(11)(12)(13)(14). CKD, also known to increase mortality and morbidity in both adult and pediatric HT recipients, is also exacerbated by cardiovascular risk factors (15,16). Despite the continued trend of increased obesity seen in the general pediatric population, with 17% of children between the ages of 2-19 years classi ed as obese and 5.8% as morbidly obese (17), there have been limited data o...