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; Henderson, Heather; Beddows, Kimberly; Fricker, F. Jay; Mahle, William T.

doi:10.1016/j.healun.2014.04.021

Cited by 17 publications

(23 citation statements)

References 19 publications

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“…The lack of cardiac catheterization data in 70% of pediatric patients in the UNOS database significantly reduces the ability to make broadly generalizable conclusions. The completeness of hemodynamic data in the UNOS database mirrors that found in other studies suggesting that a large number of pediatric patients currently undergo transplantation without the need for hemodynamic assessment via catheterization . The risks associated with catheterization in infants and children combined with the presumption of a high rate of reversibility of pulmonary hypertension in young patients call into question the need for pre‐OHT catheterization in appropriately selected patients ; our sensitivity analysis of survival in patients without PVRI data (Fig.…”

Section: Discussionsupporting

confidence: 62%

Elevated pretransplant pulmonary vascular resistance index does not predict mortality after isolated orthotopic heart transplantation in children: A retrospective analysis of the UNOS database

Chiu

Schaffer

Sheikh

et al. 2015

Pediatric Transplantation

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OHT is the definitive therapy in end-stage heart failure. Elevated PVRI is considered a relative contraindication to isolated OHT; this assumption is re-evaluated using data from the UNOS database. A retrospective review of de-identified data from the UNOS dataset was performed. There were 1943 pediatric OHT recipients between 10/87 and 12/11 with sufficient data for analysis. Cox regression was performed to examine the effect of baseline characteristics on post-transplant survival. Patients were propensity matched, and Kaplan-Meier survival analysis was performed comparing cohorts of patients using thresholds of 6 and 9 WU × m(2) . PVRI was not a significant predictor of post-transplant outcomes in either univariate or multivariate Cox regression. Kaplan-Meier analysis revealed no difference in survival between both unmatched and propensity-matched OHT recipients. In conclusion, elevated PVRI was not associated with post-transplant mortality in pediatric OHT recipients. A prospective study assessing the current use of PVRI ≥6 as a threshold to contraindicate isolated OHT should be undertaken. Removing this potentially unnecessary restriction on transplant candidacy may make this life-saving therapy available to a greater number of patients.

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Section: Discussionsupporting

confidence: 62%

Elevated pretransplant pulmonary vascular resistance index does not predict mortality after isolated orthotopic heart transplantation in children: A retrospective analysis of the UNOS database

Chiu

Schaffer

Sheikh

et al. 2015

Pediatric Transplantation

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“…These findings support the conclusions of several studies which suggest that PVRi is not an accurate predictor of post‐transplant mortality in pediatric heart recipients . Several explanations have been proposed as to why PVRi may not be an appropriate tool for HTx risk assessment in this population, most of which center around the fact that PVRi is a calculated (as opposed to directly measured) variable.…”

Section: Discussionsupporting

confidence: 87%

“…Several explanations have been proposed as to why PVRi may not be an appropriate tool for HTx risk assessment in this population, most of which center around the fact that PVRi is a calculated (as opposed to directly measured) variable. Specifically, calculation of PVRi depends on reliable determination of cardiac output, for which most laboratories utilize assumed values for oxygen consumption (based on norms for age) that may be inaccurate when applied to patients with end‐stage heart failure . Furthermore, patients with CHD can have a variety of anatomic and/or physiologic abnormalities that make assessment of pulmonary blood flow—and therefore PVRi—very difficult, if not impossible .…”

Section: Discussionmentioning

confidence: 99%

Diastolic pressure indices offer a novel approach to predicting risk of graft loss after pediatric heart transplant

Albers

Bradford

Friedland‐Little

et al. 2018

Pediatric Transplantation

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PH is a risk factor for GL after HTx. However, traditional parameters are not reliable predictors of risk in children. We hypothesized that DPI (dPAP and DPG) are predictive of GL in pediatric HTx recipients. The UNOS/SRTR database was reviewed to identify pediatric HTx recipients (age <18 years) between 1994 and 2013. Recipients with pretransplant hemodynamic data were grouped by diagnosis (CMP or CHD), and the groups were analyzed separately. Bivariate Cox regression analysis examined the association between hemodynamic variables and GL. DPI showed the strongest association with early GL in recipients with CMP (dPAP: HR = 1.25 [1.09-1.42]; DPG: 1.24 [1.11-1.38]). Among CHD recipients, DPI were associated with early GL in those with preexisting PH (dPAP: HR = 1.16 [1.01-1.33]; DPG: HR = 1.10 [1.00-1.21]). No cutoff values for "high-risk" DPI were identified, but a continuous relationship between higher DPI and risk of early GL was observed. DPI are associated with early GL in select pediatric HTx recipients. Our findings suggest that DPI should be considered as part of routine hemodynamic assessment for pediatric HTx candidates.

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“…They also performed propensity matching of the cohorts to control for other variables, including missing catheterization information, and still found no influence of PVRI on outcomes. These findings are similar to other recent analysis by the Pediatric Heart Transplant Study Group where a PVRI of 5 Woods units × m 2 was also not associated with decreased survival in a large, multicenter, pediatric cohort .…”

supporting

confidence: 91%

The influence of pulmonary resistance on the success of pediatric heart transplantation: Are there still boundaries?

Castleberry

Canter

2015

Pediatric Transplantation

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

Cited by 17 publications

References 19 publications

Elevated pretransplant pulmonary vascular resistance index does not predict mortality after isolated orthotopic heart transplantation in children: A retrospective analysis of the UNOS database

Elevated pretransplant pulmonary vascular resistance index does not predict mortality after isolated orthotopic heart transplantation in children: A retrospective analysis of the UNOS database

Diastolic pressure indices offer a novel approach to predicting risk of graft loss after pediatric heart transplant

The influence of pulmonary resistance on the success of pediatric heart transplantation: Are there still boundaries?

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