Survival and risk factors for death after cardiac transplantation in infants: A multi-institutional study

Canter, Charles; Naftel, David C.; Caldwell, Randall L.; Chinnock, Richard; Pahl, E.; Frazier, Elizabeth A.; Kirklin, James K.; Boucek, Mark M.; Morrow, Robert

doi:10.1016/s0735-1097(96)81603-2

Cited by 25 publications

(34 citation statements)

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“…23,24 As in an earlier report from this institution, 25 results in the pediatric population were comparable to those in the adult population in this study. However, a pretransplant diagnosis of congenital heart disease remains a risk factor for early death after cardiac transplantation.…”

Section: Discussionsupporting

confidence: 88%

Impact of Current Management Practices on Early and Late Death in More Than 500 Consecutive Cardiac Transplant Recipients

John¹,

Rajasinghe²,

Chen³

et al. 2000

Annals of Surgery

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ObjectiveTo study risk factors for early and late death after heart transplantation in the current era. Summary Background DataThe current cardiac transplant population differs from earlier periods in that an increasing number of sicker patients, such as those with ventricular assist device (LVAD) support, prior cardiac allotransplantation, and pulmonary hypertension, are undergoing transplantation. In addition, sensitized patients constitute a greater proportion of the transplanted population. Emphasis has been placed on therapies to prevent early graft loss, such as the use of nitric oxide and improved immunosuppression, in addition to newer therapies. MethodsFive hundred thirty-six patients undergoing heart transplantation between 1993 and 1999 at a single center were evaluated (464 adults and 72 children; 109 had received prior LVAD support and 24 underwent retransplantation). The mean patient age at transplantation was 44.9 years. Logistic regression and Cox proportional hazard models were used to evaluate the following risk factors on survival: donor and recipient demographics, ischemic time, LVAD, retransplantation, pretransplant pulmonary vascular resistance, and immunologic variables (ABO, HLA matching, and pretransplant anti-HLA antibodies). ResultsThe rate of early death (less than 30 days) was 8.5% in adults and 8.8% in children. The actuarial survival rate of the 536 patients was 83%, 77%, and 71% at 1, 3, and 5 years, respectively, by Kaplan Meier analysis. Risk factors adversely affecting survival included the year of transplant, donor age, and donor-recipient gender mismatching. Neither early nor late death was influenced by elevated pulmonary vascular resistance, sensitization, prior LVAD support, or prior cardiac allotransplantation. ConclusionsPreviously identified risk factors did not adversely affect shortor long-term survival of heart transplant recipients in the current era. The steady improvement in survival during this period argues that advances in transplantation have offset the increasing acuity of transplant recipients.

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Section: Discussionsupporting

confidence: 88%

Impact of Current Management Practices on Early and Late Death in More Than 500 Consecutive Cardiac Transplant Recipients

John¹,

Rajasinghe²,

Chen³

et al. 2000

Annals of Surgery

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“…1 However, the decision to list patients with known risk factors for mortality, particularly in the context of limited donor availability, 2 remains one of the most significant challenges facing clinicians. Several retrospective studies have identified risk factors for post-HTx mortality and primary graft failure, [2][3][4][5][6][7] but variable reports of significant risk factors have complicated clinicians' ability to adequately assess postoperative risk. Although helpful in clinical decision making, the presence of a dichotomous risk factor does not allow the accurate prediction of an individual patient's overall HTx risk.…”

mentioning

confidence: 99%

“…Although the PHTS has previously published analyses of risk factors among patient subgroups, 5,6,[9][10][11][12][13][14][15][16][17][18] it has never examined risk factors in detail among the entire population of pediatric transplant recipients. Given this background, using the available data from the PHTS group, we aimed to identify independent risk factors for 1-year graft loss in pre-HTx children after stratifying by disease pathogenesis (CHD and cardiomyopathy) and to assess our ability to accurately predict graft loss using available risk factor data.…”

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confidence: 99%

Predicting Graft Loss by 1 Year in Pediatric Heart Transplantation Candidates

et al. 2015

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Background-Pediatric data on the impact of pre-heart transplantation (HTx) risk factors on early post-HTx outcomes remain inconclusive. Thus, among patients with previous congenital heart disease or cardiomyopathy, disease-specific risk models for graft loss were developed with the use pre-HTx recipient and donor characteristics. Methods and Results-Patients enrolled in the Pediatric Heart Transplant Study (PHTS) from 1996 to 2006 were stratified by pre-HTx diagnosis into cardiomyopathy and congenital heart disease cohorts. Logistic regression identified independent, pre-HTx risk factors. Risk models were constructed for 1-year post-HTx graft loss. Donor factors were added for model refinement. The models were validated with the use of patients transplanted from 2007 to 2009. Risk factors for graft loss were identified in patients with cardiomyopathy (n=896) and congenital heart disease (n=965). For cardiomyopathy, independent risk factors were earlier year of transplantation, nonwhite race, female sex, diagnosis other than dilated cardiomyopathy, higher blood urea nitrogen, and panel reactive antibody >10%. The recipient characteristic risk model had good accuracy in the validation cohort, with predicted versus actual survival of 97.5% versus 95.3% (C statistic, 0.73). For patients with congenital heart disease, independent risk factors were nonwhite race, history of Fontan, ventilator dependence, higher blood urea nitrogen, panel reactive antibody >10%, and lower body surface area. The risk model was less accurate, with 86.6% predicted versus 92.4% actual survival, in the validation cohort (C statistic, 0.63). Donor characteristics did not enhance model precision. Conclusions-Risk factors for 1-year post-HTx graft loss differ on the basis of pre-HTx cardiac diagnosis. Modeling effectively stratifies the risk of graft loss in patients with cardiomyopathy and may be an adjunctive tool in allocation policies and center performance metrics.

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“…Survival as high as 77% at 1 year and 65% at 5 years has been reported [8]. Patients are considered for transplant when, despite optimum medical therapy, they show progressive deterioration in symptomatology or ventricular function, show profound growth failure, develop life-threatening arrhythmia, require ongoing intravenous inotropic support, or exhibit an unacceptably poor quality of life [10].…”

Section: Surgical Managementmentioning

confidence: 99%

Chronic cardiac failure in children due to dilated cardiomyopathy: diagnostic approach, pathophysiology and management

Venugopalan¹,

Agarwal²,

Worthing

2000

European Journal of Pediatrics

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Current understanding of the pathophysiology of chronic congestive cardiac failure resulting from dilated cardiomyopathy has shifted management strategy from steps that directly improve myocardial function to those that modulate the neuroendocrine profile and peripheral vascular reactivity. Similar advances in therapeutic applications would be assisted by controlled studies and full licensing of drugs for use in children. Medical intervention will remain the cornerstone of management until advances in surgical techniques become more widely available.

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Survival and risk factors for death after cardiac transplantation in infants: A multi-institutional study

Cited by 25 publications

References 0 publications

Impact of Current Management Practices on Early and Late Death in More Than 500 Consecutive Cardiac Transplant Recipients

Impact of Current Management Practices on Early and Late Death in More Than 500 Consecutive Cardiac Transplant Recipients

Predicting Graft Loss by 1 Year in Pediatric Heart Transplantation Candidates

Chronic cardiac failure in children due to dilated cardiomyopathy: diagnostic approach, pathophysiology and management

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