Perioperative factors associated with in-hospital mortality or retransplantation in pediatric heart transplant recipients

Rachel D. Vanderlaan, Cedric Manlhiot, Jennifer Conway, Osami Honjo, Brian W. McCrindle, Anne I. Dipchand

Research output: Contribution to journalArticle

Abstract

Objective Despite improved long-term survival after pediatric heart transplantation, perioperative mortality has remained high. We sought to understand the factors associated with perioperative graft loss after pediatric heart transplantation. Methods The factors associated with primary heart transplant mortality and retransplantation before hospital discharge in 226 pediatric heart transplant recipients (1995-2010) at a single-center institution were analyzed using multivariable logistic regression models adjusted for age at surgery and year of surgery. Results A total of 26 patients died (n = 21) or underwent retransplantion (n = 5) before hospital discharge secondary to primary graft failure (n = 10), multisystem organ failure (n = 5), infection (n = 4), rejection (n = 2), and perioperative complications (n = 5). United Network for Organ Sharing status 1 (vs status 2) at transplantation was associated with an increased odds of death from noncardiac causes (odd ratio [OR], 4.7; 95% confidence level [CI], 1.2-22.3; P =.002). The factors associated with increased odds of perioperative mortality or retransplant were pre- and post-transplant extracorporeal membrane oxygenation (OR, 5.3; 95% CI, 1.5-18.7; P =.01; and OR, 25.9; 95% CI, 7.0-95.9; P <.001), longer ischemic times (OR, 1.4 per 30 minutes; 95% CI, 1.0-2.0; P =.04), reoperation after transplantation (OR, 3.5; 95% CI, 1.2-10.4; P =.02), and transplantation before 2002 (OR, 4.5; 95% CI, 1.4-14.9; P =.01), respectively. Conclusions The use of extracorporeal membrane oxygenation (both before and after transplantation), a longer ischemic time, and reoperation were key factors associated with perioperative graft loss, with noncardiac mortality closely related to United Network for Organ Sharing status at heart transplantation. Knowledge of the perioperative risk factors and how they affect graft survival will help guide difficult decisions around eligibility, timing of primary listing, and appropriateness for retransplantation, and potentially affect long-term survival.

Original languageEnglish (US)
Pages (from-to)282-289
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume148
Issue number1
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Hospital Mortality
Odds Ratio
Pediatrics
Transplants
Heart Transplantation
Transplantation
Extracorporeal Membrane Oxygenation
Mortality
Reoperation
Logistic Models
Graft Survival
Transplant Recipients
Cause of Death
Survival
Infection

ASJC Scopus subject areas

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

Cite this

Perioperative factors associated with in-hospital mortality or retransplantation in pediatric heart transplant recipients. / Vanderlaan, Rachel D.; Manlhiot, Cedric; Conway, Jennifer; Honjo, Osami; McCrindle, Brian W.; Dipchand, Anne I.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 148, No. 1, 01.01.2014, p. 282-289.

Research output: Contribution to journalArticle

Vanderlaan, Rachel D. ; Manlhiot, Cedric ; Conway, Jennifer ; Honjo, Osami ; McCrindle, Brian W. ; Dipchand, Anne I. / Perioperative factors associated with in-hospital mortality or retransplantation in pediatric heart transplant recipients. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 148, No. 1. pp. 282-289.
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abstract = "Objective Despite improved long-term survival after pediatric heart transplantation, perioperative mortality has remained high. We sought to understand the factors associated with perioperative graft loss after pediatric heart transplantation. Methods The factors associated with primary heart transplant mortality and retransplantation before hospital discharge in 226 pediatric heart transplant recipients (1995-2010) at a single-center institution were analyzed using multivariable logistic regression models adjusted for age at surgery and year of surgery. Results A total of 26 patients died (n = 21) or underwent retransplantion (n = 5) before hospital discharge secondary to primary graft failure (n = 10), multisystem organ failure (n = 5), infection (n = 4), rejection (n = 2), and perioperative complications (n = 5). United Network for Organ Sharing status 1 (vs status 2) at transplantation was associated with an increased odds of death from noncardiac causes (odd ratio [OR], 4.7; 95{\%} confidence level [CI], 1.2-22.3; P =.002). The factors associated with increased odds of perioperative mortality or retransplant were pre- and post-transplant extracorporeal membrane oxygenation (OR, 5.3; 95{\%} CI, 1.5-18.7; P =.01; and OR, 25.9; 95{\%} CI, 7.0-95.9; P <.001), longer ischemic times (OR, 1.4 per 30 minutes; 95{\%} CI, 1.0-2.0; P =.04), reoperation after transplantation (OR, 3.5; 95{\%} CI, 1.2-10.4; P =.02), and transplantation before 2002 (OR, 4.5; 95{\%} CI, 1.4-14.9; P =.01), respectively. Conclusions The use of extracorporeal membrane oxygenation (both before and after transplantation), a longer ischemic time, and reoperation were key factors associated with perioperative graft loss, with noncardiac mortality closely related to United Network for Organ Sharing status at heart transplantation. Knowledge of the perioperative risk factors and how they affect graft survival will help guide difficult decisions around eligibility, timing of primary listing, and appropriateness for retransplantation, and potentially affect long-term survival.",
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T1 - Perioperative factors associated with in-hospital mortality or retransplantation in pediatric heart transplant recipients

AU - Vanderlaan, Rachel D.

AU - Manlhiot, Cedric

AU - Conway, Jennifer

AU - Honjo, Osami

AU - McCrindle, Brian W.

AU - Dipchand, Anne I.

PY - 2014/1/1

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N2 - Objective Despite improved long-term survival after pediatric heart transplantation, perioperative mortality has remained high. We sought to understand the factors associated with perioperative graft loss after pediatric heart transplantation. Methods The factors associated with primary heart transplant mortality and retransplantation before hospital discharge in 226 pediatric heart transplant recipients (1995-2010) at a single-center institution were analyzed using multivariable logistic regression models adjusted for age at surgery and year of surgery. Results A total of 26 patients died (n = 21) or underwent retransplantion (n = 5) before hospital discharge secondary to primary graft failure (n = 10), multisystem organ failure (n = 5), infection (n = 4), rejection (n = 2), and perioperative complications (n = 5). United Network for Organ Sharing status 1 (vs status 2) at transplantation was associated with an increased odds of death from noncardiac causes (odd ratio [OR], 4.7; 95% confidence level [CI], 1.2-22.3; P =.002). The factors associated with increased odds of perioperative mortality or retransplant were pre- and post-transplant extracorporeal membrane oxygenation (OR, 5.3; 95% CI, 1.5-18.7; P =.01; and OR, 25.9; 95% CI, 7.0-95.9; P <.001), longer ischemic times (OR, 1.4 per 30 minutes; 95% CI, 1.0-2.0; P =.04), reoperation after transplantation (OR, 3.5; 95% CI, 1.2-10.4; P =.02), and transplantation before 2002 (OR, 4.5; 95% CI, 1.4-14.9; P =.01), respectively. Conclusions The use of extracorporeal membrane oxygenation (both before and after transplantation), a longer ischemic time, and reoperation were key factors associated with perioperative graft loss, with noncardiac mortality closely related to United Network for Organ Sharing status at heart transplantation. Knowledge of the perioperative risk factors and how they affect graft survival will help guide difficult decisions around eligibility, timing of primary listing, and appropriateness for retransplantation, and potentially affect long-term survival.

AB - Objective Despite improved long-term survival after pediatric heart transplantation, perioperative mortality has remained high. We sought to understand the factors associated with perioperative graft loss after pediatric heart transplantation. Methods The factors associated with primary heart transplant mortality and retransplantation before hospital discharge in 226 pediatric heart transplant recipients (1995-2010) at a single-center institution were analyzed using multivariable logistic regression models adjusted for age at surgery and year of surgery. Results A total of 26 patients died (n = 21) or underwent retransplantion (n = 5) before hospital discharge secondary to primary graft failure (n = 10), multisystem organ failure (n = 5), infection (n = 4), rejection (n = 2), and perioperative complications (n = 5). United Network for Organ Sharing status 1 (vs status 2) at transplantation was associated with an increased odds of death from noncardiac causes (odd ratio [OR], 4.7; 95% confidence level [CI], 1.2-22.3; P =.002). The factors associated with increased odds of perioperative mortality or retransplant were pre- and post-transplant extracorporeal membrane oxygenation (OR, 5.3; 95% CI, 1.5-18.7; P =.01; and OR, 25.9; 95% CI, 7.0-95.9; P <.001), longer ischemic times (OR, 1.4 per 30 minutes; 95% CI, 1.0-2.0; P =.04), reoperation after transplantation (OR, 3.5; 95% CI, 1.2-10.4; P =.02), and transplantation before 2002 (OR, 4.5; 95% CI, 1.4-14.9; P =.01), respectively. Conclusions The use of extracorporeal membrane oxygenation (both before and after transplantation), a longer ischemic time, and reoperation were key factors associated with perioperative graft loss, with noncardiac mortality closely related to United Network for Organ Sharing status at heart transplantation. Knowledge of the perioperative risk factors and how they affect graft survival will help guide difficult decisions around eligibility, timing of primary listing, and appropriateness for retransplantation, and potentially affect long-term survival.

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