-
Tytuł:
-
The evolution of pediatric heart retransplantation over three decades: An analysis from the PHTS.
-
Autorzy:
-
Vazquez Alvarez MDC; Labatt Family Heart Center, Hospital for the Sick Children, Toronto, Ontario, Canada.
Cantor R; University of Alabama at Birmingham, Birmingham, Alabama.
Koehl D; University of Alabama at Birmingham, Birmingham, Alabama.
Nandi D; The Heart Center, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
Kemna MS; Seattle Children's Hospital, Seattle, Washington.
Urschel S; Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
West SC; UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Lin KY; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Lim HM; University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
Allain-Rooney T; Labatt Family Heart Center, Hospital for the Sick Children, Toronto, Ontario, Canada.
Dipchand AI; Labatt Family Heart Center, Hospital for the Sick Children, Toronto, Ontario, Canada. Electronic address: .
-
Źródło:
-
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2022 Jun; Vol. 41 (6), pp. 791-801. Date of Electronic Publication: 2022 Mar 14.
-
Typ publikacji:
-
Journal Article
-
Język:
-
English
-
Imprint Name(s):
-
Publication: 1999- : New York, NY : Elsevier
Original Publication: St. Louis, Mo. : Mosby-Year Book, Inc., c1991-
-
MeSH Terms:
-
Heart Transplantation*
Heart-Assist Devices*
Child ; Graft Rejection/epidemiology ; Graft Survival ; Humans ; Reoperation ; Retrospective Studies ; Risk Factors
-
Contributed Indexing:
-
Keywords: heart transplantation; outcomes; pediatric; retransplantation
-
Entry Date(s):
-
Date Created: 20220411 Date Completed: 20220525 Latest Revision: 20220616
-
Update Code:
-
20240105
-
DOI:
-
10.1016/j.healun.2022.02.018
-
PMID:
-
35400589
-
Background: Retransplantation is rare and associated with worse survival and more morbidity. The study aim is to describe an updated cohort of pediatric retransplants, determine if there has been an era effect on outcomes, and understand if identified trends are explained by changes in patient selection.
Methods: Pediatric Heart Transplant Society database analysis of retransplantation patients <18 years of age (Era 1: 1993-2001, Era 2: 2002-2010, Era 3: 2011-2018). Multivariate analysis identified risk factors for graft loss. Multiphase parametric hazard modeling was used to depict era and risk factor effect.
Results: Survival was lower (p < .0001) for retransplant (n = 222) compared to primary transplant (n = 6548) (median 9.3 vs 20.2 years). Median survival increased from Era 1 to 2 (4.8 vs 9.3 years; p < .0001) with no incremental change in Era 3. Era 2 and 3 retransplants had a longer inter-transplant interval (p < .0001), were less frequently for early graft failure (p = .0004) or acute rejection (p = .007), more frequently from a ventricular assist device (p = .0014), and less frequently from extracorporeal membrane oxygenation (p = .0024). Predictors of graft loss included Era 1 (HR 10.55, p = .001), congenital heart disease (HR 4.42, p = .01), inter-transplant interval <1 year (HR 5.34, p = .002), and mechanical support (ventricular assist device HR 7.47, p = .0042; extracorporeal membrane oxygenation HR 10.09, p < .0001). For each 1-year increase in inter-transplant interval, graft loss risk decreased by 1.15 (p = .0002). Retransplantation was associated with more rejection, infection, and allograft vasculopathy.
Conclusions: Graft survival has improved in pediatric retransplants making it a viable option in select patients. Retransplantation should be avoided in the setting of early graft failure especially requiring mechanical support.
Competing Interests: Disclosure statement The authors have no conflicts of interest to disclose.
(Copyright © 2022 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
