Risk factors for specific causes of death following pediatric heart transplant: An analysis of the registry of the International Society of Heart and Lung Transplantation

We sought to determine temporal changes in COD and identify COD‐specific risk factors in pediatric primary HTx recipients. Using the ISHLT registry, time‐dependent hazard of death after pediatric HTx, stratified by COD, was analyzed by multiphasic parametric hazard modeling with multivariable regres...

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Bibliographic Details
Published in:Pediatric transplantation 2015-12, Vol.19 (8), p.896-905
Main Authors: Vanderlaan, R. D., Manlhiot, C., Edwards, L. B., Conway, J., McCrindle, B. W., Dipchand, A. I.
Format: Article
Language:English
Subjects:
Adolescent
Animals
Cause of Death
Child
Child, Preschool
extracorporeal membrane oxygenation
Female
Follow-Up Studies
Global Health
heart transplant
Heart Transplantation - mortality
Humans
Infant
Infant, Newborn
Male
Multivariate Analysis
Outcome Assessment (Health Care)
pediatric
Postoperative Complications - mortality
Registries
Regression Analysis
Retrospective Studies
Risk Factors
Time Factors
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Summary:We sought to determine temporal changes in COD and identify COD‐specific risk factors in pediatric primary HTx recipients. Using the ISHLT registry, time‐dependent hazard of death after pediatric HTx, stratified by COD, was analyzed by multiphasic parametric hazard modeling with multivariable regression models for risk factor analysis. The proportion of pediatric HTx deaths from each of cardiovascular cause, allograft vasculopathy, and malignancy increased over time, while all other COD decreased post‐HTx. Pre‐HTx ECMO was associated with increased risk of death from graft failure (HR 2.43; p < 0.001), infection (HR 2.85; p < 0.001), and MOF (HR 2.22; p = 0.001), while post‐HTx ECMO was associated with death from cerebrovascular events/bleed (HR 2.55; p = 0.001). CHD was associated with deaths due to pulmonary causes (HR 1.78; p = 0.007) or infection (HR 1.72; p < 0.001). Non‐adherence was a significant risk factor for all cardiac COD, notably graft failure (HR 1.66; p = 0.001) and rejection (HR 1.89; p < 0.001). Risk factors related to specific COD are varied across different temporal phases post‐HTx. Increased understanding of these factors will assist in risk stratification, guide anticipatory clinical decisions, and potentially improve patient survival.
ISSN:1397-3142
1399-3046
DOI:10.1111/petr.12594