Intermediate follow-up of pediatric heart transplant recipients with elevated pulmonary vascular resistance index

• Published in: Journal of the American College of Cardiology 1994-06, Vol.23 (7), p.1682-1687
• Main Authors: Gajarski, Robert J., Towbin, Jeffrey A., Bricker, J.Timothy, Radovancevic, Branislav, Frazier, O.Howard, Price, Julia K., Schowengerdt, Kenneth O., Denfield, Susan W.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Child; Child, Preschool; Female; Follow-Up Studies; Heart Transplantation; Humans; Male; Medical sciences; Pulmonary Artery - physiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Vascular Resistance - physiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(94)90675-0

Objectives. This study examined perioperative and intermediate outcomes in pediatric cardiac transplant recipients who had elevated pulmonary vascular resistance indexes preoperatively. Background. Elevated pulmonary vascular resistance was associated with poor outcome in previous studies and constitutes a relative contraindication to transplantation. Few studies have evaluated this poor outcome risk factor in pediatric patients. Methods. To evaluate outcomes of nonneonatal transplant recipients, records were reviewed and divided into Group I (preoperative pulmonary vascular resistance index ≥6 units·m2) and Group II (pulmonary vascular resistance index 0.25). Donor ischemic time was 215 min for Group I and 225 min for Group II (p > 0.75). Intensive care unit stay was 11.5 days in Group I and 15.1 days in Group II (p = 0.20). Infection rate was 38% in both groups (p > 0.80). Arrhythmias occurred in 90% of Group I and 42% of Group II (p < 0.03) patients. Pulmonary resistance index in Group I decreased from 11.5 ± 3.5 to 3.3 ± 1.2 units·m2(p < 0.03) by the first posttransplantation biopsy and have not changed subsequently. During 2.3 years (range 0.3 to 8.5) of follow-up, the mortality rate was 25% and 21% for Groups I and II, respectively (p > 0.80). Conclusions. Group I patients did not require significantly oversized donors, restricted donor locations or longer intensive care unit stays or have higher infection rates; however, arrhythmias were more frequent. Pulmonary resistance index normalized early after transplantation. Pulmonary vascular reactivity may be mor