HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Norihide Fukushima Steven R. Gundry Anees J. Razzouk Leonard L. Bailey Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fukushima, N. Articles by Bailey, L. L. Search for Related Content PubMed PubMed Citation Articles by Fukushima, N. Articles by Bailey, L. L.

J Thorac Cardiovasc Surg 1994;107:985-989
© 1994 Mosby, Inc.

CARDIAC AND PULMONARY TRANSPLANTATION

Risk factors for graft failure associated with pulmonary hypertension after pediatric heart transplantation

Loma Linda, Calif.

From Loma Linda University Medical Center, Department of Surgery, Division of Cardiothoracic Surgery, Loma Linda, Calif.

Address for reprints: Steven R. Gundry, MD, Professor of Surgery, Chief, Division of Cardiothoracic Surgery, Loma Linda University Medical Center, 11234 Anderson St., Loma Linda, CA 92354.

Abstract

Postoperative pulmonary hypertension can be a major cause of early death after heart transplantation in children. To identify predictive risk factors of pulmonary hypertension after heart transplantation, we performed a retrospective analysis of our 194 infant and pediatric recipients who underwent heart transplantation between 1987 and 1992. Because the response of pulmonary vasculature may change during growth, the patients were divided into two groups: age less than 1 year in group I (n = 152) and 1 year or older in group C (n = 43). The following risk factors were evaluated: cardiomyopathy, congenital heart disease and hypoplastic left heart syndrome, pretransplant pulmonary hypertension, history of operation, oversized donor (donor/recipient weight ratio greater than 2), donor's history of cardiopulmonary resuscitation, and prolonged graft ischemic time (graft ischemic time 360 minutes or longer). Though there was no significant difference between group I and group C in overall early mortality including early graft loss (19 of 152 versus 5 of 42), the mortality rate from pulmonary hypertension in group I was significantly lower than that in group C (2 of 152 versus 4 of 42; p < 0.05). The mortality rate from pulmonary hypertension in patients with congenital heart disease in group I was significantly lower than that in group C (0 of 44 versus 4 of 24; p < 0.05). In group I, there was no significant difference in the early mortality rate or the mortality rate from pulmonary hypertension from any factors studied. The mortality rate from pulmonary hypertension in association with prolonged graft ischemic time in group C was significantly higher than when no prolonged graft ischemic time was present in group C and with either prolonged graft ischemic time or no prolonged graft ischemic time in group I (4 of 16 versus 0 of 26, 0 of 37, and 2 of 115). In conclusion, older patients had a higher mortality rate from pulmonary hypertension after heart transplantation, especially in patients with congenital heart disease who received a graft preserved more than 6 hours. This study demonstrates another benefit of early heart transplantation in infancy, that is, prevention of death from pulmonary hypertension. (J THORACCARDIOVASCSURG1994;107:985-9)

This article has been cited by other articles:

				J. K. Kirklin Pediatric cardiac transplantation Ann. Thorac. Surg., May 1, 2000; 69(5): 1627 - 1628. [Full Text] [PDF]

				D. D. Ivy, J. P. Kinsella, J. W. Ziegler, and S. H. Abman Dipyridamole attenuates rebound pulmonary hypertension after inhaled nitric oxide withdrawal in postoperative congenital heart disease J. Thorac. Cardiovasc. Surg., April 1, 1998; 115(4): 875 - 882. [Abstract] [Full Text] [PDF]

				C. Canter, D. Naftel, R. Caldwell, R. Chinnock, E. Pahl, E. Frazier, J. Kirklin, M. Boucek, and R. Morrow Survival and Risk Factors for Death After Cardiac Transplantation in Infants : A Multi-institutional Study Circulation, July 1, 1997; 96(1): 227 - 231. [Abstract] [Full Text]

				R. E. Chinnock, R. L. Larsen, J. R. Emery, and L. L. Bailey Pretransplant Risk Factors and Causes of Death or Graft Loss After Heart Transplantation During Early Infancy Circulation, November 1, 1995; 92(9): 206 - 209. [Abstract] [Full Text]