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542: Simultaneous Heart-Kidney Transplantation in Children – Are the Outcomes as Bad as We Think: An Analysis of the United Network for Organ Sharing Database
The Journal of Heart and Lung Transplantation Volume 27, Number 2S
Abstracts
survival at 5 yrs-76%, 10yrs-61%, and 15 yrs-56%. This compared to an overall survival of 37% in the IT ⬎ 6 hrs group with survival at 5 yrs-70%, 10 yrs-53%, and 15 yrs-37% (p⫽0.02). Conclusions: In conclusion, there was no statistical difference in GL, death or CAD in pediatric heart transplant recipients receiving donor organs with a prolonged ischemic time. There may be a difference in survival late. Tx Age (yrs)
Yrs F/U GL
Death
GL 1st yr CAD
Acute Rejection
IT⬍ 6 0.3 (0-17.8) 8.5 (0-22) 134 (40%) 117 (35%) 52 (15%) 26 (8%) 19 (6%) hrs IT ⬎ 6 0.3 (0.01-17.1) 6.5 (0-18) 62 (50%) 52 (42%) 24 (20%) 13 (11%) 11 (9%) hrs
541 Association of Left Ventricular Dilation at Listing for Heart Transplant with Post-Listing and Early Post-Transplant Survival in Pediatric Dilated Cardiomyopathy T.P. Singh,1 L.A. Sleeper,2 S. Lipshultz,3 A. Cinar,2 C. Canter,4 S.A. Webber,5 D. Bernstein,6 E. Pahl,7 J. Alvarez,3 J.A. Towbin,8 S.A. Colan,1 1Cardiology, Children’s Hospital Boston, Boston, MA; 2 New England Research Institute, Watertown, MA; 3University of Miami School of Medicine, Miami, FL; 4Washington University, St. Louis, MO; 5Children’s Hospital of Pittsburgh, Pittsburgh, PA; 6 Stanford University, Paolo Alto, CA; 7Children’s Memorial Hospital, Chicago, IL; 8Texas Children’s Hospital, Houston, TX Purpose: In patients with dilated cardiomyopathy (DCM), the magnitude of cardiac remodeling often determines the clinical severity of heart failure. Whether it affects survival in those listed for heart transplant (TX) is not known. We sought to determine if measures of left ventricular (LV) dilation and systolic dysfunction in children with DCM at the time of listing for TX are associated with survival while waiting for and early after TX (6 months post-TX). Methods and Materials: We analyzed echocardiographic data close to listing (⫾6 months) and clinical data from 261 children with DCM in a merged multi-center database between the Pediatric Cardiomyopathy Registry (PCMR) and Pediatric Heart Transplant Study (PHTS), using multivariate Cox proportional hazards modeling with timedependent TX status. Results: The median ages at diagnosis, listing and TX (N⫽208) were 2.5 (IQR, 0.4 to 12.1), 3.7 and 5.4 years respectively. Median time to listing post DCM-diagnosis was 0.6 yrs and to TX post-listing was 0.1 years. There were 42 deaths (29 during waiting and 13 within 6 months post-TX). LV end-diastolic dimension (EDD) z-score close to listing was a significant predictor of death (Relative Risk [RR] 1.20, 95% confidence interval [CI] 1.02-1.41, P⫽0.03) in a model that included age at diagnosis (RR 1.08, 95% CI 1.02-1.14), white race (RR 0.59, 95% CI 0.28-1.22) and TX (RR 0.06, 95% CI 0.03-0.14). Thus, a child with a body surface area of 1 m2, with an LVEDD one cm larger than a child with an otherwise similar profile, has a 43% higher risk of death while waiting or within 6 months of TX. Replacing EDD z value with end-systolic dimension z value in the model demonstrated a similar association. LV fractional shortening and measures of LV wall thickness and mass were not associated with outcome. Conclusions: Among children with dilated cardiomyopathy listed for transplant, those with the most severe LV dilation appear to be at highest risk of death while waiting and early post-transplant. 542 Simultaneous Heart-Kidney Transplantation in Children – Are the Outcomes as Bad as We Think: An Analysis of the United Network for Organ Sharing Database
S255
R.R. Davies,1 M.J. Russo,2 S. Mital,3 A.C. Gelijns,2 A.J. Mosckowitz,2 R.A. Sorabella,1 R.S. Mosca,1 J.M. Quagebeur,1 J.M. Chen,1 1 Cardiothoracic Surgery, Children’s Hospital of NewYorkPresbyterian, New York, NY; 2International Center for Health Outcomes and Innovations Research (InCHOIR), Columbia University, New York, NY; 3Pediatric Cardiology, Hospital for Sick Children, Toronto, ON, Canada Purpose: Renal failure requiring dialysis in the peri-transplant period has a devastating effect on survival following heart transplantation (H-TXP) in children. One recent study suggestd that in adults, simultaneous heart-kidney transplantation (HK-TXP) improves survival in patients with pre-transplant renal failure. Out aim was to evaluate whether this was also true in children. Methods and Materials: A review of the UNOS database identified 3,106 pediatric (ⱕ 18 yrs) cardiac TXP recipients 1995-2005. Of these, 15 (0.48%) had simultaneous HK-TXP. Outcomes in these patients were compared to the entire cohort (H-TXP) and to the subset of patients requiring dialysis prior to isolated H-TXP (H-TXPDIAL, n⫽76, 2.5%). Results: Patients undergoing HK-TXP were older (13.9 vs 7.1 yrs, p ⬍ 0.0001) than H-TXP patients. Other baseline comorbidities did not differ between groups, although no patients in the HK-TXP group required mechanical circulatory support (p⫽0.1225). Thirty-day mortality was similar between the HK-TXP and H-TXP groups (6.8% vs. 7.2%, p ⫽0.9365), but there was a trend toward improved 30-day survival versus the HK-TXP-DIAL group (6.8% vs. 19.7%, p ⫽ 0.2243. A similar number of patients in both groups required dialysis after transplantation (40% vs. 56.6%, p ⫽ 0.2392). Conclusions: Children undergoing simultaneous heart-kidney transplants have similar outcomes to those undergoing isolated heart transplants. Given the poor outcomes with dialysis and renal failure surrounding transplantation, effort should be directed at identifying children unlikely to recover kidney function following heart transplantation and listing them for simultaneous kidney transplantation.
543 The Impact of High-Risk Criteria on Mortality Following Heart Transplantation in Children: A Multi-Institutional Study R.R. Davies,1 J.M. Chen,1 D.C. Naftel,3 G. Boyle,7 S. Zangwill,5 R. Gajarski,6 B. Robinson,8 R. Kirk,9 D. Hsu,2 E. Blume,4
Abstracts
survival at 5 yrs-76%, 10yrs-61%, and 15 yrs-56%. This compared to an overall survival of 37% in the IT ⬎ 6 hrs group with survival at 5 yrs-70%, 10 yrs-53%, and 15 yrs-37% (p⫽0.02). Conclusions: In conclusion, there was no statistical difference in GL, death or CAD in pediatric heart transplant recipients receiving donor organs with a prolonged ischemic time. There may be a difference in survival late. Tx Age (yrs)
Yrs F/U GL
Death
GL 1st yr CAD
Acute Rejection
IT⬍ 6 0.3 (0-17.8) 8.5 (0-22) 134 (40%) 117 (35%) 52 (15%) 26 (8%) 19 (6%) hrs IT ⬎ 6 0.3 (0.01-17.1) 6.5 (0-18) 62 (50%) 52 (42%) 24 (20%) 13 (11%) 11 (9%) hrs
541 Association of Left Ventricular Dilation at Listing for Heart Transplant with Post-Listing and Early Post-Transplant Survival in Pediatric Dilated Cardiomyopathy T.P. Singh,1 L.A. Sleeper,2 S. Lipshultz,3 A. Cinar,2 C. Canter,4 S.A. Webber,5 D. Bernstein,6 E. Pahl,7 J. Alvarez,3 J.A. Towbin,8 S.A. Colan,1 1Cardiology, Children’s Hospital Boston, Boston, MA; 2 New England Research Institute, Watertown, MA; 3University of Miami School of Medicine, Miami, FL; 4Washington University, St. Louis, MO; 5Children’s Hospital of Pittsburgh, Pittsburgh, PA; 6 Stanford University, Paolo Alto, CA; 7Children’s Memorial Hospital, Chicago, IL; 8Texas Children’s Hospital, Houston, TX Purpose: In patients with dilated cardiomyopathy (DCM), the magnitude of cardiac remodeling often determines the clinical severity of heart failure. Whether it affects survival in those listed for heart transplant (TX) is not known. We sought to determine if measures of left ventricular (LV) dilation and systolic dysfunction in children with DCM at the time of listing for TX are associated with survival while waiting for and early after TX (6 months post-TX). Methods and Materials: We analyzed echocardiographic data close to listing (⫾6 months) and clinical data from 261 children with DCM in a merged multi-center database between the Pediatric Cardiomyopathy Registry (PCMR) and Pediatric Heart Transplant Study (PHTS), using multivariate Cox proportional hazards modeling with timedependent TX status. Results: The median ages at diagnosis, listing and TX (N⫽208) were 2.5 (IQR, 0.4 to 12.1), 3.7 and 5.4 years respectively. Median time to listing post DCM-diagnosis was 0.6 yrs and to TX post-listing was 0.1 years. There were 42 deaths (29 during waiting and 13 within 6 months post-TX). LV end-diastolic dimension (EDD) z-score close to listing was a significant predictor of death (Relative Risk [RR] 1.20, 95% confidence interval [CI] 1.02-1.41, P⫽0.03) in a model that included age at diagnosis (RR 1.08, 95% CI 1.02-1.14), white race (RR 0.59, 95% CI 0.28-1.22) and TX (RR 0.06, 95% CI 0.03-0.14). Thus, a child with a body surface area of 1 m2, with an LVEDD one cm larger than a child with an otherwise similar profile, has a 43% higher risk of death while waiting or within 6 months of TX. Replacing EDD z value with end-systolic dimension z value in the model demonstrated a similar association. LV fractional shortening and measures of LV wall thickness and mass were not associated with outcome. Conclusions: Among children with dilated cardiomyopathy listed for transplant, those with the most severe LV dilation appear to be at highest risk of death while waiting and early post-transplant. 542 Simultaneous Heart-Kidney Transplantation in Children – Are the Outcomes as Bad as We Think: An Analysis of the United Network for Organ Sharing Database
S255
R.R. Davies,1 M.J. Russo,2 S. Mital,3 A.C. Gelijns,2 A.J. Mosckowitz,2 R.A. Sorabella,1 R.S. Mosca,1 J.M. Quagebeur,1 J.M. Chen,1 1 Cardiothoracic Surgery, Children’s Hospital of NewYorkPresbyterian, New York, NY; 2International Center for Health Outcomes and Innovations Research (InCHOIR), Columbia University, New York, NY; 3Pediatric Cardiology, Hospital for Sick Children, Toronto, ON, Canada Purpose: Renal failure requiring dialysis in the peri-transplant period has a devastating effect on survival following heart transplantation (H-TXP) in children. One recent study suggestd that in adults, simultaneous heart-kidney transplantation (HK-TXP) improves survival in patients with pre-transplant renal failure. Out aim was to evaluate whether this was also true in children. Methods and Materials: A review of the UNOS database identified 3,106 pediatric (ⱕ 18 yrs) cardiac TXP recipients 1995-2005. Of these, 15 (0.48%) had simultaneous HK-TXP. Outcomes in these patients were compared to the entire cohort (H-TXP) and to the subset of patients requiring dialysis prior to isolated H-TXP (H-TXPDIAL, n⫽76, 2.5%). Results: Patients undergoing HK-TXP were older (13.9 vs 7.1 yrs, p ⬍ 0.0001) than H-TXP patients. Other baseline comorbidities did not differ between groups, although no patients in the HK-TXP group required mechanical circulatory support (p⫽0.1225). Thirty-day mortality was similar between the HK-TXP and H-TXP groups (6.8% vs. 7.2%, p ⫽0.9365), but there was a trend toward improved 30-day survival versus the HK-TXP-DIAL group (6.8% vs. 19.7%, p ⫽ 0.2243. A similar number of patients in both groups required dialysis after transplantation (40% vs. 56.6%, p ⫽ 0.2392). Conclusions: Children undergoing simultaneous heart-kidney transplants have similar outcomes to those undergoing isolated heart transplants. Given the poor outcomes with dialysis and renal failure surrounding transplantation, effort should be directed at identifying children unlikely to recover kidney function following heart transplantation and listing them for simultaneous kidney transplantation.
543 The Impact of High-Risk Criteria on Mortality Following Heart Transplantation in Children: A Multi-Institutional Study R.R. Davies,1 J.M. Chen,1 D.C. Naftel,3 G. Boyle,7 S. Zangwill,5 R. Gajarski,6 B. Robinson,8 R. Kirk,9 D. Hsu,2 E. Blume,4