- Email: [email protected]
87: Influence of the New Heart Allocation System on Pediatric Waitlist and Post-Transplant Survival
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The Journal of Heart and Lung Transplantation, Vol 29, No 2S, February 2010
Methods and Materials: In a two-group experimental, repeated measures design, 33 LT recipients (19 single [SLT], 14 bilateral [BLT]; 70% male, age 56⫾13.3 years) were randomized to CPT (10am, 2pm) followed by HFCWO (6pm, 10pm; n⫽16) or vice versa (n⫽17) on postop day 3. Preand post-Tx measures were pain (verbal numeric pain score), dyspnea (modified Borg score), SpO2/FiO2 ratio, and PEF. A post-Tx sequence survey assessed patient preference. Data were analyzed by chi-square, t-test, and Mixed ANOVA. Results: BLTs were significantly younger than SLTs (46⫾13.5 vs. 64⫾5.5 years, p⬍0.001). Overall, there was a statistically significant difference between mean pre- and post- PEF scores (228 vs. 235 L/min, p⫽0.038). There was a significant increase in mean post-PEF scores from 8am to 6pm and a slight decrease at 10pm (p⫽0.004). A significant LT-type, Tx order and time point interaction was found; SLT and BLT had the highest PEF scores at 6pm and 10pm, respectively (p⫽0.02). Mean post-dyspnea scores decreased from 10am to 6pm (p⫽0.003). There was a steady increase in post- SpO2/FiO2 ratios across time points (p⫽0.19). At present, there were no significant main effects for Tx-type. Majority of patients preferred HFCWO over CPT (57% vs. 39%); one patient had no preference. Conclusions: Preliminary results suggest improved lung function (dyspnea and PEF) with both CPT and HFCWO post-LT. Although no differences were found in lung function between Tx-types, patients preferred HFCWO. We speculate HFCWO is an effective, feasible alternative to CPT. Further study of both methods is needed. 85 A High-Intensity Exercise Program Decreases Self-Reported Anxiety in Cardiac Transplant Recipients: A Randomized Study S.B. Christensen,1 C.H. Dall,2 T. Hermann,1 E. Prescott,2 F. Gustafsson.1 1Rigshospitalet, Copenhagen, Denmark; 2Bispebjerg Hospital, Copenhagen, Denmark. Purpose: Little is known about the role of high-intensity aerobic exercise as mood altering intervention after cardiac transplantation. The aim of this study was to examine changes in self-reported anxiety and depression in relation to an eight-week high-intensity aerobic training program, in stable heart transplant recipients (⬎ 1 year after transplantation). Methods and Materials: A total of 27 patients (5 women, mean age 50.5 ⫹/⫺ 14.9 years) with a mean post-transplant time of 6.9 ⫾ 4.7 years were randomized to either an eight-week high-intensity aerobic training programme (N⫽14), or control (N⫽13). The training was individualized, hospital-based and performed at ⱖ80% of peak VO2 three times a week. Anxiety and depression scores were evaluated at baseline and follow-up using the HADS-A and the HADS-D standarized scoring system. Results: Anxiety evaluated by HADS-A decreased significantly in the exercise group (HADS-A from 4.7⫾1.8 to 1.8⫾0.8, P⫽0.01), but not in the control group (3.2⫾1.6 to 3.7⫾2.3, NS). Depression scores were not influenced significantly by exercise. There was no significant correlation between improvement in HADS-A score and improvement in peakVO2 or maximal workload in the exercise group (R2⫽0.20, P⫽NS). No adverse events were recorded in the exercise group. Conclusions: Participation in high-intensity aerobic training long after cardiac transplantation significantly decreases self-reported anxiety. Improvement in psychological well-being is not directly related to improvement in physical performance. High-intensity aerobic exercise is an effective intervention to reduce psychological distress in heart transplant recipients. 86 Outcomes of Children Implanted with Ventricular Assist Device Therapy: Analysis of the Interagency Registry for Mechanical Circulatory Support (INTERMACS) E.D. Blume,1 D.N. Rosenthal,2 J.M. Chen,3 C.S.D. Almond,1 P.D. Wearden,4 D.C. Naftel,5 J.K. Kirklin.5 1Children’s Hospital, Boston, MA; 2Stanford University Medical Center, Palo Alto, CA; 3 Morgan Stanley Children’s Hospital of NewYork-Presbyterian, New York, NY; 4Children’s Hospital of Pittsburgh, Pittsburgh, PA; 5 University of Alabama at Birmingham, Birmingham, AL.
Purpose: INTERMACS, a federally-supported national registry for FDAapproved durable VADs, is a unique collaboration with the central purpose of improving pt outcomes. While the number of pediatric registrants in INTERMACS is limited, an overview of the pediatric experience provides an opportunity to review the potentials and challenges of employing INTERMACS in the pediatric population. Methods and Materials: All pts reported to INTERMACS (n⫽1321) between June 2006 and March 2009 were analyzed. The pediatric cohort was defined as pts⬍19 yrs of age at the time of implant. Recipient characteristics and adverse events were reported using standardized definitions. Outcomes were analyzed using Cox proportional hazard analysis. Results: Twenty U.S. sites have enrolled 35 pediatric pts (2.5%) with a median age 16 yrs, range 4.5-18.9 yrs. Eighty-nine percent were ⬎12 yrs of age. Pediatric pts undergoing VAD implantation were evenly divided between INTERMACS heart failure profile 1-critical cardiogenic shock (n⫽16, of whom 12 were intubated) and 2 -progressive decline (n⫽15). Overall, 17 (49%) were listed for transplant at VAD implantation. Twentytwo pts (62%) received LVAD support; 10 (29%) received BIVAD support. At a median follow-up of 2.2 mos, 5 pts died (14%), 17 had been transplanted, and 4 were explanted. Children receiving BiVAD support had a higher unadjusted risk of death on device (p⫽0.02) compared to pts on LVAD support alone. Compared to adult LVAD pts, pediatric LVAD pts had a higher unadjusted hazard of infection (p⬍0.01) and neurological (p⬍0.01) adverse events. Conclusions: Although the number of enrolled subjects is small, the pediatric INTERMACS data provides important information on the VAD experience in children. Outcomes appear favorable and support the continued development and use of mechanical circulatory support in children. With expanded enrollment, pediatric INTERMACS has the potential to generate valuable information for practitioners in the field of pediatric mechanical support.
87 Influence of the New Heart Allocation System on Pediatric Waitlist and Post-Transplant Survival A. Iribarne,1 M.J. Russo,1 R.R. Davies,1 H. Takayama,1 J.M. Quaegebeur,1 L.J. Addonizio,2 J.M. Chen.1 1Children’s Hospital of New York-Presbyterian, New York, NY; 2Children’s Hospital of New York-Presbyterian, New York, NY. Purpose: The policy for heart allocation was changed on July 12, 2006 by OPTN/UNOS such that organs for status 1A and B patients are now allocated in a regional zone (within 500 miles) before allocating locally to status 2 patients. In this study, we assess the extent to which this policy has influenced pediatric waitlist and post-transplant survival. Methods and Materials: De-identified data was obtained from UNOS. Analysis included waitlist candidates aged ⬍ 18 years listed between 7/12/04-7/12/08 (n⫽1,982). Candidates were divided into 2 cohorts: prepolicy (n⫽952) and post-policy change (n⫽1,030). Kaplan-Meier analysis was used to calculate waitlist and post-transplant survival stratified by urgency status at time of listing. Cox regression was used to generate risk-adjusted hazard ratios. Results: During the analysis period, the average age at listing decreased from 6.7⫾0.21 years to 5.9⫾0.21 years (p⫽0.0045). When controlling for age at listing, there was a significant improvement in waitlist survival among status 1A but not status 1B or 2 patients, although there was a trend toward improved survival in each group.[table1]The average miles from donor hospital did not change (p⫽0.91) nor did ischemic time (p⫽0.224) after policy implementation. There was no significant difference in posttransplant graft survival under the new policy [Table 1]. Conclusions: The new heart allocation policy has decreased waitlist mortality of status 1A but not 1B patients with no negative effect on waitlist survival of status 2 patients. There was no negative effect on post-transplant survival in any group. Further analysis is necessary to assess longterm outcomes on waitlist and post-transplant survival under the new allocation policy.
Abstracts
S35
Table 1
Waitlist status 1A 1B 2 Transplant status 1A 1B 2
Hazard Ratio
95% CI
p-value
0.78 0.80 0.94
0.61-0.99 0.36-1.76 0.56-1.61
0.040 0.580 0.845
1.08 2.03 0.81
0.75-1.54 0.72-5.76 0.22-2.99
0.679 0.181 0.747
(LVEDd) and a novel superior-inferior heart measure to better predict acceptable donor heart size and potentially expand donor use. Methods and Materials: We reviewed 200 normal 2D echos from pts age 1 day–22 years utilizing subxyphoid short axis views to obtain average distance in cm from the SVC-right atrial junction to the IVC-right atrial junction(SVC-IVC). This measure, along with M-mode LVEDd were plotted against the subject’s weight and height. Regression analyses were performed to find the best fit equations. Results: The relationship between pt weight and heart dimension is not linear. However, there is a strong linear relationship between height and both SVC-IVC distance (R2⫽0.87) and LVEDd (R2⫽0.88). [figure1] [figure2]
88 Donor-to-Recipient Weight Ratio Effects on Post-Transplant Survival in Pediatric Heart Transplant Recipients: Analysis of the United Network for Organ Sharing (UNOS) Database L. Tang, W. Du, T. L’Ecuyer, M. Zilberman. Children’s Hospital of Michigan, Detroit, MI. Purpose: One of the limitations of pediatric heart transplant (PHT) is the shortage of donor hearts. Strict size-matching criteria further diminish the donor pool and increase the mortality of children awaiting heart transplantation. Methods and Materials: We examined the effect of donor-to-recipient weight ratios (DRWR) on the post-transplant survival of PHT recipients using the UNOS database. PHT patients were divided into 4 groups based on the DRWR: Low (0.5-0.79) (n⫽204), Ideal (0.8-1.99) (n⫽2844), High (2.0-2.69) (n⫽341), and Very High (VH) DRWR (⬎2.7) (n⫽87). Results: There were 3476 recipients (1023 infant recipients). The recipients were significantly younger in the VH DRWR group (1.7yrs ⫾ 3.4) than in the other groups (Low DRWR 8.3 yrs ⫾ 3.4, Ideal DRWR 6.9 yrs ⫾ 6.2, and High DRWR 2.9 yrs ⫾ 4.6). The VH DRWR group required more re-operation post transplant (15% vs. 7% in LowDRWR vs. 8% in Ideal DRWRvs. 5.6% in High DRWR) and a longer hospital stay post transplant (37days ⫾79 vs. Low DRWR, 26.3 days ⫾ 38; Ideal DRWR, 25.6 days ⫾ 40; High DRWR, 24.7 days ⫾ 26) than the other groups. The Low, Ideal and High DRWR groups did not differ from each other. There was no difference in gender, primary diagnosis, post transplant dialysis, or episodes of acute rejection among the four groups. The 30-day survival was significantly lower for the VH DRWR Group (87%) than that of the other three groups (Low DRWR, 93%; Ideal DRWR, 93%; and High DRWR, 93%). The Long-term survival did not differ among the four groups. While infants with the DRWR ⬍ 0.6 had lower 30 day survival than infants within the Ideal group (82.7% vs. 90.5%; P⫽0.046), the 30-day and long-term survival of infants with the DRWR 0.6-0.8 did not differ from that of the Ideal group (P⫽0.16). Conclusions: The use of undersized and oversized cardiac allografts (DRWR: 0.6-2.7 for infants and 0.5-2.7 for other ages) has no adverse effect on post-transplant morbidity and short- and long-term survival and should be considered in PHT. 89 A Novel Approach to Size-Matching for Pediatric Heart Transplantation. Can We Do Better? W.A. Zuckerman,1 M.E. Richmond,1 R.K. Singh,1 J.M. Chen,2 K. Altmann,1 L.J. Addonizio.1 1New York Presbyterian Hospital/Columbia University Medical Center, New York, NY; 2New York Presbyterian Hospital/Columbia University Medical Center, New York, NY. Purpose: Criteria for donor selection in pediatrics usually limits allografts to donors sized ⬍ 20% to 2-3 times ⬎ the recipient’s weight. Donor scarcity, use of bicaval anastomoses, and a wide range of donor weights, leads us to question whether size-matching by weight is most appropriate. The purpose of our study is to correlate patient(pt) size variables with echocardiogram(echo) derived left ventricular end-diastolic diameter-
Conclusions: Height, not weight, better correlates to both standard and novel echo measures in normal pediatric pts. When evaluating donors, use of these parameters, rather than weight, may be better for size-matching (particularly for bicaval anastomoses) and maximize use of the donor pool.
90 Body Mass Index and Its Impact on Outcome in Children after Lung Transplantation: An Analysis of the ISHLT Pediatric Lung Transplant Registry C. Benden,1 D.A. Ridout,2 S.C. Sweet,3 A. Boehler.1 1University Hospital Zurich, Zurich, Switzerland; 2UCL Institute of Child Health, London, United Kingdom; 3Washington University School of Medicine, St. Louis, MO. Purpose: Malnutrition is often diagnosed in children undergoing lung transplantation, particularly in those with cystic fibrosis (CF) whilst severe malnutrition is considered a relative contraindication for pediatric lung
The Journal of Heart and Lung Transplantation, Vol 29, No 2S, February 2010
Methods and Materials: In a two-group experimental, repeated measures design, 33 LT recipients (19 single [SLT], 14 bilateral [BLT]; 70% male, age 56⫾13.3 years) were randomized to CPT (10am, 2pm) followed by HFCWO (6pm, 10pm; n⫽16) or vice versa (n⫽17) on postop day 3. Preand post-Tx measures were pain (verbal numeric pain score), dyspnea (modified Borg score), SpO2/FiO2 ratio, and PEF. A post-Tx sequence survey assessed patient preference. Data were analyzed by chi-square, t-test, and Mixed ANOVA. Results: BLTs were significantly younger than SLTs (46⫾13.5 vs. 64⫾5.5 years, p⬍0.001). Overall, there was a statistically significant difference between mean pre- and post- PEF scores (228 vs. 235 L/min, p⫽0.038). There was a significant increase in mean post-PEF scores from 8am to 6pm and a slight decrease at 10pm (p⫽0.004). A significant LT-type, Tx order and time point interaction was found; SLT and BLT had the highest PEF scores at 6pm and 10pm, respectively (p⫽0.02). Mean post-dyspnea scores decreased from 10am to 6pm (p⫽0.003). There was a steady increase in post- SpO2/FiO2 ratios across time points (p⫽0.19). At present, there were no significant main effects for Tx-type. Majority of patients preferred HFCWO over CPT (57% vs. 39%); one patient had no preference. Conclusions: Preliminary results suggest improved lung function (dyspnea and PEF) with both CPT and HFCWO post-LT. Although no differences were found in lung function between Tx-types, patients preferred HFCWO. We speculate HFCWO is an effective, feasible alternative to CPT. Further study of both methods is needed. 85 A High-Intensity Exercise Program Decreases Self-Reported Anxiety in Cardiac Transplant Recipients: A Randomized Study S.B. Christensen,1 C.H. Dall,2 T. Hermann,1 E. Prescott,2 F. Gustafsson.1 1Rigshospitalet, Copenhagen, Denmark; 2Bispebjerg Hospital, Copenhagen, Denmark. Purpose: Little is known about the role of high-intensity aerobic exercise as mood altering intervention after cardiac transplantation. The aim of this study was to examine changes in self-reported anxiety and depression in relation to an eight-week high-intensity aerobic training program, in stable heart transplant recipients (⬎ 1 year after transplantation). Methods and Materials: A total of 27 patients (5 women, mean age 50.5 ⫹/⫺ 14.9 years) with a mean post-transplant time of 6.9 ⫾ 4.7 years were randomized to either an eight-week high-intensity aerobic training programme (N⫽14), or control (N⫽13). The training was individualized, hospital-based and performed at ⱖ80% of peak VO2 three times a week. Anxiety and depression scores were evaluated at baseline and follow-up using the HADS-A and the HADS-D standarized scoring system. Results: Anxiety evaluated by HADS-A decreased significantly in the exercise group (HADS-A from 4.7⫾1.8 to 1.8⫾0.8, P⫽0.01), but not in the control group (3.2⫾1.6 to 3.7⫾2.3, NS). Depression scores were not influenced significantly by exercise. There was no significant correlation between improvement in HADS-A score and improvement in peakVO2 or maximal workload in the exercise group (R2⫽0.20, P⫽NS). No adverse events were recorded in the exercise group. Conclusions: Participation in high-intensity aerobic training long after cardiac transplantation significantly decreases self-reported anxiety. Improvement in psychological well-being is not directly related to improvement in physical performance. High-intensity aerobic exercise is an effective intervention to reduce psychological distress in heart transplant recipients. 86 Outcomes of Children Implanted with Ventricular Assist Device Therapy: Analysis of the Interagency Registry for Mechanical Circulatory Support (INTERMACS) E.D. Blume,1 D.N. Rosenthal,2 J.M. Chen,3 C.S.D. Almond,1 P.D. Wearden,4 D.C. Naftel,5 J.K. Kirklin.5 1Children’s Hospital, Boston, MA; 2Stanford University Medical Center, Palo Alto, CA; 3 Morgan Stanley Children’s Hospital of NewYork-Presbyterian, New York, NY; 4Children’s Hospital of Pittsburgh, Pittsburgh, PA; 5 University of Alabama at Birmingham, Birmingham, AL.
Purpose: INTERMACS, a federally-supported national registry for FDAapproved durable VADs, is a unique collaboration with the central purpose of improving pt outcomes. While the number of pediatric registrants in INTERMACS is limited, an overview of the pediatric experience provides an opportunity to review the potentials and challenges of employing INTERMACS in the pediatric population. Methods and Materials: All pts reported to INTERMACS (n⫽1321) between June 2006 and March 2009 were analyzed. The pediatric cohort was defined as pts⬍19 yrs of age at the time of implant. Recipient characteristics and adverse events were reported using standardized definitions. Outcomes were analyzed using Cox proportional hazard analysis. Results: Twenty U.S. sites have enrolled 35 pediatric pts (2.5%) with a median age 16 yrs, range 4.5-18.9 yrs. Eighty-nine percent were ⬎12 yrs of age. Pediatric pts undergoing VAD implantation were evenly divided between INTERMACS heart failure profile 1-critical cardiogenic shock (n⫽16, of whom 12 were intubated) and 2 -progressive decline (n⫽15). Overall, 17 (49%) were listed for transplant at VAD implantation. Twentytwo pts (62%) received LVAD support; 10 (29%) received BIVAD support. At a median follow-up of 2.2 mos, 5 pts died (14%), 17 had been transplanted, and 4 were explanted. Children receiving BiVAD support had a higher unadjusted risk of death on device (p⫽0.02) compared to pts on LVAD support alone. Compared to adult LVAD pts, pediatric LVAD pts had a higher unadjusted hazard of infection (p⬍0.01) and neurological (p⬍0.01) adverse events. Conclusions: Although the number of enrolled subjects is small, the pediatric INTERMACS data provides important information on the VAD experience in children. Outcomes appear favorable and support the continued development and use of mechanical circulatory support in children. With expanded enrollment, pediatric INTERMACS has the potential to generate valuable information for practitioners in the field of pediatric mechanical support.
87 Influence of the New Heart Allocation System on Pediatric Waitlist and Post-Transplant Survival A. Iribarne,1 M.J. Russo,1 R.R. Davies,1 H. Takayama,1 J.M. Quaegebeur,1 L.J. Addonizio,2 J.M. Chen.1 1Children’s Hospital of New York-Presbyterian, New York, NY; 2Children’s Hospital of New York-Presbyterian, New York, NY. Purpose: The policy for heart allocation was changed on July 12, 2006 by OPTN/UNOS such that organs for status 1A and B patients are now allocated in a regional zone (within 500 miles) before allocating locally to status 2 patients. In this study, we assess the extent to which this policy has influenced pediatric waitlist and post-transplant survival. Methods and Materials: De-identified data was obtained from UNOS. Analysis included waitlist candidates aged ⬍ 18 years listed between 7/12/04-7/12/08 (n⫽1,982). Candidates were divided into 2 cohorts: prepolicy (n⫽952) and post-policy change (n⫽1,030). Kaplan-Meier analysis was used to calculate waitlist and post-transplant survival stratified by urgency status at time of listing. Cox regression was used to generate risk-adjusted hazard ratios. Results: During the analysis period, the average age at listing decreased from 6.7⫾0.21 years to 5.9⫾0.21 years (p⫽0.0045). When controlling for age at listing, there was a significant improvement in waitlist survival among status 1A but not status 1B or 2 patients, although there was a trend toward improved survival in each group.[table1]The average miles from donor hospital did not change (p⫽0.91) nor did ischemic time (p⫽0.224) after policy implementation. There was no significant difference in posttransplant graft survival under the new policy [Table 1]. Conclusions: The new heart allocation policy has decreased waitlist mortality of status 1A but not 1B patients with no negative effect on waitlist survival of status 2 patients. There was no negative effect on post-transplant survival in any group. Further analysis is necessary to assess longterm outcomes on waitlist and post-transplant survival under the new allocation policy.
Abstracts
S35
Table 1
Waitlist status 1A 1B 2 Transplant status 1A 1B 2
Hazard Ratio
95% CI
p-value
0.78 0.80 0.94
0.61-0.99 0.36-1.76 0.56-1.61
0.040 0.580 0.845
1.08 2.03 0.81
0.75-1.54 0.72-5.76 0.22-2.99
0.679 0.181 0.747
(LVEDd) and a novel superior-inferior heart measure to better predict acceptable donor heart size and potentially expand donor use. Methods and Materials: We reviewed 200 normal 2D echos from pts age 1 day–22 years utilizing subxyphoid short axis views to obtain average distance in cm from the SVC-right atrial junction to the IVC-right atrial junction(SVC-IVC). This measure, along with M-mode LVEDd were plotted against the subject’s weight and height. Regression analyses were performed to find the best fit equations. Results: The relationship between pt weight and heart dimension is not linear. However, there is a strong linear relationship between height and both SVC-IVC distance (R2⫽0.87) and LVEDd (R2⫽0.88). [figure1] [figure2]
88 Donor-to-Recipient Weight Ratio Effects on Post-Transplant Survival in Pediatric Heart Transplant Recipients: Analysis of the United Network for Organ Sharing (UNOS) Database L. Tang, W. Du, T. L’Ecuyer, M. Zilberman. Children’s Hospital of Michigan, Detroit, MI. Purpose: One of the limitations of pediatric heart transplant (PHT) is the shortage of donor hearts. Strict size-matching criteria further diminish the donor pool and increase the mortality of children awaiting heart transplantation. Methods and Materials: We examined the effect of donor-to-recipient weight ratios (DRWR) on the post-transplant survival of PHT recipients using the UNOS database. PHT patients were divided into 4 groups based on the DRWR: Low (0.5-0.79) (n⫽204), Ideal (0.8-1.99) (n⫽2844), High (2.0-2.69) (n⫽341), and Very High (VH) DRWR (⬎2.7) (n⫽87). Results: There were 3476 recipients (1023 infant recipients). The recipients were significantly younger in the VH DRWR group (1.7yrs ⫾ 3.4) than in the other groups (Low DRWR 8.3 yrs ⫾ 3.4, Ideal DRWR 6.9 yrs ⫾ 6.2, and High DRWR 2.9 yrs ⫾ 4.6). The VH DRWR group required more re-operation post transplant (15% vs. 7% in LowDRWR vs. 8% in Ideal DRWRvs. 5.6% in High DRWR) and a longer hospital stay post transplant (37days ⫾79 vs. Low DRWR, 26.3 days ⫾ 38; Ideal DRWR, 25.6 days ⫾ 40; High DRWR, 24.7 days ⫾ 26) than the other groups. The Low, Ideal and High DRWR groups did not differ from each other. There was no difference in gender, primary diagnosis, post transplant dialysis, or episodes of acute rejection among the four groups. The 30-day survival was significantly lower for the VH DRWR Group (87%) than that of the other three groups (Low DRWR, 93%; Ideal DRWR, 93%; and High DRWR, 93%). The Long-term survival did not differ among the four groups. While infants with the DRWR ⬍ 0.6 had lower 30 day survival than infants within the Ideal group (82.7% vs. 90.5%; P⫽0.046), the 30-day and long-term survival of infants with the DRWR 0.6-0.8 did not differ from that of the Ideal group (P⫽0.16). Conclusions: The use of undersized and oversized cardiac allografts (DRWR: 0.6-2.7 for infants and 0.5-2.7 for other ages) has no adverse effect on post-transplant morbidity and short- and long-term survival and should be considered in PHT. 89 A Novel Approach to Size-Matching for Pediatric Heart Transplantation. Can We Do Better? W.A. Zuckerman,1 M.E. Richmond,1 R.K. Singh,1 J.M. Chen,2 K. Altmann,1 L.J. Addonizio.1 1New York Presbyterian Hospital/Columbia University Medical Center, New York, NY; 2New York Presbyterian Hospital/Columbia University Medical Center, New York, NY. Purpose: Criteria for donor selection in pediatrics usually limits allografts to donors sized ⬍ 20% to 2-3 times ⬎ the recipient’s weight. Donor scarcity, use of bicaval anastomoses, and a wide range of donor weights, leads us to question whether size-matching by weight is most appropriate. The purpose of our study is to correlate patient(pt) size variables with echocardiogram(echo) derived left ventricular end-diastolic diameter-
Conclusions: Height, not weight, better correlates to both standard and novel echo measures in normal pediatric pts. When evaluating donors, use of these parameters, rather than weight, may be better for size-matching (particularly for bicaval anastomoses) and maximize use of the donor pool.
90 Body Mass Index and Its Impact on Outcome in Children after Lung Transplantation: An Analysis of the ISHLT Pediatric Lung Transplant Registry C. Benden,1 D.A. Ridout,2 S.C. Sweet,3 A. Boehler.1 1University Hospital Zurich, Zurich, Switzerland; 2UCL Institute of Child Health, London, United Kingdom; 3Washington University School of Medicine, St. Louis, MO. Purpose: Malnutrition is often diagnosed in children undergoing lung transplantation, particularly in those with cystic fibrosis (CF) whilst severe malnutrition is considered a relative contraindication for pediatric lung