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Bridge to Pediatric Heart Transplantation Using Mechanical Circulatory Support: An Analysis \of the UNOS Database
Abstracts pain (62%). Least frequently occurring included depression (21%). Three SCs were extracted in a PCA: Sickness Behavior (anxiety, depression, daytime sleepiness, cognitive dysfunction, fatigue), Discomforts (dyspnea, edema, pain), and GI Disturbamces (appetite/hunger). Sickness Behavior was the only predictor (b¼-0.635; p¼o0.0001) of QOL. Approximately 40% of the variance in QOL was explained by this symptom cluster (F¼75.12; p¼0.0001; R2¼.404). Conclusions: Sickness Behaviors had a significant negative effect on QOL and suggests that incorporating an evaluation of each of these symptoms may facilitate identification and treatment of symptoms having an additive and detrimental impact on QOL. Future studies to examine the stability of the cluster are warranted. 327
S127 investigating pre-transplant psychological risk factors associated with poor medical outcome post transplant. This study examines prevalence of distress in UK transplant candidates and potentially modifiable psychological risk factors. Methods and Materials: 109 consecutive transplant candidates completed the Hospital Anxiety and Depression Scales (HADS) and Millon Behavioural Medicine Diagnostic inventory (MBMD). (62% male, 82% awaiting lung, 18% awaiting heart transplant). Results: 61.5% transplant candidates reported HADS scores within the clinically significant range with only 38.5% reporting scores below cutoffs. HADS scores in clinical range were associated with increased prevalence of negative stress moderators: Illness Apprehension X2 ¼10.44 po0.01(Df¼1); Future Pessimism X2¼4.17, po0.05 (Df¼1); Problematic Compliance X2¼37.73 po0.001 (Df¼1); Adjustment Difficulties X2¼22.82, po0.001 (Df¼1).
Differential Impacts of Implantable Ventricular Assist Device on Quality of Life and Depression in Patients with Heart Failure and Their Caregivers N. Kato,1 K. Kinugawa,2 M. Endo,3 Y. Kagami,3 T. Imamura,1 H. Muraoka,1 S. Minatsuki,1 T. Inaba,1 H. Maki,1 T. Shiga,1 M. Hatano,1 A. Yao,1 S. Kyo,2 I. Komuro,1 M. Ono.4 1Dept of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan; 2Dept of Therapeutic Strategy for Heart Failure, The University of Tokyo Graduate School of Medicine, Tokyo, Japan; 3Dept of Organ Transplantation, The University of Tokyo Hospital, Tokyo, Japan; 4Dept of Cardiothoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan. Purpose: Ventricular assist device (VAD) is an established therapy for patients with stage D heart failure. We aimed to clarify impacts of VAD on quality of life (QOL) and depression in those patients and their caregivers. Methods and Materials: A total of 43 patients who were listed for heart transplantation were enrolled (43.0⫾11.5 years, male 86%). Of them, 13 patients were treated with implantable LVAD, and others were received extracorporeal Nipro VAD. QOL of patients and their caregivers was assessed with the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and SF-8, respectively. A lower MLHFQ score and a higher SF-8 score indicates better QOL. Patients and their caregivers were classified as suffering from depression when they had Center for Epidemiologic Studies Depression scale score Z16. These outcomes were assessed approximately 6 month after VAD therapy and compared among the following three groups: medical therapy, extracorporeal Nipro VAD, and implantable LVAD. Results: The MLHFQ score and prevalence of depression in patients receiving the Nipro VAD (n¼13) were similar to those in patients with medical therapy (n¼17) (42.8⫾27.4 vs. 47.3⫾22.0; 50% vs. 47%). On the other hand, implantable LVAD appeared to decrease patient’s MLHFQ score (-13.5⫾12.4, p¼0.045 by paired t-test), but did not significantly change prevalence of depression (31%, p¼0.460). In contrast, prevalence of depression in patients’ caregivers was likely to increase after placement of implantable LVAD (n¼23, 17% vs. 36%). Physical summary score calculated from the SF-8 in the caregivers whose patients were treated with implantable LVAD was also significantly lower than that in Japanese national norms (n¼12, 27.2⫾10.4 vs. 48.6⫾7.2, po0.001 by unpaired t-test). Conclusions: We demonstrate that implantable LVAD could improve patient’s QOL, consistently with earlier studies. Our results also suggest the need for support to reduce caregiver’s burden associated with implantable LVAD. 328 Prevalence of Psychological Distress and Stress Moderators in UK Transplant Candidates: Z.G. Malpus, A. Horan, N. Yonan. Heart and Lung Transplant Unit, University Hospital South Manchester, Wythenshawe, Manchester, United Kingdom. Purpose: The UK is currently standardising pre-transplant psychological assessments. This data forms part of a longitudinal study
Conclusions: A high prevalence of anxiety and/or depression was found in transplant candidates and this was associated with factors that are amenable to psychological therapy. These factors included preoccupation with and rumination on illness, hopelessness, ambivalence about effectiveness of treatment and difficulties with acceptance. This study has identified a clear need for evidence-based psychological care. This study also highlights the utility of standardised psychometric measures to identify prevalence of distress in transplant candidates. Future studies should focus upon effectiveness of psychological interventions tailored for transplant candidates. 329 Bridge to Pediatric Heart Transplantation Using Mechanical Circulatory Support: An Analysis \of the UNOS Database B. Wehman, G. Bittle, Z.N. Kon, M. Gibber, C. Evans, K. Rajagopal, S. Kaushal, B.P. Griffith. Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD. Purpose: Pediatric patients awaiting orthotopic heart transplantation (OHT) face increasing wait-list times and often require mechanical circulatory support (MCS) as a bridge to transplantation (BTT). Posttransplant outcomes in this this group have not been well described. Methods and Materials: A retrospective review of the United Network of Organ Sharing database was performed to identify pediatric patients requiring MCS as a BTT. Patients were stratified into 3 groups: extracorporeal membranous oxygenation (ECMO), ventricular assist device (VAD) and direct transplantation (DTXP). The primary outcome was survival. Results: From 2004 to 2011, 1,997 pediatric patients underwent OHT. There were 389 patients BTT with MCS (19.5%) and 1,608 with DTXP. There were 228 VAD BTT (58.6%) and 161 ECMO BTT (41.4%). Compared to VAD BTT, patients with ECMO BTT were younger (2.9 vs 9.2 years, po0.001) and smaller (14.4 vs 41.1 kg, po0.001). Survival at 30 days, 1 year and 3 years was 79.6%, 65.5% and 60.3% with ECMO BTT and 97.0%, 90.4% and 89.4% with DTXP (Po0.0001). There was no difference in survival between VAD BTT and DTXP (VAD BTT 99.0%, 98.0% and 90.3% at 30 days, 1 year and 3 years; p¼0.59) (Fig. 1). In multivariate analysis, ECMO BTT (OR 5.1, p¼0.001) and functional status at the time of transplant (OR 0.98, p¼0.002) were found to be independent predictors of mortality. Conclusions: This review represents the largest survival analysis of BTT with MCS for pediatric OHT. Patients with ECMO BTT were smaller
S128
The Journal of Heart and Lung Transplantation, Vol 32, No 4S, April 2013 Patient Control Median Max IL1B 0.6 IL8 3.5 sVCAM_1 538 sE selectin 15 Thrombomodulin 7.0 hsCRP 0.3 IL6 3.9 TNF alpha 5.0
0.001 1.6 244 7.6 4.4 0.01 1.4 2.7
Min
Median Max
Min
4.2 0.001 0.001 0.9 9.0 4.3 2.0 9.1 758 442 318 676 27.7 11.4 7.5 19.6 11.3 5.2 4.4 9.1 8.7 0.2 0.05 3.4 20.7 3.1 1.7 13.3 10.9 5.3 3.6 8.0
p value o0.01 0.06 0.03 0.005 o0.01 0.9 0.3 0.3
Mean IMT
and younger than those with VAD BTT and had significantly poorer survival than those with direct transplantation. Importantly, however, the use of VAD for BTT did not worsen post-transplant survival. 330 The Effect of Nutritional Status on Heart Transplant Survival in Patients under Two Years of Age J. Godown, J. Friedland-Little, R.J. Gajarski, S. Yu, J.E. Donohue, K.R. Schumacher. Pediatric Cardiology, University of Michigan, Ann Arbor, MI. Purpose: Nutritional status has been shown to affect survival after heart transplant (HTx) in adults and older children. The impact of nutritional status on survival to HTx and HTx outcomes in children o2 years of age is unknown. We sought to determine the effect of nutritional status on wait-list and early post-HTx survival in this population. Methods and Materials: Children 0-2 years listed for HTx from 1997-2011 were identified from the Organ Procurement and Transplantation Network database. Weight-for-height z-scores and percent ideal body weight (%IBW) were calculated at listing and at transplant. Nutritional status was categorized using the Waterlow criteria based on %IBW. The impact of nutritional status on survival to HTx was evaluated using logistic regression analysis and 1-year post-HTx survival was analyzed using Cox proportional hazard models. Results: 1,653 children were included. At listing, 899 (55%) were categorized as normal nutrition status, 445 (27%) mildly wasted, 203 (12%) moderate or severely wasted, and 106 (6%) with elevated weightto-height (W:H) ratio. Moderate or severe wasting (Adjusted Odds Ratio [AOR] 1.9; 95% Confidence Interval [CI] 1.3, 2.7) and elevated W:H ratio (AOR 1.6; CI 1.1, 2.6) were independent risk factors for wait-list mortality. Among 1,167 patients who underwent HTx, 87% (n¼1,016) survived 1-year post-HTx. Pre-transplant nutritional status was not significantly associated with the need for early reoperation, dialysis, incidence of infection, stroke, rejection prior to hospital discharge, or 1-year mortality. Conclusions: Moderate or severe wasting and elevated W:H ratio by Waterlow criteria are independent risk factors for wait-list mortality in patients o2 years of age. Poor nutritional status at listing does not influence post-HTx outcomes in patients who survive to HTx. Better pre-HTx nutrition for patients with moderate or severe wasting may improve waitlist survival. 331 Endothelial Activation and Coagulation Homeostasis Play a Role in Coronary Allograft Vasculopathy after Heart Transplantation in Children M. Fenton, J. Simmonds, V. Shah, P. Brogan, N. Klein, J. Deanfield, B. Michael. Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
ng/ml
4 0.5 mm
o 0.5 mm
p value
Thrombomodulin TF vWF
6.0 27.8 0.79
7.2 35.3 0.54
0.046 0.023 0.013
Purpose: Inflammation and endothelial dysfunction are involved in coronary allograft vasculopathy (CAV) after heart transplant (HT) but the mechanisms and the potential impact on the native vasculature is unknown. Methods and Materials: We used IVUS to evaluate CAV in children after transplant and studied native, systemic vascular structure and function with carotid intima-medial thickness (cIMT) and brachial artery flow mediated dilatation (FMD). In 54 children (28 male) age 9 to 18 years, we undertook IVUS, cIMT and FMD median 58 months (2.2 to 151) after HT. Findings were compared to 16 age, sex matched, healthy controls. Circulating markers of inflammation and endothelial activation were also measured. Results: 10 patients had evidence of CAV with mean intima-media thickening 4 0.5 mm analysed over 26 mm (SD 9) of the LAD coronary. This represents patients in the upper quartile. No relation to time post transplant and donor age was detected. HT patients had evidence of endothelial activation with an increase in soluble e-selectin, VCAM1 and thrombomodulin in the absence of raised inflammatory cytokines. CAV was related to low levels of thrombomodulinTM, tissue factor (TF) and increased von Willebrand Factor (vWF) in peripheral blood suggesting a relationship to coagulation homeostasis. In contrast there were no abnormalities of systemic vascular structure and function. Conclusions: After heart transplant there was evidence of significant CAV but not systemic vasculopathy. TF, TM and vWF were related to coronary IMT suggesting involvement in pathogenesis of CAV and novel treatment opportunities. 332 Donor-Recipient Size Matching in Pediatric Heart Transplantation: Is Weight the Most Appropriate Parameter To Predict Outcomes in All Age Groups? A.S. Bayoumi, H. Liu, F. Fynn-Thompson. Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA. Purpose: The aim of this study is to retrospectively review our practice of donor-recipient (D/R) size matching by weight criteria alone and simultaneously reassess and compare post-transplant outcomes using the additional variables of height and body-surface area (BSA). Methods and Materials: We retrospectively reviewed the medical records of 211 patients who underwent orthotopic heart transplantation at Boston Children’s Hospital over the past 20 years. The patients were divided into the following age groups: o1 years (n¼30), 1-12 years (n¼107) and 412 years (n¼74). Donor/recipient weight, height and BSA ratios were determined for each age group at the date of
S127 investigating pre-transplant psychological risk factors associated with poor medical outcome post transplant. This study examines prevalence of distress in UK transplant candidates and potentially modifiable psychological risk factors. Methods and Materials: 109 consecutive transplant candidates completed the Hospital Anxiety and Depression Scales (HADS) and Millon Behavioural Medicine Diagnostic inventory (MBMD). (62% male, 82% awaiting lung, 18% awaiting heart transplant). Results: 61.5% transplant candidates reported HADS scores within the clinically significant range with only 38.5% reporting scores below cutoffs. HADS scores in clinical range were associated with increased prevalence of negative stress moderators: Illness Apprehension X2 ¼10.44 po0.01(Df¼1); Future Pessimism X2¼4.17, po0.05 (Df¼1); Problematic Compliance X2¼37.73 po0.001 (Df¼1); Adjustment Difficulties X2¼22.82, po0.001 (Df¼1).
Differential Impacts of Implantable Ventricular Assist Device on Quality of Life and Depression in Patients with Heart Failure and Their Caregivers N. Kato,1 K. Kinugawa,2 M. Endo,3 Y. Kagami,3 T. Imamura,1 H. Muraoka,1 S. Minatsuki,1 T. Inaba,1 H. Maki,1 T. Shiga,1 M. Hatano,1 A. Yao,1 S. Kyo,2 I. Komuro,1 M. Ono.4 1Dept of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan; 2Dept of Therapeutic Strategy for Heart Failure, The University of Tokyo Graduate School of Medicine, Tokyo, Japan; 3Dept of Organ Transplantation, The University of Tokyo Hospital, Tokyo, Japan; 4Dept of Cardiothoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan. Purpose: Ventricular assist device (VAD) is an established therapy for patients with stage D heart failure. We aimed to clarify impacts of VAD on quality of life (QOL) and depression in those patients and their caregivers. Methods and Materials: A total of 43 patients who were listed for heart transplantation were enrolled (43.0⫾11.5 years, male 86%). Of them, 13 patients were treated with implantable LVAD, and others were received extracorporeal Nipro VAD. QOL of patients and their caregivers was assessed with the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and SF-8, respectively. A lower MLHFQ score and a higher SF-8 score indicates better QOL. Patients and their caregivers were classified as suffering from depression when they had Center for Epidemiologic Studies Depression scale score Z16. These outcomes were assessed approximately 6 month after VAD therapy and compared among the following three groups: medical therapy, extracorporeal Nipro VAD, and implantable LVAD. Results: The MLHFQ score and prevalence of depression in patients receiving the Nipro VAD (n¼13) were similar to those in patients with medical therapy (n¼17) (42.8⫾27.4 vs. 47.3⫾22.0; 50% vs. 47%). On the other hand, implantable LVAD appeared to decrease patient’s MLHFQ score (-13.5⫾12.4, p¼0.045 by paired t-test), but did not significantly change prevalence of depression (31%, p¼0.460). In contrast, prevalence of depression in patients’ caregivers was likely to increase after placement of implantable LVAD (n¼23, 17% vs. 36%). Physical summary score calculated from the SF-8 in the caregivers whose patients were treated with implantable LVAD was also significantly lower than that in Japanese national norms (n¼12, 27.2⫾10.4 vs. 48.6⫾7.2, po0.001 by unpaired t-test). Conclusions: We demonstrate that implantable LVAD could improve patient’s QOL, consistently with earlier studies. Our results also suggest the need for support to reduce caregiver’s burden associated with implantable LVAD. 328 Prevalence of Psychological Distress and Stress Moderators in UK Transplant Candidates: Z.G. Malpus, A. Horan, N. Yonan. Heart and Lung Transplant Unit, University Hospital South Manchester, Wythenshawe, Manchester, United Kingdom. Purpose: The UK is currently standardising pre-transplant psychological assessments. This data forms part of a longitudinal study
Conclusions: A high prevalence of anxiety and/or depression was found in transplant candidates and this was associated with factors that are amenable to psychological therapy. These factors included preoccupation with and rumination on illness, hopelessness, ambivalence about effectiveness of treatment and difficulties with acceptance. This study has identified a clear need for evidence-based psychological care. This study also highlights the utility of standardised psychometric measures to identify prevalence of distress in transplant candidates. Future studies should focus upon effectiveness of psychological interventions tailored for transplant candidates. 329 Bridge to Pediatric Heart Transplantation Using Mechanical Circulatory Support: An Analysis \of the UNOS Database B. Wehman, G. Bittle, Z.N. Kon, M. Gibber, C. Evans, K. Rajagopal, S. Kaushal, B.P. Griffith. Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD. Purpose: Pediatric patients awaiting orthotopic heart transplantation (OHT) face increasing wait-list times and often require mechanical circulatory support (MCS) as a bridge to transplantation (BTT). Posttransplant outcomes in this this group have not been well described. Methods and Materials: A retrospective review of the United Network of Organ Sharing database was performed to identify pediatric patients requiring MCS as a BTT. Patients were stratified into 3 groups: extracorporeal membranous oxygenation (ECMO), ventricular assist device (VAD) and direct transplantation (DTXP). The primary outcome was survival. Results: From 2004 to 2011, 1,997 pediatric patients underwent OHT. There were 389 patients BTT with MCS (19.5%) and 1,608 with DTXP. There were 228 VAD BTT (58.6%) and 161 ECMO BTT (41.4%). Compared to VAD BTT, patients with ECMO BTT were younger (2.9 vs 9.2 years, po0.001) and smaller (14.4 vs 41.1 kg, po0.001). Survival at 30 days, 1 year and 3 years was 79.6%, 65.5% and 60.3% with ECMO BTT and 97.0%, 90.4% and 89.4% with DTXP (Po0.0001). There was no difference in survival between VAD BTT and DTXP (VAD BTT 99.0%, 98.0% and 90.3% at 30 days, 1 year and 3 years; p¼0.59) (Fig. 1). In multivariate analysis, ECMO BTT (OR 5.1, p¼0.001) and functional status at the time of transplant (OR 0.98, p¼0.002) were found to be independent predictors of mortality. Conclusions: This review represents the largest survival analysis of BTT with MCS for pediatric OHT. Patients with ECMO BTT were smaller
S128
The Journal of Heart and Lung Transplantation, Vol 32, No 4S, April 2013 Patient Control Median Max IL1B 0.6 IL8 3.5 sVCAM_1 538 sE selectin 15 Thrombomodulin 7.0 hsCRP 0.3 IL6 3.9 TNF alpha 5.0
0.001 1.6 244 7.6 4.4 0.01 1.4 2.7
Min
Median Max
Min
4.2 0.001 0.001 0.9 9.0 4.3 2.0 9.1 758 442 318 676 27.7 11.4 7.5 19.6 11.3 5.2 4.4 9.1 8.7 0.2 0.05 3.4 20.7 3.1 1.7 13.3 10.9 5.3 3.6 8.0
p value o0.01 0.06 0.03 0.005 o0.01 0.9 0.3 0.3
Mean IMT
and younger than those with VAD BTT and had significantly poorer survival than those with direct transplantation. Importantly, however, the use of VAD for BTT did not worsen post-transplant survival. 330 The Effect of Nutritional Status on Heart Transplant Survival in Patients under Two Years of Age J. Godown, J. Friedland-Little, R.J. Gajarski, S. Yu, J.E. Donohue, K.R. Schumacher. Pediatric Cardiology, University of Michigan, Ann Arbor, MI. Purpose: Nutritional status has been shown to affect survival after heart transplant (HTx) in adults and older children. The impact of nutritional status on survival to HTx and HTx outcomes in children o2 years of age is unknown. We sought to determine the effect of nutritional status on wait-list and early post-HTx survival in this population. Methods and Materials: Children 0-2 years listed for HTx from 1997-2011 were identified from the Organ Procurement and Transplantation Network database. Weight-for-height z-scores and percent ideal body weight (%IBW) were calculated at listing and at transplant. Nutritional status was categorized using the Waterlow criteria based on %IBW. The impact of nutritional status on survival to HTx was evaluated using logistic regression analysis and 1-year post-HTx survival was analyzed using Cox proportional hazard models. Results: 1,653 children were included. At listing, 899 (55%) were categorized as normal nutrition status, 445 (27%) mildly wasted, 203 (12%) moderate or severely wasted, and 106 (6%) with elevated weightto-height (W:H) ratio. Moderate or severe wasting (Adjusted Odds Ratio [AOR] 1.9; 95% Confidence Interval [CI] 1.3, 2.7) and elevated W:H ratio (AOR 1.6; CI 1.1, 2.6) were independent risk factors for wait-list mortality. Among 1,167 patients who underwent HTx, 87% (n¼1,016) survived 1-year post-HTx. Pre-transplant nutritional status was not significantly associated with the need for early reoperation, dialysis, incidence of infection, stroke, rejection prior to hospital discharge, or 1-year mortality. Conclusions: Moderate or severe wasting and elevated W:H ratio by Waterlow criteria are independent risk factors for wait-list mortality in patients o2 years of age. Poor nutritional status at listing does not influence post-HTx outcomes in patients who survive to HTx. Better pre-HTx nutrition for patients with moderate or severe wasting may improve waitlist survival. 331 Endothelial Activation and Coagulation Homeostasis Play a Role in Coronary Allograft Vasculopathy after Heart Transplantation in Children M. Fenton, J. Simmonds, V. Shah, P. Brogan, N. Klein, J. Deanfield, B. Michael. Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
ng/ml
4 0.5 mm
o 0.5 mm
p value
Thrombomodulin TF vWF
6.0 27.8 0.79
7.2 35.3 0.54
0.046 0.023 0.013
Purpose: Inflammation and endothelial dysfunction are involved in coronary allograft vasculopathy (CAV) after heart transplant (HT) but the mechanisms and the potential impact on the native vasculature is unknown. Methods and Materials: We used IVUS to evaluate CAV in children after transplant and studied native, systemic vascular structure and function with carotid intima-medial thickness (cIMT) and brachial artery flow mediated dilatation (FMD). In 54 children (28 male) age 9 to 18 years, we undertook IVUS, cIMT and FMD median 58 months (2.2 to 151) after HT. Findings were compared to 16 age, sex matched, healthy controls. Circulating markers of inflammation and endothelial activation were also measured. Results: 10 patients had evidence of CAV with mean intima-media thickening 4 0.5 mm analysed over 26 mm (SD 9) of the LAD coronary. This represents patients in the upper quartile. No relation to time post transplant and donor age was detected. HT patients had evidence of endothelial activation with an increase in soluble e-selectin, VCAM1 and thrombomodulin in the absence of raised inflammatory cytokines. CAV was related to low levels of thrombomodulinTM, tissue factor (TF) and increased von Willebrand Factor (vWF) in peripheral blood suggesting a relationship to coagulation homeostasis. In contrast there were no abnormalities of systemic vascular structure and function. Conclusions: After heart transplant there was evidence of significant CAV but not systemic vasculopathy. TF, TM and vWF were related to coronary IMT suggesting involvement in pathogenesis of CAV and novel treatment opportunities. 332 Donor-Recipient Size Matching in Pediatric Heart Transplantation: Is Weight the Most Appropriate Parameter To Predict Outcomes in All Age Groups? A.S. Bayoumi, H. Liu, F. Fynn-Thompson. Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA. Purpose: The aim of this study is to retrospectively review our practice of donor-recipient (D/R) size matching by weight criteria alone and simultaneously reassess and compare post-transplant outcomes using the additional variables of height and body-surface area (BSA). Methods and Materials: We retrospectively reviewed the medical records of 211 patients who underwent orthotopic heart transplantation at Boston Children’s Hospital over the past 20 years. The patients were divided into the following age groups: o1 years (n¼30), 1-12 years (n¼107) and 412 years (n¼74). Donor/recipient weight, height and BSA ratios were determined for each age group at the date of