Abstract 18474: Risk Factors for Long Term Morbidity After Pediatric Heart Retransplantation : Analysis from the International Society of Heart and Lung Transplantation Registry
Recent detailed analysis of the ISHLT registry has shown that retransplantation [ReTx] following pediatric primary heart transplantation [PTx] has inferior outcomes. Little is known about long-term morbidities following ReTx. Data from the ISHLT registry (1998-2010) were used to examine risk factors for long-term morbidities in all ReTx patients with a PTx at age < 18 y. 9,966 transplants were reviewed: 9,248 PTx, 602 first ReTx and 32 second ReTx. Long term morbidities were significantly (p<0.001) more common after ReTx than PTx including allograft vasculopathy [AV] (HR 2.8), late rejection (HR 2.0) and late renal dysfunction (HR 2.6); but not PTLD (HR 1.2, p=0.52). Factors associated with development of AV after ReTx included history of hypertension [HTN] pre-ReTx (HR 1.8, p=0.003), AV as the indication for ReTx (HR 1.96, p=0.003) , donor factors including HTN (HR 5.7, p=0.001) , diabetes (HR 5.7, p=0.005), cocaine use (HR 2.6, p=0.02), male donor to female recipient (HR 1.5, p=0.02); and post-ReTx factors including renal dysfunction (HR 1.8, p=0.002), hospitalization for infection (HR 2.7, p=0.04) and drug treated HTN (HR 1.6, p=0.05). Risk for late rejection after ReTx included CMV+ serology pre-ReTx (HR 1.7, p=0.03), donor CMV+ serology (HR 1.8, p=0.007), early rejection post-ReTx (HR 1.6, p=0.03), documented non-compliance (HR 3.6, p<0.001), and later year of ReTx (HR 1.3, p<0.001). Risk factors for late renal dysfunction included higher pre-ReTx creatinine (HR 1.3, p<0.001), later year of ReTx (HR 1.1, p<0.001), dialysis post-ReTx (HR 4.0, p<0.001), drug treated HTN in follow-up (HR 3.4, p<0.001), development of AV (HR 1.7, p=0.003) and hospitalization for infection (HR 4.1, p=0.008). In a multivariate model, no associations were found between duration of PTx (e.g. cumulative health burden) and any of the ReTx morbidities. ReTx following PTx in the pediatric age range is associated not only with inferior outcomes but also with a significant risk of long term morbidities. Further study of the key risk factors identified may help in patient and donor selection for ReTx with the goal to improve outcomes.
- © 2012 by American Heart Association, Inc.