Abstract 16671: Elevated Pulmonary Vascular Resistance Index Does Not Predict Postoperative Mortality in Pediatric Heart Transplantation: A Retrospective Analysis of the United Network for Organ Sharing Database
Introduction: Orthotopic heart transplantation (OHT) remains the definitive therapy in end stage heart failure. Right heart failure is a major source of post-transplant morbidity and mortality. Elevated pulmonary vascular resistance index (PVRI) is thought to be a relative contraindication to isolated OHT. The current study reevaluates this practice in children using data from the UNOS database.
Methods: A retrospective review of de-identified data from the UNOS dataset was performed. There were 1943 pediatric OHT recipients between 10/1987 and 12/2011 with sufficient data. Multiple imputation of non-hemodynamic demographic variables was employed to avoid case deletion. Cox proportional hazards regression was performed using 44 variables to examine the effect of baseline characteristics on post-transplant survival. Patients were propensity matched, and Kaplan-Meier survival analysis was performed comparing cohorts of patients with PVRI above and below 6 and 9.
Results: PVRI did not predict post-transplant outcomes in either univariate or multivariate Cox regression. African American Race, low-volume center, earlier year of transplant, higher BMI, retransplant, use of mechanical circulatory support, and congenital heart disease predicted worse survival. Survival was not different between OHT recipients with a PVRI ≥6 and those with a PVRI<6 in both our unmatched and matched comparisons. Analyses were repeated with a threshold of 9; again, no difference in outcomes was noted.
Conclusion: After controlling for baseline differences in populations using multivariate Cox regression, PVRI is not a statistically significant predictor of survival in pediatric OHT recipients with relevant data available from the UNOS database. Additionally, neither PVRI ≥6 nor PVRI ≥9 is a negative predictor of survival. In a well-selected group of patients at an experienced center, patients with elevated PVRI can be successfully transplanted with excellent results.
- © 2013 by American Heart Association, Inc.