Impact of Heart Transplantation on the Functional Status of U.S. Children with End-Stage Heart Failure. Analysis of Data from the Organ Procurement and Transplantation Network
Background—There are limited data describing the functional status (FS) of children after heart transplant (HT). We sought to describe the FS of children surviving at least one year after HT, to evaluate the impact of HT on FS, and to identify factors associated with abnormal FS post-HT.
Methods—Organ Procurement and Transplantation Network data were used to identify all US children age <21 years surviving ≥1 year post-HT from 2005-2014 with a functional status score (FSS) available at three time points (listing, transplant, ≥1 year post-HT). Logistic regression and generalized estimating equations were used to identify factors associated with abnormal FS (FSS≤8) post-HT.
Results—A total of 1,633 children met study criteria. At the 1-year assessment, 64% were "fully active/no limitations" (FSS=10), 21% had "minor limitations with strenuous activity" (FSS=9); 15% scored lower than 9. Compared to listing FS, FS at 1-year post-HT increased in 91% and declined/remained unchanged in 9%. A stepwise regression procedure selected the following variables for association with abnormal FS at 1-year post-HT: age ≥18 years (OR 1.8, 95% CI 1.2-2.7), African American race (OR 1.5, 95% CI 1.1-2.0), support with ≥inotropes at HT (OR 1.7, 95% CI 1.2-2.5), being hospitalized at HT (OR 1.5, 95% CI 1.0-2.19), chronic steroid use at HT (OR 1.5, 95% CI 1.0-2.2), and treatment for early rejection (OR 2.0, 95% CI 1.5-2.7).
Conclusions—Among US children who survive at least one year after HT, functional status is excellent for the majority of patients. HT is associated with substantial improvement in functional status for most children. Early rejection, older age, African American race, chronic steroid use, hemodynamic support at HT and being hospitalized at HT are associated with abnormal functional status post-HT.
- functional status
- heart failure
- functional capacity impairment
- quality of life
- Received March 16, 2015.
- Revision received December 19, 2016.
- Accepted January 12, 2017.