Impact of pulmonary hypertension on transplant outcomes in pediatric cardiomyopathy patients.

Controversy exists over whether PHTN in heart transplant candidates increases post-transplant mortality. We performed analysis of data reported to UNOS for children who underwent primary heart transplantation for cardiomyopathy from January 1994 to June 2010. Patients were divided into two groups depending on their pre-transplant TPG: no-PHTN (TPG ≤ 12 mmHg) and PHTN (TPG >12 mm Hg). A total of 6139 children underwent transplantation of whom 2456 (40%) were for cardiomyopathies; 1322 (54%) of these had catheterization data available. The PHTN group (mean TPG 19.5 ± 8.6) had 312 patients and no-PHTN (TPG 6.7 ± 4.0) had 1010. Mortality at one month (4.5% vs. 2.3%) and three months (6.1% vs. 3.1%) post-transplant was significantly higher in the PHTN than the no-PHTN group with an odds ratio of 2 (p < 0.05). There was no significant effect of PHTN on early mortality in children <1 yr age. There was no significant improvement in early survival for transplants performed after compared to before 2003 in patients with PHTN despite availability of pulmonary dilators. Pre-transplant PHTN increases early post-transplant mortality in pediatric cardiomyopathy patients above one yr of age. There has been no significant improvement in the outcome of this group over the last seven yr.