Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics.
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA.
J Heart Lung Transplant. 2019 Jun;38(6):601-608. doi: 10.1016/j.healun.2019.01.1310. Epub 2019 Jan 24.
Previous reports of primary graft dysfunction (PGD) in pediatric heart transplant (HT) recipients are limited to descriptive series of children who required extracorporeal membrane oxygenation (ECMO) support shortly after HT. In this study we sought to determine the incidence, risk factors, and survival after severe PGD in pediatric HT recipients.
We identified all children <18 years old who underwent HT in the United States during 1996 to 2015 using the Organ Procurement and Transplant Network database and then identified those who developed severe PGD by linking patient variables to Extracorporeal Life Support Organization registry data. Logistic regression models were used to assess risk factors for developing severe PGD.
The overall incidence of severe PGD was 4.7% over 20 years (95% confidence interval 4.2% to 5.3%). The incidence was 4.1%, 4.5%, 5.3%, and 4.6%, respectively, in consecutive 5-year periods (p for trend = 0.48). Independent risk factors for developing severe PGD were younger age, congenital heart disease, HT while supported on ECMO, higher serum bilirubin, and graft ischemic time ≥4 hours. Ventricular assist device support as bridge to HT and available donor variables were not associated. Death (or graft loss) before discharge occurred in 40.6% of children with PGD (105 deaths, 7 re-transplants) and in 5.6% of children without PGD.
Severe PGD remains an important clinical morbidity in pediatric HT recipients in the current era and is associated with high mortality. These findings highlight the need for research in preventing and treating PGD in pediatric HT recipients for improving overall post-transplant survival.
既往关于儿科心脏移植（HT）受者原发性移植物功能障碍（PGD）的报道仅限于接受体外膜氧合（ECMO）支持的儿童的描述性系列。在这项研究中，我们旨在确定儿科 HT 受者严重 PGD 的发生率、危险因素和存活率。
我们使用器官获取和移植网络数据库确定了 1996 年至 2015 年期间在美国接受 HT 的所有<18 岁的儿童，并通过将患者变量与体外生命支持组织登记数据相链接，确定了那些发生严重 PGD 的患者。Logistic 回归模型用于评估发生严重 PGD 的危险因素。
20 年来，严重 PGD 的总发生率为 4.7%（95%置信区间 4.2%至 5.3%）。在连续的 5 年期间，发生率分别为 4.1%、4.5%、5.3%和 4.6%（趋势 p=0.48）。发生严重 PGD 的独立危险因素为年龄较小、先天性心脏病、ECMO 支持下进行 HT、血清胆红素升高和移植物缺血时间≥4 小时。作为 HT 桥接的心室辅助装置支持和可获得的供体变量与 PGD 无关。PGD 患儿中有 40.6%（105 例死亡，7 例再次移植）在出院前死亡（或移植物丢失），而无 PGD 患儿中仅有 5.6%。
在当前时代，严重 PGD 仍然是儿科 HT 受者的重要临床发病率，并且与高死亡率相关。这些发现强调了需要研究预防和治疗儿科 HT 受者的 PGD，以提高整体移植后存活率。
