Balakrishnan Komarakshi R, Rao Kemundel Genny Suresh, Subramaniam Ganapathy Krishnan, Tanguturu Murali Krishna, Arvind Ajay, Ramanan Veena, Dhushyanthan Jagdish, Ramasubramanian K, Kumaran K Suresh, Sellamuthu Gunalan, Rajam Mohan, Mettur Senthil, Gnansekharan Pradeep, Ratnagiri Ravikumar
Department of Pediatric Cardiac Surgery, Institute of Heart and Lung Transplantation, MGM Health Care, Chennai, Tamil Nadu, India.
Ann Pediatr Cardiol. 2021 Jan-Mar;14(1):42-52. doi: 10.4103/apc.APC_129_20. Epub 2021 Jan 16.
There is a paucity of data regarding the outcomes of Heart transplantation in children from the Indian subcontinent. The data of patients under the age of 18 undergoing an isolated heart transplantation was analyzed for patient clinical profiles and risk factors for early and medium-term mortality. Hospital mortality was defined as death within 90 days of transplantation and medium-term survival as follow up of up to 6 years.
A total of 97 patients operated between March 2014 and October 2019 were included in this study. Data was collected about their INTERMACS status, pulmonary vascular resistance, donor heart ischemic times, donor age, donor to recipient weight ratio and creatinine levels.
The age range was from 1 to 18 with a mean of 10.6 ± 4.6 years. 67 % patients were in INTERMACS category 3 or less.12 children were on mechanical circulatory support at the time of transplant. The 90 day survival was 89 %. The risk factors for hospital mortality was lower INTERMACS category (odd's ratio 0.2143, = 0.026), elevated creatinine (odd's ratio 5.42, = 0.076) and elevated right atrial pressure (odd's ratio 1.19, = 0.015). Ischemic time, pulmonary vascular resistance (PVR) and PVR index (PVRI) had no effect on 90 day survival. Kaplan Meier estimates for 5 year survival was 73 %. The medium term survival was affected by INTERMACS category (Hazard ratio 0.7, = .078), donor age > 25 (Hazard ratio 1.6, = 0.26) and raised serum creatinine values.(Hazard ratio 2.7, = 0.012). All the survivors are in good functional class.
Excellent outcomes are possible after heart transplantation in a pediatric population even in a resource constrained environment of a developing economy. More efforts are needed to promote pediatric organ donation and patients need to be referred in better INTERMACS category for optimal outcomes.
关于印度次大陆儿童心脏移植结果的数据匮乏。对18岁以下接受单纯心脏移植患者的数据进行分析，以了解患者临床特征及早期和中期死亡的危险因素。医院死亡率定义为移植后90天内死亡，中期生存定义为随访长达6年。
本研究纳入了2014年3月至2019年10月期间接受手术的97例患者。收集了他们的INTERMACS状态、肺血管阻力、供心缺血时间、供体年龄、供受体体重比和肌酐水平等数据。
年龄范围为1至18岁，平均年龄为10.6±4.6岁。67%的患者处于INTERMACS 3级或更低级别。12名儿童在移植时接受机械循环支持。90天生存率为89%。医院死亡的危险因素为较低的INTERMACS级别（比值比0.2143，P = 0.026）、肌酐升高（比值比5.42，P = 0.076）和右心房压力升高（比值比1.19，P = 0.015）。缺血时间、肺血管阻力（PVR）和肺血管阻力指数（PVRI）对90天生存率无影响。Kaplan Meier法估计的5年生存率为73%。中期生存受INTERMACS级别（风险比0.7，P =.078）、供体年龄>25岁（风险比1.6，P = 0.26）和血清肌酐值升高（风险比2.7，P = 0.012）影响。所有幸存者功能状态良好。
即使在发展中经济体资源有限的环境下，儿科人群心脏移植后也可能取得优异的结果。需要做出更多努力来促进儿科器官捐赠，并且患者需要以更好的INTERMACS级别转诊以获得最佳结果。
