Department of Cardiology Boston Children's Hospital Boston MA.
Department of Pediatrics Harvard Medical School Boston MA.
J Am Heart Assoc. 2021 Jul 6;10(13):e021082. doi: 10.1161/JAHA.121.021082. Epub 2021 Jun 29.
Background Previous studies suggest that infant heart transplant (HT) recipients are at higher risk of developing severe primary graft dysfunction (PGD) than older children. We sought to identify risk factors for developing severe PGD in infant HT recipients. Methods and Results We identified all HT recipients aged <1 year in the United States during 1996 to 2015 using the Organ Procurement and Transplant Network database. We linked their data to ELSO (Extracorporeal Life Support Organization) registry data to identify those with severe PGD, defined by initiation of extracorporeal membrane oxygenation support for PGD within 2 days following HT. We used multivariable logistic regression to assess risk factors for developing severe PGD. Of 1718 infants analyzed, 600 (35%) were <90 days old and 1079 (63%) had congenital heart disease. Overall, 134 (7.8%) developed severe PGD; 95 (71%) were initiated on extracorporeal membrane oxygenation support on the day of HT, 34 (25%) the next day, and 5 (4%) the following day. In adjusted analysis, recipient congenital heart disease, extracorporeal membrane oxygenation, or biventricular assist device support at transplant, recipient blood type AB, donor-recipient weight ratio <0.9, and graft ischemic time ≥4 hours were independently associated with developing severe PGD whereas left ventricular assist device support at HT was not. One-year graft survival was 48% in infants with severe PGD versus 87% without severe PGD. Conclusions Infant HT recipients with severe PGD have poor graft survival. Although some recipient-level risk factors are nonmodifiable, avoiding modifiable risk factors may mitigate further risk in infants at high risk of developing severe PGD.
先前的研究表明，婴儿心脏移植（HT）受者发生严重原发性移植物功能障碍（PGD）的风险高于大龄儿童。我们试图确定婴儿 HT 受者发生严重 PGD 的危险因素。
我们使用器官获取和移植网络数据库在美国确定了 1996 年至 2015 年间所有年龄<1 岁的 HT 受者。我们将他们的数据与 ELSO（体外生命支持组织）登记处的数据相链接，以确定那些发生严重 PGD 的患者，其定义为 HT 后 2 天内因 PGD 开始体外膜氧合支持。我们使用多变量逻辑回归来评估发生严重 PGD 的危险因素。在分析的 1718 名婴儿中，600 名（35%）<90 天，1079 名（63%）患有先天性心脏病。总体而言，134 名（7.8%）发生严重 PGD；95 名（71%）在 HT 当天开始体外膜氧合支持，34 名（25%）在第二天开始，5 名（4%）在第三天开始。在调整分析中，受者先天性心脏病、HT 时的体外膜氧合或双心室辅助设备支持、受者血型 AB、供受者体重比<0.9 和移植物缺血时间≥4 小时与发生严重 PGD 独立相关，而 HT 时的左心室辅助设备支持则不然。严重 PGD 婴儿的 1 年移植物存活率为 48%，而无严重 PGD 婴儿的存活率为 87%。
发生严重 PGD 的婴儿 HT 受者移植物存活率差。尽管一些受者水平的危险因素是不可改变的，但避免可改变的危险因素可能会降低发生严重 PGD 的高危婴儿的进一步风险。
