University of Iowa Stead Family Children's Hospital, University of Iowa, Iowa City, Iowa.
Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
J Heart Lung Transplant. 2023 Jul;42(7):964-973. doi: 10.1016/j.healun.2023.02.007. Epub 2023 Feb 21.
Functional status predicts waitlist survival in adult heart transplantation and is an independent predictor of outcomes in pediatric liver transplantation. This has not been studied in pediatric heart transplantation. Study aims were to determine the association of: (1) functional status at listing with waitlist and post-transplant outcomes, and (2) functional status at transplant with post-transplant outcomes in pediatric heart transplantation.
Retrospective United Network of Organ Sharing database study of pediatric patients listed for heart transplant between 2005 and 2019 with Lansky Play Performance Scale (LPPS) scores at listing. Standard statistical methods were used to assess relationships between LPPS and outcomes (waitlist and post-transplant). Negative waitlist outcome was defined as death or removal from waitlist due to clinical deterioration.
There were 4,169 patients identified, including 1,080 with LPPS 80-100 (normal activity), 1,603 with LPPS 50-70 (mild limitations), and 1,486 with LPPS 10-40 (severe limitations). LPPS 10-40 correlated with negative waitlist outcomes (HR 1.69, CI 1.59-1.80, p < 0.0001). While LLPS at listing had no association with post-transplant survival, those with LPPS 10-40 at transplant had inferior 1-year post-transplant survival compared to those with LPPS ≥50 (92% vs 95%-96%, p = 0.0011). Functional status was an independent predictor of post-transplant outcomes in patients with cardiomyopathy. A functional improvement of ≥20 points between listing and transplant (N = 770, 24%) was associated with higher 1-year post-transplant survival (HR 1.63, 95% CI: 1.10-2.41, p = 0.018).
Functional status is associated with waitlist and post-transplant outcomes. Interventions targeting functional impairment may improve pediatric heart transplantation outcomes.
功能状态可预测成人心脏移植的候补者生存情况，并且是儿童肝移植结果的独立预测因子。但这在儿童心脏移植中尚未得到研究。本研究旨在确定：（1） 列入名单时的功能状态与候补者和移植后结果之间的关联；（2） 儿童心脏移植中移植时的功能状态与移植后结果之间的关联。
回顾性分析 2005 年至 2019 年期间在器官共享联合网络数据库中登记的儿童心脏移植患者，在登记时进行兰斯基表演状态量表（Lansky Play Performance Scale，LPPS）评分。采用标准统计方法评估 LPPS 与结果（候补者和移植后）之间的关系。候补者负面结果定义为死亡或因临床恶化而从候补者名单中删除。
共确定了 4169 例患者，其中 1080 例 LPPS 为 80-100（正常活动），1603 例 LPPS 为 50-70（轻度受限），1486 例 LPPS 为 10-40（严重受限）。LPPS 10-40 与候补者负面结果相关（HR 1.69，CI 1.59-1.80，p<0.0001）。尽管 LPPS 在登记时与移植后生存无关，但移植时 LPPS 为 10-40 的患者与 LPPS ≥50 的患者相比，移植后 1 年的生存率较低（92% vs 95%-96%，p=0.0011）。功能状态是心肌病患者移植后结果的独立预测因子。登记和移植之间功能状态提高≥20 分（N=770，24%）与移植后 1 年生存率较高相关（HR 1.63，95%CI：1.10-2.41，p=0.018）。
功能状态与候补者和移植后结果相关。针对功能障碍的干预措施可能会改善儿童心脏移植的结果。
