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Diastolic pressure indices offer a novel approach to predicting risk of graft loss after pediatric heart transplant
Author(s) -
Albers Erin L.,
Bradford Miranda C.,
FriedlandLittle Joshua M.,
Hong Borah J.,
Kemna Mariska S.,
Chen Jonathan M.,
Law Yuk M.
Publication year - 2018
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13126
Subject(s) - medicine , hemodynamics , proportional hazards model , cardiology , bivariate analysis , surgery , statistics , mathematics
Abstract PH is a risk factor for GL after HT x. However, traditional parameters are not reliable predictors of risk in children. We hypothesized that DPI ( dPAP and DPG ) are predictive of GL in pediatric HT x recipients. The UNOS / SRTR database was reviewed to identify pediatric HT x recipients (age <18 years) between 1994 and 2013. Recipients with pretransplant hemodynamic data were grouped by diagnosis ( CMP or CHD ), and the groups were analyzed separately. Bivariate Cox regression analysis examined the association between hemodynamic variables and GL . DPI showed the strongest association with early GL in recipients with CMP ( dPAP : HR = 1.25 [1.09‐1.42]; DPG : 1.24 [1.11‐1.38]). Among CHD recipients, DPI were associated with early GL in those with preexisting PH ( dPAP : HR = 1.16 [1.01‐1.33]; DPG : HR = 1.10 [1.00‐1.21]). No cutoff values for “high‐risk” DPI were identified, but a continuous relationship between higher DPI and risk of early GL was observed. DPI are associated with early GL in select pediatric HT x recipients. Our findings suggest that DPI should be considered as part of routine hemodynamic assessment for pediatric HT x candidates.