Diastolic pressure indices offer a novel approach to predicting risk of graft loss after pediatric heart transplant

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.