David M Peng1, Yulin Zhang1, David N Rosenthal1, Michal Palmon1, Sharon Chen1, Beth D Kaufman1, Katsuhide Maeda1, Seth A Hollander1, Nancy McDonald1, Leslie B Smoot1, Daniel Bernstein1, Christopher S Almond2. 1. From Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, and the Department of Pediatrics, Stanford University, Palo Alto, CA (D.M.P., D.N.R., S.C., B.D.K., S.A.H., N.M., D.B., C.S.A.); the Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (Y.Z., M.P.); and Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, MA (L.B.S.). 2. From Division of Pediatric Cardiology and The Heart Center Clinical and Translational Research Program, Lucile Packard Children's Hospital, and the Department of Pediatrics, Stanford University, Palo Alto, CA (D.M.P., D.N.R., S.C., B.D.K., S.A.H., N.M., D.B., C.S.A.); the Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (Y.Z., M.P.); and Department of Cardiology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, MA (L.B.S.). christopher.almond@stanford.edu.
Abstract
BACKGROUND: There are limited data describing the functional status (FS) of children after heart transplant (HT). We sought to describe the FS of children surviving at least 1 year after HT, to evaluate the impact of HT on FS, and to identify factors associated with abnormal FS post-HT. METHODS: Organ Procurement and Transplantation Network data were used to identify all US children <21 years of age surviving ≥1 year post-HT from 2005 to 2014 with a functional status score (FSS) available at 3 time points (listing, transplant, ≥1 year post-HT). Logistic regression and generalized estimating equations were used to identify factors associated with abnormal FS (FSS≤8) post-HT. RESULTS: A total of 1633 children met study criteria. At the 1-year assessment, 64% were "fully active/no limitations" (FSS=10), 21% had "minor limitations with strenuous activity" (FSS=9); and 15% scored ≤8. In comparison with listing FS, FS at 1 year post-HT increased in 91% and declined/remained unchanged in 9%. A stepwise regression procedure selected the following variables for association with abnormal FS at 1 year post-HT: ≥18 years of age (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2-2.7), black race (OR, 1.5; 95% CI, 1.1-2.0), support with ≥inotropes at HT (OR, 1.7; 95% CI, 1.2-2.5), hospitalization status at HT (OR, 1.5; 95% CI, 1.0-2.19), chronic steroid use at HT (OR, 1.5; 95% CI, 1.0-2.2), and treatment for early rejection (OR, 2.0; 95% CI, 1.5-2.7). CONCLUSION: Among US children who survive at least 1 year after HT, FS is excellent for the majority of patients. HT is associated with substantial improvement in FS for most children. Early rejection, older age, black race, chronic steroid use, hemodynamic support at HT, and being hospitalized at HT are associated with abnormal FS post-HT.
BACKGROUND: There are limited data describing the functional status (FS) of children after heart transplant (HT). We sought to describe the FS of children surviving at least 1 year after HT, to evaluate the impact of HT on FS, and to identify factors associated with abnormal FS post-HT. METHODS: Organ Procurement and Transplantation Network data were used to identify all US children <21 years of age surviving ≥1 year post-HT from 2005 to 2014 with a functional status score (FSS) available at 3 time points (listing, transplant, ≥1 year post-HT). Logistic regression and generalized estimating equations were used to identify factors associated with abnormal FS (FSS≤8) post-HT. RESULTS: A total of 1633 children met study criteria. At the 1-year assessment, 64% were "fully active/no limitations" (FSS=10), 21% had "minor limitations with strenuous activity" (FSS=9); and 15% scored ≤8. In comparison with listing FS, FS at 1 year post-HT increased in 91% and declined/remained unchanged in 9%. A stepwise regression procedure selected the following variables for association with abnormal FS at 1 year post-HT: ≥18 years of age (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2-2.7), black race (OR, 1.5; 95% CI, 1.1-2.0), support with ≥inotropes at HT (OR, 1.7; 95% CI, 1.2-2.5), hospitalization status at HT (OR, 1.5; 95% CI, 1.0-2.19), chronic steroid use at HT (OR, 1.5; 95% CI, 1.0-2.2), and treatment for early rejection (OR, 2.0; 95% CI, 1.5-2.7). CONCLUSION: Among US children who survive at least 1 year after HT, FS is excellent for the majority of patients. HT is associated with substantial improvement in FS for most children. Early rejection, older age, black race, chronic steroid use, hemodynamic support at HT, and being hospitalized at HT are associated with abnormal FS post-HT.
Authors: Stefan Roest; Marijke H van der Meulen; Lennie M van Osch-Gevers; Ulrike S Kraemer; Alina A Constantinescu; Matthijs de Hoog; Ad J J C Bogers; Olivier C Manintveld; Pieter C van de Woestijne; Michiel Dalinghaus Journal: Neth Heart J Date: 2022-07-15 Impact factor: 2.854