Variations in Criteria and Practices for Heart Transplantation Listing Among Pediatric Transplant Cardiologists (original) (raw)

2015, The Journal of Heart and Lung Transplantation

Purpose: Severe renal dysfunction may be prohibitive to HT. However, the acceptable threshold is not well defined. CKD staging has prognostic implications for the adult population, however, its influence on pediatric recipients is unknown and may be an important consideration in patient selection. Methods: 3241 HT pts were identified from UNOS (1987-2011) & stratified by CKD stage using the MDRD formula as the UNOS registry does not capture variables for pediatric GFR calculators. Exclusions: age > 17y, re-HT, multiorgan transplant/listing, & patients lost to follow-up (FU). Survival was censored at 12y & multivariate Cox proportional hazard regression models were adjusted for age, sex, diabetes, race, ischemic time, dialysis, ischemic etiology, life support, wait time & HLA mismatch. Results: CKD stages 1 (n= 2854) & 2 (n= 188) were most prevalent compared to CKD 3 (n= 71), 4 (n= 15) & 5 (113). 1066 died during the study period (31%, 45%, 55%, 67% & 45% for CKD 1-5 respectively). Crude survival is shown in Figure. Unadjusted HR for all-cause mortality (compared to CKD 1) was: CKD 2 [1.38 (1.09-1.74)*], CKD 3 [1.89 (1.36-2.62)*]; CKD 4 [2.36 (1.23-4.56)*]; CKD 5 [1.99 (1.47-2.68)*]. Adjusted multivariate analysis showed: Stage 2 [1.16 (0.87-1.53)**]; Stage 3 [1.95 (1.33-2.86)*]; Stage 4 [3.93 (1.92-8.04)*]; Stage 5 [1.91 (1.35-2.71)*]. Conclusion: CKD stage is an independent predictor of mortality post HT in pediatric recipients. CKD stages 2-5 have significantly worse outcomes than CKD stage 1. MDRD may be useful for risk stratification in pediatric recipients. Further studies are warranted.*p < 0.001; **p= NS