Not all durations of preheart transplant mechanical ventilation portend inferior post-transplant survival in children.
Pediatr Transplant
; 27(3): e14433, 2023 05.
Article
in En
| MEDLINE
| ID: mdl-36345131
ABSTRACT
BACKGROUND:
Mechanical ventilation prior to pediatric heart transplantation predicts inferior post-transplant survival, but the impact of ventilation duration on survival is unclear.METHODS:
Data from the United Network for Organ Sharing and Pediatric Health Information System were used to identify pediatric (<18 years) heart transplant recipients from 2003 to 2020. Patients ventilated pretransplant were first compared to no ventilation, then ventilation durations were compared across quartiles of ventilation (≤1 week, 8 days-5 weeks, >5 weeks).RESULTS:
At transplant, 11% (511/4506) of patients required ventilation. Ventilated patients were younger, had more congenital heart disease, more urgent listing-status, and greater rates of nephropathy, TPN-dependence, and inotrope and ECMO requirements (p < .001 for all). Post-transplant, previously ventilated patients experienced longer ventilation durations, ICU and hospital stays, and inferior survival (all p < .001). Hospital outcomes and survival worsened with longer pretransplant ventilation. One-year and overall survival were similar between the no-ventilation and ≤1 week groups (p = .703 & p = .433, respectively) but were significantly worse for ventilation durations >1 week (p < .001). On multivariable analysis, ventilation ≤1 week did not predict mortality (HR 0.98 [95% CI 0.85-1.43]), whereas ventilation >1 week did (HR 1.18 [1.01-1.39]).CONCLUSIONS:
Longer pretransplant ventilation portends worse outcomes, although only ventilation >1 week predicts mortality. These findings can inform pretransplant prognostication.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Heart Transplantation
/
Health Information Systems
Type of study:
Prognostic_studies
Limits:
Child
/
Humans
Language:
En
Journal:
Pediatr Transplant
Journal subject:
PEDIATRIA
/
TRANSPLANTE
Year:
2023
Document type:
Article
Affiliation country: