ORIGINAL ARTICLE Multiple Risk Factors Before Pediatric Cardiac Transplantation Are Associated With Increased Graft Loss Scott R. Auerbach • Marc E. Richmond • Jonathan M. Chen • Ralph S. Mosca • Jan M. Quaegebeur • Linda J. Addonizio • Daphne T. Hsu • Jacqueline M. Lamour Received: 29 March 2011 / Accepted: 20 July 2011 / Published online: 4 September 2011 Ó Springer Science+Business Media, LLC 2011 Abstract Identification of heart transplant recipients at highest risk for a poor outcome could lead to improved posttransplantation survival. A chart review of primary heart transplantations from 1993 to 2006 was performed. Analysis was performed to evaluate the risk of graft loss for those with a transplantation age less than 1 year, congenital heart disease (CHD), elevated pulmonary vascular resistance (index [ 6), positive panel reactive antibody or crossmatch, liver or renal dysfunction, mechanical ventilation, or mechanical circulatory support (MCS). Primary transplan- tation was performed for 189 patients. Among these patients, 37% had CHD, 23% had mechanical ventilation, and 6% had renal dysfunction. Overall graft survival was 82% at 1 year and 68% at 5 years. The univariate risk factors for graft loss included mechanical ventilation (hazard ratio [HR], 1.9; 95% confidence interval [CI], 1.15–3.18), CHD (HR, 1.68; 95% CI, 1.04–2.70), and renal dysfunction (HR, 3.05; 95% CI, 1.34–6.70). The multivariate predictors of graft loss were CHD (HR, 1.8; 95% CI, 1.02–2.64), mechanical ventilation (HR, 1.9; 95% CI, 1.13–3.10), and the presence of two or more statistically significant univariate risk factors (SRF) (HR, 3.8; 95% CI, 2.00–7.32). Mechanical ventilation, CHD, and the presence of two or more SRFs identify pediatric patients at higher risk for graft loss and should be considered in the management of children with end-stage heart failure. Keywords Alternate listing Á Cardiac transplantation Á Congenital heart disease Á Graft survival Á Pediatrics Á Risk factors Cardiac transplantation has become a standard treatment for children with end-stage cardiomyopathy (CMP), con- genital heart disease (CHD) refractory to surgical pallia- tion, and other forms of end-stage heart failure. In recent years, survival after transplantation has improved to nearly 90% at 1 year and 75% at 5 years [15]. Although this improved survival is encouraging, identification of patients at higher risk for unfavorable outcomes after transplanta- tion is important, both to guide therapy aimed at avoiding pre- and posttransplant morbidity and to better determine optimal donor allocation strategies [7, 23]. Previously identified pretransplantation risk factors for graft loss include donor-to-recipient weight ratio [9, 28], age younger than 1 year [5], renal insufficiency, pretrans- plantation need for mechanical ventilation, diagnosis of CHD [16], elevated pulmonary vascular resistance [16], Presented at the American College of Cardiology National Conference, 31 March 2008. S. R. Auerbach Department of Pediatric Cardiology, University of Colorado, Children’s Hospital Colorado, Denver, CO, USA M. E. Richmond Á L. J. Addonizio Division of Pediatric Cardiology, Columbia University, Morgan Stanley Children’s Hospital of New York at the Columbia University Medical Center, New York, NY, USA J. M. Chen Á J. M. Quaegebeur Division of Pediatric Cardiac Surgery, Columbia University, Morgan Stanley Children’s Hospital of New York at the Columbia University Medical Center, New York, NY, USA R. S. Mosca Division of Cardiovascular Surgery, New York University, NYU Langone Medical Center, New York, NY, USA D. T. Hsu Á J. M. Lamour (&) Division of Pediatric Cardiology, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, R3, 3415 Bainbridge Avenue, Bronx, NY 10467-2490, USA e-mail: jlamour@montefiore.org 123 Pediatr Cardiol (2012) 33:49–54 DOI 10.1007/s00246-011-0077-7