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Functional status improves in most children who survive 1 year after heart transplant
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Functional status was found to be excellent in most U.S. children who received a heart transplant and survived at least 1 year after the transplant, according to research recently published in Circulation.
Excellent functional status was defined as being highly active without significant limitations.
For most children, heart transplant was linked to a significant improvement in functional status, but certain factors were related to abnormal functional status after heart transplant, researchers reported.
The researchers used data from the Organ Procurement and Transplantation Network, identifying children in the United States younger than 21 years who had survived 1 year or more after a heart transplant.
The transplants took place from 2005 to 2014, and all 1,633 children included in the study had a functional status score available at three intervals: at listing, at transplant, and at 1 year after heart transplant or longer.
A functional status score of 10 indicated that the child was fully active with no limitations. A score of 9 indicated that the child had minor limitations with strenuous activity, and a score of 8 or less indicated an abnormal functional status. When determining abnormal functional status, the researchers used logistic regression and generalized estimating equations.
At the 1-year assessment, 64% of participants had a functional status score of 10; 21% had a score of 9; and 15% had a score of 8 or lower.
Ninety-one percent of the participants had a higher functional status score at 1 year after heart transplant vs. their listing functional status score, whereas 9% of all participants experienced a decline or an unchanged functional status score a year after heart transplant.
The following variables were associated with abnormal functional status 1 year after transplant: age 18 years or older (OR = 1.8; 95% CI, 1.2-2.7), black race (OR = 1.5; 95% CI, 1.1-2), higher level of hemodynamic support at transplantation (OR = 1.7; 95% CI, 1.2-2.5), being hospitalized at transplant (OR = 1.5; 95% CI, 1-2.19), chronic steroid use at transplant (OR = 1.5; 95% CI, 1-2.2) and treatment for early rejection (OR = 2; 95% CI, 1.5-2.7).
“These present-day findings may be helpful to clinicians who are tasked with counseling families regarding the expectations for post-[heart transplant] life, and perhaps to critical care providers whose direct experience looking after the sickest patients may not always allow them to appreciate the long-term promise of [heart transplant] therapy. Lastly, as patient survival continues to improve across eras, greater attention needs to be placed on understanding how to optimize the overall quality of life of children after a lifesaving heart transplant and into adulthood,” David M. Peng, MD, of the division of pediatric cardiology, Lucile Packard Children’s Hospital at Stanford University, California, and colleagues wrote. – by Suzanne Reist
Disclosure: The researchers report no relevant financial disclosures.
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