Introduction: The purpose of this study was to investigate associations between clinical factors and cardiac function as measured by pressure-volume loops (PVL) in a pediatric heart transplant cohort.

Methods: Patients (age < 20 years) who underwent heart transplantation presenting for a clinically indicated catheterization were enrolled. PVLs were recorded using microconductance catheters (CD Leycom ®, Zoetermeer, Netherlands). Demographic data, serum B-type natriuretic peptide (BNP), time from transplant, ischemic time, the presence of transplant coronary artery disease, donor specific antibodies and history of rejection were recorded at the time of catheterization. PVL data included contractility indices: end systolic elastance (Ees) and preload recruitable stroke work (PRSW); ventricular-arterial coupling index; ventricular stiffness constant, β; and isovolumic relaxation time constant, tau. Associations between PVL measures and clinical data were investigated using non-parametric statistical tests.

Results: A total of 18 patients were enrolled. Median age was 8.7 years (IQR 5-14y). There were ten males and eight females. Seven patients had a history of rejection and ten had positive donor specific antibodies. There was no transplant coronary artery disease. Median BNP was 100 pg/mL (IQR 46-140). Time from transplant to PVL data obtained during catheterization procedure was 4.1 years (IQR 1.7-7.8y). No single clinical characteristic was statistically significant when correlated with PVL data. However, longer ischemic time was associated with worse β (r = 0.49, p = 0.05).

Conclusion: Our study found that longer ischemic times are associated with increased chamber stiffness. This is remarkable as all measurements were taken more than 1-year post transplant. Ischemic times appear to have a long term deleterious effect on graft function. No other single clinical variable is associated with cardiac dysfunction as determined by PVL analysis.

CITATION INFORMATION: Schroeder L, Chowdhury S, Burnette A, Baker H, Savage A, Atz A, Butts R. Longer Ischemic Time Is Associated with Late Graft Dysfunction in Pediatric Heart Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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