Risk Factors for the Development of Late Pulmonary Complications Following Pediatric Heart Transplant

• Published in: The Journal of heart and lung transplantation Vol. 32; no. 4; p. S238
• Main Authors: Steinfeld, T, Preston, H, Mach, K, Shelswell, A, Teskey, J, Mathur, S, Sollazzo, S, Dipchand, A.I, Deliva, R
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2013
• Subjects: Surgery
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2013.01.609

Purpose Survival following pediatric heart transplant (PHTx) continues to improve, however the development of late pulmonary complications (LPC), of multifactorial etiologies, poses a threat to quality of life and function. The purpose of this study was to describe development of LPC and use of cardiopulmonary physical therapy (CPT) interventions in PHTx recipients. Methods and Materials Single centre retrospective review of PHTx recipients transplanted between January 1997 and June 2010. Results 128 subjects (71 males) met inclusion criteria with a median age at transplant of 2.2 years (range 0-17). Sixty-five (51%) had an underlying diagnosis of congenital heart disease (CHD). Seventy-six patients (59.4%) had ≥1 comorbidity at time of Tx, most commonly developmental delay (29.7%). Fifty subjects (39%) developed LPC: recurrent pneumonia (n=37, 28.9%), bronchiectasis (n=9, 7.0%), pleural effusion/chylothorax (n=6, 4.7%), asthma (n=13, 10.2%), interstitial lung disease (n=5, 3.9%), or other (n=20, 15.6%). Facters associated with increased risk of developing LPC included age < 4 years (OR 2.85, CI 1.33-6.10, p=0.007), CHD (OR 4.11, CI 1.91-8.86 p<0.001), presence of comorbidities (OR 3.64, CI 1.70-7.79, p=0.001), cyclosporine use (OR 2.84, CI 1.31-6.16, p=0.008), phrenic nerve damage (OR 2.86, CI 1.02-7.97, p=0.044), acute pneumonia (OR 3.31, CI 1.48-7.41, p=0.004), failed extubation (OR 3.73, CI 1.58-8.79, p=0.003) and longer time on ventilator (OR 1.06, CI 1.02-1.11, p=0.003). Previous surgery and history of aspiration were not associated with increased risk of development of LPC. Sixty-two percent of the LPC group (24% of sample) were receiving CPT greater than 6 months post-HTx. Conclusions LPC develop in a significant portion of PHTx recipients. Risk factors include young age, CHD, comorbidities, phrenic nerve damage, prior pneumonias and longer need for mechanical ventilation. CPT for LPC is indicated to assist with impaired airway clearance, however the impact on long term outcomes remains to be determined.