Andersons pediatric cardiology 1780
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ofdeathsbetween5and10yearsaftertransplantation(Fig.67.14).
Table67.3
CausesofDeathinChildrenAfterHeartTransplantation(January
2004toJune2015)
0–30Days
(N=256)
CAV
4(1.6%)
Acuterejection 17(6.6%)
Lymphoma
0
Malignancy,
0
other
CMV
0
Infection,non- 16(6.3%)
CMV
Graftfailure
98(38.3%)
Technical
20(7.8%)
Other
23(9%)
Multipleorgan 30(11.7%)
failure
Renalfailure
1(0.4%)
Pulmonary
10(3.9%)
Cerebrovascular 37(14.5%)
CauseofDeath
31Days–1Year
(N=297)
9(3.0%)
45(15.2%)
5(1.7%)
3(1.0%)
>1–3Years
(N=236)
33(14.0%)
42(17.8%)
9(3.8%)
3(1.3%)
>3–5Years
(N=204)
36(17.6%)
30(14.7%)
9(4.4%)
1(0.5%)
>5–10Years
(N=366)
75(20.5%)
39(10.7%)
22(6.0%)
7(1.9%)
>10Years
(N=408)
99(24.3%)
21(5.1%)
26(6.4%)
17(4.2%)
6(2.0%)
37(12.5%)
0
14(5.9%)
0
12(5.9%)
0
20(5.5%)
0
24(5.9%)
61(20.5%)
2(0.7%)
21(7.1%)
64(21.5%)
89(37.7%)
0
15(6.4%)
13(5.5%)
76(37.3%)
1(0.5%)
14(6.9%)
8(3.9%)
145(39.6%)
4(1.1%)
19(5.2%)
14(3.8%)
135(33.1%)
5(1.2%)
24(5.9%)
25(6.1%)
4(1.3%)
29(9.8%)
11(3.7%)
1(0.4%)
11(4.7%)
6(2.5%)
1(0.5%)
9(4.4%)
7(3.4%)
1(0.3%)
11(3.0%)
9(2.5%)
12(2.9%)
7(1.7%)
13(3.2%)
CAV,Cardiacallograftvasculopathy;CMV,cytomegalovirus.
DatafromtheregistryoftheInternationalSocietyofHeartandLungTransplantation.JHeart
LungTransplant.2016:35(10):1185–1195.
FIG.67.14 Relativeincidenceoftheleadingcausesofdeathforthemost
recenterafrom2004toJune2014followinghearttransplantationin
children.CAV,Cardiacallograftvasculopathy;CMV,cytomegalovirus.
(FromtheregistryoftheInternationalSocietyofHeartandLung
Transplantation.JHeartLungTransplant.2016;35(10):1185–1195.)
IndicationsandContraindicationsto
Transplantation
AssessmentPriortoTransplantation
Carefulassessmentpriortotransplantationisrequiredinorder,first,toidentify
potentiallyreversiblecausesofend-stageheartfailureandoptimize
management;second,toidentifyindicationsfortransplantation;andthird,to
identifyconfoundingfactorsorcontraindicationsthatmayprecludecandidacy
fortransplantation.Thegeneralcomponentsrequiredforacomprehensive
assessmentpriortotransplantationareoutlinedinBox67.1.Inadditionto
assessmentoftheheartbythecardiothoracicsurgeonsandtransplant
cardiologists,consultationsfromaninterdisciplinaryteam—includingsocial
workers,psychiatrists,physiotherapists,pharmacists,dieticians,occupational
therapists,specialistsinadolescentmedicine,andkeymedicalservicesincluding
nephrologyandanesthesia—arecriticaltotheprocess.Forexample,renaland/or
hepaticdysfunctionhasbeenassociatedwithareductioninintermediateand
long-termsurvivalandmustthereforebeintegratedintotheassessmentofrisk.
Psychosocialassessmentoftheentirefamilyisparamount.Thisisespecially
importantinassessingadolescents,giventheincreasingawarenessoftheimpact
ofnonadherenceandrisk-takingbehaviorsonsurvivalofboththegraftandthe
patient.18,19Educationcanbeinvaluableinhelpingthepatientandhisorher
siblingstolearnaboutandunderstandthediseaseandtheprocessof
transplantation.Prelistingeducationofthefamilyandpatientalsoincludes
descriptionsoftherolesofthetransplantteam,explanationofgovernment
guidelines(e.g.,TheUnitedNetworkforOrganSharing,listingandallocation
criteriaintheUnitedStates),andprovisionofcenter-specificsurvivalstatistics
asreportedbytheUSScientificRegistryofTransplantRecipients.20
Box67.1
GeneralComponentsoftheAssessmentPrior
toTransplantation
