Michelle Lim, MD
Assistant Clinical Professor
University of California Davis Health
Sacramento, California
Disclosure information not submitted.
Myung Sim, PhD
Associate Professor
David Geffen School of Medicine, UCLA, United States
Disclosure information not submitted.
Mengtong Pan
N/A
David Geffen School of Medicine, UCLA, United States
Disclosure information not submitted.
Juan Alejos, MD
Professor
David Geffen School of Medicine, UCLA, United States
Disclosure information not submitted.
Myke Federman, MD
Professor
David Geffen School of Medicine UCLA, United States
Disclosure information not submitted.
Title: Early Postoperative Volume Overload is a Predictor of Death in Pediatric Heart Transplant Recipients
Introduction: Fluid restricted goals and diuretic management has been the mainstay of postoperative management of cardiac patients, at high risk for both postoperative volume overload and vulnerable to its potential deleterious effects on cardiac and secondary end-organ function. We sought to investigate whether postoperative volume overload is related to overall mortality and primary graft function among pediatric heart transplant recipients.
Methods: This was a retrospective cohort study from a single-center pediatric heart transplant center. Children aged between 0 to 21 years old undergoing cardiac transplantation between the time frame of January 2010 to May 2018 were included in the analysis. Fluid overload was assessed as a percent fluid accumulation (total volume input-total volume of fluid output)/admission weight (kg) x 100) and patients were subsequently stratified into 3 categories of fluid balance: < 5%, 5-10% and > 10%.
Results: A total of 102 pediatric orthotopic heart transplant (OHT) recipients were included in the study. Early fluid overload ( >10% within 72 hours of OHT) occurred in 14% of patients and overall fluid overload ( > 10% within 1 week of OHT) occurred in 23% of patients. Risk factors for postoperative volume overload included younger age, lower weight, cyanotic heart disease, and the presence of immediate graft failure requiring ECMO. Early fluid overload was noted to be associated with overall mortality, OR 4.8 (95% CI 1.3, 17.5), p=0.02 and this association was noted to have the highest association at 1 year, OR 11.4 (95% CI 1.8, 70.8), p=0.01. This association held true, following a multivariate analysis adjusting for age and weight. There was no significant relationship between volume overload and graft function, as measured by rates of clinical rejection and cardiopulmonary filling pressures with routine cardiac catheterization within the first year of transplant.
Conclusions: Early postoperative volume overload is prevalent and correlated with increased risk of death among pediatric heart transplant recipients. It is an important early postoperative metric of transplant survival among pediatric OHT recipients, and larger prospective studies are warranted to better explore this relationship.