Abstract 10642: Hemodynamics One Year Post Pediatric Heart Transplant Are Associated With Pre-Transplant Variables and Correlate With Mortality

Abstract

Background: Hemodynamics (HDS) after pediatric heart transplant (PHT) are understudied and may predict future outcomes. We sought to identify variables associated with normalization (NML) of HDS in the 1 st year post-HT and determine association with post-HT outcomes. Methods: HDS were collected from patients who underwent HT between 2013-2020 without a history of pre-HT mechanical support and with at least 3 catheterizations in the 1st year post-HT. NML was defined as 2 consecutive catheterizations with pulmonary vascular resistance index (PVRi) < 3Wu/m 2 , cardiac index (CI) > 2.5L/min/m 2 , and pulmonary wedge pressure (PCWP) <12 mmHg. Freidman repeated measure was used to assess HDS over time and Cox regression associations with NML and long-term mortality. Results: Among 97 patients included, PCWP decreased, CI increased, and PVR remained stable over the 1 st year post-HT (Figure 1A). Only 50% (n=47) had NML by 1 year. Median time to NML was 181 days (IQR 355). Mean PCWP and PVR over the 1st year were higher in non-NML vs NML patients (13.3 vs. 10.8, p<0.001; 2.2 vs. 1.8, p=0.024). On multivariate analysis, patients with retransplant (HR 2.91, p<0.001) and normal HDS at the 1 st post-HT catheterization (HR 4.08, p<0.001) were more likely to have NML, while those with pre-HT congenital heart disease (HR 0.46, p=0.043) were less likely (Table 1/Figure 1B). NML by 1 year-post-HT was not associated with long-term mortality (p=0.794), but lower CI (HR 0.10, p=0.048) and higher PCWP (HR 1.44, p=0.006) at 1 year post-HT were associated with mortality. Conclusion: Only half of PHT recipients have NML of HDS at 1-year post-HT. The CI and PCWP at 1 year post-HT correlated with long-term mortality.