Abstract SNACC-13

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Cardiac Dysfunction After Multiple Causes of Pediatric Brain Death

Borbely X, Krishnamoorthy V, Rowhani-Rahbar A, Souter M, Vavilala M
University of Washington, Seattle, WA, USA

Background:
The lack of adequate donor hearts for transplantation is still a major worldwide problem. Cardiac dysfunction (CD) has been reported to occur in as much as 42% of adults with brain death[1], and may limit cardiac donation after brain death (BD)[2]. This number might even be higher in the pediatric population[3], although investigations have been limited to small case reports and series. A knowledge of the prevalence and natural course of CD after BD may help to improve screening and transplant practices. Therefore, the aims of our study are to describe the prevalence and course of cardiac dysfunction after pediatric brain death.

Methods:
We conducted a cross-sectional study using a database (Life Center Northwest) of pediatric organ donors diagnosed with BD between Jan 2011 and Nov 2013.
We identified 60 pediatric donors (age ≤ 18years) with at least one transthoracic echocardiogram (TTE) following brain death. TTEs were reviewed for CD [defined as ejection fraction (EF) < 50% and/or presence of regional wall motion abnormalities (RWMA)]. Descriptive statistics were used to analyze clinical characteristics and describe longitudinal echocardiogram findings in a subgroup of patients (n=11). A multivariate Poisson regression analysis was performed to evaluate the association of cardiac dysfunction with respect to cause of brain death.

Results:
Cardiac dysfunction was present in 23 (38%) patients. Mean EF and proportion of harvested hearts differed significantly between the groups with and without cardiac dysfunction (Table 1). Regarding the 11 subjects with serial TTE data (Table 2), 8 (73%) patients with CD resolved over time, leading to organ harvest; the remaining 3 subjects were not harvested for transplantation. Regression analysis revealed no association between cardiac dysfunction and particular causes of BD (Table 3).

Conclusions:
Our study is the largest study of CD in the pediatric BD population, and has confirmed that the prevalence of CD in the pediatric population is similar to adult populations. Serial TTEs in patients with CD showed improvement of cardiac function in 73% of patients, leading to organ harvest for transplantation. CD after pediatric BD should be studied in well-designed prospective studies, and findings may lead to an improvement in the number of hearts available for transplantation.

References:

1. Dujardin, K.S., et al., Myocardial dysfunction associated with brain death: clinical, echocardiographic, and pathologic features. J Heart Lung Transplant, 2001. 20(3): p. 350-7.
2. Zaroff, J.G., W.D. Babcock, and S.C. Shiboski, The impact of left ventricular dysfunction on cardiac donor transplant rates. J Heart Lung Transplant, 2003. 22(3): p. 334-7.
3. Paul, J.J., et al., Spectrum of left ventricular dysfunction in potential pediatric heart transplant donors. J Heart Lung Transplant, 2003. 22(5): p. 548-52.



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