Preoperative echocardiographic parameters predict primary graft dysfunction following pediatric lung transplantation

Adam S. Himebauch, Wai Wong, Yan Wang, Francis X. McGowan, Robert A. Berg, Christopher E. Mascio, Todd J. Kilbaugh, Kimberly Y. Lin, Samuel B. Goldfarb, Steven M. Kawut, Laura Mercer-Rosa, Nadir Yehya

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5 Scopus citations


The importance of preoperative cardiac function in pediatric lung transplantation is unknown. We hypothesized that worse preoperative right ventricular (RV) systolic and worse left ventricular (LV) diastolic function would be associated with a higher risk of primary graft dysfunction grade 3 (PGD 3) between 48 and 72 hours. We performed a single center, retrospective pilot study of children (<18 years) who had echocardiograms <1 year prior to lung transplantation between 2006 and 2019. Conventional and strain echocardiography parameters were measured, and PGD was graded. Area under the receiver operating characteristic (AUROC) curves and logistic regression were performed. Forty-one patients were included; 14 (34%) developed PGD 3 and were more likely to have pulmonary hypertension (PH) as the indication for transplant (P =.005). PGD 3 patients had worse RV global longitudinal strain (P =.01), RV free wall strain (FWS) (P =.003), RV fractional area change (P =.005), E/e’ (P =.01) and lateral e’ velocity (P =.004) but not tricuspid annular plane systolic excursion (P =.61). RV FWS (AUROC 0.79, 95% CI 0.62-0.95) and lateral e’ velocity (AUROC 0.87, 95% CI 0.68-1.00) best discriminated PGD 3 development and showed the strongest association with PGD 3 (RV FWS OR 3.87 [95% CI 1.59-9.43], P =.003; lateral e’ velocity OR 0.10 [95% CI 0.01-0.70], P =.02). These associations remained when separately adjusting for age, weight, primary PH diagnosis, ischemic time, and bypass time. In this pilot study, worse preoperative RV systolic and worse LV diastolic function were associated with PGD 3 and may be modifiable recipient risk factors in pediatric lung transplantation.

Original languageEnglish (US)
Article numbere13858
JournalPediatric transplantation
Issue number2
StatePublished - Oct 19 2020
Externally publishedYes

Bibliographical note

Funding Information:
This study had no direct funding. Other funding sources for the authors include: Adam S. Himebauch, Laura Mercer‐Rosa: Institutional grants from The Children's Hospital of Philadelphia; Wai Wong, Yan Wang, Christopher E. Mascio, Samuel B. Goldfarb: None; Francis X. McGowan: NIH 1R4‐HL144HL136008‐01A1, PI initiated industry‐sponsored grant from Merck & Co Robert A. Berg: NIH UG1‐HD063018, NIH R01‐HL13544, NIH RO1‐MD011518, NIH R21‐HD089132, NIH R01‐HD095894, NIH R01‐HL147616, NIH R01‐HL141386; Todd J. Kilbaugh: NIH R21‐NS103826, DOD PR171698, NIH R01‐HL141386‐01, NIH R41‐NS115249‐01, NIH R01‐NS113945‐01, Institutional Grants from The Children's Hospital of Philadelphia and University of Pennsylvania, PI initiated industry‐sponsored grant from Ischemix, Inc; Kimberly Y. Lin: NIH R01‐HL149722‐01, Institutional Grants from The Children's Hospital of Philadelphia and University of Pennsylvania; Steven M. Kawut: NIH K24‐HL103844; Nadir Yehya: NIH K23‐HL136688, NIH R01‐HL148054.

Publisher Copyright:
© 2020 Wiley Periodicals LLC


  • left ventricular diastolic function
  • lung transplantation
  • pediatric
  • primary graft dysfunction
  • pulmonary hypertension
  • right ventricular systolic function
  • strain echocardiography


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