VENTRICULAR REMODELING FOLLOWING INFANT-PEDIATRIC CARDIAC TRANSPLANTATION - DOES AGE AT TRANSPLANTATION OR SIZE DISPARITY MATTER

Early left ventricular (LV) remodeling following pediatric cardiac tra nsplantation has not been described, To identify patterns and determin ants of change in left ventricular mass and volume posttransplant, we studied 125 consecutive children who underwent cardiac transplantation between January 1, 1989 and July 31, 1993. Two-dimensional imaging-di rected M-mode echocardiograms were studied weekly until 26 weeks post- transplant. LV mass and volume (indexed to BSA(1.5)) were measured. LV mass index increased until 3 weeks post-transplant, and then decrease d. The mean decrement in LV mass index after 8 weeks post-transplant ( relative to baseline) was significantly larger in patients with donor- recipient weight ratio >1.5 compared with patients with donor-recipien t weight ratio less than or equal to 1.5 (-2.2 g/m(3) compared with 33 .4 g/m(3), respectively, P<0.01), Multiple linear regression was perfo rmed employing donor-recipient weight ratio, time since transplantatio n, ischemic time, and age at transplant as prognostic variables. Donor -recipient weight ratio (P<0.0001), time since transplant (P<0.01), an d age at transplant (P=0.02) were identified as independent predictors of change in LV mass index. Donor-recipient weight ratio (P=0.001) an d time since transplantation (P=0.02) were independent predictors of c hange in LV volume index, There was an interaction between donor-recip ient weight ratio and time since transplantation, suggesting that dono r-recipient weight ratio has an independent effect as well as a time-d ependent effect on change in LV mass and volume indices. LV mass and v olume indices increased early posttransplant and then decreased; this pattern was temporally predictable, and dependent on donor-recipient w eight ratio and age at transplant.