PEDIATRICS

X. Yu¹, B. Larsen², L.J. West³, S. Urschel³, I.M. Rebeyka², D.B. Ross⁴, P. Cheung², J. Li^1
1Pediatrics, University of Alberta, Edmonton/AB/CANADA, ², University of Alberta, Edmonton/CANADA, ³Department Of Pediatrics, Cardiac Transplant Research, University of Alberta, Edmonton/CANADA, ⁴Cardiac Surgery, University of Alberta, Edmonton/CANADA

Body: Introduction: The acute metabolic response to critical illness can be characterized by increased synthesis of C-reactive protein (CRP) at the expense of visceral proteins such as prealbumin (PA). CRP and PA concentrations have been used to stratify the metabolic response and relate to clinical outcomes in children after surgery. However, little is known about their changes in children early after heart transplantation (HTx). We sought to evaluate the perioperative changes in CRP and PA and clinical implications in children undergoing HTx. Methods: Charts of 44 children (median age 24, range 0 to 168 months) undergoing HTx between 2002 and 2009 were reviewed. CRP and PA were measured in 26 children twice weekly. CRP and PA were recorded before and within one month after HTx, with total white blood cell (WBC) and lymphocyte counts, doses of inotropes and immunosuppressants, and cultures of blood and body fluids. Demographic data included weight, duration of cardiopulmonary bypass, aortic cross clamp and donor heart ischemia, and days in ICU and hospital. Mixed linear regression for repeated measures was used to analyze the changes of the variables during the study period and correlations between the variables. Results: There was no death or clinical evidence of rejection in one month after HTx. CRP was 34±44 mg/L before HTx and increased to 81±75 mg/L in postoperative day 2-5 (p=0.03), then decreased to 24±15 mg/L by 20 days (p=0.02) and remained stable thereafter. PA was 0.15±0.05 g/L before HTx and 0.14±0.05 g/L on day 2-5, increased to 0.21 g/L in day 10-15 (p=0.048) and remained stable thereafter (Fig1A). The changes in WBC and lymphocytes are shown in Fig1B. Postoperative CRP positively correlated with WBC (slope=1.3, p=0.02), negatively correlated with lymphocytes (slope=-5.9, p=0.02) and age (slope=-0.3, p=0.03). PA negatively correlated with WBC (slope=-0.003, p=0.0003), positively correlated with lymphocytes (slope=0.01, p=0.004) and age (slope=0.0008, p=0.005). There were no correlations between CRP or PA with ICU and hospital stay and other variables. Conclusion: Metabolic stress is present before HTx and acutely intensified after HTx. The metabolic response to HTx appears greater and longer as compared to children undergoing other cardiac surgery as previously reported. It is mainly influenced by infection and age. The lack of correlation with ICU and hospital stay may be due to the complicated postoperative course in this high risk group of patients.

Disclosure: All authors have declared no conflicts of interest.