{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T13:56:35Z","timestamp":1764251795961,"version":"3.41.2"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,1,2]],"date-time":"2023-01-02T00:00:00Z","timestamp":1672617600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Elevated pulmonary vascular resistance (PVR) in the setting of left heart failure may contribute to poor outcomes after pediatric heart transplant (HTx), but peri\u2010transplant management is variable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We sought to characterize international practice by surveying physicians at pediatric HTx centers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We received 49 complete responses from 39 centers in 16 countries. Most respondents are pediatric cardiologists (90%), practice at centers offering heart (86%) and lung (55%) transplant, and perform pre\u2010HTx acute vasoreactivity testing (AVT, 88%) in patients with elevated PVR. Half (51%) reported defining a PVR cutoff for HTx eligibility as \u22646\u00a0WU\u2009m<jats:sup>2<\/jats:sup> (56%) post\u2010AVT (84%). The highest post\u2010AVT PVR ever accepted for HTx ranged from 3\u201314.4 (median 6) WU\u2009m<jats:sup>2<\/jats:sup>. To treat elevated pre\u2010transplant PVR, phosphodiesterase type 5 inhibitors are most common (65%) followed by oxygen (31%), nitric oxide (14%), endothelin receptor antagonists (11%), and prostacyclins (6%). Nearly a third (31%) do not routinely use pulmonary vasodilators without implantation of a left ventricular assist device (LVAD). Case scenarios highlight treatment variability: in a restrictive cardiomyopathy scenario, HTx listing with post\u2010transplant vasodilator therapy was favored, whereas in a Shone's complex patient with fixed PVR, LVAD\u2009\u00b1\u2009pulmonary vasodilators followed by repeat catheterization was most common. Management of dilated cardiomyopathy with reactive PVR was variable. Most continue vasodilator therapy until HTx (16%), PVR normalizes (16%) or \u22646\u2009months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Management of elevated PVR in children awaiting HTx is heterogenous. Evidence\u2010based guidelines are needed to allow for longitudinal determination of optimal outcomes and standardized care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.14461","type":"journal-article","created":{"date-parts":[[2023,1,3]],"date-time":"2023-01-03T05:10:44Z","timestamp":1672722644000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["International practice heterogeneity in pre\u2010transplant management of pulmonary hypertension related to pediatric left heart disease"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7483-2825","authenticated-orcid":false,"given":"Rachel K.","family":"Hopper","sequence":"first","affiliation":[{"name":"Department of Pediatrics (Cardiology) Stanford University School of Medicine  Palo Alto California 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