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Lee JY, Kidambi S, Zawadzki RS, Rosenthal DN, Dykes JC, Nasirov T, Ma M. Weight Matching in Infant Heart Transplantation: A National Registry Analysis. Ann Thorac Surg 2023; 116:1241-1248. [PMID: 35835207 PMCID: PMC10321673 DOI: 10.1016/j.athoracsur.2022.05.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 04/26/2022] [Accepted: 05/31/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Infants account for a significant proportion of pediatric heart transplantation but also suffer from a high waitlist mortality. Donor oversizing by weight-based criteria is common practice in transplantation and is prevalent in this group. We sought to analyze the impact of oversizing on outcomes in infants. METHODS Infant heart transplantations reported to the United Network for Organ Sharing from January 1994 to September 2019 were retrospectively analyzed. 2384 heart transplantation recipients were divided into quintiles (Q1-Q5) on the basis of donor-to-recipient weight ratio (DRWR). Multivariate Cox regression was used to estimate the effect of DRWR. The primary end point was graft survival at 1 year. RESULTS The median DRWR for each quintile was 0.90 (0.37-1.04), 1.17 (1.04-1.29), 1.43 (1.29-1.57), 1.74 (1.58-1.97), and 2.28 (1.97-5.00). Pairwise comparisons showed improved survival for Q3 and Q4 over each of the bottom 2 quintiles and the top quintile. Regression analyses found that Q3 and Q4 were protective against graft failure compared with the bottom 2 quintiles. There was no difference in hazard among the top 3 quintiles. Significant covariates included primary diagnosis, ischemia time, serum bilirubin level, transplantation year, mechanical ventilation at transplantation, and extracorporeal membrane oxygenation at transplantation. Sex, female-to-male transplantation, and mechanical circulatory support at transplantation were not significant in univariate analyses. CONCLUSIONS Modest oversizing by DRWR (1.29-1.97) is associated with increased survival and lower risk in infant heart transplantation. Additional investigation is needed to establish best practices for size matching in this population.
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Affiliation(s)
- James Y Lee
- Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Sumanth Kidambi
- Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Roy S Zawadzki
- Department of Statistics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, California
| | - David N Rosenthal
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - John C Dykes
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Teimour Nasirov
- Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Michael Ma
- Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California.
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2
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Khan A, Pahl E, Koehl DA, Cantor RS, Kirklin JK, Rusconi P, Barnes AP, Azeka E, Everitt MD. Improved heart transplant survival for children with congenital heart disease and heterotaxy syndrome in the current era: An analysis from the pediatric heart transplant society. J Heart Lung Transplant 2021; 40:1153-1163. [PMID: 34366230 DOI: 10.1016/j.healun.2021.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/01/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Challenges exist with heterotaxy due to the complexity of heart disease, abnormal venous connections, and infection risks. This study aims to understand heart transplant outcomes for children with heterotaxy. METHODS All children with congenital heart disease listed for transplant from 1993 to 2018 were included. Those with and without heterotaxy were compared. Waitlist outcomes and survival post-listing and transplant were analyzed. Post-transplant risk factors were identified using multiphase parametric hazard modeling. RESULTS There were 4814 children listed, of whom 196 (4%) had heterotaxy. Heterotaxy candidates were older (5.8 ± 5.7 vs 4.2 ± 5.5 years, p < 0.01), listed at a lower urgency status (29.8% vs 18.4%, p < 0.01), more commonly single ventricle physiology (71.3% vs 59.2%, p < 0.01), and less often supported by mechanical ventilation (22% vs 29.1%, p < 0.05) or extracorporeal membrane oxygenation (3.6% vs 7.5%, p < 0.05). There were no differences in waitlist outcomes of transplant, death, or removal. Overall, post-transplant survival was worse for children with heterotaxy: one-year survival 77.2% vs 85.1%, with and without heterotaxy, respectively. Heterotaxy was an independent predictor for early mortality in the earliest era (1993-2004), HR 2.09, CI 1.16-3.75, p = 0.014. When stratified by era, survival improved with time. Heterotaxy patients had a lower freedom from infection and from severe rejection, but no difference in vasculopathy or malignancy. CONCLUSIONS Mortality risk associated with heterotaxy is mitigated in the recent transplant era. Early referral may improve waitlist outcomes for heterotaxy patients who otherwise have a lower status at listing. Lower freedom from both infection and severe rejection after transplant in heterotaxy highlights the challenges of balancing immune suppression.
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Affiliation(s)
- Asma Khan
- Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago
| | - Elfriede Pahl
- Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago
| | - Devin A Koehl
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paolo Rusconi
- Department of Pediatrics, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Aliessa P Barnes
- Department of Pediatrics, Division of Pediatric Cardiology, University of Missouri-Kansas City, Kansas City, Missouri
| | - Estela Azeka
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Melanie D Everitt
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, Colorado.
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3
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A Systematic Review for Variables to Be Collected in a Transplant Database for Improving Risk Prediction. Transplantation 2020; 103:2591-2601. [PMID: 30768569 DOI: 10.1097/tp.0000000000002652] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND This systematic review was commissioned to identify new variables associated with transplant outcomes that are not currently collected by the Organ Procurement and Transplantation Network (OPTN). METHODS We identified 81 unique studies including 1 193 410 patients with median follow-up of 36 months posttransplant, reporting 108 unique risk factors. RESULTS Most risk factors (104) were recipient related; few (4) were donor related. Most risk factors were judged to be practical and feasible to routinely collect. Relative association measures were small to moderate for most risk factors (ranging between 1.0 and 2.0). The strongest relative association measure for a heart transplant outcome with a risk factor was 8.6 (recipient with the previous Fontan operation), for a kidney transplant 2.8 (sickle cell nephropathy as primary cause of end-stage renal disease), for a liver transplant 14.3 (recipient serum ferritin >500 µg/L), and for a lung transplant 6.3 (Burkholderia cepacia complex infection for 1 y or less). OPTN may consider some of these 108 variables for future collection to enhance transplant research and clinical care. CONCLUSIONS Evidence-based approaches can be used to determine variables collected in databases and registries. Several candidate variables have been identified for OPTN.
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4
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Scheel J, Canter CE. Center volume and outcomes in pediatric heart transplantation-Bigger is better until it isn't. Am J Transplant 2018; 18:2843-2844. [PMID: 30040193 DOI: 10.1111/ajt.15034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/27/2018] [Accepted: 07/04/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Janet Scheel
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Charles E Canter
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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Thammineni K, Vinocur JM, Harvey B, Menk JS, Kelleman MS, Korakiti AM, Thomas AS, Moller JH, St Louis JD, Kochilas LK. Outcomes after surgical coronary artery revascularisation in children with congenital heart disease. Heart 2018; 104:1417-1423. [PMID: 29472291 PMCID: PMC6092219 DOI: 10.1136/heartjnl-2017-312652] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/16/2018] [Accepted: 02/02/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Surgical coronary revascularisation in children with congenital heart disease (CHD) is a rare event for which limited information is available. In this study, we review the indications and outcomes of surgical coronary revascularisation from the Pediatric Cardiac Care Consortium, a large US-based multicentre registry of interventions for CHD. METHODS This is a retrospective cohort study of children (<18 years old) with CHD who underwent surgical coronary revascularisation between 1982 and 2011. In-hospital mortality and graft patency data were obtained from the registry. Long-term transplant-free survival through 2014 was achieved for patients with adequate identifiers via linkage with the US National Death Index and the Organ Procurement and Transplantation Network. RESULTS Coronary revascularisation was accomplished by bypass grafting (n=72, median age 6.8 years, range 3 days-17.4 years) or other operations (n=65, median age 2.6 years, range 5 days-16.7 years) in 137 patients. Most revascularisations were related to the aortic root (61.3%) or coronary anomalies (27.7%), but 10.9% of them were unrelated to either of them. Twenty in-hospital deaths occurred, 70% of them after urgent 'rescue' revascularisation in association with another operation. Long-term outcomes were available by external linkage for 54 patients surviving to hospital discharge (median follow-up time 15.0 years, max follow-up 29.8 years) with a 15-year transplant-free survival of 91% (95% CI 83% to 99%). CONCLUSIONS Surgical coronary revascularisation can be performed in children with CHD with acceptable immediate and long-term survival. Outcomes are dependent on indication, with the highest mortality in rescue procedures.
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Affiliation(s)
| | - Jeffrey M Vinocur
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Brian Harvey
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jeremiah S Menk
- Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Anna-Maria Korakiti
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Amanda S Thomas
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - James H Moller
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - James D St Louis
- Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Lazaros K Kochilas
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Sibley Heart Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Chen CK, Manlhiot C, Mital S, Schwartz SM, Van Arsdell GS, Caldarone C, McCrindle BW, Dipchand AI. Prelisting predictions of early postoperative survival in infant heart transplantation using classification and regression tree analysis. Pediatr Transplant 2018; 22. [PMID: 29271030 DOI: 10.1111/petr.13105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 11/27/2022]
Abstract
Infants listed for heart transplantation experience high waitlist and early post-transplant mortality, and thus, optimal allocation of scarce donor organs is required. Unfortunately, the creation and validation of multivariable regression models to identify risk factors and generate individual-level predictions are challenging. We sought to explore the use of data mining methods to generate a prediction model. CART analysis was used to create a model which, at the time of listing, would predict which infants listed for heart transplantation would survive at least 3 months post-transplantation. A total of 48 infants were included; 13 died while waiting, and six died within 3 months of heart transplant. CART analysis identified RRT, blood urea nitrogen, and hematocrit as terminal nodes with alanine transaminase as an intermediate node predicting death. No patients listed on RRT (n = 10) survived and only three of 12 (25%) patients listed on ECLS survived >3 months post-transplant. CART analysis overall accuracy was 83%, with sensitivity of 95% and specificity 76%. This study shows that CART analysis can be used to generate accurate prediction models in small patient populations. Model validation will be necessary before incorporation into decision-making algorithms used to determine transplant candidacy.
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Affiliation(s)
- Ching Kit Chen
- Cardiology Service, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore City, Singapore
| | - Cedric Manlhiot
- Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Seema Mital
- Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Steven M Schwartz
- Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Glen S Van Arsdell
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Christopher Caldarone
- Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Brian W McCrindle
- Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Anne I Dipchand
- Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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7
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Outcomes and risk factors for heart transplantation in children with congenital heart disease. J Thorac Cardiovasc Surg 2015; 150:1455-62.e3. [DOI: 10.1016/j.jtcvs.2015.06.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 06/04/2015] [Accepted: 06/07/2015] [Indexed: 11/19/2022]
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Kulkarni A, Neugebauer R, Lo Y, Gao Q, Lamour JM, Weinstein S, Hsu DT. Outcomes and risk factors for listing for heart transplantation after the Norwood procedure: An analysis of the Single Ventricle Reconstruction Trial. J Heart Lung Transplant 2015; 35:306-311. [PMID: 26632030 DOI: 10.1016/j.healun.2015.10.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/14/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Infants with hypoplastic left heart syndrome after palliation have the worst survival among heart transplant recipients. Heart transplantation is often reserved for use in patients with sub-optimal results after palliative surgery. This study characterized outcomes after listing in infants with a single ventricle who had undergone the Norwood procedure and identified predictors of the decision to list for heart transplantation. METHODS The public-use database from the multicenter, prospective randomized Single Ventricle Reconstruction trial was used to identify patients who were listed for heart transplantation. Outcomes on the waiting list and after transplantation were determined. Risk factors were compared between those who were listed and those who survived without listing. RESULTS Among 555 patients, 33 patients (5.9%) were listed and 18 underwent heart transplantation. Mortality was 39% while waiting for a heart and was 33% after heart transplantation. Overall, 1-year survival after listing (including death after transplantation) was 48%. Factors associated with listing were a lower right ventricular fractional area change at birth, non-hypoplastic left heart syndrome diagnosis, and a more complicated post-Norwood course, defined as a higher need for extracorporeal membrane oxygenation, longer intensive care unit stay, more complications, and a higher number of discharge medications. CONCLUSIONS Worse right ventricular function, non-hypoplastic left heart syndrome diagnosis, and complex intensive care unit stay were significant risk factors for listing for heart transplantation after the Norwood procedure. Heart transplantation as a rescue procedure after the Norwood procedure in the first year of life carries a significant risk of mortality.
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Affiliation(s)
- Aparna Kulkarni
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York.
| | | | - Yungtai Lo
- Department of Biostatistics, Albert Einstein College of Medicine, Bronx, New York
| | - Qi Gao
- Department of Biostatistics, Albert Einstein College of Medicine, Bronx, New York
| | - Jacqueline M Lamour
- Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, New York
| | - Samuel Weinstein
- Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, New York
| | - Daphne T Hsu
- Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, New York
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9
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Abstract
Paediatric heart transplantation has evolved over the last 3 decades. The research group, Pediatric Heart Transplant Study, has been in step with that evolution over the nearly 20 years of its existence by utilising its registry to contribute a wealth of clinical research to the field. The highlights of its studies will be presented in this review.
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Affiliation(s)
- Daphne T Hsu
- From the Division of Pediatric Cardiology, Department of Pediatrics, Albert Einstein College of Medicine and the Children's Hospital at Montefiore, Bronx, NY.
| | - Jacqueline M Lamour
- From the Division of Pediatric Cardiology, Department of Pediatrics, Albert Einstein College of Medicine and the Children's Hospital at Montefiore, Bronx, NY
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Risk factors for requiring extracorporeal membrane oxygenation support after a Norwood operation. J Thorac Cardiovasc Surg 2014; 148:266-72. [DOI: 10.1016/j.jtcvs.2013.08.051] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 08/06/2013] [Accepted: 08/15/2013] [Indexed: 11/21/2022]
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12
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Conway J, Chrisant MRK, West LJ, Ameduri RK, Alejos JC, Lamour JM, Das B, Gilbert D, Tresler M, Naftel DC, Miyamoto SD. Outcomes of fetal listed patients awaiting heart transplantation. Pediatr Transplant 2013; 17:653-60. [PMID: 23919733 DOI: 10.1111/petr.12130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2013] [Indexed: 11/27/2022]
Abstract
HTx in neonates is mainstay therapy for those with severe cardiomyopathies and congenital heart disease. Fetal listing for HTx has been proposed as a way to increase the potential window for a donor with outcomes predicted to be similar to the neonatal population. Data from the PHTS, a prospective multicenter study, were used to examine the outcomes of fetuses listed between 1993 and 2009. Four thousand three hundred and sixty-five children were listed for HTx during this period. Fetuses comprised 1% and neonates 19.8% of listed patients. In those patients listed as fetus and transplanted, the median wait time from listing to HTx was 55 days (range 4-255), with a median of 25 days (range 0-233) after birth. By six months post-listing, a higher proportion of fetal listed patients had undergone HTx with a lower waitlist mortality when compared with neonate. There was no significant difference in survival following HTx between the two group (p = 0.4). While the results of this study may be less applicable to current practice due to changes in referrals for fetal listing, they do indicate that fetal listing can be a reasonable option. These results are of particular interest at the present time given the ongoing public discourse on the proposed elimination of fetal listing within UNOS.
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Zampi JD, Donohue JE, Charpie JR, Yu S, Hanauer DA, Hirsch JC. Retrospective database research in pediatric cardiology and congenital heart surgery: an illustrative example of limitations and possible solutions. World J Pediatr Congenit Heart Surg 2013; 3:283-7. [PMID: 23804858 DOI: 10.1177/2150135112440462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Secondary use of data, whether from clinical information systems or registries, for carrying out clinical research in rare diseases is a common practice but is fraught with potential errors. We sought to elucidate some of the limitations of database research and describe possible solutions to overcome these limitations. METHODS Using a disease model of a rare postsurgical outcome, we evaluated the ability of four different data sources to correctly identify patients who had that outcome both as individual databases and also when used in conjunction with each other. These results were compared with manual chart review. RESULTS The sensitivity of the various databases to pick up a rare and specific outcome was poor (9.9%-37%), while the specificities were fairly good (91%-96.7%). By combining the databases, the sensitivity was increased to as much as 56.8% without a large decrease in the specificity (85.2%-91.6%). The electronic medical record (EMR) search engine had the highest sensitivity (96.9%) and a high specificity (89.3%) with a very high negative predictive value (99.4%). CONCLUSION For rare and specific diseases or outcomes, a single data source search methodology can miss large numbers of patients and potentially bias study results. Combining overlapping databases can improve the ability to capture these rare diseases or outcomes. While chart review remains the most accurate way to obtain complete case capture, new tools like EMR search engines can facilitate the efficiency of this process without sacrificing search quality.
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Affiliation(s)
- Jeffrey D Zampi
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
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Dipchand AI, Kirk R, Mahle WT, Tresler MA, Naftel DC, Pahl E, Miyamoto SD, Blume E, Guleserian KJ, White-Williams C, Kirklin JK. Ten yr of pediatric heart transplantation: a report from the Pediatric Heart Transplant Study. Pediatr Transplant 2013; 17:99-111. [PMID: 23442098 DOI: 10.1111/petr.12038] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2012] [Indexed: 11/27/2022]
Abstract
The PHTS was founded in 1991 as a not-for-profit organization dedicated to the advancement of the science and treatment of children during listing for and following heart transplantation. Now, 21 yr later, the PHTS has contributed significantly to the field, most notably in the form of outcomes analyses and risk factor assessment, in addition to amassing the most detailed dataset on pediatric heart transplant recipients worldwide. The purpose of this report is to review the last decade of pediatric patients listed for heart transplantation (January 1, 2000-December 31, 2009) and summarize the changes, trends, outcomes, and lessons learned.
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Auerbach SR, Smith JK, Gralla J, Mitchell MB, Campbell DN, Jaggers J, Pietra BA, Miyamoto SD. Graft survival is better without prior surgery in cardiac transplantation for functionally univentricular hearts. J Heart Lung Transplant 2012; 31:987-95. [PMID: 22789137 DOI: 10.1016/j.healun.2012.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 05/07/2012] [Accepted: 05/14/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The effect of surgical history on graft outcomes in patients with functionally univentricular hearts (UH) is not well understood. We compared graft outcomes after heart transplantation in children with a UH between patients who received allografts without prior cardiac surgery (Group A) and patients who underwent transplantation after prior cardiac surgery (Group B). METHODS We reviewed all patients who received allografts for UH at our institution from 1990 to 2009. Differences in the probability of acute rejection (AR), incidence of graft vasculopathy (GV), and incidence of death or retransplantation were compared between Group A and Group B. Student's t-test, Mann-Whitney U-test, the log-rank test, logistic regression, and Cox proportional hazards modeling were used as appropriate. RESULTS During the study period, 180 patients with a UH received allografts: 105 in Group A and 75 in Group B at a median (interquartile range) age of 84 (47-120) days vs 584 (168-2,956) days, respectively (p < 0.001). The odds of AR were higher in Group B (odds ratio, 2.7, 95% confidence interval, 1.3-5.4). Group A had lower univariable risks of GV (p = 0.034) and graft loss (p = 0.003). Median graft survival was 18 years in Group A vs 8 years in Group B. The risk of graft loss after 5 years post-transplant was higher in Group B patients who were aged ≥ 1 year at time of transplant (p < 0.001). CONCLUSIONS Heart transplantation without prior cardiac surgery in patients with a UH was associated with better graft survival and lower probability of AR. The effect of age is complex and time-dependent, with age affecting outcomes after 5 years.
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Affiliation(s)
- Scott R Auerbach
- Department of Pediatrics, Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA.
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