den Boer SL, Lennie van Osch-Gevers M, van Ingen G, du Marchie Sarvaas GJ, van Iperen GG, Tanke RB, Backx APCM, Ten Harkel ADJ, Helbing WA, Delhaas T, Bogers AJJC, Rammeloo LAJ, Dalinghaus M. Management of children with dilated cardiomyopathy in The Netherlands: Implications of a low early transplantation rate.
J Heart Lung Transplant 2015;
34:963-9. [PMID:
25840505 DOI:
10.1016/j.healun.2015.01.980]
[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: 06/27/2014] [Revised: 01/23/2015] [Accepted: 01/31/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND
The policy for listing and transplant for children with dilated cardiomyopathy (DCM) in The Netherlands has been conservative because of low donor availability. The effects of this policy on outcome are reported.
METHODS
This was a multicenter, nationwide study performed in 148 children with DCM. The primary outcome was death or heart transplant.
RESULTS
Overall, 43 patients (29%) died or were transplanted. Within 1 year of diagnosis, 21 patients died, and only 4 underwent transplantation (3 on mechanical circulatory support). The 1-year survival was 85% (95% confidence interval [CI] = 79-91), and 5-year survival was 84% (95% CI = 78-90). Transplantation-free survival at 1 year was 82% (95% CI = 75-88) and at 5 years was 72% (95% CI = 64-80). Within 1 year of diagnosis, with death as the main end-point (21 of 25, 84%), intensive care unit admission (hazard ratio = 2.6, p = 0.05) and mechanical circulatory support (hazard ratio = 3.2, p = 0.03) were risk factors (multivariable Cox analysis); inotropic support was longer in patients reaching an end-point. At >1 year after diagnosis, with transplantation as the main end-point (15 of 18, 83%), age >6 years (hazard ratio = 6.1, p = 0.02) was a risk factor. There were 56 (38%) children who recovered, 50% within 1 year of diagnosis. Recovery was associated with younger age; was similar in patients with myocarditis (43%) and idiopathic disease (41%); and was similar in patients initially admitted to the intensive care unit, admitted to the ward, or treated as outpatients.
CONCLUSIONS
The transplantation rate in our cohort in the first year was low, with 1-year and 5-year survival rates similar to other cohorts. Our results suggest that a conservative approach to list children for transplantation early after presentation may be justifiable except for patients with prolonged intensive care unit or mechanical circulatory support.
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