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Heart transplantation in children: risk factors of early and late mortality
P R Vouhé1, D Tamisier, F Leca
1Department of Cardiac Surgery, Hôpital Laënnec, Paris, France.
Insights
Post-heart transplant survival in children is 62% at 1 year. Early low cardiac output syndrome with pulmonary hypertension significantly increases mortality risk in pediatric heart transplant recipients.
Area of Science:
- Pediatric Cardiology
- Transplantation Medicine
- Immunology
Background:
- Pediatric heart transplantation is a life-saving procedure for end-stage heart failure.
- Identifying risk factors for poor outcomes is crucial for improving survival rates in pediatric recipients.
Purpose of the Study:
- To identify predictive risk factors for poor outcomes after heart transplantation in children.
- To analyze survival rates and associated complications in a pediatric heart transplant cohort.
Main Methods:
- Retrospective analysis of 31 pediatric heart transplant recipients (15 days to 15 years old).
- Evaluation of risk factors including age, diagnosis, hemodynamic status, surgical factors, and graft preservation techniques.
- Univariate analysis to assess the impact of various factors on early and late mortality.
Main Results:
- Overall actuarial survival was 62% at 1 year and 53% at 2 years.
- Early low cardiac output syndrome (LCOS) with pulmonary hypertension (PHT) significantly increased mortality (78% early, 100% overall).
- Younger age (≤1 year) and improved graft preservation techniques showed a trend towards increased early survival.
Conclusions:
- Early LCOS with PHT is a critical predictor of poor outcomes in pediatric heart transplantation.
- While survival rates are improving, further research into optimizing graft preservation and early management of complications is warranted.
- Younger recipient age may be associated with better early survival, suggesting potential benefits of early intervention.
Abstract:
In order to identify predictive risk factors of poor outcome following heart transplantation in children, we performed a retrospective analysis of our pediatric recipient population: 31 children, aged 15 days to 15 years (mean = 5.2 +/- 4.9 years). The preoperative diagnosis was cardiomyopathy in 17 (55%), congenital heart disease in 13 (42%) and end-stage valvular disease in 1 (3%). There were 5 operative deaths: hyperacute rejection (2), low cardiac output syndrome (3); 4 in-hospital deaths: infection (2), multiorgan failure (2) and 4 late deaths: acute rejection (1), chronic rejection (1), lymphoma (1), unknown (1). The actuarial probability of survival (+/- SE) was 62% +/- 10% at 1 year and 53% +/- 12% at 2 years. Univariate analysis was used to evaluate the following risk factors: age, diagnosis, hemodynamic decompensation, previous cardiac surgery, ischemic time of the graft, technique of graft preservation, preoperative pulmonary artery pressure, occurrence of postoperative low cardiac output syndrome (LCOS) with pulmonary hypertension (PHT). The occurrence of early LCOS with PHT significantly increased both early and late mortality (78% early mortality, 100% overall mortality). This syndrome occurred in 9 patients (29%) and was attributed to primary graft failure in 2, increased pulmonary vascular resistances in 6 and multiple factors in 1. Although not significant, two factors may increase early survival: young age (less than or equal to 1 year) at operation and improved technique of graft preservation.