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Early survival after heart transplant in young infants is lowest after failed single-ventricle palliation: a
Melanie D Everitt1, Gerard J Boyle, Kenneth B Schechtman
1Primary Children's Medical Center, Division of PediatricCardiology, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, USA. melanie.everitt@imail.org
Insights
Infant heart transplant outcomes vary by diagnosis. Hypoplastic Left Heart Syndrome (HLHS) with surgery has the lowest survival, unchanged by the current era, highlighting the need for improved infant heart transplant strategies.
Area of Science:
- Pediatric cardiology
- Transplant surgery
- Congenital heart disease research
Background:
- Infant heart transplant recipients show excellent long-term survival.
- Limited donor availability and high early mortality impact therapeutic effectiveness.
- Understanding pre-transplant diagnosis impact is crucial for infant heart transplantation.
Purpose of the Study:
- To determine the relationship between pre-heart transplant diagnosis and early outcomes in infants.
- To define mortality risk associated with congenital heart disease (CHD) in infant heart transplant recipients.
- To examine differences in outcomes between early and current heart transplant eras.
Main Methods:
- Utilized the Pediatric Heart Transplant Study (PHTS) database for 739 infant heart transplant recipients (age ≤ 6 months, 1993-2008).
- Categorized recipients by etiology: cardiomyopathy (CM), hypoplastic left heart syndrome (HLHS) with/without surgery, and other CHD with/without surgery.
- Compared severity of illness, post-transplant survival, and era effects.
Main Results:
- One-year survival: CM (89%), other CHD with surgery (82%), other CHD without surgery (79%), HLHS without surgery (79%), HLHS with surgery (70%).
- Mortality risk differences persisted across etiologic groups after adjusting for illness severity.
- Survival for HLHS with surgery remained similar between early (71%) and current (70%) eras (1993-2008).
Conclusions:
- Pre-heart transplant diagnosis significantly impacts post-transplant outcomes in infants.
- Infants with HLHS undergoing surgery exhibit the lowest survival rates.
- Outcomes for HLHS infants with surgery have not improved in the current era.
Background:
Infant heart transplant (HT) recipients have the best long-term survival of any age group, but the small donor pool and high early mortality limit the therapeutic effectiveness. We sought to determine the relationship between pre-HT diagnosis and early HT outcome to better define the mortality risk associated with a diagnosis of congenital heart disease (CHD) and to examine differences between early and current HT eras.
Methods:
The Pediatric Heart Transplant Study (PHTS) database was used to identify 739 infant HT recipients at age ≤ 6 months between 1993 and 2008 divided into the following etiologic groups: cardiomyopathy (CM), 18%; hypoplastic left heart syndrome (HLHS) without surgery, 41%; HLHS with surgery, 9%; other CHD without surgery, 16%; and other CHD with surgery, 15%. Severity of illness at HT, post-HT survival, and era effects were compared.
Results:
At 1 year after HT, survival was 89% for the CM group, which was the best, 79% for CHD without surgery, 82% for CHD with surgery, 79% for HLHS without surgery, and 70% for HLHS with surgery, which was the worst outcome. Hazard function analysis demonstrated the difference occurred within the first 3 months after HT. After adjusting for illness severity, differences in mortality risk persisted across etiologic groups. HT survival was similar in the current surgical era for HLHS with surgery, 71% (1993-1998) vs 70% (1999-2008).
Conclusions:
Infant HT recipients with different pre-HT diagnoses have significantly different post-HT outcomes. HLHS infants with surgery have the lowest survival and their outcome is unchanged in the current era.
