Changes in Risk Profile Over Time in the Population of a Pediatric Heart Transplant Program

Area of Science:

• Pediatric Cardiology
• Transplantation Medicine
• Cardiovascular Surgery

Background:

• Pediatric heart transplantation data over extended periods is limited.
• Analysis of evolving risk profiles and survival outcomes in pediatric heart transplantation is crucial.

Purpose of the Study:

• To analyze changes in risk profile and survival outcomes of pediatric heart transplantation over four decades at a single center.
• To identify trends in patient demographics, transplant indications, and mechanical support utilization.

Main Methods:

• A retrospective analysis of 320 pediatric heart transplants performed between 1974 and 2014.
• Patients were divided into three eras based on time: 1974-1994, 1995-2004, and 2005-2014.
• Key variables analyzed included age at transplant, indication, mechanical support, and survival rates.

Main Results:

• The average age at transplant decreased in the most recent era (5.6 years) compared to earlier eras (10.4 and 11.9 years).
• Mechanical support use increased significantly, from 1% in the first era to 30% in the most recent era.
• Overall survival improved significantly over time, with notable advantages for patients with cardiomyopathy compared to congenital heart disease.

Conclusions:

• The risk profile of pediatric heart transplant recipients has increased, characterized by younger patients and greater reliance on mechanical support.
• Transplantation for end-stage congenital heart disease is becoming more prevalent.
• Despite increased patient complexity, long-term survival outcomes in pediatric heart transplantation have shown consistent and significant improvement.