Improved Survival While Waiting and Risk Factors for Death in Pediatric Patients Listed for Cardiac Transplantation

Area of Science:

• Pediatric Cardiology
• Transplantation Medicine
• Outcomes Research

Background:

• Survival rates for pediatric patients awaiting heart transplantation (HTx) are influenced by pre-transplant management and the era of listing.
• Understanding risk factors for mortality during the waitlist period is crucial for improving outcomes.

Purpose of the Study:

• To evaluate the impact of pre-transplant management and listing era on pediatric heart transplant (HTx) survival.
• To identify risk factors associated with death among children on the HTx waitlist.

Main Methods:

• Retrospective analysis of 254 children listed for HTx between January 1993 and December 2009.
• Survival analysis and competing outcomes modeling were employed to assess mortality and transplant rates.
• Risk factors for wait-list mortality were analyzed, comparing outcomes before and after 2004, and considering the introduction of ventricular assist devices (VADs).

Main Results:

• Overall wait-list mortality was 17% at 6 months, with 69% undergoing transplant.
• Wait-list mortality decreased significantly after 2004 (7% vs. 23% before).
• Extracorporeal membrane oxygenation (ECMO) and earlier listing years were significant risk factors for wait-list mortality, while VAD availability significantly reduced mortality.

Conclusions:

• Pediatric heart transplant (HTx) survival has markedly improved in recent years at this institution.
• The availability of pediatric ventricular assist devices (VADs) has significantly enhanced survival for children awaiting heart transplantation.
• Factors such as race, gender, blood type, and congenital diagnosis did not significantly impact wait-list mortality.