Related Experiment Video
Updated: Feb 17, 2026
Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Fatal cardiac arrest in pediatric heart transplant recipients: Query of the UNOS database
Robert W Loar1, Susan W Denfield1, Shaine A Morris1
1Pediatric Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA.
Insights
Cardiac arrest (CA) is a significant cause of death after heart transplantation (PHTx). Factors like older age at transplant, pacemaker (PM) presence, and reduced ejection fraction (EF) increase fatal CA risk.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Devices
Background:
- Cardiac arrest (CA) is a known complication after heart transplantation (PHTx).
- The incidence and specific risk factors for fatal CA post-PHTx are not well-established.
- The impact of pacemakers (PMs) on survival after PHTx, particularly concerning CA, requires further investigation.
Purpose of the Study:
- To determine the incidence of death due to CA in patients following PHTx.
- To identify factors associated with fatal CA after PHTx.
- To evaluate the effect of pacemaker (PM) presence on survival in these patients.
Main Methods:
- Retrospective cohort study using the United Network of Organ Sharing (UNOS) registry.
- Inclusion criteria: patients aged ≤18 years at the time of PHTx.
- Statistical analyses included multivariable and Kaplan-Meier analyses to assess outcomes related to fatal CA.
Main Results:
- Out of 7719 PHTx patients, 11% died from CA.
- Significant risk factors for fatal CA included age ≥13 years at transplant, PM presence, and depressed ejection fraction (EF).
- Long-term post-transplant CA deaths (beyond 10 years) were linked to depressed EF, cardiac allograft vasculopathy (CAV), and PM presence. 15% of patients with a PM died from CA.
Conclusions:
- CA is a common cause of mortality after PHTx.
- While PMs do not offer complete protection, their role in survival post-PHTx requires further clarification.
- Vigilant surveillance and consideration for retransplantation are recommended for patients with identified risk factors for fatal CA.
Abstract:
The incidence of death by CA after PHTx is unknown. We aimed to determine the incidence and factors for fatal CA after PHTx, and whether a PM affects survival. Retrospective cohort study utilizing the United Network of Organ Sharing registry of patients transplanted ≤18 years. Multivariable analyses in hazard-function domain and Kaplan-Meier analyses were performed for an outcome of death due to CA. There were 7719 PHTx patients queried. CA was the reported cause of death in 11%. Age ≥13 years at time of transplant, presence of a PM, and depressed EF were identified as significant factors for fatal CA. Death due to CA beyond 10 years post-transplant was associated with depressed EF, CAV, and presence of a PM. Kaplan-Meier analysis demonstrated higher likelihood of fatal CA in patients with CAV and in those with a PM vs those without. In total, 15% of patients with a PM died from CA. CA is a relatively common cause of death after PHTx. The benefit of a PM remains unclear, but its presence does not confer complete protection. Patients with associated factors warrant vigilant surveillance and consideration for retransplantation.
Related Concept Videos
01:23Cardiopulmonary Resuscitation III: AED Use
01:28Kidney Transplant I: Introduction