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Listing Low-Weight or Ill Infants for Heart Transplantation: Is It Prudent?

Raheel Rizwan1, Farhan Zafar1, Clifford Chin2

  • 1Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

The Annals of Thoracic Surgery
|July 17, 2018
PubMed

Insights

Infants weighing less than 2.5 kg awaiting heart transplantation (HTx) have significantly lower survival rates. Illness factors like ventilator support and congenital heart disease further decrease survival for infants on the HTx waitlist.

Area of Science:

  • Pediatric Cardiology
  • Transplantation Medicine
  • Critical Care Medicine

Background:

  • Infants awaiting heart transplantation (HTx) face the highest waitlist mortality among all HTx patients.
  • Weight is a critical factor influencing outcomes for infants on the HTx waitlist.

Purpose of the Study:

  • To analyze the impact of pre-transplant weight on waitlist and post-transplant outcomes in infants.
  • To identify other factors affecting survival in infants awaiting heart transplantation.

Main Methods:

  • Analysis of infants on the HTx waitlist from the United Network for Organ Sharing database (October 1987 to June 2016).
  • Infants categorized into weight groups: <2.5 kg, 2.5–3.9 kg, and >4 kg.
  • Kaplan-Meier analysis used to compare survival from listing, regardless of transplantation.

Main Results:

  • Infants <2.5 kg had the worst 1-year survival (43%) compared to heavier groups (54% and 66%).
  • Weight <2.5 kg, ventilator support, extracorporeal membrane oxygenation (ECMO), and congenital heart disease (CHD) were associated with increased 1-year mortality.
  • Median waitlist time was similar for infants <2.5 kg and 2.5–3.9 kg, but longer for infants >4 kg.

Conclusions:

  • Infant survival after listing for HTx is significantly influenced by both weight and pre-existing illness.
  • Transplanting very small infants or those critically ill may not be advisable due to limited donor availability and poorer outcomes.
Abstract

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