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Repeat pediatric heart transplantation: A united network for organ sharing database analysis
Georgina Rowe1, George Gill1, M Mujeeb Zubair1
1Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Insights
Outcomes for pediatric repeat heart transplantation are poor, especially with intervals under 3.6 years. Underlying diagnosis does not significantly affect outcomes after repeat heart transplants, considering other risk factors.
Area of Science:
- Pediatric Cardiology
- Transplant Surgery
- Immunology
Background:
- Previous heart transplantation and congenital heart disease independently predict poorer survival in pediatric heart transplant recipients.
- Understanding the specific characteristics and outcomes of repeat heart transplantation in children is crucial for improving patient care.
Purpose of the Study:
- To evaluate the characteristics and outcomes of children undergoing repeat heart transplantation in the United States.
- To analyze the impact of underlying diagnosis on outcomes in pediatric repeat heart transplant recipients.
Main Methods:
- Utilized the United Network for Organ Sharing (UNOS) database to identify 8111 pediatric heart transplant recipients (2000-2021), including 435 repeat transplants.
- Employed restricted cubic spline and multivariable Cox regression analyses to assess the relationship between inter-transplant interval and outcomes (mortality or re-transplantation).
Main Results:
- Repeat transplant recipients were older (median 12 vs. 4 years) and less likely to be UNOS status 1A compared to primary recipients.
- Ten-year survival free from mortality or re-transplantation was significantly lower for repeat transplants (51.4%) versus primary transplants (70.5%).
- An inter-transplant interval >3.6 years was associated with non-significant hazard for adverse outcomes in repeat transplant patients.
Conclusions:
- Long-term outcomes for pediatric repeat heart transplantation remain suboptimal, particularly with inter-transplant intervals less than 3.6 years.
- The underlying diagnosis does not appear to be an independent predictor of outcomes following repeat heart transplantation when other risk factors are considered.
Background:
A history of congenital heart disease and previous transplantation are each independently associated with worse survival following pediatric heart transplantation. This study aimed to evaluate the characteristics and outcomes of children undergoing repeat heart transplantation in the United States based on the underlying diagnosis.
Methods:
The United Network for Organ Sharing database was used to identify 8111 patients aged <18 years undergoing isolated heart transplantation from 2000 to 2021, including 435 (5.4%) repeat transplants. Restricted cubic spline analysis assessed the non-linear relationship between inter-transplant interval and the primary outcome of all-cause mortality or re-transplantation. Multivariable Cox regression assessed the impact of re-transplantation on the primary outcome. Median follow-up was 5.0 (interquartile range 1.9-9.9) years.
Results:
Repeat transplant patients were older (median age 12 vs. 4 years; p < .001), and less likely to be in UNOS status 1A (66.0%, n = 287 vs. 81.0% n = 6217; p < .001) than primary transplant patients. Freedom from the primary outcome was 51.4% (95% confidence interval [CI] 45.5-57.2) among repeat transplants and 70.5% (95% CI 69.2-71.8) among primary transplants at 10 years (p < .001). Among repeat transplant patients, the relative hazard of the primary outcome became non-significant when the inter-transplant interval >3.6 years. Congenital heart disease was an independent predictor of mortality among primary (HR 1.8, 95% CI 1.6-1.9) but not repeat transplant (HR 1.1, 95% CI .8-1.6) patients.
Conclusions:
Long-term outcomes remain poor for patients undergoing repeat heart transplantation, particularly those with an inter-transplant interval <3.6 years. Underlying diagnosis does not impact outcomes after repeat transplantation, after accounting for other risk factors.
