Repeat pediatric heart transplantation: A united network for organ sharing database analysis

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.