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Published on: September 21, 2021
Pathology of explanted pediatric hearts: An 11-year study. Population characteristics and implications for outcomes
Takato Yamasaki1,2, Stephen P Sanders1,3, Robyn J Hylind4
1The Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Pediatric heart transplant recipients with cardiomyopathy had better survival than those with congenital heart defects (CHD). Ventricular fibrosis in CHD hearts predicted poorer outcomes, and younger age at transplant was linked to lower survival rates.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Transplantation Immunology
Background:
- Optimizing heart transplantation (HT) outcomes in pediatric patients requires understanding pathological predictors.
- Accurate pre-transplantation evaluation is crucial for effective donor organ utilization.
Purpose of the Study:
- To identify pathological predictors of cardiac allograft survival in pediatric heart transplant recipients.
- To analyze clinical-pathological factors influencing outcomes in explanted pediatric hearts.
Main Methods:
- Analysis of 149 explanted pediatric hearts over an 11-year period.
- Evaluation of patient demographics, transplant indications, and clinical-pathological factors.
- Comparison of outcomes between congenital heart defect (CHD) and cardiomyopathy groups.
Main Results:
- Congenital heart defect (CHD) patients were younger with lower pulmonary artery pressure and resistance compared to cardiomyopathy patients.
- Overall mortality or retransplantation rate was 14.1%.
- Survival was significantly higher in the cardiomyopathy group and in patients older than 10 years at HT. Early rejection was more common in CHD patients with prior homograft exposure. Ventricular fibrosis in CHD hearts correlated with higher mortality and lower allograft survival.
Conclusions:
- Heart transplantation outcomes are better in pediatric cardiomyopathy patients compared to those with congenital heart defects (CHD).
- Age over 10 years at transplantation and absence of prior homograft use are associated with improved survival.
- Ventricular fibrosis in explanted CHD hearts is a significant predictor of adverse outcomes.
Background:
As more pediatric patients become candidates for heart transplantation (HT), understanding pathological predictors of outcome and the accuracy of the pretransplantation evaluation are important to optimize utilization of scarce donor organs and improve outcomes. The authors aimed to investigate explanted heart specimens to identify pathologic predictors that may affect cardiac allograft survival after HT.
Methods:
Explanted pediatric hearts obtained over an 11-year period were analyzed to understand the patient demographics, indications for transplant, and the clinical-pathological factors.
Results:
In this study, 149 explanted hearts, 46% congenital heart defects (CHD), were studied. CHD patients were younger and mean pulmonary artery pressure and resistance were significantly lower than in cardiomyopathy patients. Twenty-one died or underwent retransplantation (14.1%). Survival was significantly higher in the cardiomyopathy group at all follow-up intervals. There were more deaths and the 1-, 5- and 7-year survival was lower in patients ≤10 years of age at HT. Early rejection was significantly higher in CHD patients exposed to homograft tissue, but not late rejection. Mortality/retransplantation rate was significantly higher and allograft survival lower in CHD hearts with excessive fibrosis of one or both ventricles. Anatomic diagnosis at pathologic examination differed from the clinical diagnosis in eight cases.
Conclusions:
Survival was better for the cardiomyopathy group and patients >10 years at HT. Prior homograft use was associated with a higher prevalence of early rejection. Ventricular fibrosis (of explant) was a strong predictor of outcome in the CHD group. We presented several pathologic findings in explanted pediatric hearts.
