Pathology of explanted pediatric hearts: An 11-year study. Population characteristics and implications for outcomes

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.