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Updated: May 6, 2026
A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
Changes in waiting time, need for mechanical circulatory support and outcomes in paediatric heart transplant
Lisa-Maria Rosenthal1,2,3, Annemarie Krauss1, Oliver Miera1
1Department of Congenital Heart Disease-Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany.
Insights
Paediatric heart transplantation survival has significantly improved over 35 years, with better outcomes despite increased waiting times and mechanical circulatory support (MCS) use. These advancements ensure favourable long-term results for young heart failure patients.
Area of Science:
- Cardiology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Heart transplantation is a critical treatment for pediatric end-stage heart failure.
- Excellent long-term outcomes are achievable in pediatric heart recipients.
Purpose of the Study:
- To analyze trends in pediatric heart transplantation over 35 years.
- To evaluate changes in diagnoses, survival rates, waiting times, and mechanical circulatory support (MCS) utilization.
- To assess the impact of these changes on patient outcomes.
Main Methods:
- Retrospective analysis of 244 pediatric heart transplant recipients (<18 years) from 1986-2022.
- Data divided into three decades: 1991-2000, 2001-2010, and 2011-2020.
- Examination of survival, waiting times, and MCS use over time.
Main Results:
- 1-year survival improved from 79.3% to 92.3% (P=0.041) over the study period.
- Median overall survival reached 18.0 years; conditional survival at 1 year was 20.9 years.
- Increased waiting times, particularly for younger children, and a surge in MCS (VAD) use (67% in the last decade) were observed, yet survival remained favorable.
Conclusions:
- Pediatric heart transplant outcomes show continuous improvement.
- Increased demand for organs and reliance on VADs as a bridge to transplantation do not compromise post-transplant survival.
- Long-term results remain favorable despite evolving challenges in pediatric heart transplantation.
Aims:
Heart transplantation is a well-established treatment for end-stage heart failure in paediatric patients, demonstrating excellent long-term outcomes.
Methods:
This retrospective study analyses 35 years of data on 244 paediatric recipients (<18 years) at a single institution from 1986 to 2022. The analysis explores changes in diagnoses, survival, waiting times and mechanical circulatory support (MCS) over three decades (1991-2000, 2001-2010 and 2011-2020).
Results:
Survival outcomes significantly improved over the study period, with 1-year survival rates increasing from 79.3% (1991-2000) to 92.3% (2011-2020, P = 0.041). The median overall survival was 18.0 years, and median conditional survival to 1 year post-transplant was 20.9 years. Survival differences were noted among age groups, with infants under 1 year of age experiencing higher early mortality, and adolescents (aged 11-17 years) facing increased long-term risks, possibly linked to adult donor characteristics. Waiting times for heart transplantation increased, especially for younger age groups (0-5 and 6-10 years), reflecting the growing demand for donor organs. The use of MCS, including ventricular assist devices (VAD), surged, with 67% of recipients in the most recent decade receiving pre-transplant VAD support. Importantly, despite prolonged waiting times and increased VAD use, overall survival continued to be favourable.
Conclusions:
Early and long-term results after paediatric heart transplantation have been continuously improving over the past decades. Despite an increased demand for donor organs and the growing reliance on VAD as bridge to transplantation, post-transplantation survival is not compromised.
