Related Experiment Video
Updated: Jun 9, 2025
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Improvement in patient selection, management and outcomes in infant heart transplant from 2000 to 2020
Toyokazu Endo1, Jaimin Trivedi1, Deborah Kozik1
1Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, KY 40202, USA.
Insights
Infant heart transplant survival has improved significantly over two decades, despite longer wait times. Key factors influencing survival include congenital heart disease and mechanical support.
Area of Science:
- Pediatric Cardiology
- Transplant Surgery
- Outcomes Research
Background:
- Heart transplantation is a critical treatment for end-stage heart failure in infants.
- Assessing long-term outcomes and trends in infant heart transplantation is essential for improving patient care.
- Advancements in medical technology and surgical techniques may impact transplant success rates.
Purpose of the Study:
- To evaluate the trend of post-transplant survival in infants over the past 20 years.
- To analyze changes in infant waitlist mortality, waitlist duration, and survival factors.
- To identify key determinants affecting infant survival following heart transplantation.
Main Methods:
- Utilized the United Network for Organ Sharing (UNOS) database for infant heart transplant recipients (age ≤ 1) from 2000-2020.
- Divided the study period into three distinct eras for comparative analysis: 2000-2006, 2007-2013, and 2014-2020.
- Employed non-parametric tests, Chi-Squared, Log-Rank, and Cox-Proportional hazard ratio analyses (α=0.05).
Main Results:
- A total of 4234 infants were listed for heart transplantation.
- Infants in the most recent era (2014-2020) presented with better pre-transplant health indicators, including higher weight and improved renal function.
- While left ventricular assist device use increased significantly, waitlist and post-transplant survival rates showed no significant difference between eras; however, overall waitlist and post-transplant survival improved across all eras.
- Congenital heart disease and extracorporeal membrane oxygenation were associated with poorer waitlist survival.
- Infants experienced significantly longer waitlist times in successive eras (67 days in Era 3 vs. 33 days in Era 1).
Conclusions:
- Infant heart transplant outcomes have demonstrably improved over the last two decades.
- Despite survival improvements, infants now face extended waitlist durations.
- Enhancing the donor pool and establishing expert consensus on listing and donor utilization strategies are crucial for further outcome improvements.
Objectives:
The study's primary outcome was to evaluate if post-transplant survival has improved over the last 2 decades. Secondary outcomes were the infant's waitlist mortality, waitlist time and identifying factors that affected the infant's survival.
Methods:
United Network for Organ Sharing (UNOS) database was queried for infants (age ≤ 1) who were listed for heart transplantation between 2000 and 2020. The years were divided into 3 eras (Era 1 2000-2006, Era 2 2007-2013 and Era 3 2014-2020). Non-parametric tests, Chi-Squared, Log-Rank test and Cox-Proportional hazard ratio were used for analysis (α = 0.05).
Results:
4234 infants were listed for heart transplants between 2000 and 2020. At the time of listing, Infants in era 3 were more likely to be heavier [in kg (P < 0.001)] and had better renal function (P < 0.001). Additionally, they were less likely to be on dialysis (P < 0.001), on a ventilator (P < 0.001) and on extracorporeal membrane oxygenation (P < 0.001). There has been a significant increase in left ventricular assist device use (P < 0.001), though there was no difference in waitlist (0.154) or post-transplant survival (0.51). In all 3 eras, waitlist survival (P < 0.001) and post-transplant survival (P < 0.001) have improved significantly. Congenital heart disease and extracorporeal membrane oxygenation were associated with worse waitlist survival in all 3 eras (P < 0.05). Infants are now waiting longer on the waitlist (in days) (33 Era 1 vs 46 Era 2 vs 67 Era 3, P < 0.001).
Conclusions:
Infant heart transplant outcomes have improved, but they are now waiting longer on the waitlist. Further improvement in increasing the donor pool, expert consensus on listing strategies and donor utilization is needed to improve outcomes.
