Long-Term Survival in Children Following Heart Transplantation

Area of Science:

• Pediatric Cardiology
• Transplant Immunology
• Biostatistics

Background:

• Pediatric heart transplantation outcomes have improved, yet long-term survival faces challenges.
• Identifying factors influencing long-term survival in pediatric heart transplant recipients is essential.

Purpose of the Study:

• To investigate long-term outcomes of pediatric heart transplantation.
• To identify protective and risk factors associated with long-term survival in children.

Main Methods:

• Utilized the Pediatric Heart Transplant Society (PHTS) database (1993-2010).
• Analyzed pediatric heart transplant recipients ≤10 years of age with conditional graft survival >3 and ≥10 years.
• Employed Kaplan-Meier method and Cox proportional hazard modeling.

Main Results:

• 1610 pediatric patients (≤10 years) transplanted 1993-2010 with 3-year survival.
• 1170 patients had 10-year conditional survival; infants (<1 year) showed improved survival.
• Risk factors for graft loss after 3 years included malignancy, rejection, cardiac allograft vasculopathy (CAV), age, congenital heart disease, female sex, and Black race.

Conclusions:

• Heart transplantation is effective in children, with increasing long-term survivors.
• Key mortality risk factors in pediatric recipients (≤10 years) with 3-year survival include CAV, rejection, malignancy, female sex, and Black race.
• Further research is needed to address racial and sex disparities in pediatric transplant outcomes.