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Published on: June 23, 2014
Long-Term Survival in Children Following Heart Transplantation
Emily A Hayes1, Devin Koehl2, Ryan Cantor2
1Nationwide Children's Hospital, Columbus, Ohio, USA.
Insights
Pediatric heart transplantation offers effective long-term survival, but certain factors like malignancy and rejection pose risks. Identifying these risk factors in young heart transplant recipients is crucial for improving outcomes.
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.
Background:
Short-term outcomes following heart transplantation in children have improved, but comparable improvements in long-term survival continues to have barriers. We sought to investigate long-term outcomes following heart transplantation and to identify protective and risk factors associated with long-term survival in children.
Methods:
The Pediatric Heart Transplant Society (PHTS) database was queried for heart transplant recipients from 1993 to 2010 who were ≤ 10 years of age at time of transplant. Patients with conditional graft survival > 3 years and at ≥ 10 years were analyzed. Survival and time-to-event were compared using the Kaplan-Meier method with a log-rank test for significance. Factors associated with graft loss were identified using Cox proportional hazard modeling.
Results:
There were 1610 patients ≤ 10 year of age who were transplanted between 1993 and 2010 with conditional survival to 3 years post-transplant. Of those patients, there were 1170 with conditional survival to 10 years post-transplant. Patients < 1 year at transplant had improved survival compared to other age groups. Risk factors for graft loss after 3 years post-transplant were malignancy, rejection, cardiac allograft vasculopathy (CAV), age, congenital heart disease, female sex, and Black race (p value for all < 0.05).
Conclusions:
Heart transplantation remains an effective therapy in children with a growing number of long-term survivors. Risk factors for mortality in patients ≤ 10 years of age at transplant with conditional survival to 3 years post-transplant include CAV, rejection, malignancy, female sex, and Black race. Further studies are needed to understand the social and biologic causes of racial and sex disparities in pediatric transplant patients.
