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Published on: September 21, 2021
Fifty-year pediatric heart transplant outcomes: A pediatric-adult center linked analysis
Seth A Hollander1, Stephanie Hsiao2, Anubodh S Varshney2
1Department of Pediatrics (Cardiology), Stanford University School of Medicine, Stanford, California.
Insights
Pediatric heart transplantation (pHT) shows excellent long-term survival exceeding 15 years, with outcomes improving over time. Most retransplants occur after patients transition to adult care, while kidney transplants are infrequent.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Transplant Surgery
Background:
- Long-term outcomes for pediatric heart transplant (pHT) are underreported due to program age and lost follow-up post-transition to adult care.
- Analyzing 50-year pHT outcomes requires leveraging program history and integrated electronic medical records.
Purpose of the Study:
- To analyze 50-year outcomes after pediatric heart transplant (pHT), including events occurring after transfer to adult care.
- To assess long-term survival, retransplantation rates, and subsequent organ transplantation in a pediatric heart transplant cohort.
Main Methods:
- Retrospective review of all pediatric heart transplants (pHT) over 50 years (1974-2024).
- Data ascertained from linked pediatric and adult electronic medical records, public records, and inter-center communications.
- Follow-up confirmed for 97% of patients, capturing outcomes like death, retransplant, and kidney transplant.
Main Results:
- 567 pHTs in 540 patients were analyzed, with a median survival of 16.7 years.
- Survival rates have significantly improved across successive eras (p<0.001).
- 9% underwent retransplantation (50% post-adult care transfer), 1% received a third transplant, 1% received a kidney transplant, and 39% died.
Conclusions:
- Linked analysis demonstrates excellent long-term outcomes for pediatric heart transplant (pHT), with median survival over 15 years and improving trends.
- A significant proportion of retransplants occur after transition to adult care.
- Subsequent kidney transplantation is an infrequent event in this cohort.
Purpose:
Long-term outcomes after pediatric heart transplant (pHT) are rarely reported owing to young programs and loss of follow-up after transition to adult care. We leveraged our program age, center volume, and linked electronic medical record to analyze 50-year outcomes after pHT, including events after adult care transfer.
Methods:
Retrospective review of all pHT over 50 years at Stanford (August 19, 1974 to August 19, 2024). Patient characteristics and posttransplant outcomes, including death, retransplant, and subsequent kidney transplantation, were ascertained from the pediatric and adult electronic medical records, public records, and personal communication with other centers.
Results:
There were 567 pHTs in 540 patients. Status as of August 19, 2024 was confirmed for 526 (97%),11 (2%) had partial follow-up, and 3 were missing. Over 1,888,341 follow-up days, 50 (9%) received a second heart transplant (27 pediatric, 23 adult) after a median of 9 (5, 14) years; 3 (1%) received a third heart transplant; 6 (1%) received a subsequent kidney transplant, and 212 (39%) died (172 pediatric, 40 adult). Median survival was 16.7 years; survival improved in successive eras (p<0.001).
Conclusion:
This linked analysis of pediatric and adult programs shows excellent long-term pHT outcomes with median survival exceeding 15 years and improving. Nearly half of retransplants occur after transfer; subsequent kidney transplant occurs infrequently.
