Eur J Cardiothorac Surg. 2024 Jun 24:ezae255. doi: 10.1093/ejcts/ezae255. Online ahead of print.
ABSTRACT
OBJECTIVES: Paediatric heart transplantation in children who fail multistage palliation for hypoplastic left heart syndrome is associated with challenges related to immune, clinical, or anatomic risk factors. We review current outcomes and risk factors for survival following heart transplantation in this challenging patient population.
METHODS: The United Network for Organ Sharing transplantation database was merged with Paediatric Health Information System database to identify children who received heart transplantation following prior palliation for hypoplastic left heart syndrome. Multivariable Cox analysis of outcomes and factors affecting survival was performed.
RESULTS: Our cohort included 849 children between 2009-21. Median age was 1044 days (interquartile range 108-3535) and median weight was 13 kg (interquartile range 7-26). Overall survival at 10 years following heart transplantation was 71%, with the majority of death being peri-operative. On multivariable analysis, risk factors for survival included black race (HR = 1.630, p = 0.0253), blood type other than B (HR = 2.564, p = 0.0052), and male donor gender (HR = 1.367, p = 0.0483). Recipient age, the use of ventricular assist device or extracorporeal membrane oxygenation were not significantly associated with survival. 24 patients underwent retransplantation and 10-year freedom from retransplantation was 98%. Rejection prior to hospital discharge and within one year from transplantation was 20% and 24%, respectively, with infants having lower rejection rates.
CONCLUSIONS: Compared to existing literature, the number of children with prior hypoplastic left heart syndrome palliation who receive heart transplantation has increased in the current era. Survival following transplantation in this patient population is acceptable. The majority of death is perioperative. Efforts to properly support these patients prior to transplantation might decrease early mortality and improve overall survival.
PMID:38913846 | DOI:10.1093/ejcts/ezae255
