Survival and Risk Factors for Death After Cardiac Transplantation in Infants

Author:

Canter Charles1,Naftel David1,Caldwell Randall1,Chinnock Richard1,Pahl Elfriede1,Frazier Elizabeth1,Kirklin James1,Boucek Mark1,Morrow Robert1

Affiliation:

1. From Washington University (C.C.), St Louis, Mo; University of Alabama at Birmingham (D.N., J.K.); Indiana University (R. Caldwell) (Indianapolis); Loma Linda University (R. Chinnock) Loma Linda, Calif; Northwestern University (E.P.), Chicago, Ill; Arkansas Children’s Hospital (E.F.), Little Rock; University of Colorado (M.B.) (Denver); and Children’s Hospital of Michigan (R.M.) (Detroit).

Abstract

Background Despite the increasing application of cardiac transplantation in infants, reported survival rates vary, and risk factors for death are poorly understood. Methods and Results To examine early survival and risk factors for death in infants (<1 year of age) undergoing cardiac transplantation, 141 infants (36 <1 month of age) underwent primary cardiac transplantation between January 1, 1993, and January 1, 1995, at 23 centers in the Pediatric Heart Transplant Study (PHTS). Diagnoses were hypoplastic left heart syndrome (66%), other congenital heart disease (17%), cardiomyopathy (14%), and other (3%). Actuarial survival after cardiac transplantation was 84% at 1 month, 70% at 1 year, and 69% at 2 years, with the greatest hazard for death within the first 3 months. The principal cause of death was early graft failure in 20 patients (52% of deaths), infection in 10 (26% of deaths), and rejection in 4 (10%). On the basis of multivariate analysis, risk factors for early mortality were history of previous sternotomy ( P =.0003), nonidentical blood type donor ( P =.01), recipient non–blood group A ( P =.02), and donor cause of death other than closed head trauma ( P =.04). Diagnosis at listing, waiting time (mean, 1.3 months), graft ischemic time (mean, 228 minutes; range, 68 to 479 minutes), and recipient ventilatory or inotropic support at listing were not predictive for mortality after transplant. Conclusions The higher mortality rate observed with infant heart transplantation is due to a higher mortality within the first month after transplantation as a result of early graft failure. Strategies to improve donor heart function at implantation would have the greatest impact on survival after infant cardiac transplantation.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

Reference17 articles.

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2. Cardiac Transplantation for Infants With Hypoplastic Left-Heart Syndrome

3. Intermediate term results of infant orthotopic cardiac transplantation from two centers

4. Canter CE Moorhead S Huddleston CB Spray TL. Restrictive atrial septal communication as a determinant of outcome of cardiac transplantation for hypoplastic left heart syndrome. Circulation. 1993;88(suppl II):II-456-II-460.

5. 1995 Annual Report of the US Scientific Registry for Transplant Recipients and the Organ Procurement and Transplantation Network: Transplant Data: 1988-1994 . Richmond Va: UNOS/Rockville Md: Division of Transplantation Bureau of Health Resources Development Health Resources and Services Administration US Department of Health and Human Services; 1995.

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