Heart Transplantation in Infants with Congenital Heart Disease: Outcomes Stratified by Prior Surgery

• Published in: The Journal of heart and lung transplantation Vol. 41; no. 4; pp. S504 - S505
• Main Authors: Vaughn, G., Chau, P., Artrip, J., Ganta, S., Abcede, E., Haldeman, S., Sekeres, J., Nigro, J.J., Bock, M.J.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2022
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2022.01.1280

Infant heart transplant (HTX) for complex congenital heart disease (CHD) has been performed since the 1980s. While HTX prior to cardiac surgery was common early, trends toward HTX after failed palliation are now more common. Between 1993-2008, data supported superior outcomes of infants undergoing HTX for CHD prior to palliation, while outcomes were poorest after failed palliation. Currently, palliation of complex CHD is more common, except where infants unsuitable for palliation proceed directly to HTX. We hypothesize that survival after infant HTX in the current era remains higher for those who have not undergone prior surgery. All infants with CHD with (CHD-W) and without (CHD-WO) prior surgery listed for primary, isolated, HTX between 2004-2020 were identified in the UNOS database. Demographics, clinical co-variates, waitlist survival, and post-transplant survival were compared between the groups using descriptive statistics, Kaplan-Meier analysis, and Cox Proportional Hazards modeling. Between 2004-2020, 1,465 (70%) CHD-W and 618 (30%) CHD-WO infants were listed for HTX. Of these, 813 (55%) CHD-W and 363 (59%) CHD-WO underwent HTX (p=0.17). CHD-WO were more likely to be smaller, listed status 1A, and to receive prostaglandin and less likely to have VAD, ECMO, inotrope, or dialysis requirement compared to CHD-W (all p<0.02). Waitlist survival between the groups was not different (p=0.93). Post-transplant graft survival was higher in CHD-WO (p=0.02) (Figure) and this difference persists after one-year post-transplant (p<0.01). CHD-W predicted worse graft survival in the multivariate model [HR 1.35 (1.03-1.76), p=0.03], along with ECMO, dialysis, race, higher bilirubin, and earlier year of listing. Survival after HTX in infants with CHD-WO continues to be superior in the current era. Identifying those at risk of requiring HTX as an infant prior to surgery is crucial and will aid in improved long-term outcomes in children with the most severe forms of CHD.