Risk Factor Analysis in Pediatric Heart Transplantation

• Published in: The Journal of heart and lung transplantation Vol. 27; no. 4; pp. 408 - 415
• Main Authors: Tjang, Yanto Sandy, MD, DSc, Stenlund, Hans, PhD, Tenderich, Gero, MD, PhD, Hornik, Lech, MD, Bairaktaris, Andreas, MD, Körfer, Reiner, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2008; Elsevier Science
• Subjects: Adolescent; Age Factors; Biological and medical sciences; Body Weight; Cardiology. Vascular system; Cardiomyopathy, Dilated - surgery; Cardiopulmonary Bypass - adverse effects; Child; Child, Preschool; Coronary Disease - etiology; Coronary Disease - mortality; Female; Follow-Up Studies; Graft Rejection - mortality; Heart Defects, Congenital - surgery; Heart Transplantation - mortality; Humans; Infant; Male; Medical sciences; Postoperative Complications; Risk Assessment; Risk Factors; Sex Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Analysis; Time Factors; Tissue Donors; Human; Heart; Pediatrics; Factor analysis; Transplantation; Risk analysis; Homotransplantation; Phlebology; Treatment; Surgery; Risk factor; Graft; Circulatory system; Cardiology; Child
• ISSN: 1053-2498; 1557-3117; 1557-3117
• DOI: 10.1016/j.healun.2008.01.007

Background Steady assessment of risk factors will enable identification of patients at higher risk for post-transplant death, and may thus improve organ utilization and outcomes. In this study we aimed to identify the risk factors of mortality in pediatric heart transplantation. Methods Between November 1989 and February 2004, there were 116 orthotopic heart transplantations performed in patients <18 years of age at our institution. Results The 30-day mortality risk was 12% (dilated cardiomyopathy 7%, congenital heart disease 26%; univariate analysis: p = 0.023). The main cause of 30-day mortality was primary graft failure (36%). The late mortality rate was 31 per 1,000 person-years. The main causes of late mortality were acute rejection (44%) and cardiac allograft vasculopathy (26%). The 1-, 5-, 10- and 15-year survival rates were 85%, 77%, 65% and 53%, respectively. Male donor (odds ratio [OR] 6.33, 95% confidence interval [CI] 1.11 to 36.01) and cardiopulmonary bypass >210 minutes (OR 43.05, 95% CI 1.11 to 1,669) were risk factors for 30-day mortality. Risk factors for 1- and 5-year mortality were body weight ratio <0.8 (OR 40.36, 95% CI 3.04 to 536.47) and male donor (OR 3.36, 95% CI 1.05 to 10.75), respectively. Recipient age <1 year (OR 64.65, 95% CI 1.69 to 2,466.77) and donor–recipient body surface area mismatch of <0.9 (OR 10.58, 95% CI 1.03 to 108.25) were risk factors for 10-year mortality. Conclusions Pediatric heart transplantation can be performed with an expectation of excellent results. Certain risk factors suggest poorer outcomes.