Outcomes After Heart Transplantation in Children Under Six Years of Age

• Published in: The Annals of thoracic surgery Vol. 92; no. 1; pp. 174 - 182
• Main Authors: Joffe, Ari R., MD, Quiñonez, Luis G., MD, Robertson, Charlene M.T., MD, Dinu, Irina A., PhD, Alton, Gwen, MN, Coe, James, MD, Sauve, Reg, MD, Acton, Bryan V., PhD, Ross, David B., MD, Rebeyka, Ivan M., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2011; Elsevier
• Subjects: Age Factors; Alberta; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Cardiomyopathies - diagnosis; Cardiomyopathies - mortality; Cardiomyopathies - surgery; Cardiothoracic Surgery; Child; Child, Preschool; Cohort Studies; Confidence Intervals; Developmental Disabilities - epidemiology; Developmental Disabilities - etiology; Disability Evaluation; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - mortality; Heart Defects, Congenital - surgery; Heart Transplantation - methods; Heart Transplantation - mortality; Humans; Linear Models; Logistic Models; Male; Medical sciences; Multivariate Analysis; Pneumology; Postoperative Complications - mortality; Postoperative Complications - physiopathology; Quality of Life; Retrospective Studies; Risk Assessment; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Analysis; Time Factors; Treatment Outcome; Alberta; 34; Human; Heart; Prognosis; Homotransplantation; Treatment; Surgery; Graft; Anesthesia; Cardiac transplantation; Circulatory system; Cardiology; Child; Age
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2011.02.038

Background Survival after heart transplant has improved and more attention is focused on developmental outcomes. We aimed to determine the survival, morbidity, and developmental outcomes of young children after heart transplant. Methods All children under 6 years of age having a heart transplant in Edmonton between 1999 and 2006 were included in this inception cohort study. Demographics, pretransplant, transplant, and posttransplant variables were collected. The association of potentially predictive variables with neurodevelopmental outcomes at least 12 months posttransplant were determined by univariate and multiple regression analyses. Results Thirty-three children had a heart transplant; 18 with congenital heart disease (CHD) and 15 with cardiomyopathy-myocarditis (non-CHD). Mortality during 19 (8) months of follow-up was 12% (95% confidence interval [CI] 3% to 28%). Survivors had frequent low weight (28%) and height (31%), and delay in language (41%), motor (52%), mental (34%), and general adaptive composite (48%) scores. Only CHD was associated with death-disability-mental delay on multiple regression (odds ratio 7.94; 95% CI 1.6 to 39.4, p = 0.011). The CHD was also associated with mental and language delay on multiple regressions. Mental delay occurred in 8 (53%) with CHD and 2 (14%) with non-CHD ( p = 0.05). Mental score of 85 or greater was found in 13.4% of patients with CHD compared with 50% with non-CHD ( p = 0.05). Conclusions In this single-center inception cohort study, adverse neurodevelopmental outcomes in survivors of heart transplant before the age 6 years were common, particularly in those with CHD. Careful pretransplant and posttransplant counseling are needed, and close follow-up with early intervention for these high-risk children is imperative.