Improvement in patient selection, management, and outcomes in infant heart transplant from 2000 to 2020

• Published in: European journal of cardio-thoracic surgery
• Main Authors: Endo, Toyokazu, Trivedi, Jaimin, Kozik, Deborah, Alsoufi, Bahaaldin
• Format: Journal Article
• Language: English
• Published: Germany 25.10.2024
• Subjects: Infant; Survival; Heart Transplant; Post-Transplant; Waitlist
• ISSN: 1873-734X; 1873-734X
• DOI: 10.1093/ejcts/ezae384

The study's primary outcome was to evaluate if post-transplant survival has improved over the last two decades. Secondary outcomes were the infant's waitlist mortality, waitlist time, and identifying factors that affected the infant's survival. United Network for Organ Sharing (UNOS) database was queried for infants (age ≤ 1) who were listed for heart transplantation between 2000-2020. The years were divided into three eras (Era 1 2000-2006, Era 2 2007-2013, and Era 3 2014-2020). Non-parametric tests, Chi-Squared, Log-Rank test, and Cox-Proportional hazard ratio were used for analysis (alpha = 0.05). 4234 infants were listed for heart transplants between 2000 and 2020. At the time of listing, Infants in era 3 were more likely to be heavier (in kg (p < 0.001) and had better renal function (p < 0.001). Additionally, they were less likely to be on dialysis (p < 0.001), on a ventilator (p < 0.001), and on ECMO (p < 0.001). There has been a significant increase in LVAD use (p < 0.001), though there was no difference in waitlist (0.154) or post-transplant survival (0.51). In all three eras, waitlist survival (p < 0.001) and post-transplant survival (p < 0.001) have improved significantly. CHD and ECMO were associated with worse waitlist survival in all three eras (p < 0.05). Infants are now waiting longer on the waitlist (in days) (33 Era 1 v. 46 Era 2 v. 67 Era 3, p < 0.001). Infant heart transplant outcomes have improved, but they are now waiting longer on the waitlist. Further improvement in increasing the donor pool, expert consensus on listing strategies, and donor utilization is needed to improve outcomes.