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J Heart Lung Transplant. 2012 May;31(5):509-16. doi: 10.1016/j.healun.2011.12.013. Epub 2012 Feb 9.

Early survival after heart transplant in young infants is lowest after failed single-ventricle palliation: a multi-institutional study.

Author information

1
Primary Children's Medical Center, Division of PediatricCardiology, 100 N Mario Capecchi Drive, Salt Lake City, UT 84113, USA. melanie.everitt@imail.org

Abstract

BACKGROUND:

Infant heart transplant (HT) recipients have the best long-term survival of any age group, but the small donor pool and high early mortality limit the therapeutic effectiveness. We sought to determine the relationship between pre-HT diagnosis and early HT outcome to better define the mortality risk associated with a diagnosis of congenital heart disease (CHD) and to examine differences between early and current HT eras.

METHODS:

The Pediatric Heart Transplant Study (PHTS) database was used to identify 739 infant HT recipients at age ≤ 6 months between 1993 and 2008 divided into the following etiologic groups: cardiomyopathy (CM), 18%; hypoplastic left heart syndrome (HLHS) without surgery, 41%; HLHS with surgery, 9%; other CHD without surgery, 16%; and other CHD with surgery, 15%. Severity of illness at HT, post-HT survival, and era effects were compared.

RESULTS:

At 1 year after HT, survival was 89% for the CM group, which was the best, 79% for CHD without surgery, 82% for CHD with surgery, 79% for HLHS without surgery, and 70% for HLHS with surgery, which was the worst outcome. Hazard function analysis demonstrated the difference occurred within the first 3 months after HT. After adjusting for illness severity, differences in mortality risk persisted across etiologic groups. HT survival was similar in the current surgical era for HLHS with surgery, 71% (1993-1998) vs 70% (1999-2008).

CONCLUSIONS:

Infant HT recipients with different pre-HT diagnoses have significantly different post-HT outcomes. HLHS infants with surgery have the lowest survival and their outcome is unchanged in the current era.

PMID:
22325692
DOI:
10.1016/j.healun.2011.12.013
[Indexed for MEDLINE]

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