Abstract 2557: Clinical Factors Associated with UNOS Status and Outcome After Listing for Heart Transplant in Children with Dilated Cardiomyopathy
The importance of clinical presentation and course in children with dilated cardiomyopathy (DCM) listed for heart transplantation (Tx) is not well defined. Merged data from the Pediatric Cardiomyopathy Registry and Pediatric Heart Transplant Study identified 261 DCM pts; mean age at diagnosis 6±6.2 yrs and mean time from diagnosis to listing 0.6±1.2 yrs. The impact of age at listing and presentation, length of illness, gender, race, insurance status, # of hospitalizations and myocarditis at presentation on
severity of illness at listing (Status 1),
death while waiting and
death post-Tx was determined. Shorter duration of illness (p=0.06) and Medicaid insurance (p<0.01) were associated with listing as Status 1 but not with an increased risk of death while waiting or post-Tx. No risk factor was significantly associated with death while waiting.
Death while waiting occurred in 1/29 (3%) pts with myocarditis and 28/232 (12%) pts with no myocarditis (p=0.16). Death post-Tx was associated with older age at diagnosis (p=0.02) and non-white race (p<0.01). Survival post-Tx was significantly lower in pts with myocarditis (Figure⇓). Cause of death post-Tx in the myocarditis pts included rejection, 4; myocardial infarction, 2; early graft failure, 1; infection, 1; unknown, 1.
Conclusions: Pre-listing factors were not significantly associated with death while waiting. Older age at presentation and non-white race were associated with worse outcome post-Tx. Although 97% of pts who had myocarditis at presentation survived from listing to Tx, death post-Tx was significantly higher in this group, raising questions regarding the influence of generalized inflammation on graft survival.