Abstract 4955: Analysis of Heart Transplant Waitlist Mortality for Children
Background: The outcomes following pediatric heart transplantation (tx) have continued to improve, but pre-tx attrition has been a major concern. Historically, the risk of death while awaiting tx has been greater in children than adults. We sought to determine if recent advances in medical management have reduced the risk of death for children awaiting heart tx.
Methods. An analysis of the Scientific Registry of Transplant Recipients was undertaken to determine the risk of death while awaiting tx for children as compared to adults. Deaths were determined from the Social Security Death Master File and Centers for Medicaid and Medicare Service.
Results: During the 10 yr study period the number of children listed for heart tx increased by an average of 1% each year. Over the same time the number of pediatric donors decreased slightly. The number of deaths per patient listed decreased significantly in the non-infant pediatric patients and adults (table⇓). In the infant population the proportion of deaths did not change over time and generally exceeded 20%. In the most recent era–for the first time–non-infant pediatric patients had proportionally fewer waiting list deaths than adults. When one examines the annual death rates expressed per 1,000 patient-yrs at risk the non-infant pediatric pts also showed a marked reduction from 409.4 to 185.7, p<.01, whereas the rates for infants showed no improvement 1688.8 to 1788.9.
Conclusion: For children ages 1–17yrs waiting list mortality has improved dramatically in spite of a static rate of pediatric organ donation, suggesting that improved medical management has contributed to improved survival. There has been no improvement in waiting list mortality in the infant population. Whether the increased use of ABO incompatible donor organs and the advent of ventricular assist devices for this population will reduce waitlist mortality for this vulnerable group remains to be determined.