Abstract 3532: Predictors of Mortality Prior to Discharge for Infants Undergoing Heart Transplantation in the US in the Current Era: Analysis of Data From the United Network for Organ Sharing
Background: Infants undergoing heart transplantation (HT) have the highest early mortality of any age group despite having the best long-term survival. We sought to determine the incidence and risk factors for death prior to hospital discharge for infants undergoing HT to better understand the factors responsible for this early attrition.
Methods: Retrospective cohort study using the United Network for Organ Sharing (UNOS) database. All infants <12 months undergoing heart transplantation between 1999 and 2009 were included. Multivariable logistic regression was used to identify independent risk factors for death prior to discharge.
Results: Of 748 infants who were transplanted, the median age was 3.8 months [1.7, 6.7], the median weight was 4.7 kg [3.6, 6.0], 476 (64%) had congenital heart disease (CHD) [of whom 205 (27%) were repaired and 113 (15%) were unrepaired on prostaglandins], 219 (29%) were ventilated, 98 (13%) were on Extracorporeal Membrane Oxygenation (ECMO), and 22 (3%) were on Ventricular Assist Device (VAD) support. Overall, 91 infants (12.2%) died prior to hospital discharge. Multivariable analysis demonstrated pre-discharge death was more likely with repaired congenital heart disease (OR 3.9, 95%CI 2.0 –7.4) and unrepaired congenital heart disease not on prostaglandins (OR 2.8, 95%CI 1.3–5.9), as well as pre-transplant ECMO support (OR 6.5, 95%CI 3.1–13.4), ventilator support (OR 4.2, 95%CI 2.3–7.8), dialysis (OR 4.8, 95%CI 1.7–13.3) and creatinine clearance <40 mL/min (OR 2.9, 95%CI 1.7–5.0). Infants supported with prostaglandins or VAD pre-transplant had no increased risk of in-hospital death following HT.
Conclusions: Overall in-hospital mortality for infants undergoing heart transplantation is 12%. Pre-transplant ECMO, mechanical ventilation, dialysis, renal failure, and CHD were associated with increased in-hospital mortality after HT, whereas prostaglandin use and VAD support were not. These clinical factors can help risk-stratify infant HT candidates.