Abstract 14631: Factors Predictive of Ten Year Survival in Pediatric Heart Transplantation: an Analysis of Over 2,000 Patients
Objectives: Factors predictive of long-term survival in pediatric orthotopic heart transplantation (OHT) remain to be elucidated. The aim of this study was to utilize the United Network for Organ Sharing (UNOS) database to evaluate variables that may impact 10-year survival following pediatric OHT.
Methods: UNOS data was limited to pediatric (<18 years) patients undergoing OHT between 1987-1999. Patients undergoing retransplantation or multivisceral transplantation were excluded from analysis. A control group consisted of patients with mortality within 5 years after transplant. Preoperative recipient, donor, matching, transplant and hemodynamic data were compared between controls and 10-year survivors. Those covariates significantly associated with 10-year survival in univariate analysis were entered into a multivariate logistic regression model.
Results: A total of 2,731 pediatric patients underwent OHT during the study period. There were 1,148 (42%) 10-year survivors, and 878 (32%) patients died within 5 years of transplantation. Mean age was 5.3 ± 6.1 years, with 1,186 (59%) males. Average weight was 21.2 ± 22.2 kg. The most common etiologies for heart failure included congenital heart disease (n=1,109; 55%) and dilated cardiomyopathy (n=736; 36%). Multivariate logistic regression analysis identified several covariates as significant predictors of 10-year survival (see Table).
Conclusions: This is the largest study examining predictors of 10-year survival following pediatric OHT in over 2,000 patients. Later transplant year, Caucasian race, male gender, lower BMI, dilated cardiomyopathy, and younger donor age are associated with improved 10-year survival, whereas the need for mechanical ventilation and/or intra-aortic balloon pump counterpulsation significantly reduces the likelihood of long-term survival. Incorporation of these predictors may be helpful to providers in the allocation of organs and in prognostication.
- © 2011 by American Heart Association, Inc.