Abstract 16311: Survival of Fontan Patients After Heart Transplant; Has Survival Improved in the Current Era?
Heart transplant (HT) after the Fontan procedure has been associated with increased mortality compared to other pediatric heart diseases. Recent data from the Pediatric Heart Transplant Study demonstrated improved survival after HT over time in children with congenital heart disease (CHD). We hypothesized that this trend extends to Fontan patients undergoing HT in the current era.
Between 1993 to December 2012, 680 pediatric patients who were ≥ 2 years old at listing with CHD underwent HT, of which 254 had a prior Fontan Procedure. Era 1 (1993-2006: 175 Fontan, 376 non-Fontan CHD (NF-CHD)) was compared to Era 2 (2007-2012: 197 Fontan, 221 NF-CHD) for listed patients ≥ 2 years old. An analysis of survival and risk factors by multivariable analysis examined our study hypothesis.
Similar to other groups, Fontan patients in the late era were more likely to be listed as status 1 (69 vs. 90%, p<0.0001), require inotropic support (55 vs. 69%, p=0.0218), have failure to thrive (20 vs. 36%, p=0.0038) and were younger at Fontan (4.3 vs. 3.4 years, p=0.0196) compared to the early era. NF-CHD patients had better survival after HT (p=0.0378) in the late versus early era. Fontan patients failed to show similar improvement in survival between eras (p=0.319). There was a non-significant trend toward improved survival in NF-CHD compared to Fontan patients in the late era (p=0.0607) (Figure). Risk factors (HR, 95% CI) for increased mortality after HT in the Fontan patients by multivariate analysis included longer ischemic time (1.29, 1.03-1.63, p=0.0296) and ventilator dependence (5.41, 2.5-11.72, p<0.0001).
In contrast to the improvements seen in survival among children ≥ 2 years old with other CHD, Fontan patient survival post-HT has not improved. Fontan patients continue to have poorer survival after HT than other CHD. This may be partly explained by the increased risk profile of Fontans at HT in the current era; death being particularly likely when patients are ventilator dependent at transplant.
Author Disclosures: K.E. Simpson: None. J.K. Kirklin: None. D.C. Naftel: None. E. Pruitt: None. R. Singh: None. R.E. Edens: None. A.P. Barnes: None. C.E. Canter: None.
- © 2014 by American Heart Association, Inc.