Abstract 17968: Increased Risk of Post-Heart Transplant Mortality in Small Infants
Background: Infants awaiting heart transplant (HTx) continue to have high waitlist and early post-HTx mortality. The impact of small patient size on wait-list and post-HTx outcomes in infants has not been well studied. The objective of this study was to assess the effect of small size at the time of listing on waitlist outcomes, post-HTx mortality, and post-HTx complications.
Methods: Infants weighing < 5kg listed for HTx from 1994-2013 were identified from the Organ Procurement and Transplantation Network database. The cohort was divided into 2 groups: < 3kg and 3-5kg. Waitlist duration was compared using Wilcoxon rank sum test. Waitlist mortality was examined using competing risk analysis, with delisting as a competing risk. Cox proportional hazard model assessed the impact of size at listing on post-HTx 1-year mortality.
Results: Of 1,966 infants included in the analysis, 442 (22.5 %) weighed < 3 kg, and 1,524 (77.5 %) weighed 3-5 kg at listing. Between the two groups, there was no significant difference in waitlist duration (p=0.24) or waitlist mortality (Adjusted hazard ratio (AHR) 1.13, 95% confidence interval (CI) 0.90, 1.40; p=0.29). Weight < 3kg was an independent risk factor for 1-year post-HTx mortality (AHR 1.53, 95% CI 1.14, 2.05; p=0.01), despite similar donor-to-recipient weight ratios. Post-HTx complications including infection, dialysis, stroke, and the need for re-operation were found to be similar despite patient size.
Conclusions: Weight < 3 kg at listing did not affect waitlist duration or waitlist mortality but was an independent risk factor for 1-year post-HTx mortality. These findings suggest that small infants can be effectively supported to HTx, but small size must be considered when assessing an infant’s overall risk for post-HTx mortality.
Author Disclosures: H.M. Lim: None. J. Godown: None. S. Yu: None. J.E. Donohue: None. J.M. Friedland-Little: None. R.J. Gajarski: None. K.R. Schumacher: None.
- © 2014 by American Heart Association, Inc.