Factors associated with in-hospital mortality in infants undergoing heart transplantation in the United States

Abstract

Objective Infants undergoing heart transplantation have the highest early posttransplant mortality of any age group. We sought to determine the pretransplantation factors associated with in-hospital mortality in transplanted infants in the current era. Methods All infants under 12 months of age who underwent primary heart transplantation during a recent 10-year period (1999-2009) in the United States were identified using the Organ Procurement and Transplant Network database. Multivariable logistic regression was used to identify independent pretransplantation factors associated with in-hospital mortality. Results Of 730 infants in the study (median age 3.8 months), 462 (63%) had congenital heart disease, 282 (39%) were supported by a ventilator, 94 (13%) with extracorporeal membrane oxygenation, and 22 (3%) with a ventricular assist device at the time of transplantation. Overall, 82 (11.2%) infants died before their initial hospital discharge. In adjusted analysis, in-hospital mortality was associated with repaired congenital heart disease (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.8, 7.2), unrepaired congenital heart disease not on prostaglandin E (OR, 2.8; CI, 1.3, 6.1), extracorporeal membrane oxygenator support (OR, 6.1; CI, 2.8, 13.4), ventilator support (OR, 4.4; CI, 2.3, 8.3), creatinine clearance less than 40 mL · min−1 · 1.73 m−2 (OR, 3.1; CI, 1.7, 5.3), and dialysis (OR, 6.2; CI, 2.1, 18.3) at transplantation. Conclusions One in 9 infants undergoing heart transplantation dies before hospital discharge. Pretranplantation factors associated with early mortality include congenital heart disease, extracorporeal membrane oxygenator support, mechanical ventilation, and renal failure. Risk stratification for early posttransplant mortality among infants listed for heart transplantation may improve decision-making for transplant eligibility, organ allocation, and posttransplant interventions to reduce mortality.

Current Outcomes in US Children With Cardiomyopathy Listed for Heart Transplantation

“…This finding was not reported in the PHTS report but is consistent with our previous work in other cohorts. 7,[19][20][21] Third, although black children remain at higher risk of posttransplant mortality, 1 we did not find any association of race/ethnicity with wait-list mortality. This finding is consistent with a recent report that showed that racial gaps, previously present in children awaiting HT in the United States, are absent in the current era.…”

609 Steroid Avoidance in Pediatric Heart Transplantation Results in Excellent Graft Survival

“…Differences in pre-HT risk of graft loss could have played a role in graft outcomes between SF and MS groups; however, we found no difference in graft or patient survival based on MS use in multivariable analysis. Variables other than MS that we found to be independent risk factors for graft loss have been shown to be independent risk factors in previous studies (4)(5)(6)(7)(8), The results of our multivariable model were confirmed by our propensity-matched analysis, which similarly showed that there is no graft or patient survival advantage to the use of MS. Propensity-matched analysis did not show that induction therapy influenced outcomes or that a combination of induction therapy or no induction with or without MS use made a difference in graft outcomes, which is consistent with data from the International Society for Heart and Lung Transplantation registry (1). However, we did not differentiate between the type of induction agent used and it is not known whether any combination of a particular induction agent with an MS or SF regimen would affect graft outcomes.…”

Transplantation in the single ventricle population

“…Re-entry of the thorax becomes increasingly challenging and hazardous with each prior sternotomy and is associated with a 4-fold elevation of in-hospital mortality (15). Adhesions, destabilising bleeding on resternotomy, and difficult cannulation may be encountered.…”