Fontan Patient Survival After Pediatric Heart Transplantation Has Improved in the Current Era

Simpson, Kathleen E.; Pruitt, Elizabeth; Kirklin, James K.; Naftel, David C.; Singh, Rakesh K.; Edens, R. Erik; Barnes, Aliessa P.; Canter, Charles E.

doi:10.1016/j.athoracsur.2016.08.110

Cited by 69 publications

(55 citation statements)

References 17 publications

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“…Although this may have contributed to the trend toward decreased waitlist mortality among all CHD candidates, we surmise that these changes were secondary to changes in management of the CHD population over time rather than as a result of the criteria revision. For example, there has been increased emphasis in the last decade on care of the Fontan patient, including recommendations to consider earlier transplant evaluation referral . This is supported by the greater listing rate we observed for CHD but not CM candidates in Era 2.…”

Section: Discussionmentioning

confidence: 63%

Impact of the 2016 revision of US Pediatric Heart Allocation Policy on waitlist characteristics and outcomes

Magnetta

Godown

West

et al. 2019

American Journal of Transplantation

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US Pediatric Heart Allocation Policy was recently revised, deprioritizing candidates with cardiomyopathy while maintaining status 1A eligibility for congenital heart disease (CHD) candidates on “high‐dose” inotropes. We compared waitlist characteristics and mortality around this change. Status 1A listings decreased (70% to 56%, P < .001) and CHD representation increased among status 1A listings (48% vs 64%, P < .001). Waitlist mortality overall (subdistribution hazard ratio [SHR] 0.96, P = .63) and among status 1A candidates (SHR 1.16, P = .14) were unchanged. CHD waitlist mortality trended better (SHR 0.82, P = .06) but was unchanged for CHD candidates listed status 1A (SHR 0.92, P = .47). Status 1A listing exceptions increased 2‐ to 3‐fold among hypertrophic and restrictive cardiomyopathy candidates and 13.5‐fold among dilated cardiomyopathy (DCM) candidates. Hypertrophic (SHR 6.25, P = .004) and restrictive (SHR 3.87, P = .03) cardiomyopathy candidates without status 1A exception had increased waitlist mortality, but those with DCM did not (SHR 1.26, P = .32). Ventricular assist device (VAD) use increased only among DCM candidates ≥1 years old (26% vs 38%, P < .001). Current allocation policy has increased CHD status 1A representation but has not improved their waitlist mortality. Excessive DCM status 1A listing exceptions and continued status 1A prioritization of children on stable VADs potentially diminish the intended benefits of policy revision.

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Section: Discussionmentioning

confidence: 63%

Impact of the 2016 revision of US Pediatric Heart Allocation Policy on waitlist characteristics and outcomes

Magnetta

Godown

West

et al. 2019

American Journal of Transplantation

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“…When looking at 402 Fontan patients (<18 years of age) who underwent heart transplant—patients in the early era of transplant (1993‐2006) had a 1‐year post‐transplant survival of 77% and a more contemporary era (2007‐2014) had a 1‐year post‐transplant survival of 89%. In this same 2007‐2014 era, the 1‐year post‐transplant survival for non‐Fontan CHD was 92% …”

Section: Introductionmentioning

confidence: 95%

“…Previously reported outcomes following heart transplantation in the Fontan population have been poor, but recent analyses by Simpson et al demonstrate improved one‐year survival . Lamour et al (2009) reported a 1‐year post‐transplant survival of 71% in Fontan patients and 83% in non‐Fontan congenital heart disease (CHD) patients .…”

Section: Introductionmentioning

confidence: 99%

Heart and heart–liver transplantation in adults with failing Fontan physiology

Reardon

DePasquale

Tarabay³

et al. 2018

Clinical Transplantation

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“…However, recent interrogation of the Paediatric Heart Transplant Study Database showed improved 1-year survival from 71% [1993][1994][1995][1996][1997][1998][1999][2000][2001][2002][2003][2004][2005][2006] to 89% [2007][2008][2009][2010][2011][2012][2013][2014] for those undergoing OHT for FFP, reaching comparable outcomes to other CHD patients (42). Other paediatric registry data has shown comparable outcomes between Fontan and nonFontan SV OHT patients (27,43,44).…”

Section: Mortality In Sv Heart Transplantationmentioning

confidence: 99%

Transplantation in the single ventricle population

Kenny¹,

DeRita²,

Nassar³

et al. 2018

Ann. Cardiothorac. Surg.

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The single ventricle patient population comprises the most complex cohort presenting to the cardiac transplant team, in terms of demographics, anatomic substrate, and unique physiology. It is also the most rapidly growing diagnostic group presenting for heart transplantation. In this manuscript, we aim to describe the changing landscape of transplantation in single ventricle conditions through reflection on our own institution's practice and experience, alongside contemporary literature review. Single ventricle patients are heterogeneous in terms of age, anatomic diagnosis and physiology according to surgical stage of repair.Progress in surgical palliative strategies has impacted upon the present composition of the population, with growing numbers of hypoplastic left heart syndrome patients and those with late physiology failure following Fontan completion. Multiple prior surgeries, immunological sensitivity and multi-organ involvement impart high peri-operative risk but can be mitigated in part by careful pre-operative planning by a dedicated multidisciplinary team addressing issues such as planning of concurrent reconstructive surgery, minimizing the post-operative effect of collaterals, timely harvesting, oversizing of donor organs to minimize graft failure, and strategies to address anticipated post-operative elevation in pulmonary vascular resistance. Determining optimal timing for transplant in these patients remains unclear, but understanding the risk of alternative surgical options can help guide decision making with regards to listing.

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Fontan Patient Survival After Pediatric Heart Transplantation Has Improved in the Current Era

Abstract: Survival of Fontan patients after HT has significantly improved in the current era. Currently, expected post-HT survival for Fontan patients is on par with other CHD patients. Fontan patients should not be excluded from consideration for HT solely on a history of Fontan.

Cited by 69 publications

References 17 publications

Impact of the 2016 revision of US Pediatric Heart Allocation Policy on waitlist characteristics and outcomes

Impact of the 2016 revision of US Pediatric Heart Allocation Policy on waitlist characteristics and outcomes

Heart and heart–liver transplantation in adults with failing Fontan physiology

Transplantation in the single ventricle population

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