BACKGROUND: Neonatal and infant heart transplantation is a therapeutic option for patients with end-stage cardiac lesions, yet infants continue to face a considerable shortage of donor organs. We sought to ascertain outcomes after listing for heart transplantation using a competing outcomes methodology, and to identify factors predicting each outcome. METHODS: Review of the Toronto cardiac transplant database was undertaken to identify infant patients (<or=12 months) wait-listed for heart transplantation. Achievement of one of five possible outcomes was parametrically modeled, including: transplantation; death on the wait-list; delisting: too sick; delisting: clinically improved; and delisting for surgical palliation. RESULTS: Forty-three percent (117 of 269) of the total patient listings were infants (26 fetal/63 neonatal). Of the 117 patients, 80 (68%) underwent transplantation, 15 died on the wait-list, 9 were delisted (too sick/no longer eligible for transplant), 9 opted for surgical palliation and 4 were delisted (clinical improvement). Eighty-nine percent of outcomes were achieved by 3 months from listing. Blood group and transplant era predicted achieving transplantation. Factors predicting death on the wait-list included Canadian Status 4 (most urgent), and mechanical support. Status at listing also predicted delisting: too sick. Fetal listing predicted delisting for surgical alternative. CONCLUSIONS: The first 3 months after listing are critical for achieving an outcome, particularly in higher status patients, affirming the need for timely organ replacement. Strategies such as ABO-incompatible transplantation continue to decrease wait-list mortality; however, these data demonstrate that blood type O and B patients continue to face longer wait-list duration. It is imperative that we continue to seek solutions for the shortage of infant donor organs in order to maximize the utility of heart transplantation as a therapeutic option.
BACKGROUND: Neonatal and infant heart transplantation is a therapeutic option for patients with end-stage cardiac lesions, yet infants continue to face a considerable shortage of donor organs. We sought to ascertain outcomes after listing for heart transplantation using a competing outcomes methodology, and to identify factors predicting each outcome. METHODS: Review of the Toronto cardiac transplant database was undertaken to identify infantpatients (<or=12 months) wait-listed for heart transplantation. Achievement of one of five possible outcomes was parametrically modeled, including: transplantation; death on the wait-list; delisting: too sick; delisting: clinically improved; and delisting for surgical palliation. RESULTS: Forty-three percent (117 of 269) of the total patient listings were infants (26 fetal/63 neonatal). Of the 117 patients, 80 (68%) underwent transplantation, 15 died on the wait-list, 9 were delisted (too sick/no longer eligible for transplant), 9 opted for surgical palliation and 4 were delisted (clinical improvement). Eighty-nine percent of outcomes were achieved by 3 months from listing. Blood group and transplant era predicted achieving transplantation. Factors predicting death on the wait-list included Canadian Status 4 (most urgent), and mechanical support. Status at listing also predicted delisting: too sick. Fetal listing predicted delisting for surgical alternative. CONCLUSIONS: The first 3 months after listing are critical for achieving an outcome, particularly in higher status patients, affirming the need for timely organ replacement. Strategies such as ABO-incompatible transplantation continue to decrease wait-list mortality; however, these data demonstrate that blood type O and B patients continue to face longer wait-list duration. It is imperative that we continue to seek solutions for the shortage of infantdonor organs in order to maximize the utility of heart transplantation as a therapeutic option.
Authors: Christopher S D Almond; Ravi R Thiagarajan; Gary E Piercey; Kimberlee Gauvreau; Elizabeth D Blume; Heather J Bastardi; Francis Fynn-Thompson; T P Singh Journal: Circulation Date: 2009-01-26 Impact factor: 29.690
Authors: Douglas Mah; Tajinder P Singh; Ravi R Thiagarajan; Kimberlee Gauvreau; Gary E Piercey; Elizabeth D Blume; Francis Fynn-Thompson; Christopher S D Almond Journal: J Heart Lung Transplant Date: 2009-09-26 Impact factor: 10.247
Authors: Richard Kirk; David Naftel; Timothy M Hoffman; Christopher Almond; Gerard Boyle; Randall L Caldwell; James K Kirklin; Kirstie White; Anne I Dipchand Journal: J Heart Lung Transplant Date: 2009-09-26 Impact factor: 10.247