OBJECTIVE: Current literature assessing factors associated with outcomes of patients waiting for pediatric heart transplants has focused on survival to transplant and mortality. Our aim was to determine risk factors associated with the outcomes of delisting, transplant, or death while waiting. METHODS: In this single-center, retrospective study of patients listed for heart transplants, competing risk analysis was used to model survival from listing to 4 competing outcomes (transplant, death, delisting for clinical deterioration, delisting for clinical improvement or surgical intervention). RESULTS: There were 308 listing episodes in 280 patients. In competing risk analysis, 11% remained listed at 6 months (transplant 62%, dead 13%, delisted worse 6%, delisted improved 8%). Extracorporeal membrane oxygenation and ventricular assist devices were associated both with higher probability of transplant (hazard ratio [HR], 2.8; P < .001) and delisting for clinical deterioration (HR, 2.7; P = .06). Younger age at listing and complex congenital heart disease were shared risk factors for mortality (HR, 1.07; P = .05; HR, 2.9; P = .003) and delisting because of clinical deterioration (HR, 1.17; P = .01; HR, 2.8; P = .02). Younger age at listing and fetal listing were associated with delisting for clinical improvement or surgical intervention (HR, 1.13; P = .01; HR, 2.9; P = .02). CONCLUSIONS: Overall survival to transplant depends on risk factors including age at listing, cardiac diagnosis, and mechanical circulatory support. Knowledge of risk factors for death and delisting for clinical deterioration or improvement can assist patient selection and timing of transplant listing.
OBJECTIVE: Current literature assessing factors associated with outcomes of patients waiting for pediatric heart transplants has focused on survival to transplant and mortality. Our aim was to determine risk factors associated with the outcomes of delisting, transplant, or death while waiting. METHODS: In this single-center, retrospective study of patients listed for heart transplants, competing risk analysis was used to model survival from listing to 4 competing outcomes (transplant, death, delisting for clinical deterioration, delisting for clinical improvement or surgical intervention). RESULTS: There were 308 listing episodes in 280 patients. In competing risk analysis, 11% remained listed at 6 months (transplant 62%, dead 13%, delisted worse 6%, delisted improved 8%). Extracorporeal membrane oxygenation and ventricular assist devices were associated both with higher probability of transplant (hazard ratio [HR], 2.8; P < .001) and delisting for clinical deterioration (HR, 2.7; P = .06). Younger age at listing and complex congenital heart disease were shared risk factors for mortality (HR, 1.07; P = .05; HR, 2.9; P = .003) and delisting because of clinical deterioration (HR, 1.17; P = .01; HR, 2.8; P = .02). Younger age at listing and fetal listing were associated with delisting for clinical improvement or surgical intervention (HR, 1.13; P = .01; HR, 2.9; P = .02). CONCLUSIONS: Overall survival to transplant depends on risk factors including age at listing, cardiac diagnosis, and mechanical circulatory support. Knowledge of risk factors for death and delisting for clinical deterioration or improvement can assist patient selection and timing of transplant listing.
Authors: Danielle S Burstein; Joseph W Rossano; JoAnn Lindenfeld; Kelly H Schlendorf; Nhue Do; Justin Godown; Matthew J O'Connor; Katsuhide Maeda; Jonathan B Edelson; Kimberly Y Lin; Jeremy A Mazurek; Shelley R Scholl; Jonathan N Menachem Journal: JAMA Cardiol Date: 2022-09-21 Impact factor: 30.154
Authors: Ryan J Williams; Minmin Lu; Lynn A Sleeper; Elizabeth D Blume; Paul Esteso; Francis Fynn-Thompson; Christina J Vanderpluym; Simone Urbach; Kevin P Daly Journal: Am J Transplant Date: 2022-02-08 Impact factor: 9.369
Authors: Min Sub Jeung; Mi Jin Kim; June Huh; I-Seok Kang; Gi Beom Kim; Jeong Jin Yu; Jinyoung Song Journal: J Korean Med Sci Date: 2021-11-15 Impact factor: 2.153
Authors: Stefan Roest; Marijke H van der Meulen; Lennie M van Osch-Gevers; Ulrike S Kraemer; Alina A Constantinescu; Matthijs de Hoog; Ad J J C Bogers; Olivier C Manintveld; Pieter C van de Woestijne; Michiel Dalinghaus Journal: Neth Heart J Date: 2022-07-15 Impact factor: 2.854