Over two decades of pediatric heart transplantation: How has survival changed?

Objective

In 1984, the first successful infant heart transplant was performed at Texas Children’s Hospital. This study analyzes the 21-year experience with pediatric heart transplantation at Texas Children’s Hospital to assess whether and how survival has changed over time.

Methods

Between November 1, 1984, and October 3, 2005, 164 consecutive orthotopic heart transplants were performed on 154 patients. Characteristics: mean age 7.1 ± 6.0 years, mean body surface area 0.8 ± 0.5 m². Diagnosis at transplant: cardiomyopathy 53.0% (n = 87), congenital heart defect 39.0% (n = 64), retransplant 7.9% (n = 13). Multivariate risk factor analysis of 32 variables was completed by Cox proportional hazards regression models.

Results

Mean follow-up was 5.9 ± 4.8 years. Overall Kaplan–Meier survival was 82% at 1 year, 65% at 5 years, and 54% at 10 years. After 1995, Kaplan–Meier survival (91% at 1 year and 71% at 5 years) was significantly improved over pre-1995 survival (71% at 1 year, 57% at 5 years, and 48% at 10 years; P =.026). Hospital survival improved in the post-1995 era (96%) compared with the pre-1995 era (77%; P < .001). Life-table analysis by yearly increments demonstrates only an improved survival (pre-1995, 71% →post-1995, 91%) in the first posttransplant year (P = .001); every subsequent year the mortality rates are the same (P = .92). Risk factors for overall mortality are prolonged postoperative intubation (>5 days) and longer cardiopulmonary bypass time.

Conclusions

Primarily attributable to an increase in early survival, overall pediatric heart transplant survival is improved. However, after the first posttransplant year, the rate of mortality has not changed in 21 years. This highlights the need for new therapies to treat children both with or in need of a heart transplant.

CTSNet classification: 34

Abbreviations and Acronyms: CHD, congenital heart disease, ISHLT, International Society for Heart and Lung Transplantation, MMF, mycophenolate mofetil, PVRI, pulmonary vascular resistance index, TCH, Texas Children’s Hospital