Risk Factors for Survival After Heart Transplantation in Children and Young Adults: A 22-Year Study of 179 Transplants

Shawn Shah, Alfred Asante-Korang, Sharon R. Ghazarian, Gary Stapleton, Carrie Herbert, Jamie Decker, Melvin C. Almodovar, Tom R. Karl, Nhue L. Do, James A. Quintessenza, Constantine Mavroudis, Luca A. Vricella, Hugh M. van Gelder, Vyas Kartha, Plato Alexander, Jennifer Carapellucci, Diane Krasnopero, Jade Hanson, Ernest Amankwah, Joeli RothJeffrey P. Jacobs

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: This article reviews all patients who underwent heart transplantation (HTx) within a single institution (172 patients underwent 179 HTx [167 first-time HTxs, 10 second HTxs, 2 third HTxs]) to describe diagnostic characteristics, management protocols, and risk factors for mortality. METHODS: Descriptive analysis was performed for the entire cohort using mean, standard deviation, median, interquartile range, and overall range, as appropriate. Univariable and multivariable Cox proportional hazards models were performed to identify prognostic factors for outcomes over time. The primary outcome of interest was mortality, which was modeled by Kaplan-Meier analysis. RESULTS: Median age at HTx was 263 days (range, 5 days to 24 years; mean = 4.63 ± 5.95 years; 18 neonates, 79 infants). Median weight at HTx was 7.5 kg (range, 2.2-113 kg; mean = 19.36 ± 23.54). Diagnostic categories were cardiomyopathy (n = 62), primary transplantation for hypoplastic left heart syndrome (HLHS) or HLHS-related malformation (n = 33), transplantation after cardiac surgery for HLHS or HLHS-related malformation (n = 17), non-HLHS congenital heart disease (n = 55), and retransplant (n = 12). Operative mortality was 10.1% (18 patients). Cumulative total follow-up is 1,355 years. Late mortality was 18.4% (33 patients). Overall Kaplan-Meier five-year survival was 76.2%. One hundred twenty-one patients are alive with a mean follow-up of 7.61 ± 6.46 years. No survival differences were seen among the five diagnostic subgroups ( P = .064) or between immunosensitized patients (n = 31) and nonimmunosensitized patients (n = 141; P = .422). CONCLUSIONS: Excellent results are expected for children undergoing HTx with comparable results among diagnostic groups. Pretransplant mechanical circulatory support and posttransplant mechanical circulatory support are risk factors for decreased survival. Survival after transplantation for HLHS or HLHS-related malformation is better with primary HTx in comparison to HTx after prior cardiac surgery.

Original languageEnglish (US)
Pages (from-to)557-564
Number of pages8
JournalWorld journal for pediatric & congenital heart surgery
Volume9
Issue number5
DOIs
StatePublished - Sep 1 2018
Externally publishedYes

Fingerprint

Hypoplastic Left Heart Syndrome
Heart Transplantation
Young Adult
Transplants
Survival
Mortality
Transplantation
Thoracic Surgery
Kaplan-Meier Estimate
Cardiomyopathies
Proportional Hazards Models
Heart Diseases
Newborn Infant
Weights and Measures

Keywords

  • BVAD
  • cardiomyopathy
  • circulatory assist devices (LVAD
  • ECMO (extracorporeal membrane oxygenation)
  • heart
  • hypoplastic left heart syndrome
  • RVAD
  • TAH)
  • transplantation

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

Cite this

Risk Factors for Survival After Heart Transplantation in Children and Young Adults : A 22-Year Study of 179 Transplants. / Shah, Shawn; Asante-Korang, Alfred; Ghazarian, Sharon R.; Stapleton, Gary; Herbert, Carrie; Decker, Jamie; Almodovar, Melvin C.; Karl, Tom R.; Do, Nhue L.; Quintessenza, James A.; Mavroudis, Constantine; Vricella, Luca A.; van Gelder, Hugh M.; Kartha, Vyas; Alexander, Plato; Carapellucci, Jennifer; Krasnopero, Diane; Hanson, Jade; Amankwah, Ernest; Roth, Joeli; Jacobs, Jeffrey P.

In: World journal for pediatric & congenital heart surgery, Vol. 9, No. 5, 01.09.2018, p. 557-564.

Research output: Contribution to journalArticle

Shah, S, Asante-Korang, A, Ghazarian, SR, Stapleton, G, Herbert, C, Decker, J, Almodovar, MC, Karl, TR, Do, NL, Quintessenza, JA, Mavroudis, C, Vricella, LA, van Gelder, HM, Kartha, V, Alexander, P, Carapellucci, J, Krasnopero, D, Hanson, J, Amankwah, E, Roth, J & Jacobs, JP 2018, 'Risk Factors for Survival After Heart Transplantation in Children and Young Adults: A 22-Year Study of 179 Transplants', World journal for pediatric & congenital heart surgery, vol. 9, no. 5, pp. 557-564. https://doi.org/10.1177/2150135118782190
Shah, Shawn ; Asante-Korang, Alfred ; Ghazarian, Sharon R. ; Stapleton, Gary ; Herbert, Carrie ; Decker, Jamie ; Almodovar, Melvin C. ; Karl, Tom R. ; Do, Nhue L. ; Quintessenza, James A. ; Mavroudis, Constantine ; Vricella, Luca A. ; van Gelder, Hugh M. ; Kartha, Vyas ; Alexander, Plato ; Carapellucci, Jennifer ; Krasnopero, Diane ; Hanson, Jade ; Amankwah, Ernest ; Roth, Joeli ; Jacobs, Jeffrey P. / Risk Factors for Survival After Heart Transplantation in Children and Young Adults : A 22-Year Study of 179 Transplants. In: World journal for pediatric & congenital heart surgery. 2018 ; Vol. 9, No. 5. pp. 557-564.
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abstract = "BACKGROUND: This article reviews all patients who underwent heart transplantation (HTx) within a single institution (172 patients underwent 179 HTx [167 first-time HTxs, 10 second HTxs, 2 third HTxs]) to describe diagnostic characteristics, management protocols, and risk factors for mortality. METHODS: Descriptive analysis was performed for the entire cohort using mean, standard deviation, median, interquartile range, and overall range, as appropriate. Univariable and multivariable Cox proportional hazards models were performed to identify prognostic factors for outcomes over time. The primary outcome of interest was mortality, which was modeled by Kaplan-Meier analysis. RESULTS: Median age at HTx was 263 days (range, 5 days to 24 years; mean = 4.63 ± 5.95 years; 18 neonates, 79 infants). Median weight at HTx was 7.5 kg (range, 2.2-113 kg; mean = 19.36 ± 23.54). Diagnostic categories were cardiomyopathy (n = 62), primary transplantation for hypoplastic left heart syndrome (HLHS) or HLHS-related malformation (n = 33), transplantation after cardiac surgery for HLHS or HLHS-related malformation (n = 17), non-HLHS congenital heart disease (n = 55), and retransplant (n = 12). Operative mortality was 10.1{\%} (18 patients). Cumulative total follow-up is 1,355 years. Late mortality was 18.4{\%} (33 patients). Overall Kaplan-Meier five-year survival was 76.2{\%}. One hundred twenty-one patients are alive with a mean follow-up of 7.61 ± 6.46 years. No survival differences were seen among the five diagnostic subgroups ( P = .064) or between immunosensitized patients (n = 31) and nonimmunosensitized patients (n = 141; P = .422). CONCLUSIONS: Excellent results are expected for children undergoing HTx with comparable results among diagnostic groups. Pretransplant mechanical circulatory support and posttransplant mechanical circulatory support are risk factors for decreased survival. Survival after transplantation for HLHS or HLHS-related malformation is better with primary HTx in comparison to HTx after prior cardiac surgery.",
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author = "Shawn Shah and Alfred Asante-Korang and Ghazarian, {Sharon R.} and Gary Stapleton and Carrie Herbert and Jamie Decker and Almodovar, {Melvin C.} and Karl, {Tom R.} and Do, {Nhue L.} and Quintessenza, {James A.} and Constantine Mavroudis and Vricella, {Luca A.} and {van Gelder}, {Hugh M.} and Vyas Kartha and Plato Alexander and Jennifer Carapellucci and Diane Krasnopero and Jade Hanson and Ernest Amankwah and Joeli Roth and Jacobs, {Jeffrey P.}",
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TY - JOUR

T1 - Risk Factors for Survival After Heart Transplantation in Children and Young Adults

T2 - A 22-Year Study of 179 Transplants

AU - Shah, Shawn

AU - Asante-Korang, Alfred

AU - Ghazarian, Sharon R.

AU - Stapleton, Gary

AU - Herbert, Carrie

AU - Decker, Jamie

AU - Almodovar, Melvin C.

AU - Karl, Tom R.

AU - Do, Nhue L.

AU - Quintessenza, James A.

AU - Mavroudis, Constantine

AU - Vricella, Luca A.

AU - van Gelder, Hugh M.

AU - Kartha, Vyas

AU - Alexander, Plato

AU - Carapellucci, Jennifer

AU - Krasnopero, Diane

AU - Hanson, Jade

AU - Amankwah, Ernest

AU - Roth, Joeli

AU - Jacobs, Jeffrey P.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - BACKGROUND: This article reviews all patients who underwent heart transplantation (HTx) within a single institution (172 patients underwent 179 HTx [167 first-time HTxs, 10 second HTxs, 2 third HTxs]) to describe diagnostic characteristics, management protocols, and risk factors for mortality. METHODS: Descriptive analysis was performed for the entire cohort using mean, standard deviation, median, interquartile range, and overall range, as appropriate. Univariable and multivariable Cox proportional hazards models were performed to identify prognostic factors for outcomes over time. The primary outcome of interest was mortality, which was modeled by Kaplan-Meier analysis. RESULTS: Median age at HTx was 263 days (range, 5 days to 24 years; mean = 4.63 ± 5.95 years; 18 neonates, 79 infants). Median weight at HTx was 7.5 kg (range, 2.2-113 kg; mean = 19.36 ± 23.54). Diagnostic categories were cardiomyopathy (n = 62), primary transplantation for hypoplastic left heart syndrome (HLHS) or HLHS-related malformation (n = 33), transplantation after cardiac surgery for HLHS or HLHS-related malformation (n = 17), non-HLHS congenital heart disease (n = 55), and retransplant (n = 12). Operative mortality was 10.1% (18 patients). Cumulative total follow-up is 1,355 years. Late mortality was 18.4% (33 patients). Overall Kaplan-Meier five-year survival was 76.2%. One hundred twenty-one patients are alive with a mean follow-up of 7.61 ± 6.46 years. No survival differences were seen among the five diagnostic subgroups ( P = .064) or between immunosensitized patients (n = 31) and nonimmunosensitized patients (n = 141; P = .422). CONCLUSIONS: Excellent results are expected for children undergoing HTx with comparable results among diagnostic groups. Pretransplant mechanical circulatory support and posttransplant mechanical circulatory support are risk factors for decreased survival. Survival after transplantation for HLHS or HLHS-related malformation is better with primary HTx in comparison to HTx after prior cardiac surgery.

AB - BACKGROUND: This article reviews all patients who underwent heart transplantation (HTx) within a single institution (172 patients underwent 179 HTx [167 first-time HTxs, 10 second HTxs, 2 third HTxs]) to describe diagnostic characteristics, management protocols, and risk factors for mortality. METHODS: Descriptive analysis was performed for the entire cohort using mean, standard deviation, median, interquartile range, and overall range, as appropriate. Univariable and multivariable Cox proportional hazards models were performed to identify prognostic factors for outcomes over time. The primary outcome of interest was mortality, which was modeled by Kaplan-Meier analysis. RESULTS: Median age at HTx was 263 days (range, 5 days to 24 years; mean = 4.63 ± 5.95 years; 18 neonates, 79 infants). Median weight at HTx was 7.5 kg (range, 2.2-113 kg; mean = 19.36 ± 23.54). Diagnostic categories were cardiomyopathy (n = 62), primary transplantation for hypoplastic left heart syndrome (HLHS) or HLHS-related malformation (n = 33), transplantation after cardiac surgery for HLHS or HLHS-related malformation (n = 17), non-HLHS congenital heart disease (n = 55), and retransplant (n = 12). Operative mortality was 10.1% (18 patients). Cumulative total follow-up is 1,355 years. Late mortality was 18.4% (33 patients). Overall Kaplan-Meier five-year survival was 76.2%. One hundred twenty-one patients are alive with a mean follow-up of 7.61 ± 6.46 years. No survival differences were seen among the five diagnostic subgroups ( P = .064) or between immunosensitized patients (n = 31) and nonimmunosensitized patients (n = 141; P = .422). CONCLUSIONS: Excellent results are expected for children undergoing HTx with comparable results among diagnostic groups. Pretransplant mechanical circulatory support and posttransplant mechanical circulatory support are risk factors for decreased survival. Survival after transplantation for HLHS or HLHS-related malformation is better with primary HTx in comparison to HTx after prior cardiac surgery.

KW - BVAD

KW - cardiomyopathy

KW - circulatory assist devices (LVAD

KW - ECMO (extracorporeal membrane oxygenation)

KW - heart

KW - hypoplastic left heart syndrome

KW - RVAD

KW - TAH)

KW - transplantation

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U2 - 10.1177/2150135118782190

DO - 10.1177/2150135118782190

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JO - World Journal for Pediatric and Congenital Hearth Surgery

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