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Improved Survival While Waiting and Risk Factors for Death in Pediatric Patients Listed for Cardiac Transplantation

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Abstract

Our aim is to determine (a) the effect of changes in pre-transplant management and era of listing on survival of children listed for HTx and (b) risk factors for death while waiting. This retrospective study included all children listed between 1/1993 and 12/2009 at our center. Survival was determined using survival analysis and competing outcomes modeling. There were 254 listed patients of whom 144 (57%) had congenital heart disease, 208 (82%) were status 1, 52 used ECMO (20%), and 28 used ventricular assist device support (VAD) (11%) beginning in 2005. Overall mortality while waiting was 17% at 6 months, and 69% underwent transplant. Seven of 95 patients (7%) died waiting after 2004 compared to 36 of 159 (23%) before. ECMO and earlier year of listing were significant risk factors (p < 0.001) for wait-list mortality, whereas mortality was significantly lower (p = 0.002) after availability of VADs. Race, gender, blood type, and congenital diagnosis were not significant risk factors for death. Survival in pediatric patients listed for HTx has improved significantly in the current era at our institution. The availability of pediatric VADs has had a significant impact on survival while waiting in children listed for transplantation.

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Authors Contribution

All authors have made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data, and have been involved in drafting the article and revising it critically for important intellectual content; and have given final approval of the version to be published. The authors attest that the manuscript is being submitted only to pediatric transplantation, that it will not be submitted elsewhere while under consideration, and that it has not been published elsewhere.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, College of Medicine, Arkansas Children’s Hospital, University of Arkansas for Medical Sciences, 1 Children’s Way, Slot 512-3, Little Rock, AR, USA

    Dala Zakaria, Elizabeth Frazier, Xiomara Garcia, Sherry Pye, Kenneth R. Knecht, Parthak Prodhan & Jeffrey R. Gossett

  2. Division of Pediatric Cardiothoracic Surgery, Arkansas Children’s Hospital, University of Arkansas for the Medical Science, Little Rock, AR, USA

    Michiaki Imamura

  3. Biostatistics Program, Arkansas Children’s Hospital, University of Arkansas for the Medical Science, Little Rock, AR, USA

    Christopher J. Swearingen

  4. Division of Pediatric Cardiology, Children’s Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA

    W. Robert Morrow

Authors
  1. Dala Zakaria
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  2. Elizabeth Frazier
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  3. Michiaki Imamura
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  4. Xiomara Garcia
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  5. Sherry Pye
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  6. Kenneth R. Knecht
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  7. Parthak Prodhan
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  8. Jeffrey R. Gossett
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  9. Christopher J. Swearingen
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  10. W. Robert Morrow
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Correspondence to Dala Zakaria.

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Zakaria, D., Frazier, E., Imamura, M. et al. Improved Survival While Waiting and Risk Factors for Death in Pediatric Patients Listed for Cardiac Transplantation. Pediatr Cardiol 38, 77–85 (2017). https://doi.org/10.1007/s00246-016-1486-4

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  • DOI: https://doi.org/10.1007/s00246-016-1486-4

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