TY - JOUR
T1 - Heart Transplantation for Pediatric and Congenital Cardiac Disease
T2 - A Comparison of Two Eras over 23 Years and 188 Transplants at a Single Institution
AU - Tuite, Genevieve C.
AU - Quintessenza, James A.
AU - Asante-Korang, Alfred
AU - Ghazarian, Sharon R.
AU - Wisotzkey, Bethany L.
AU - Shah, Shawn
AU - Stapleton, Gary E.
AU - Decker, Jamie A.
AU - Herbert, Carrie E.
AU - Kartha, Vyas
AU - Alexander, Plato
AU - Carapellucci, Jennifer
AU - Krasnopero, Diane
AU - Hanson, Jade
AU - Goldenberg, Neil A.
AU - Do, Nhue L.
AU - Mavroudis, Constantine
AU - Karl, Tom R.
AU - Boucek, Robert J.
AU - Kutty, Shelby
AU - Vricella, Luca A.
AU - van Gelder, Hugh M.
AU - Jacobs, Jeffrey P.
N1 - Publisher Copyright:
© The Author(s) 2020.
PY - 2021/1
Y1 - 2021/1
N2 - Background: To assess changes in patterns of practice and outcomes over time, we reviewed all patients who underwent heart transplantation (HTx) at our institution and compared two consecutive eras with significantly different immunosuppressive protocols (cohort 1 [80 HTx, June 1995-June 2006]; cohort 2 [108 HTx, July 2006-September 2018]). Methods: Retrospective study of 180 patients undergoing 188 HTx (June 1995-September 2018; 176 first time HTx, 10 second HTx, and 2 third HTx). In 2006, we commenced pre-HTx desensitization for highly sensitized patients and started using tacrolimus as our primary postoperative immunosuppressive agent. The primary outcome was mortality. Survival was modeled by the Kaplan-Meier method. Univariable and multivariable Cox proportional hazard models were created to identify prognostic factors for survival. Results: Our 188 HTx included 18 neonates, 85 infants, 83 children, and 2 adults (>18 years). Median age was 260.0 days (range: 5 days-23.8 years). Median weight was 7.5 kg (range: 2.2-113 kg). Patients in cohort 1 were less likely to have been immunosensitized preoperatively (12.5% vs 28.7%, P =.017). Nevertheless, Kaplan-Meier analysis suggested superior survival in cohort 2 (P =.0045). Patients in cohort 2 were more likely to be alive one year, five years, and ten years after HTx. Multivariable analysis identified the earlier era (hazard ratio [HR] [95% confidence interval] for recent era = 0.32 [0.14-0.73]), transplantation after prior Norwood operation (HR = 4.44 [1.46-13.46]), and number of prior cardiac operations (HR = 1.33 [1.03-1.71]) as risk factors for mortality. Conclusions: Our analysis of 23 years of pediatric and congenital HTx reveals superior survival in the most recent 12-year era, despite the higher proportion of patients with elevated panel reactive antibody in the most recent era. This improvement was temporally associated with changes in our immunosuppressive strategy.
AB - Background: To assess changes in patterns of practice and outcomes over time, we reviewed all patients who underwent heart transplantation (HTx) at our institution and compared two consecutive eras with significantly different immunosuppressive protocols (cohort 1 [80 HTx, June 1995-June 2006]; cohort 2 [108 HTx, July 2006-September 2018]). Methods: Retrospective study of 180 patients undergoing 188 HTx (June 1995-September 2018; 176 first time HTx, 10 second HTx, and 2 third HTx). In 2006, we commenced pre-HTx desensitization for highly sensitized patients and started using tacrolimus as our primary postoperative immunosuppressive agent. The primary outcome was mortality. Survival was modeled by the Kaplan-Meier method. Univariable and multivariable Cox proportional hazard models were created to identify prognostic factors for survival. Results: Our 188 HTx included 18 neonates, 85 infants, 83 children, and 2 adults (>18 years). Median age was 260.0 days (range: 5 days-23.8 years). Median weight was 7.5 kg (range: 2.2-113 kg). Patients in cohort 1 were less likely to have been immunosensitized preoperatively (12.5% vs 28.7%, P =.017). Nevertheless, Kaplan-Meier analysis suggested superior survival in cohort 2 (P =.0045). Patients in cohort 2 were more likely to be alive one year, five years, and ten years after HTx. Multivariable analysis identified the earlier era (hazard ratio [HR] [95% confidence interval] for recent era = 0.32 [0.14-0.73]), transplantation after prior Norwood operation (HR = 4.44 [1.46-13.46]), and number of prior cardiac operations (HR = 1.33 [1.03-1.71]) as risk factors for mortality. Conclusions: Our analysis of 23 years of pediatric and congenital HTx reveals superior survival in the most recent 12-year era, despite the higher proportion of patients with elevated panel reactive antibody in the most recent era. This improvement was temporally associated with changes in our immunosuppressive strategy.
KW - congenital heart disease (CHD)
KW - congenital heart surgery
KW - Fontan
KW - heart
KW - hypoplastic left heart syndrome
KW - immunology
KW - Norwood procedure
KW - pediatric
KW - rejection (immunologic)
KW - transplantation
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U2 - 10.1177/2150135120954149
DO - 10.1177/2150135120954149
M3 - Article
C2 - 33407028
AN - SCOPUS:85146133207
SN - 2150-1351
VL - 12
SP - 17
EP - 26
JO - World Journal for Pediatric and Congenital Hearth Surgery
JF - World Journal for Pediatric and Congenital Hearth Surgery
IS - 1
ER -