TY - JOUR
T1 - Mortality and morbidity after retransplantation after primary heart transplant in childhood
T2 - An analysis from the registry of the International Society for Heart and Lung Transplantation
AU - Conway, Jennifer
AU - Manlhiot, Cedric
AU - Kirk, Richard
AU - Edwards, Leah B.
AU - McCrindle, Brian W.
AU - Dipchand, Anne I.
N1 - Funding Information:
The authors have no conflicts of interest to disclose. This project was supported by an ISHLT Early Career Award.
PY - 2014/3
Y1 - 2014/3
N2 - Retransplantation for graft failure in the pediatric population is rare with reports of decreased survival compared with primary transplantation. Little is known about the risk factors for retransplantation or death after retransplantation; in addition, there is a paucity of data in the literature on transplant-related morbidities in this patient population. The purpose of this analysis of the registry of the International Society of Heart and Lung Transplant (ISHLT) was to describe outcomes after retransplantation as compared with primary transplantation, including identifying risk factors leading to retransplantation and both transplant-related morbidities and mortality after retransplantation. Methods Data from 1998 to 2010 were used to identify all patients whose primary transplantation was performed at <18 years of age. Of the 9,966 transplants reviewed, 9,248 primary transplants and 602 retransplants were analyzed. Results The median age for retransplantation was 14 (range 1 to 26) years, with the most common indication being allograft vasculopathy (58.5%). After retransplantation, early time-related risk of mortality was similar to that after primary transplantation (HR 1.07 [0.92 to 1.25], p = 0.40), but both late-phase time-related risk of mortality (HR 1.67 [1.40 to 1.99], p < 0.001) and requirement of an additional graft (HR 1.69 [1.18 to 2.43], p = 0.004) were higher. Long-term morbidities were significantly more common after retransplantation than with primary transplantation. These included allograft vasculopathy (HR 2.8 [2.37 to 3.38], p < 0.001), late rejection (HR 2.0 [1.65 to 2.40], p < 0.001) and late renal dysfunction (HR 2.6 [2.18 to 3.12], p < 0.001), but not cancer (HR 1.16 [0.74 to 1.82], p = 0.52). Numerous patient-, donor- and transplant-related risk factors were identified that increased both the risk of mortality and transplant-related morbidities after retransplantation. Conclusions Retransplantation after primary transplant in the pediatric age group, although feasible with similar early survival, is associated with decreased long-term survival and an increase in transplant-related morbidities. The results of this study highlight the ongoing challenges of managing patients after retransplant and also suggest some modifiable risk factors, for both the donor and recipient, which may improve survival and decrease the burden of morbidities.
AB - Retransplantation for graft failure in the pediatric population is rare with reports of decreased survival compared with primary transplantation. Little is known about the risk factors for retransplantation or death after retransplantation; in addition, there is a paucity of data in the literature on transplant-related morbidities in this patient population. The purpose of this analysis of the registry of the International Society of Heart and Lung Transplant (ISHLT) was to describe outcomes after retransplantation as compared with primary transplantation, including identifying risk factors leading to retransplantation and both transplant-related morbidities and mortality after retransplantation. Methods Data from 1998 to 2010 were used to identify all patients whose primary transplantation was performed at <18 years of age. Of the 9,966 transplants reviewed, 9,248 primary transplants and 602 retransplants were analyzed. Results The median age for retransplantation was 14 (range 1 to 26) years, with the most common indication being allograft vasculopathy (58.5%). After retransplantation, early time-related risk of mortality was similar to that after primary transplantation (HR 1.07 [0.92 to 1.25], p = 0.40), but both late-phase time-related risk of mortality (HR 1.67 [1.40 to 1.99], p < 0.001) and requirement of an additional graft (HR 1.69 [1.18 to 2.43], p = 0.004) were higher. Long-term morbidities were significantly more common after retransplantation than with primary transplantation. These included allograft vasculopathy (HR 2.8 [2.37 to 3.38], p < 0.001), late rejection (HR 2.0 [1.65 to 2.40], p < 0.001) and late renal dysfunction (HR 2.6 [2.18 to 3.12], p < 0.001), but not cancer (HR 1.16 [0.74 to 1.82], p = 0.52). Numerous patient-, donor- and transplant-related risk factors were identified that increased both the risk of mortality and transplant-related morbidities after retransplantation. Conclusions Retransplantation after primary transplant in the pediatric age group, although feasible with similar early survival, is associated with decreased long-term survival and an increase in transplant-related morbidities. The results of this study highlight the ongoing challenges of managing patients after retransplant and also suggest some modifiable risk factors, for both the donor and recipient, which may improve survival and decrease the burden of morbidities.
KW - allograft vasculopathy
KW - cancer
KW - morbidity
KW - outcomes
KW - pediatrics
KW - rejection
KW - renal dysfunction
KW - retransplant
UR - http://www.scopus.com/inward/record.url?scp=84894314068&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84894314068&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2013.11.006
DO - 10.1016/j.healun.2013.11.006
M3 - Article
C2 - 24462559
AN - SCOPUS:84894314068
SN - 1053-2498
VL - 33
SP - 241
EP - 251
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 3
ER -