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Comparative Study
. 2009 Dec;28(12):1292-8.
doi: 10.1016/j.healun.2009.06.013. Epub 2009 Sep 26.

Incidence and risk factors for mortality in infants awaiting heart transplantation in the USA

Douglas Mah  1 , Tajinder P Singh, Ravi R Thiagarajan, Kimberlee Gauvreau, Gary E Piercey, Elizabeth D Blume, Francis Fynn-Thompson, Christopher S D Almond
Affiliations
Comparative Study

Incidence and risk factors for mortality in infants awaiting heart transplantation in the USA

Douglas Mah et al. J Heart Lung Transplant. 2009 Dec.

Abstract

Background: Infants awaiting heart transplantation (HT) face the highest wait-list mortality among all children and adults listed for HT in the USA. We sought to determine the risk of death for infants <12 months old while awaiting HT in the current era, and to identify the principle risk factors associated with wait-list mortality.

Methods: We analyzed outcomes for all infants listed for HT in the USA from January 1999 to July 2006, using data reported to the U.S. Scientific Registry of Transplant Recipients.

Results: Of the 1,133 listed infants, 61% were <3 months of age, 80% were listed as Status 1A, 64% had a congenital heart disease (CHD) and 31% had cardiomyopathy. Of 724 infants with CHD, 25% were on prostaglandin (PG) and 27% had a history of prior surgery. By 6 months after listing, 23% died on the wait-list and 54% were transplanted. Multivariate factors associated with wait-list mortality were weight <3 kg (hazard ratio [HR] 1.4, 95% confidence interval [CI] 1.0 to 1.9), extracorporeal membrane oxygenation (ECMO) support (HR 5.6, CI 4.0 to 7.9), ventilator support (HR 2.1, 95% CI 1.6 to 2.8), CHD with PG support (HR 2.8, 95% CI 1.8 to 4.3), CHD without prior surgery (HR 2.8, 95% CI 1.9 to 3.9) and non-white race/ethnicity (HR 1.8, 95% CI 1.4 to 2.3).

Conclusions: One in four infants listed for HT in the USA die before a donor heart can be identified. Wait-list mortality is associated with weight <3 kg, level of invasive support and CHD, but not listing status, which captures medical urgency poorly. Measures to expand infant organ donation, especially among neonates, are urgently needed.

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Figures

Figure 1
Figure 1
Distribution of study infants listed for heart transplant by diagnosis. PG – Prostaglandin infusion.
Figure 2
Figure 2
Percentage of infants with congenital heart disease (CHD) on prostaglandin (PG) infusion at the time of listing for heart transplant (n = 724). The percent of patients on PG infusion decreased from 43% of all infants in 1999 to 9% in 2006.
Figure 3
Figure 3
Competing outcomes for all infants in the study cohort (n=1133).
Figure 4
Figure 4
Kaplan-Meier survival curves for wait-list mortality in infants according to their level of invasive hemodynamic support at the time of listing for heart transplant. Patients were censored at transplant. ECMO – Extra-corporeal membranous oxygenation.
Figure 5
Figure 5
Kaplan-Meier survival curves for wait-list mortality in infants, on neither extra-corporeal membranous oxygenation (ECMO) nor inotropic support, according to their listing diagnosis (n = 527). Patients were censored at transplant. CHD – Congenital heart disease; CMP – Cardiomyopathy; PG – Prostaglandin infusion.
See this image and copyright information in PMC

References

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