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(Circulation. 1995;92:206-209.)
© 1995 American Heart Association, Inc.

Articles

Pretransplant Risk Factors and Causes of Death or Graft Loss After Heart Transplantation During Early Infancy

Presented during the 67th Scientific Sessions of the American Heart Association, Dallas, Tex, November 14-17, 1994, published in abstract form (Circulation. 1994;90[suppl I]:I-97).

Richard E. Chinnock, MD; Ranae L. Larsen, MD; Janet R. Emery, MD; Leonard L. Bailey, MD; the Pediatric Heart Transplant Team Loma Linda

From the Departments of Pediatrics (R.E.C., R.L.L., J.R.E.) and Surgery (L.L.B.), Loma Linda University Children's Hospital and Medical Center and Loma Linda University School of Medicine, Loma Linda, Calif.

Background This study was performed to report causes of death or graft loss and to identify possible pretransplant risk factors for death or graft loss in infants after heart transplantation.

Methods and Results Pretransplant risk factors were compared for 153 infants registered for heart transplantation within 90 days of life and transplanted from November 1985 to June 1994. Factors assessed were diagnosis, age at transplantation, race, weight, blood type, sex, donor/recipient blood type match, sex match, weight ratio, fetal registration, locale of pretransplant waiting period, mechanical ventilation, ischemic time, and the need for atrial septostomy or septectomy pretransplantation. No factor was associated with death or graft loss at 1 month or 1 year. Causes of death or graft loss were determined using clinical course and pathology data when available. Death or grafts lost at 1 month, 1 year, and >1 year were 14, 13, and 15, respectively. Causes of death or graft loss expressed as a percent (at 1 month, 1 year, and >1 year, respectively) were acute rejection (14, 23, 27), chronic rejection and posttransplant coronary disease (0, 8, 47), infectious causes (21, 15, 13), early graft failure (21, 0, 0), technical issues (21, 23, 0), chronic graft dysfunction (0, 15, 0), and miscellaneous (21, 15, 13). The graft loss rate at 1 year was significantly correlated (linear regression, r²=.66; P<.05) with the year of transplantation. Actuarial survival in this population was 91% at 1 month, 81% at 1 year, and 73% at 3 years.

Conclusions Heart transplantation in the young infant can be performed with acceptable short-term and midterm results. Causes of death or graft loss and survival are similar to adult data. No pretransplant risk factors were identified. The experience level of the transplant team members affects survival. The diagnosis and management of rejection remain a major challenge.

Key Words: transplantation • rejection • pediatrics • mortality