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Risk factors for mortality or delisting of patients from the pediatric heart transplant waiting list.

Abstract

OBJECTIVE

Current literature assessing factors associated with outcomes of patients waiting for pediatric heart transplants has focused on survival to transplant and mortality. Our aim was to determine risk factors associated with the outcomes of delisting, transplant, or death while waiting.

METHODS

In this single-center, retrospective study of patients listed for heart transplants, competing risk analysis was used to model survival from listing to 4 competing outcomes (transplant, death, delisting for clinical deterioration, delisting for clinical improvement or surgical intervention).

RESULTS

There were 308 listing episodes in 280 patients. In competing risk analysis, 11% remained listed at 6 months (transplant 62%, dead 13%, delisted worse 6%, delisted improved 8%). Extracorporeal membrane oxygenation and ventricular assist devices were associated both with higher probability of transplant (hazard ratio [HR], 2.8; P < .001) and delisting for clinical deterioration (HR, 2.7; P = .06). Younger age at listing and complex congenital heart disease were shared risk factors for mortality (HR, 1.07; P = .05; HR, 2.9; P = .003) and delisting because of clinical deterioration (HR, 1.17; P = .01; HR, 2.8; P = .02). Younger age at listing and fetal listing were associated with delisting for clinical improvement or surgical intervention (HR, 1.13; P = .01; HR, 2.9; P = .02).

CONCLUSIONS

Overall survival to transplant depends on risk factors including age at listing, cardiac diagnosis, and mechanical circulatory support. Knowledge of risk factors for death and delisting for clinical deterioration or improvement can assist patient selection and timing of transplant listing.

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  • Authors+Show Affiliations

    ,

    Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: jeewa@bcm.edu.

    ,

    Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada.

    ,

    Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada.

    ,

    Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada.

    ,

    Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada.

    Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada.

    Source

    MeSH

    Adolescent
    Age Factors
    Child
    Child, Preschool
    Extracorporeal Membrane Oxygenation
    Female
    Heart Failure
    Heart Transplantation
    Heart-Assist Devices
    Humans
    Infant
    Infant, Newborn
    Male
    Multivariate Analysis
    Ontario
    Patient Selection
    Proportional Hazards Models
    Retrospective Studies
    Risk Factors
    Time Factors
    Treatment Outcome
    Waiting Lists

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    24183905

    Citation

    Jeewa, Aamir, et al. "Risk Factors for Mortality or Delisting of Patients From the Pediatric Heart Transplant Waiting List." The Journal of Thoracic and Cardiovascular Surgery, vol. 147, no. 1, 2014, pp. 462-8.
    Jeewa A, Manlhiot C, Kantor PF, et al. Risk factors for mortality or delisting of patients from the pediatric heart transplant waiting list. J Thorac Cardiovasc Surg. 2014;147(1):462-8.
    Jeewa, A., Manlhiot, C., Kantor, P. F., Mital, S., McCrindle, B. W., & Dipchand, A. I. (2014). Risk factors for mortality or delisting of patients from the pediatric heart transplant waiting list. The Journal of Thoracic and Cardiovascular Surgery, 147(1), pp. 462-8. doi:10.1016/j.jtcvs.2013.09.018.
    Jeewa A, et al. Risk Factors for Mortality or Delisting of Patients From the Pediatric Heart Transplant Waiting List. J Thorac Cardiovasc Surg. 2014;147(1):462-8. PubMed PMID: 24183905.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Risk factors for mortality or delisting of patients from the pediatric heart transplant waiting list. AU - Jeewa,Aamir, AU - Manlhiot,Cedric, AU - Kantor,Paul F, AU - Mital,Seema, AU - McCrindle,Brian W, AU - Dipchand,Anne I, Y1 - 2013/11/01/ PY - 2012/11/08/received PY - 2013/08/12/revised PY - 2013/09/08/accepted PY - 2013/11/5/entrez PY - 2013/11/5/pubmed PY - 2014/2/14/medline KW - 20 KW - 34.1 KW - ABO incompatible KW - ABO-I KW - CAV KW - CHD KW - COAS KW - Canadian organ allocation system KW - ECMO KW - HLHS KW - MCS KW - SRTR KW - Scientific Registry of Transplant Recipients KW - UNOS KW - United Network for Organ Sharing KW - cardiac allograft vasculopathy KW - congenital heart disease KW - extracorporeal membrane oxygenation KW - hypoplastic left heart syndrome KW - mechanical circulatory support SP - 462 EP - 8 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 147 IS - 1 N2 - OBJECTIVE: Current literature assessing factors associated with outcomes of patients waiting for pediatric heart transplants has focused on survival to transplant and mortality. Our aim was to determine risk factors associated with the outcomes of delisting, transplant, or death while waiting. METHODS: In this single-center, retrospective study of patients listed for heart transplants, competing risk analysis was used to model survival from listing to 4 competing outcomes (transplant, death, delisting for clinical deterioration, delisting for clinical improvement or surgical intervention). RESULTS: There were 308 listing episodes in 280 patients. In competing risk analysis, 11% remained listed at 6 months (transplant 62%, dead 13%, delisted worse 6%, delisted improved 8%). Extracorporeal membrane oxygenation and ventricular assist devices were associated both with higher probability of transplant (hazard ratio [HR], 2.8; P < .001) and delisting for clinical deterioration (HR, 2.7; P = .06). Younger age at listing and complex congenital heart disease were shared risk factors for mortality (HR, 1.07; P = .05; HR, 2.9; P = .003) and delisting because of clinical deterioration (HR, 1.17; P = .01; HR, 2.8; P = .02). Younger age at listing and fetal listing were associated with delisting for clinical improvement or surgical intervention (HR, 1.13; P = .01; HR, 2.9; P = .02). CONCLUSIONS: Overall survival to transplant depends on risk factors including age at listing, cardiac diagnosis, and mechanical circulatory support. Knowledge of risk factors for death and delisting for clinical deterioration or improvement can assist patient selection and timing of transplant listing. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/24183905/Risk_factors_for_mortality_or_delisting_of_patients_from_the_pediatric_heart_transplant_waiting_list_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(13)01095-7 DB - PRIME DP - Unbound Medicine ER -