TY - JOUR
T1 - Competing Outcomes After Neonatal and Infant Wait-listing for Heart Transplantation
AU - Pollock-BarZiv, Stacey M.
AU - McCrindle, Brian W.
AU - West, Lori J.
AU - Manlhiot, Cedric
AU - VanderVliet, Meghan
AU - Dipchand, Anne I.
N1 - Funding Information:
This research was partially supported by a post-doctoral research fellowship to Dr Pollock-BarZiv from the Canadian Institute for Health Research (CIHR).
PY - 2007/10
Y1 - 2007/10
N2 - Background: Neonatal and infant heart transplantation is a therapeutic option for patients with end-stage cardiac lesions, yet infants continue to face a considerable shortage of donor organs. We sought to ascertain outcomes after listing for heart transplantation using a competing outcomes methodology, and to identify factors predicting each outcome. Methods: Review of the Toronto cardiac transplant database was undertaken to identify infant patients (≤12 months) wait-listed for heart transplantation. Achievement of one of five possible outcomes was parametrically modeled, including: transplantation; death on the wait-list; delisting: too sick; delisting: clinically improved; and delisting for surgical palliation. Results: Forty-three percent (117 of 269) of the total patient listings were infants (26 fetal/63 neonatal). Of the 117 patients, 80 (68%) underwent transplantation, 15 died on the wait-list, 9 were delisted (too sick/no longer eligible for transplant), 9 opted for surgical palliation and 4 were delisted (clinical improvement). Eighty-nine percent of outcomes were achieved by 3 months from listing. Blood group and transplant era predicted achieving transplantation. Factors predicting death on the wait-list included Canadian Status 4 (most urgent), and mechanical support. Status at listing also predicted delisting: too sick. Fetal listing predicted delisting for surgical alternative. Conclusions: The first 3 months after listing are critical for achieving an outcome, particularly in higher status patients, affirming the need for timely organ replacement. Strategies such as ABO-incompatible transplantation continue to decrease wait-list mortality; however, these data demonstrate that blood type O and B patients continue to face longer wait-list duration. It is imperative that we continue to seek solutions for the shortage of infant donor organs in order to maximize the utility of heart transplantation as a therapeutic option.
AB - Background: Neonatal and infant heart transplantation is a therapeutic option for patients with end-stage cardiac lesions, yet infants continue to face a considerable shortage of donor organs. We sought to ascertain outcomes after listing for heart transplantation using a competing outcomes methodology, and to identify factors predicting each outcome. Methods: Review of the Toronto cardiac transplant database was undertaken to identify infant patients (≤12 months) wait-listed for heart transplantation. Achievement of one of five possible outcomes was parametrically modeled, including: transplantation; death on the wait-list; delisting: too sick; delisting: clinically improved; and delisting for surgical palliation. Results: Forty-three percent (117 of 269) of the total patient listings were infants (26 fetal/63 neonatal). Of the 117 patients, 80 (68%) underwent transplantation, 15 died on the wait-list, 9 were delisted (too sick/no longer eligible for transplant), 9 opted for surgical palliation and 4 were delisted (clinical improvement). Eighty-nine percent of outcomes were achieved by 3 months from listing. Blood group and transplant era predicted achieving transplantation. Factors predicting death on the wait-list included Canadian Status 4 (most urgent), and mechanical support. Status at listing also predicted delisting: too sick. Fetal listing predicted delisting for surgical alternative. Conclusions: The first 3 months after listing are critical for achieving an outcome, particularly in higher status patients, affirming the need for timely organ replacement. Strategies such as ABO-incompatible transplantation continue to decrease wait-list mortality; however, these data demonstrate that blood type O and B patients continue to face longer wait-list duration. It is imperative that we continue to seek solutions for the shortage of infant donor organs in order to maximize the utility of heart transplantation as a therapeutic option.
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U2 - 10.1016/j.healun.2007.07.024
DO - 10.1016/j.healun.2007.07.024
M3 - Article
C2 - 17919616
AN - SCOPUS:34848854130
SN - 1053-2498
VL - 26
SP - 980
EP - 985
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 10
ER -