Repeat pediatric heart transplantation: A united network for organ sharing database analysis - PubMed (original) (raw)

. 2023 Nov;37(11):e15073.

doi: 10.1111/ctr.15073. Epub 2023 Aug 14.

George Gill 1, M Mujeeb Zubair 1, Qiudong Chen 1, Jason Thomas 1, Shrishiv A Timbalia 2, Asishana A Osho 3, Dominic Emerson 1, Richard Kim 1, Michael E Bowdish 1, Joanna Chikwe 1, Joseph W Turek 4

Affiliations

Repeat pediatric heart transplantation: A united network for organ sharing database analysis

Georgina Rowe et al. Clin Transplant. 2023 Nov.

Abstract

Background: A history of congenital heart disease and previous transplantation are each independently associated with worse survival following pediatric heart transplantation. This study aimed to evaluate the characteristics and outcomes of children undergoing repeat heart transplantation in the United States based on the underlying diagnosis.

Methods: The United Network for Organ Sharing database was used to identify 8111 patients aged <18 years undergoing isolated heart transplantation from 2000 to 2021, including 435 (5.4%) repeat transplants. Restricted cubic spline analysis assessed the non-linear relationship between inter-transplant interval and the primary outcome of all-cause mortality or re-transplantation. Multivariable Cox regression assessed the impact of re-transplantation on the primary outcome. Median follow-up was 5.0 (interquartile range 1.9-9.9) years.

Results: Repeat transplant patients were older (median age 12 vs. 4 years; p < .001), and less likely to be in UNOS status 1A (66.0%, n = 287 vs. 81.0% n = 6217; p < .001) than primary transplant patients. Freedom from the primary outcome was 51.4% (95% confidence interval [CI] 45.5-57.2) among repeat transplants and 70.5% (95% CI 69.2-71.8) among primary transplants at 10 years (p < .001). Among repeat transplant patients, the relative hazard of the primary outcome became non-significant when the inter-transplant interval >3.6 years. Congenital heart disease was an independent predictor of mortality among primary (HR 1.8, 95% CI 1.6-1.9) but not repeat transplant (HR 1.1, 95% CI .8-1.6) patients.

Conclusions: Long-term outcomes remain poor for patients undergoing repeat heart transplantation, particularly those with an inter-transplant interval <3.6 years. Underlying diagnosis does not impact outcomes after repeat transplantation, after accounting for other risk factors.

Keywords: United Network for Organ Sharing (UNOS); graft survival; heart disease:congenital; registry/registry analysis; retransplantation.

© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

Dr Emerson has received honoraria from Abiomed. All other authors have nothing to disclose with regard to commercial support.

Figures

FIGURE 1

FIGURE 1

Survival free from repeat transplantation following pediatric heart transplantation. (A) Survival up to 90 days post-transplant, stratified by previous transplant status. (B) Survival up to 2 years post-transplant, stratified by previous transplant status. (C) Survival up to 10 years post-transplant, stratified by previous transplant status. (D) Survival up to 10 years post-transplant, stratified by primary diagnosis among repeat transplant patients. 95% confidence intervals represented by the shaded regions.

FIGURE 2

FIGURE 2

The relationship between the inter-transplant interval and unadjusted relative hazard of mortality or repeat transplantation.

FIGURE 3

FIGURE 3

Results of the multivariable regression model for independent predictors of mortality following pediatric heart transplantation, with an interaction term between transplantation episode and diagnosis. Additional covariates in model: sex, ethnicity, hospitalization status, donor cause of death.

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