Over two decades of pediatric heart transplantation

How has survival changed?

David L.S. Morales, William J. Dreyer, Susan W. Denfield, Jeffrey S. Heinle, E. Dean McKenzie, Daniel E. Graves, Jack F. Price, Jeffrey Towbin, O. H. Frazier, Denton A. Cooley, Charles D. Fraser

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Objective: In 1984, the first successful infant heart transplant was performed at Texas Children's Hospital. This study analyzes the 21-year experience with pediatric heart transplantation at Texas Children's Hospital to assess whether and how survival has changed over time. Methods: Between November 1, 1984, and October 3, 2005, 164 consecutive orthotopic heart transplants were performed on 154 patients. Characteristics: mean age 7.1 ± 6.0 years, mean body surface area 0.8 ± 0.5 m2. Diagnosis at transplant: cardiomyopathy 53.0% (n = 87), congenital heart defect 39.0% (n = 64), retransplant 7.9% (n = 13). Multivariate risk factor analysis of 32 variables was completed by Cox proportional hazards regression models. Results: Mean follow-up was 5.9 ± 4.8 years. Overall Kaplan-Meier survival was 82% at 1 year, 65% at 5 years, and 54% at 10 years. After 1995, Kaplan-Meier survival (91% at 1 year and 71% at 5 years) was significantly improved over pre-1995 survival (71% at 1 year, 57% at 5 years, and 48% at 10 years; P =.026). Hospital survival improved in the post-1995 era (96%) compared with the pre-1995 era (77%; P < .001). Life-table analysis by yearly increments demonstrates only an improved survival (pre-1995, 71% →post-1995, 91%) in the first posttransplant year (P = .001); every subsequent year the mortality rates are the same (P = .92). Risk factors for overall mortality are prolonged postoperative intubation (>5 days) and longer cardiopulmonary bypass time. Conclusions: Primarily attributable to an increase in early survival, overall pediatric heart transplant survival is improved. However, after the first posttransplant year, the rate of mortality has not changed in 21 years. This highlights the need for new therapies to treat children both with or in need of a heart transplant.

Original languageEnglish (US)
Pages (from-to)632-639
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume133
Issue number3
DOIs
StatePublished - Mar 1 2007
Externally publishedYes

Fingerprint

Heart Transplantation
Pediatrics
Survival
Transplants
Congenital Heart Defects
Body Surface Area
Cardiopulmonary Bypass
Cardiomyopathies
Proportional Hazards Models
Statistical Factor Analysis
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Morales, D. L. S., Dreyer, W. J., Denfield, S. W., Heinle, J. S., McKenzie, E. D., Graves, D. E., ... Fraser, C. D. (2007). Over two decades of pediatric heart transplantation: How has survival changed? Journal of Thoracic and Cardiovascular Surgery, 133(3), 632-639. https://doi.org/10.1016/j.jtcvs.2006.09.055

Over two decades of pediatric heart transplantation : How has survival changed? / Morales, David L.S.; Dreyer, William J.; Denfield, Susan W.; Heinle, Jeffrey S.; McKenzie, E. Dean; Graves, Daniel E.; Price, Jack F.; Towbin, Jeffrey; Frazier, O. H.; Cooley, Denton A.; Fraser, Charles D.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 133, No. 3, 01.03.2007, p. 632-639.

Research output: Contribution to journalArticle

Morales, DLS, Dreyer, WJ, Denfield, SW, Heinle, JS, McKenzie, ED, Graves, DE, Price, JF, Towbin, J, Frazier, OH, Cooley, DA & Fraser, CD 2007, 'Over two decades of pediatric heart transplantation: How has survival changed?', Journal of Thoracic and Cardiovascular Surgery, vol. 133, no. 3, pp. 632-639. https://doi.org/10.1016/j.jtcvs.2006.09.055
Morales, David L.S. ; Dreyer, William J. ; Denfield, Susan W. ; Heinle, Jeffrey S. ; McKenzie, E. Dean ; Graves, Daniel E. ; Price, Jack F. ; Towbin, Jeffrey ; Frazier, O. H. ; Cooley, Denton A. ; Fraser, Charles D. / Over two decades of pediatric heart transplantation : How has survival changed?. In: Journal of Thoracic and Cardiovascular Surgery. 2007 ; Vol. 133, No. 3. pp. 632-639.
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abstract = "Objective: In 1984, the first successful infant heart transplant was performed at Texas Children's Hospital. This study analyzes the 21-year experience with pediatric heart transplantation at Texas Children's Hospital to assess whether and how survival has changed over time. Methods: Between November 1, 1984, and October 3, 2005, 164 consecutive orthotopic heart transplants were performed on 154 patients. Characteristics: mean age 7.1 ± 6.0 years, mean body surface area 0.8 ± 0.5 m2. Diagnosis at transplant: cardiomyopathy 53.0{\%} (n = 87), congenital heart defect 39.0{\%} (n = 64), retransplant 7.9{\%} (n = 13). Multivariate risk factor analysis of 32 variables was completed by Cox proportional hazards regression models. Results: Mean follow-up was 5.9 ± 4.8 years. Overall Kaplan-Meier survival was 82{\%} at 1 year, 65{\%} at 5 years, and 54{\%} at 10 years. After 1995, Kaplan-Meier survival (91{\%} at 1 year and 71{\%} at 5 years) was significantly improved over pre-1995 survival (71{\%} at 1 year, 57{\%} at 5 years, and 48{\%} at 10 years; P =.026). Hospital survival improved in the post-1995 era (96{\%}) compared with the pre-1995 era (77{\%}; P < .001). Life-table analysis by yearly increments demonstrates only an improved survival (pre-1995, 71{\%} →post-1995, 91{\%}) in the first posttransplant year (P = .001); every subsequent year the mortality rates are the same (P = .92). Risk factors for overall mortality are prolonged postoperative intubation (>5 days) and longer cardiopulmonary bypass time. Conclusions: Primarily attributable to an increase in early survival, overall pediatric heart transplant survival is improved. However, after the first posttransplant year, the rate of mortality has not changed in 21 years. This highlights the need for new therapies to treat children both with or in need of a heart transplant.",
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AU - Morales, David L.S.

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AU - Denfield, Susan W.

AU - Heinle, Jeffrey S.

AU - McKenzie, E. Dean

AU - Graves, Daniel E.

AU - Price, Jack F.

AU - Towbin, Jeffrey

AU - Frazier, O. H.

AU - Cooley, Denton A.

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N2 - Objective: In 1984, the first successful infant heart transplant was performed at Texas Children's Hospital. This study analyzes the 21-year experience with pediatric heart transplantation at Texas Children's Hospital to assess whether and how survival has changed over time. Methods: Between November 1, 1984, and October 3, 2005, 164 consecutive orthotopic heart transplants were performed on 154 patients. Characteristics: mean age 7.1 ± 6.0 years, mean body surface area 0.8 ± 0.5 m2. Diagnosis at transplant: cardiomyopathy 53.0% (n = 87), congenital heart defect 39.0% (n = 64), retransplant 7.9% (n = 13). Multivariate risk factor analysis of 32 variables was completed by Cox proportional hazards regression models. Results: Mean follow-up was 5.9 ± 4.8 years. Overall Kaplan-Meier survival was 82% at 1 year, 65% at 5 years, and 54% at 10 years. After 1995, Kaplan-Meier survival (91% at 1 year and 71% at 5 years) was significantly improved over pre-1995 survival (71% at 1 year, 57% at 5 years, and 48% at 10 years; P =.026). Hospital survival improved in the post-1995 era (96%) compared with the pre-1995 era (77%; P < .001). Life-table analysis by yearly increments demonstrates only an improved survival (pre-1995, 71% →post-1995, 91%) in the first posttransplant year (P = .001); every subsequent year the mortality rates are the same (P = .92). Risk factors for overall mortality are prolonged postoperative intubation (>5 days) and longer cardiopulmonary bypass time. Conclusions: Primarily attributable to an increase in early survival, overall pediatric heart transplant survival is improved. However, after the first posttransplant year, the rate of mortality has not changed in 21 years. This highlights the need for new therapies to treat children both with or in need of a heart transplant.

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