Changing Indications in Pediatric Transplants

Major Finding: Survival was best in patients who were transplanted for cardiomyopathy (1-, 3-, 5-, and 10-year survival of 90%, 84%, 81%, and 81%, respectively) and worst in patients with failed palliations for SV anomalies, especially failed Fontan procedures (1-, 3-, 5-, and 10-year survival of 66%, 61%, 61%, and 53%, respectively).

Data Source: A retrospective study of 307 pediatric heart transplants over a 24-year period at St. Louis Children's Hospital.

Disclosures: Dr. Voeller reported that none of the authors had any financial disclosures.

SAN DIEGO – Over the past 24 years, the prevalence of indications for pediatric heart transplantation resulting from congenital heart disease has changed. Transplantation for failed single-ventricle palliation, including failed Fontan procedure, has now become the predominant indication, according to the observations of a single-center experience reported in the J. Maxwell Chamberlain Memorial Paper for Congenital Heart Surgery at the meeting.

Heart transplantation is the only viable treatment for children with end-stage heart failure resulting from congenital heart disease (CHD) or cardiomyopathy. The purpose of this study by Dr. Rochus K. Voeller and his colleagues at Washington University in St. Louis was to review the trends in the indications for transplant and survival following transplant, using a retrospective review of all 307 orthotopic heart transplants performed at St. Louis Children's Hospital from January 1986 to December 2009. Combined heart-lung transplants were excluded from the study.

The indications for transplantation in 1986–2009 were 39% cardiomyopathy, 57% CHD, and 4% retransplant. Of the 174 patients with CHD, 80% had single-ventricle (SV) anomalies. In the CHD group, transplantation for failed SV palliation, including the failed Fontan procedure, became the predominant indication in the latest 8-year interval of their program (increasing from 11% during 1984–1993 to 60% during 2002–2009). The retransplantation rate remained low and unchanged across the various time periods, Dr. Voeller reported.

The mean recipient age was 6.1 years, with 41% of the recipients aged younger than 1 year at the time of transplantation. Nearly one-third of all patients had prior surgical procedures or surgery ranging from banding to Fontan operations; 55% of the patients were boys; 8% of patients were bridged with either ECMO (extracorporeal circulation membrane oxygenation) or VAD (ventricular assist devices).

Overall survival of transplant patients was 81%, 76%, 72%, and 65% at 1, 3, 5, and 10 years, respectively. Survival was best in those patients who were transplanted for cardiomyopathy (1-, 3-, 5-, and 10-year survival of 90%, 84%, 81%, and 81%, respectively) and worst in patients with failed palliations for SV anomalies, especially failed Fontan procedures (1-, 3-, 5-, and 10-year survival of 66%, 61%, 61%, and 53%, respectively).

“As the survival with early palliation for SV anomaly patients improves, more centers will be referred with these patients who will require transplantation at some point,” Dr. Voeller said in an interview. This will impact not only pediatric transplant programs, but also adult programs, he added. Risk factor analysis will determine which patients can benefit from earlier transplant referral and how to better prepare these patients for the procedure, he concluded.

As survival with early palliation for SV anomaly improves, more patients will require transplantation.

Source DR. VOELLER

Major Finding: Survival was best in patients who were transplanted for cardiomyopathy (1-, 3-, 5-, and 10-year survival of 90%, 84%, 81%, and 81%, respectively) and worst in patients with failed palliations for SV anomalies, especially failed Fontan procedures (1-, 3-, 5-, and 10-year survival of 66%, 61%, 61%, and 53%, respectively).

Data Source: A retrospective study of 307 pediatric heart transplants over a 24-year period at St. Louis Children's Hospital.

Disclosures: Dr. Voeller reported that none of the authors had any financial disclosures.

SAN DIEGO – Over the past 24 years, the prevalence of indications for pediatric heart transplantation resulting from congenital heart disease has changed. Transplantation for failed single-ventricle palliation, including failed Fontan procedure, has now become the predominant indication, according to the observations of a single-center experience reported in the J. Maxwell Chamberlain Memorial Paper for Congenital Heart Surgery at the meeting.

Heart transplantation is the only viable treatment for children with end-stage heart failure resulting from congenital heart disease (CHD) or cardiomyopathy. The purpose of this study by Dr. Rochus K. Voeller and his colleagues at Washington University in St. Louis was to review the trends in the indications for transplant and survival following transplant, using a retrospective review of all 307 orthotopic heart transplants performed at St. Louis Children's Hospital from January 1986 to December 2009. Combined heart-lung transplants were excluded from the study.

The indications for transplantation in 1986–2009 were 39% cardiomyopathy, 57% CHD, and 4% retransplant. Of the 174 patients with CHD, 80% had single-ventricle (SV) anomalies. In the CHD group, transplantation for failed SV palliation, including the failed Fontan procedure, became the predominant indication in the latest 8-year interval of their program (increasing from 11% during 1984–1993 to 60% during 2002–2009). The retransplantation rate remained low and unchanged across the various time periods, Dr. Voeller reported.

The mean recipient age was 6.1 years, with 41% of the recipients aged younger than 1 year at the time of transplantation. Nearly one-third of all patients had prior surgical procedures or surgery ranging from banding to Fontan operations; 55% of the patients were boys; 8% of patients were bridged with either ECMO (extracorporeal circulation membrane oxygenation) or VAD (ventricular assist devices).

Overall survival of transplant patients was 81%, 76%, 72%, and 65% at 1, 3, 5, and 10 years, respectively. Survival was best in those patients who were transplanted for cardiomyopathy (1-, 3-, 5-, and 10-year survival of 90%, 84%, 81%, and 81%, respectively) and worst in patients with failed palliations for SV anomalies, especially failed Fontan procedures (1-, 3-, 5-, and 10-year survival of 66%, 61%, 61%, and 53%, respectively).

“As the survival with early palliation for SV anomaly patients improves, more centers will be referred with these patients who will require transplantation at some point,” Dr. Voeller said in an interview. This will impact not only pediatric transplant programs, but also adult programs, he added. Risk factor analysis will determine which patients can benefit from earlier transplant referral and how to better prepare these patients for the procedure, he concluded.

As survival with early palliation for SV anomaly improves, more patients will require transplantation.

Source DR. VOELLER

Major Finding: Survival was best in patients who were transplanted for cardiomyopathy (1-, 3-, 5-, and 10-year survival of 90%, 84%, 81%, and 81%, respectively) and worst in patients with failed palliations for SV anomalies, especially failed Fontan procedures (1-, 3-, 5-, and 10-year survival of 66%, 61%, 61%, and 53%, respectively).

Data Source: A retrospective study of 307 pediatric heart transplants over a 24-year period at St. Louis Children's Hospital.

Disclosures: Dr. Voeller reported that none of the authors had any financial disclosures.

SAN DIEGO – Over the past 24 years, the prevalence of indications for pediatric heart transplantation resulting from congenital heart disease has changed. Transplantation for failed single-ventricle palliation, including failed Fontan procedure, has now become the predominant indication, according to the observations of a single-center experience reported in the J. Maxwell Chamberlain Memorial Paper for Congenital Heart Surgery at the meeting.

Heart transplantation is the only viable treatment for children with end-stage heart failure resulting from congenital heart disease (CHD) or cardiomyopathy. The purpose of this study by Dr. Rochus K. Voeller and his colleagues at Washington University in St. Louis was to review the trends in the indications for transplant and survival following transplant, using a retrospective review of all 307 orthotopic heart transplants performed at St. Louis Children's Hospital from January 1986 to December 2009. Combined heart-lung transplants were excluded from the study.

The indications for transplantation in 1986–2009 were 39% cardiomyopathy, 57% CHD, and 4% retransplant. Of the 174 patients with CHD, 80% had single-ventricle (SV) anomalies. In the CHD group, transplantation for failed SV palliation, including the failed Fontan procedure, became the predominant indication in the latest 8-year interval of their program (increasing from 11% during 1984–1993 to 60% during 2002–2009). The retransplantation rate remained low and unchanged across the various time periods, Dr. Voeller reported.

The mean recipient age was 6.1 years, with 41% of the recipients aged younger than 1 year at the time of transplantation. Nearly one-third of all patients had prior surgical procedures or surgery ranging from banding to Fontan operations; 55% of the patients were boys; 8% of patients were bridged with either ECMO (extracorporeal circulation membrane oxygenation) or VAD (ventricular assist devices).

Overall survival of transplant patients was 81%, 76%, 72%, and 65% at 1, 3, 5, and 10 years, respectively. Survival was best in those patients who were transplanted for cardiomyopathy (1-, 3-, 5-, and 10-year survival of 90%, 84%, 81%, and 81%, respectively) and worst in patients with failed palliations for SV anomalies, especially failed Fontan procedures (1-, 3-, 5-, and 10-year survival of 66%, 61%, 61%, and 53%, respectively).

“As the survival with early palliation for SV anomaly patients improves, more centers will be referred with these patients who will require transplantation at some point,” Dr. Voeller said in an interview. This will impact not only pediatric transplant programs, but also adult programs, he added. Risk factor analysis will determine which patients can benefit from earlier transplant referral and how to better prepare these patients for the procedure, he concluded.

As survival with early palliation for SV anomaly improves, more patients will require transplantation.

Source DR. VOELLER