Early survival after heart transplant in young infants is lowest after failed single-ventricle palliation: a multi-institutional study

J Heart Lung Transplant. 2012 May;31(5):509-16. doi: 10.1016/j.healun.2011.12.013. Epub 2012 Feb 9.


Background: Infant heart transplant (HT) recipients have the best long-term survival of any age group, but the small donor pool and high early mortality limit the therapeutic effectiveness. We sought to determine the relationship between pre-HT diagnosis and early HT outcome to better define the mortality risk associated with a diagnosis of congenital heart disease (CHD) and to examine differences between early and current HT eras.

Methods: The Pediatric Heart Transplant Study (PHTS) database was used to identify 739 infant HT recipients at age ≤ 6 months between 1993 and 2008 divided into the following etiologic groups: cardiomyopathy (CM), 18%; hypoplastic left heart syndrome (HLHS) without surgery, 41%; HLHS with surgery, 9%; other CHD without surgery, 16%; and other CHD with surgery, 15%. Severity of illness at HT, post-HT survival, and era effects were compared.

Results: At 1 year after HT, survival was 89% for the CM group, which was the best, 79% for CHD without surgery, 82% for CHD with surgery, 79% for HLHS without surgery, and 70% for HLHS with surgery, which was the worst outcome. Hazard function analysis demonstrated the difference occurred within the first 3 months after HT. After adjusting for illness severity, differences in mortality risk persisted across etiologic groups. HT survival was similar in the current surgical era for HLHS with surgery, 71% (1993-1998) vs 70% (1999-2008).

Conclusions: Infant HT recipients with different pre-HT diagnoses have significantly different post-HT outcomes. HLHS infants with surgery have the lowest survival and their outcome is unchanged in the current era.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Cardiomyopathies / mortality
  • Cardiomyopathies / surgery
  • Female
  • Heart Defects, Congenital / mortality*
  • Heart Defects, Congenital / surgery*
  • Heart Transplantation*
  • Humans
  • Hypoplastic Left Heart Syndrome / mortality
  • Hypoplastic Left Heart Syndrome / surgery
  • Infant
  • Infant, Newborn
  • Male
  • Palliative Care*
  • Retrospective Studies
  • Severity of Illness Index
  • Survival Rate
  • Time Factors
  • Treatment Failure
  • Treatment Outcome
  • Ventricular Dysfunction / surgery*