Risk factors for mortality or delisting of patients from the pediatric heart transplant waiting list

J Thorac Cardiovasc Surg. 2014 Jan;147(1):462-8. doi: 10.1016/j.jtcvs.2013.09.018. Epub 2013 Nov 1.


Objective: Current literature assessing factors associated with outcomes of patients waiting for pediatric heart transplants has focused on survival to transplant and mortality. Our aim was to determine risk factors associated with the outcomes of delisting, transplant, or death while waiting.

Methods: In this single-center, retrospective study of patients listed for heart transplants, competing risk analysis was used to model survival from listing to 4 competing outcomes (transplant, death, delisting for clinical deterioration, delisting for clinical improvement or surgical intervention).

Results: There were 308 listing episodes in 280 patients. In competing risk analysis, 11% remained listed at 6 months (transplant 62%, dead 13%, delisted worse 6%, delisted improved 8%). Extracorporeal membrane oxygenation and ventricular assist devices were associated both with higher probability of transplant (hazard ratio [HR], 2.8; P < .001) and delisting for clinical deterioration (HR, 2.7; P = .06). Younger age at listing and complex congenital heart disease were shared risk factors for mortality (HR, 1.07; P = .05; HR, 2.9; P = .003) and delisting because of clinical deterioration (HR, 1.17; P = .01; HR, 2.8; P = .02). Younger age at listing and fetal listing were associated with delisting for clinical improvement or surgical intervention (HR, 1.13; P = .01; HR, 2.9; P = .02).

Conclusions: Overall survival to transplant depends on risk factors including age at listing, cardiac diagnosis, and mechanical circulatory support. Knowledge of risk factors for death and delisting for clinical deterioration or improvement can assist patient selection and timing of transplant listing.

Keywords: 20; 34.1; ABO incompatible; ABO-I; CAV; CHD; COAS; Canadian organ allocation system; ECMO; HLHS; MCS; SRTR; Scientific Registry of Transplant Recipients; UNOS; United Network for Organ Sharing; cardiac allograft vasculopathy; congenital heart disease; extracorporeal membrane oxygenation; hypoplastic left heart syndrome; mechanical circulatory support.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Age Factors
  • Child
  • Child, Preschool
  • Extracorporeal Membrane Oxygenation
  • Female
  • Heart Failure / diagnosis
  • Heart Failure / mortality*
  • Heart Failure / surgery*
  • Heart Transplantation / adverse effects
  • Heart Transplantation / mortality*
  • Heart-Assist Devices
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Multivariate Analysis
  • Ontario
  • Patient Selection
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Waiting Lists / mortality*