Clinical profiles and risk factors for early and medium-term mortality following heart transplantation in a pediatric population: A single-center experience

Komarakshi R Balakrishnan; Kemundel Genny Suresh Rao; Ganapathy Krishnan Subramaniam; Murali Krishna Tanguturu; Ajay Arvind; Veena Ramanan; Jagdish Dhushyanthan; K Ramasubramanian; K Suresh Kumaran; Gunalan Sellamuthu; Mohan Rajam; Senthil Mettur; Pradeep Gnansekharan; Ravikumar Ratnagiri

doi:10.4103/apc.APC_129_20

Clinical profiles and risk factors for early and medium-term mortality following heart transplantation in a pediatric population: A single-center experience

Ann Pediatr Cardiol. 2021 Jan-Mar;14(1):42-52. doi: 10.4103/apc.APC_129_20. Epub 2021 Jan 16.

Authors

Affiliation

¹ Department of Pediatric Cardiac Surgery, Institute of Heart and Lung Transplantation, MGM Health Care, Chennai, Tamil Nadu, India.

Abstract

Aims and objectives: There is a paucity of data regarding the outcomes of Heart transplantation in children from the Indian subcontinent. The data of patients under the age of 18 undergoing an isolated heart transplantation was analyzed for patient clinical profiles and risk factors for early and medium-term mortality. Hospital mortality was defined as death within 90 days of transplantation and medium-term survival as follow up of up to 6 years.

Materials and methods: A total of 97 patients operated between March 2014 and October 2019 were included in this study. Data was collected about their INTERMACS status, pulmonary vascular resistance, donor heart ischemic times, donor age, donor to recipient weight ratio and creatinine levels.

Results: The age range was from 1 to 18 with a mean of 10.6 ± 4.6 years. 67 % patients were in INTERMACS category 3 or less.12 children were on mechanical circulatory support at the time of transplant. The 90 day survival was 89 %. The risk factors for hospital mortality was lower INTERMACS category (odd's ratio 0.2143, P = 0.026), elevated creatinine (odd's ratio 5.42, P = 0.076) and elevated right atrial pressure (odd's ratio 1.19, P = 0.015). Ischemic time, pulmonary vascular resistance (PVR) and PVR index (PVRI) had no effect on 90 day survival. Kaplan Meier estimates for 5 year survival was 73 %. The medium term survival was affected by INTERMACS category (Hazard ratio 0.7, P = .078), donor age > 25 (Hazard ratio 1.6, P = 0.26) and raised serum creatinine values.(Hazard ratio 2.7, P = 0.012). All the survivors are in good functional class.

Conclusions: Excellent outcomes are possible after heart transplantation in a pediatric population even in a resource constrained environment of a developing economy. More efforts are needed to promote pediatric organ donation and patients need to be referred in better INTERMACS category for optimal outcomes.

Keywords: Pediatric Heart transplant; Pediatric heart transplant India; pediatric heart transplant Outcomes.