Pediatric Heart Transplantation: A 35-Year Single-Center Experience

Background: Outcomes after pediatric heart transplantation have significantly improved over the past decades.

Method: We retrospectively evaluated our results after heart transplantation between May 1986 and September 2022 in pediatric recipients with a follow-up period of 35 years with regard to changes in survival, diagnoses, waiting time, and mechanical circulatory support over time.

Results: We included 246 heart recipients who were transplanted at our institution between May 1986 and September 2022. Median age at transplantation was 8.1 years (IQR: 2.5–14.2), 142 patients were male (57.7%), 4 patients (1.6%) were > 18 years. Median weight at transplantation was 22 kg (IQR: 11–43.25 kg, range: 3–110 kg) and median height 127 cm (IQR: 86.75–160.3 cm, range: 51–190 cm). Diagnoses prior to transplantation were dilated cardiomyopathy (DCM) in 67.5% of the patients followed by congenital heart disease (CHD, 21.2%). The percentage of patients with CHD has risen in the last decade. Waiting time significantly increased for the age groups 0 to 5 years from a median time of 50 days (IQR: 22–78) to 282 days (IQR: 80–498, p < 0.0001) and 6 to 11 years from a median time of 11 days (IQR: 3–56) to 189 days (IQR: 43–360, p = 0.002) over the past two decades. Overall, need for mechanical circulatory (MCS) support was 37% in our patient cohort. It increased from 20% in the first decade to 75% in the past decade. Need for MCS did not increase mortality. Survival within 12 months increased from 84% in the first decade (1991–2000) to 90% in the past decade (2011–2020, n.s.). Overall survival significantly increased over time when comparing the decades 1991–2000, 2001–2010, and 2011–2020 (log-rank p = 0.0095). Overall survival after 35 years of follow-up time was 35%.

Conclusion: Pediatric heart transplantation is an effective therapy for end-stage heart failure with good long-term results. Significant increases in waiting time due to organ shortage leading to a higher demand for MCS could be observed. Despite the frequent use of MCS in our patient cohort survival was not inferior to international registry data with considerable lower incidence of MCS and improved over time.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
28 January 2023