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Listing Low-Weight or Ill Infants for Heart Transplantation: Is It Prudent?
Annals of Thoracic Surgery 2018 October
BACKGROUND: Infants awaiting heart transplantation (HTx) have the highest waitlist mortality than other HTx patients. This study analyzed the impact of weight and other factors on waitlist and post-HTx outcomes in infants.
METHODS: All infants on the HTx waitlist in the United Network for Organ Sharing database from October 1987 to June 2016 were divided into the following weight groups: less than 2.5 kg, 2.5 to 3.9 kg, and more than 4 kg. Survival from listing regardless of transplantation was compared by using Kaplan-Meier analysis.
RESULTS: Of 4,711 infants listed for HTx, 250 (5.3%) weighed less than 2.5 kg, 1,993 (42%) weighed 2.5 to 3.9 kg, and 2,468 (52%) weighed more than 4 kg. Median time on the waitlist was similar between the groups weighing less than 2.5 kg and 2.5 to 3.9 kg (28 days versus 31 days, p = 0.423), whereas the group weighing more than 4 kg waited longer (42 days; p = 0.027 and p < 0.001). Infants weighing less than 2.5 kg (1 year, 43%) had the worst survival from listing regardless of transplantation compared with other groups (versus weighing 2.5 to 3.9 kg: 1 year, 54%, p = 0.001; versus weighing >4 kg: 1 year, 66%, p < 0.001). For infants weighing less than 2.5 kg on ventilator support, the 1 year-survival was 35%, on extracorporeal membrane oxygenation (ECMO) it was 10%. For infants weighing 2.5 to 3.9 kg on ventilator support, the 1 year-survival was 45%, on ECMO it was 23%. An infant with congenital heart disease (CHD) on ventilator support awaiting transplantation has a 1 year-survival rate of 37% to 42% regardless of weight. Multivariate analysis found that weighing less than 2.5 kg and being on ventilator support, ECMO, or having CHD were associated with 1-year mortality.
CONCLUSIONS: Survival of infants after being listed for HTx is substantially affected by weight but also by illness at listing. Therefore, going into a transplantation ill or too small, as seen in the present study, may not be prudent, given the limited resource of infant donors.
METHODS: All infants on the HTx waitlist in the United Network for Organ Sharing database from October 1987 to June 2016 were divided into the following weight groups: less than 2.5 kg, 2.5 to 3.9 kg, and more than 4 kg. Survival from listing regardless of transplantation was compared by using Kaplan-Meier analysis.
RESULTS: Of 4,711 infants listed for HTx, 250 (5.3%) weighed less than 2.5 kg, 1,993 (42%) weighed 2.5 to 3.9 kg, and 2,468 (52%) weighed more than 4 kg. Median time on the waitlist was similar between the groups weighing less than 2.5 kg and 2.5 to 3.9 kg (28 days versus 31 days, p = 0.423), whereas the group weighing more than 4 kg waited longer (42 days; p = 0.027 and p < 0.001). Infants weighing less than 2.5 kg (1 year, 43%) had the worst survival from listing regardless of transplantation compared with other groups (versus weighing 2.5 to 3.9 kg: 1 year, 54%, p = 0.001; versus weighing >4 kg: 1 year, 66%, p < 0.001). For infants weighing less than 2.5 kg on ventilator support, the 1 year-survival was 35%, on extracorporeal membrane oxygenation (ECMO) it was 10%. For infants weighing 2.5 to 3.9 kg on ventilator support, the 1 year-survival was 45%, on ECMO it was 23%. An infant with congenital heart disease (CHD) on ventilator support awaiting transplantation has a 1 year-survival rate of 37% to 42% regardless of weight. Multivariate analysis found that weighing less than 2.5 kg and being on ventilator support, ECMO, or having CHD were associated with 1-year mortality.
CONCLUSIONS: Survival of infants after being listed for HTx is substantially affected by weight but also by illness at listing. Therefore, going into a transplantation ill or too small, as seen in the present study, may not be prudent, given the limited resource of infant donors.
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