title: Competing outcomes after neonatal and infant wait-listing for heart transplantation.
abstract: BACKGROUND
  Neonatal and infant heart transplantation is a therapeutic option for patients with end-stage cardiac lesions, yet infants continue to face a considerable shortage of donor organs. We sought to ascertain outcomes after listing for heart transplantation using a competing outcomes methodology, and to identify factors predicting each outcome.
  
  
  METHODS
  Review of the Toronto cardiac transplant database was undertaken to identify infant patients (<or=12 months) wait-listed for heart transplantation. Achievement of one of five possible outcomes was parametrically modeled, including: transplantation; death on the wait-list; delisting: too sick; delisting: clinically improved; and delisting for surgical palliation.
  
  
  RESULTS
  Forty-three percent (117 of 269) of the total patient listings were infants (26 fetal/63 neonatal). Of the 117 patients, 80 (68%) underwent transplantation, 15 died on the wait-list, 9 were delisted (too sick/no longer eligible for transplant), 9 opted for surgical palliation and 4 were delisted (clinical improvement). Eighty-nine percent of outcomes were achieved by 3 months from listing. Blood group and transplant era predicted achieving transplantation. Factors predicting death on the wait-list included Canadian Status 4 (most urgent), and mechanical support. Status at listing also predicted delisting: too sick. Fetal listing predicted delisting for surgical alternative.
  
  
  CONCLUSIONS
  The first 3 months after listing are critical for achieving an outcome, particularly in higher status patients, affirming the need for timely organ replacement. Strategies such as ABO-incompatible transplantation continue to decrease wait-list mortality; however, these data demonstrate that blood type O and B patients continue to face longer wait-list duration. It is imperative that we continue to seek solutions for the shortage of infant donor organs in order to maximize the utility of heart transplantation as a therapeutic option.
authors.affiliation: Heart Transplant Program, Labatt Family Heart Centre, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada. s.pollock.barziv@utoronto.ca
authors.forename: Stacey M
authors.initials: SM
authors.lastname: Pollock-BarZiv
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.forename: Lori J
authors.initials: LJ
authors.lastname: West
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
authors.forename: Meghan
authors.initials: M
authors.lastname: VanderVliet
authors.forename: Anne I
authors.initials: AI
authors.lastname: Dipchand
mesh_terms: D016208:Databases, Factual; D018450:Disease Progression; D006331:Heart Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014850:Waiting Lists