title: The effect of age, diagnosis, and previous surgery in children and adults undergoing heart transplantation for congenital heart disease.
abstract: OBJECTIVE
  We sought to evaluate the outcomes and identify risk factors for mortality after heart transplantation (HT) for congenital heart disease (CHD) in infants, children, and adults.
  
  
  BACKGROUND
  CHD is considered a risk factor for mortality after HT, yet this unique group of patients represents a spectrum of complexity.
  
  
  METHODS
  There were 488 patients transplanted for CHD from the combined Pediatric Heart Transplant Study (1993 to 2002, n = 367) and the Cardiac Transplant Registry Database (1990 to 2002, n = 121) who were analyzed.
  
  
  RESULTS
  The median age at HT was 12.4 years. Primary diagnosis included single ventricle (36%), d-transposition of the great arteries (12%), right ventricular outflow tract lesions (10%), l-transposition of the great arteries (8%), ventricular/atrial septal defects (8%), left ventricular outflow obstruction (8%), and other (18%). Ninety-three percent of patients had at least 1 operation before HT. Survival at 3 months post-HT was significantly worse in CHD patients versus children with cardiomyopathy, but not adults with cardiomyopathy (86%, 94%, and 91%, respectively). There was no difference in conditional 3-month survival among the 3 groups. Five-year survival was 80%. Risk factors for early mortality were older recipient age, older donors with longer ischemic times, and pre-HT Fontan operations. Predicted survival in Fontan patients was lower (77% and 70% at 1 and 5 years) versus non-Fontan patients (88% and 81% at 1 and 5 years). Risk factors for constant phase mortality included younger recipient age, higher transpulmonary gradient, cytomegalovirus mismatch at HT, and earlier classical Glenn operation.
  
  
  CONCLUSIONS
  Patients undergoing transplantation for CHD have a good late survival if they survive the early post-operative period. Risk factors for reduced survival are older age at transplant and a previous Fontan operation.
authors: Department of Pediatric Cardiology, Columbia University, New York, NY, USA. jlamour@montefiore.org
authors: Jacqueline M
authors: JM
authors: Lamour
authors: Kirk R
authors: KR
authors: Kanter
authors: David C
authors: DC
authors: Naftel
authors: Maryanne R
authors: MR
authors: Chrisant
authors: William R
authors: WR
authors: Morrow
authors: Barry S
authors: BS
authors: Clemson
authors: James K
authors: JK
authors: Kirklin
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult