Outcome of pediatric patients with dilated cardiomyopathy listed for transplant: a multi-institutional study.
BACKGROUND
The course of dilated cardiomyopathy (DCM) leading to heart failure in children varies; survival with conventional treatment is 64% at 5 years. Heart transplantation (HTx) enables improved survival; however, outcomes from listing for transplant are not well described. This study reports survival of patients with DCM from listing with the availability of mechanical bridge to transplant.


METHODS
Patients with a primary diagnosis of DCM (n = 1,098) were identified from a multi-institutional, prospective, registry of patients aged < 18 years listed for HTx from January 1, 1993, to December 31, 2006.


RESULTS
Characteristics of DCM patients at listing included a mean age of 7.3 years; 51% male, 64% white ethnicity, 77% United Network for Organ Sharing status I, 66% on inotropic support, 28% mechanically ventilated, and 15% on mechanical support. Waitlist mortality was 11%, and 75% underwent HTx at 2 years after listing. Overall 10-year survival after listing was 72%, with higher risk of death associated with arrhythmias, mechanical ventilation, and extracorporeal membrane oxygenation (ECMO) support, but not ventricular assist device (VAD) support. Survival at 10 years post-HTx was 72%, with a higher risk of death associated with black race, older age, mechanical ventilation, longer ischemic time, and earlier era of transplant.


CONCLUSIONS
Transplantation for DCM in the pediatric population offers enhanced survival compared with the natural history. Overall waitlist mortality for DCM is low, with the exception of patients on ECMO, mechanically ventilated, or with arrhythmias. DCM patients fared well after transplant, making HTx a key therapeutic intervention.
Kirk
Richard
R
Department of Pediatric Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom. Richard.kirk@nuth.nhs.uk
Naftel
David
D
Hoffman
Timothy M
TM
Almond
Christopher
C
Boyle
Gerard
G
Caldwell
Randall L
RL
Kirklin
James K
JK
White
Kirstie
K
Dipchand
Anne I
AI
D002311:Cardiomyopathy, Dilated / Q000401:mortality* / Q000601:surgery; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D057234:Preoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists