Factors associated with in-hospital mortality in infants undergoing heart transplantation in the United States.
OBJECTIVE
Infants undergoing heart transplantation have the highest early posttransplant mortality of any age group. We sought to determine the pretransplantation factors associated with in-hospital mortality in transplanted infants in the current era.


METHODS
All infants under 12 months of age who underwent primary heart transplantation during a recent 10-year period (1999-2009) in the United States were identified using the Organ Procurement and Transplant Network database. Multivariable logistic regression was used to identify independent pretransplantation factors associated with in-hospital mortality.


RESULTS
Of 730 infants in the study (median age 3.8 months), 462 (63%) had congenital heart disease, 282 (39%) were supported by a ventilator, 94 (13%) with extracorporeal membrane oxygenation, and 22 (3%) with a ventricular assist device at the time of transplantation. Overall, 82 (11.2%) infants died before their initial hospital discharge. In adjusted analysis, in-hospital mortality was associated with repaired congenital heart disease (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.8, 7.2), unrepaired congenital heart disease not on prostaglandin E (OR, 2.8; CI, 1.3, 6.1), extracorporeal membrane oxygenator support (OR, 6.1; CI, 2.8, 13.4), ventilator support (OR, 4.4; CI, 2.3, 8.3), creatinine clearance less than 40 mL·min(-1)·1.73 m(-2) (OR, 3.1; CI, 1.7, 5.3), and dialysis (OR, 6.2; CI, 2.1, 18.3) at transplantation.


CONCLUSIONS
One in 9 infants undergoing heart transplantation dies before hospital discharge. Pretranplantation factors associated with early mortality include congenital heart disease, extracorporeal membrane oxygenator support, mechanical ventilation, and renal failure. Risk stratification for early posttransplant mortality among infants listed for heart transplantation may improve decision-making for transplant eligibility, organ allocation, and posttransplant interventions to reduce mortality.
Department of Cardiology, Children's Hospital Boston, and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA. Rupali.Gandhi@childrens.harvard.edu
Rupali
R
Gandhi
Christopher
C
Almond
Tajinder P
TP
Singh
Kimberlee
K
Gauvreau
Gary
G
Piercey
Ravi R
RR
Thiagarajan
D016009:Chi-Square Distribution; D019992:Databases as Topic; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery; D016027:Heart Transplantation / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D051437:Renal Insufficiency / Q000401:mortality; D012121:Respiration, Artificial / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D014481:United States
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