title: Lessons learned from 119 consecutive cardiac transplants for pediatric and congenital heart disease.
abstract: BACKGROUND
  This manuscript reviews all patients who underwent orthotopic heart transplantations (OHT) at our program (116 patients underwent 119 OHT) to describe their diagnostic characteristics and to assess risk factors for mortality.
  
  
  METHODS
  Median age at OHT was 179 days (mean, 1,446.6 ± 188.9 days [4.0 ± 0.5 years]; range, 5 days to 7,125 days [19.5 years]; 15 neonates, 68 infants). Median weight at OHT was 5.5 kg (mean, 17.2 ± 2.1 kg; range, 2.2 to 113 kg). Diagnoses were cardiomyopathy (n = 37), primary transplantation for hypoplastic left heart syndrome (HLHS) or HLHS-related malformation (n = 29), transplantation after prior cardiac surgery for HLHS or HLHS-related malformation (n = 9), non-HLHS congenital heart disease (n = 39), and retransplant (n = 5).
  
  
  RESULTS
  Overall Kaplan-Meier 5-year survival was 72.7%. Operative mortality was 12.6% (15 patients). Late mortality was 13.4% (16 patients). Eighty-five patients survived, with a mean follow-up of 5.76 ± 0.48 years (median, 5.1 years; range, 0.12 to 14.0 years). Total follow-up was 507.0 years. No survival difference was seen among the five diagnostic subgroups (p = 0.20). Univariate association between risk factors and survival was assessed for the following variables: age (p = 0.91), weight (p = 0.86), sex (p = 0.47), race (p = 0.40), insurance classification (p = 0.42), high PRA (p = 0.20), pretransplant mechanical circulatory support (p < 0.001), posttransplant mechanical circulatory support (p < 0.001), redo sternotomy (p = 0.07), heterotaxy (p = 0.02), cardiopulmonary bypass time (p = 0.01), and donor heart cross-clamp time (p = 0.02).
  
  
  CONCLUSIONS
  Excellent results are expected for children undergoing OHT regardless of diagnostic classification. Pretransplant mechanical circulatory support, posttransplant mechanical circulatory support, cardiopulmonary bypass time, donor heart cross-clamp time, and heterotaxy are risk factors for decreased survival.
authors: The Congenital Heart Institute of Florida, All Children's Hospital, Saint Petersburg, Florida, USA. jeffjacobs@msn.com
authors: Jeffrey Phillip
authors: JP
authors: Jacobs
authors: Alfred
authors: A
authors: Asante-Korang
authors: Sean M
authors: SM
authors: O'Brien
authors: Paul Jubeong
authors: PJ
authors: Chai
authors: Gul H
authors: GH
authors: Dadlani
authors: Gerson L
authors: GL
authors: Rodriguez-Fazzi
authors: Dien
authors: D
authors: Vu
authors: Jorge
authors: J
authors: McCormack
authors: Daniel E
authors: DE
authors: McKenna
authors: Robert Joseph
authors: RJ
authors: Boucek
authors: David S
authors: DS
authors: Cooper
authors: Albert
authors: A
authors: Saltiel
authors: Jennifer
authors: J
authors: Carapellucci
authors: Hugh M
authors: HM
authors: van Gelder
authors: George R
authors: GR
authors: Daicoff
authors: James Anthony
authors: JA
authors: Quintessenza
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006331:Heart Diseases / Q000151:congenital* / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D055815:Young Adult