Trends in the indications and survival in pediatric heart transplants: a 24-year single-center experience in 307 patients.
BACKGROUND
Heart transplantation is the only viable treatment for children with end-stage heart failure due to congenital heart disease (CHD) or cardiomyopathy. This study reviewed the trends in the indications for transplant and survival after transplant during the past 24 years.


METHODS
A retrospective review was performed of the 307 heart transplants performed at our center since 1986. To analyze the trends in the indications for transplant as well as operative death and late-survival, the data were divided into three periods in 8-year increments: 1986 to 1993 (50 patients), 1994 to 2001 (116 patients), and 2002 to 2009 (141 patients).


RESULTS
The indications for transplantation were 39% cardiomyopathy, 57% CHD, and 4% retransplant. Of the 173 with CHD, 139 (80%) had single-ventricle (SV) anomalies. In the CHD group, transplantation for failed SV palliation, including Fontan procedure, became the predominant indication in the last 8-year interval of our program. Survival after transplant was the best in patients with cardiomyopathy and the worst in patients with failed palliations for SV anomalies, including failed Fontan procedures.


CONCLUSIONS
Transplantation for heart failure related to failed SV palliation has become the most common indication for patients with CHD. The high-risk nature of these transplants will have significant implications for heart transplant programs as more infants with SV anomalies survive palliative procedures performed during infancy.
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri 63110, USA.
Rochus K
RK
Voeller
Deirdre J
DJ
Epstein
Tracey J
TJ
Guthrie
Sanjiv K
SK
Gandhi
Charles E
CE
Canter
Charles B
CB
Huddleston
D000046:Academic Medical Centers; D000293:Adolescent; D000367:Age Factors; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004502:Education, Medical, Continuing; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects / Q000379:methods; D005544:Forecasting; D006084:Graft Rejection; D006085:Graft Survival; D006330:Heart Defects, Congenital / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods / Q000401:mortality* / Q000639:trends*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D011379:Prognosis; D058996:Quality Improvement; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D014184:Transplantation, Homologous