title: Risk factors for mortality or delisting of patients from the pediatric heart transplant waiting list.
abstract: OBJECTIVE
  Current literature assessing factors associated with outcomes of patients waiting for pediatric heart transplants has focused on survival to transplant and mortality. Our aim was to determine risk factors associated with the outcomes of delisting, transplant, or death while waiting.
  
  
  METHODS
  In this single-center, retrospective study of patients listed for heart transplants, competing risk analysis was used to model survival from listing to 4 competing outcomes (transplant, death, delisting for clinical deterioration, delisting for clinical improvement or surgical intervention).
  
  
  RESULTS
  There were 308 listing episodes in 280 patients. In competing risk analysis, 11% remained listed at 6 months (transplant 62%, dead 13%, delisted worse 6%, delisted improved 8%). Extracorporeal membrane oxygenation and ventricular assist devices were associated both with higher probability of transplant (hazard ratio [HR], 2.8; P < .001) and delisting for clinical deterioration (HR, 2.7; P = .06). Younger age at listing and complex congenital heart disease were shared risk factors for mortality (HR, 1.07; P = .05; HR, 2.9; P = .003) and delisting because of clinical deterioration (HR, 1.17; P = .01; HR, 2.8; P = .02). Younger age at listing and fetal listing were associated with delisting for clinical improvement or surgical intervention (HR, 1.13; P = .01; HR, 2.9; P = .02).
  
  
  CONCLUSIONS
  Overall survival to transplant depends on risk factors including age at listing, cardiac diagnosis, and mechanical circulatory support. Knowledge of risk factors for death and delisting for clinical deterioration or improvement can assist patient selection and timing of transplant listing.
authors.affiliation: Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: jeewa@bcm.edu.
authors.forename: Aamir
authors.initials: A
authors.lastname: Jeewa
authors.affiliation: Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
authors.affiliation: Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Kantor
authors.affiliation: Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Seema
authors.initials: S
authors.lastname: Mital
authors.affiliation: Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.affiliation: Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Anne I
authors.initials: AI
authors.lastname: Dipchand
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006353:Heart-Assist Devices; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D009864:Ontario; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality*
keywords: 20; 34.1; ABO incompatible; ABO-I; CAV; CHD; COAS; Canadian organ allocation system; ECMO; HLHS; MCS; SRTR; Scientific Registry of Transplant Recipients; UNOS; United Network for Organ Sharing; cardiac allograft vasculopathy; congenital heart disease; extracorporeal membrane oxygenation; hypoplastic left heart syndrome; mechanical circulatory support