title: Pediatric cardiac retransplantation: Waitlist mortality stratified by age and era.
abstract: BACKGROUND
  Waitlist mortality among children listed for primary heart transplant (HTx) has been well characterized, whereas limited data exist for cardiac retransplantation (CRTx) after pediatric primary HTx. We sought to characterize the population listed for CRTx and to determine the factors that affect waitlist mortality.
  
  
  METHODS
  All individuals listed for CRTx >1 year after pediatric primary HTx between October 1, 1987, and October 14, 2012 were identified in the Organ Procurement and Transplantation Network database. Baseline characteristics and waitlist mortality were compared between age groups (< 11 years, 11-18 years, and > 18 years) and during 3 successive eras (1987-1999, 1999-2006, and 2006-2012).
  
  
  RESULTS
  The cohort comprised 632 patients who were listed for CRTx > 1 year after pediatric primary HTx. Median age was 4 years at primary HTx and 14 years at relisting. Median time from primary HTx to relisting was 7.3 years. Median waiting time was 75.3 days. Overall mortality was 25.2% (159 of 632). The most frequent relisting diagnosis was related to graft vasculopathy (62.5%). The leading causes of death were chronic rejection and vasculopathy (52%). Waitlist mortality significantly decreased after 2006 (31% vs 17%; p < 0.01), despite a relatively constant CRTx rate (67% vs 65%). Univariate analysis showed era, age, listing status, and life support (mechanical circulatory support device, extracorporeal membrane oxygenation, mechanical ventilation) were significant predictors of mortality. Multivariate analyses showed that later era (2006-2012), ages 11 to 18 years, and United Network of Organ Sharing listing status 2 predicted decreased mortality, whereas life support increased mortality.
  
  
  CONCLUSIONS
  Waitlist mortality for CRTx in children and young adults has decreased by almost 50% over time. Individuals relisted as adults have increased waitlist mortality.
authors.affiliation: Divisions of a?>Pediatric Cardiology.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bock
authors.affiliation: Pediatric Cardiothoracic Surgery.
authors.forename: Khanh
authors.initials: K
authors.lastname: Nguyen
authors.affiliation: Departments of c?>Health Evidence and Policy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Malerba
authors.affiliation: Divisions of a?>Pediatric Cardiology.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Harrison
authors.affiliation: Departments of c?>Health Evidence and Policy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Bagiella
authors.affiliation: Divisions of a?>Pediatric Cardiology.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Gelb
authors.affiliation: Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Pinney
authors.affiliation: Divisions of a?>Pediatric Cardiology. Electronic address: irene.lytrivi@mssm.edu.
authors.forename: Irene D
authors.initials: ID
authors.lastname: Lytrivi
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014850:Waiting Lists / Q000401:mortality*; D055815:Young Adult
keywords: database review; morbidity; mortality; pediatric cardiac retransplantation; risk factors; waitlist