title: Changes in Risk Profile Over Time in the Population of a Pediatric Heart Transplant Program.
abstract: BACKGROUND
  Single-center data on pediatric heart transplantation spanning long time frames is sparse. We attempted to analyze how risk profile and pediatric heart transplant survival outcomes at a large center changed over time.
  
  
  METHODS
  We divided 320 pediatric heart transplants done at Stanford University between 1974 and 2014 into three groups by era: the first 20 years (95 transplants), the subsequent 10 years (87 transplants), and the most recent 10 years (138 transplants). Differences in age at transplant, indication, mechanical support, and survival were analyzed.
  
  
  RESULTS
  Follow-up was 100% complete. Average age at time of transplantation was 10.4 years, 11.9 years, and 5.6 years in eras 1, 2, and 3, respectively. The percentage of infants who received transplants by era was 21%, 7%, and 18%, respectively. The indication of end-stage congenital heart disease vs cardiomyopathy was 24%, 22%, and 49%, respectively. Only 1 patient (1%) was on mechanical support at transplant in era 1 compared with 15% in era 2 and 30% in era 3. Overall survival was 72% at 5 years and 57% at 10 years. Long-term survival increased significantly with each subsequent era. Patients with cardiomyopathy generally had a survival advantage over those with congenital heart disease.
  
  
  CONCLUSIONS
  The risk profile of pediatric transplant patients in our institution has increased over time. In the last 10 years, median age has decreased and ventricular assist device support has increased dramatically. Transplantation for end-stage congenital heart disease is increasingly common. Despite this, long-term survival has significantly and consistently improved.
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University, Stanford, California. Electronic address: orx@stanford.edu.
authors.forename: Olaf
authors.initials: O
authors.lastname: Reinhartz
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
authors.forename: Katsuhide
authors.initials: K
authors.lastname: Maeda
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Reitz
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California.
authors.forename: Daniel
authors.initials: D
authors.lastname: Bernstein
authors.affiliation: Department of Cardiology, Stanford University, Stanford, California.
authors.forename: Helen
authors.initials: H
authors.lastname: Luikart
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Rosenthal
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Stanford, California.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Hollander
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis; D013997:Time Factors