title: Prevalence and outcomes of heart transplantation in children with intellectual disability.
abstract: Heart transplantation in children with intellectual disability is a controversial issue. We sought to describe the prevalence and outcomes of heart transplantation in children with intellectual disability and hypothesized that recipients with intellectual disability have comparable short-term outcomes compared to recipients without intellectual disability. We performed a retrospective cohort analysis of children receiving a first heart-alone transplant in the UNOS STAR database from 2008 to 2013. Recipients with intellectual disability were compared to those without using chi-square tests. Kaplan-Meier curves were constructed for patient and graft survival. Cox proportional hazard models were used to estimate the association between intellectual disability and graft failure and patient survival. Over the study period, 107 children with intellectual disability underwent initial heart transplantation, accounting for 8.9% of first pediatric heart transplants (total=1204). There was no difference in the incidence of acute rejection between groups in the first year after transplant. Mean functional status scores at follow-up improved in both groups after transplantation, but tended to be lower among children with intellectual disability than children without. Log-rank tests did not suggest significant differences in graft survival between those with and without intellectual disability during the first 4 years following transplantation. Children with intellectual disability constitute a significant portion of total heart transplants with short-term outcomes comparable to children without intellectual disability.
authors: Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
authors: Aaron
authors: http://orcid.org/0000-0003-0167-0420
authors: A
authors: Wightman
authors: Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors: Heather L
authors: HL
authors: Bartlett
authors: Department of Biostatistics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors: Qianqian
authors: Q
authors: Zhao
authors: Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
authors: Jodi M
authors: JM
authors: Smith
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000150:complications; D004992:Ethics, Medical; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006333:Heart Failure / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D008607:Intellectual Disability / Q000150:complications*; D053208:Kaplan-Meier Estimate; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: ethics; functional status; heart transplant; pediatric cardiology; survival