Long-Term Survival in Children Following Heart Transplantation

Background: Short-term outcomes following heart transplantation in children have improved, but comparable improvements in long-term survival continues to have barriers. We sought to investigate long-term outcomes following heart transplantation and to identify protective and risk factors associated with long-term survival in children. Methods: The Pediatric Heart Transplant Society (PHTS) database was queried for heart transplant recipients from 1993 to 2010 who were <= 10 years of age at time of transplant. Patients with conditional graft survival > 3 years and at >= 10 years were analyzed. Survival and time-to-event were compared using the Kaplan-Meier method with a log-rank test for significance. Factors associated with graft loss were identified using Cox proportional hazard modeling. Results: There were 1610 patients <= 10 year of age who were transplanted between 1993 and 2010 with conditional survival to 3 years post-transplant. Of those patients, there were 1170 with conditional survival to 10 years post-transplant. Patients < 1 year at transplant had improved survival compared to other age groups. Risk factors for graft loss after 3 years post-transplant were malignancy, rejection, cardiac allograft vasculopathy (CAV), age, congenital heart disease, female sex, and Black race (p value for all < 0.05). Conclusions: Heart transplantation remains an effective therapy in children with a growing number of long-term survivors. Risk factors for mortality in patients <= 10 years of age at transplant with conditional survival to 3 years post-transplant include CAV, rejection, malignancy, female sex, and Black race. Further studies are needed to understand the social and biologic causes of racial and sex disparities in pediatric transplant patients.