The Registry of the International Society for Heart and Lung Transplantation: Sixteenth Official Pediatric Heart Transplantation Report—2013; Focus Theme: Age

https://doi.org/10.1016/j.healun.2013.08.005Get rights and content

Section snippets

Registry data sources and statistical methods

ISHLT Registry data are provided by individual centers and national or regional Organ Procurement and Organ Exchange Organizations; these are listed in the introduction to the Annual Reports.

This 16th pediatric heart transplant report from the ISHLT Registry is centered on age as the central theme, focusing on the year 2000 onwards. Key topics include geographic trends, diagnosis, survival, and the conventional post-transplant morbidities. A number of these characteristics and outcomes were

Centers and activity

There were 565 heart transplants in children (aged < 18 years) reported to the Registry in 2011 (Figure 1), a slight increase from previous years. These comprise 14% of all cardiac transplants. The proportion of pediatric transplants by recipient age has remained relatively stable for the last decade. Of the centers reporting pediatric heart transplants in 2011, 54 were from North America, 40 from Europe, and 12 from the other parts of the world, with the most notable change being the slow

Indications for transplantation

Congenital heart disease remains the most common indication for heart transplant in the infant age group (54%) but has significantly decreased over time, while cardiomyopathy increased from 35% in the period 2000 to 2005 to 41% in the most recent era (Figure 5). For the other age groups, the indications for pediatric heart transplantation have remained remarkably stable over time: approximately 65% and 25% of the 11-to 17-year-olds and 55% and 38% of the 1- to 10-year olds had a transplant for

Recipient characteristics

Approximately 25% of transplant recipients in 2011 were infants (age < 1 year), 22% were aged between 1 and 5 years, 15% were between 6 and 10 years, and 40% were between 11 and 17 years (Figure 1). Infants comprised 28% of North American transplants compared with 12% in Europe and 5% in the rest of the world, where the group aged 11 to 17 years predominated (59%; Figure 7).

The proportion of children bridged to transplantation with mechanical circulatory support (MCS) remained stable at 26% in

Donor characteristics

Twenty-five percent of pediatric recipients receive a heart from an adult donor (> 18 years). Similarly to what was reported last year, a significant geographic variation exists in the proportion of adult donors allocated to pediatric recipients: 18% in North America, 43% in Europe, and 48% in the rest of the world. Not surprisingly, the groups aged 6 to 10 years and 11 to 17 years used the broadest spectrum of donors by age (Figure 11). Sixty-eight percent of recipients received a size-matched

Induction

As noted last year and still in contrast to the adult population,3 the use of induction therapy continues to trend upwards. Most pediatric heart transplant recipients (71%) receive induction therapy, comprising 47% anti-thymocyte globulin and 25% interleukin-2 receptor (IL2-R) antagonists. In a univariate analysis examining survival out to 9 years after transplant, patients who received polyclonal induction therapy had a better survival than those who received IL2-R antagonists (p = 0.014). In

Survival

Differences remain in survival by age, diagnosis, and clinical characteristics that impact long-term survival, now reported out to 15 years post-transplant. Regional differences play a role in survival as well and are examined in an exploratory manner later in this year’s report.

Mortality

The first year after transplant remains the period with the highest mortality (Figure 14), although there has been improvement over time (Figure 15). Graft failure and technical issues accounted for 30% of deaths in this time period, followed by multisystem organ failure (16%), infection, including cytomegalovirus (14%), and rejection (12%; Table 1). These causes were among the top causes of death in all 4 age groups.1

Overall, graft failure was the most common cause of death throughout the

Functional status

Functional status data, reported in the Registry since 2005, are predominantly from the United States, where submission is mandatory, and assessed with the Lansky score. A score of 100 represents full activity, 90 indicates minor restrictions to strenuous activity, and 80 indicates that the patient tires more quickly but is capable of participating in physical activity. At 1 year post-transplant, 93% of recipients have a score of ≥ 80.1

Re-hospitalization rates remain high during the first year

Conclusions

The field of pediatric heart transplantation continues to evolve. With an increasing number of patients reported to the Registry, the trend toward larger-volume centers continues but with different patient profiles based on region. Although indications for transplantation have remained essentially unchanged during the last decade, immunosuppressant combinations continue to change with an effect on incidence of rejection, which continues to decrease. Survival continues to improve, and Registry

Disclosure statement

All relevant disclosures for the Registry Director, Executive Committee Members, and authors are on file with the ISHLT and can be made available for review by contacting the Executive Director of the ISHLT.

First page preview

First page preview
Click to open first page preview

Cited by (0)

View full text