Comparison of risk factors and outcomes for pediatric patients listed for heart transplantation after bidirectional Glenn and after Fontan: an analysis from the Pediatric Heart Transplant Study.

Patients listed for transplant after the bidirectional Glenn (BDG) may have better outcomes than patients listed after Fontan. This study examined and compared outcomes after listing for BDG and Fontan patients. All patients listed for transplant after the BDG in the Pediatric Heart Transplant Study between January 1993 and December 2008 were evaluated. Comparisons were made with Fontan patients and with a matched cohort of congenital heart disease patients. Competing outcomes analysis and actuarial survival were evaluated for the study populations, including an examination of various risk factors. Competing outcomes analysis for BDG and Fontan patients after listing were similar. There was no difference in actuarial survival after listing or transplant among the 3 cohorts. Mechanical ventilation, United Network of Organ Sharing status, and age were risk factors for death after listing in BDG and Fontan patients, but ventilation at the time of transplant was significant only for the Fontan patients. Mortality was increased in Fontan patients listed < 6 months after surgery compared with patients listed > 6 months after surgery, but no difference was observed in BDG patients. There was a trend toward improved survival after listing for both populations across 3 eras of the study, but this did not reach statistical significance. Outcomes after listing for BDG and Fontan patients are similar. Mechanical ventilation at the time of transplant remains a significant risk factor for death in the Fontan population, as does listing for transplant soon after the Fontan, suggesting that some patients may benefit from transplant instead of Fontan completion.

Kovach JR ，Naftel DC ，Pearce FB ，Tresler MA ，Edens RE ，Shuhaiber JH ，Blume ED ，Fynn-Thompson F ，Kirklin JK ，Zangwill SD ... -  《-》

Outcome of listing for heart transplantation in infants younger than six months: predictors of death and interval to transplantation. The Pediatric Heart Transplantation Study Group.

Morrow WR ，Naftel D ，Chinnock R ，Canter C ，Boucek M ，Zales V ，McGiffin DC ，Kirklin JK ... -  《JOURNAL OF HEART AND LUNG TRANSPLANTATION》

Outcome of listing for cardiac transplantation for failed Fontan: a multi-institutional study.

Bernstein D ，Naftel D ，Chin C ，Addonizio LJ ，Gamberg P ，Blume ED ，Hsu D ，Canter CE ，Kirklin JK ，Morrow WR ，Pediatric Heart Transplant Study ... -  《-》

Risk factors for mortality or delisting of patients from the pediatric heart transplant waiting list.

Current literature assessing factors associated with outcomes of patients waiting for pediatric heart transplants has focused on survival to transplant and mortality. Our aim was to determine risk factors associated with the outcomes of delisting, transplant, or death while waiting. In this single-center, retrospective study of patients listed for heart transplants, competing risk analysis was used to model survival from listing to 4 competing outcomes (transplant, death, delisting for clinical deterioration, delisting for clinical improvement or surgical intervention). There were 308 listing episodes in 280 patients. In competing risk analysis, 11% remained listed at 6 months (transplant 62%, dead 13%, delisted worse 6%, delisted improved 8%). Extracorporeal membrane oxygenation and ventricular assist devices were associated both with higher probability of transplant (hazard ratio [HR], 2.8; P < .001) and delisting for clinical deterioration (HR, 2.7; P = .06). Younger age at listing and complex congenital heart disease were shared risk factors for mortality (HR, 1.07; P = .05; HR, 2.9; P = .003) and delisting because of clinical deterioration (HR, 1.17; P = .01; HR, 2.8; P = .02). Younger age at listing and fetal listing were associated with delisting for clinical improvement or surgical intervention (HR, 1.13; P = .01; HR, 2.9; P = .02). Overall survival to transplant depends on risk factors including age at listing, cardiac diagnosis, and mechanical circulatory support. Knowledge of risk factors for death and delisting for clinical deterioration or improvement can assist patient selection and timing of transplant listing.

Jeewa A ，Manlhiot C ，Kantor PF ，Mital S ，McCrindle BW ，Dipchand AI ... -  《-》

Cardiac transplantation after the Fontan or Glenn procedure.

Jayakumar KA ，Addonizio LJ ，Kichuk-Chrisant MR ，Galantowicz ME ，Lamour JM ，Quaegebeur JM ，Hsu DT ... -  《-》