From U Michigan: Outcomes of third heart transplants in pediatric and young adult patients

J Heart Lung Transplant. 2014 Apr 19. pii: S1053-2498(14)01092-4. doi: 10.1016/j.healun.2014.04.009. [Epub ahead of print]

Outcomes of third heart transplants in pediatric and young adult patients: Analysis of the United Network for Organ Sharing database.

Friedland-Little JM1, Gajarski RJ2, Yu S2, Donohue JE2, Zamberlan MC2, Schumacher KR2.

Author information

• 1Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, Michigan. Electronic address: jmfriedl@med.umich.edu.
• 2Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, Michigan.

Abstract

BACKGROUND:

Repeat heart transplantation (re-HTx) is standard practice in many pediatric centers. There are limited data available on outcomes of third HTx after failure of a second graft. We sought to compare outcomes of third HTx in pediatric and young adult patients with outcomes of second HTx in comparable recipients.

METHODS:

All recipients of a third HTx in whom the primary HTx occurred before 21 years of age were identified in the United Network for Organ Sharing database (1985 to 2011) and matched 1:3 with a control group of second HTx patients by age, era and re-HTx indication. Outcomes including survival, rejection and cardiac allograft vasculopathy (CAV) were compared between groups.

RESULTS:

There was no difference between third HTx patients (n = 27) and control second HTx patients (n = 79) with respect to survival (76% vs 80% at 1 year, 62% vs 58% at 5 years and 53% vs 34% at 10 years, p = 0.75), early (<1 year from HTx) rejection (33.3% vs 44.3%, p = 0.32) or CAV (14.8% vs 30.4%, p = 0.11). Factors associated with non-survival in third HTx patients included mechanical ventilation at listing or HTx, extracorporeal membrane oxygenation support at listing or HTx, and elevated serum bilirubin at HTx.

CONCLUSIONS:

Outcomes among recipients of a third HTx are similar to those with a second HTx in matched patients, with no difference in short- or long-term survival and comparable rates of early rejection and CAV. Although the occurrence of a third HTx remains relatively rare in the USA, consideration of a third HTx appears reasonable in appropriately selected patients.