Competing Outcomes After Neonatal and Infant Wait-listing for Heart Transplantation
| Autor: | Lori J. West, Stacey M. Pollock-BarZiv, Cedric Manlhiot, Brian W. McCrindle, Anne I. Dipchand, Meghan VanderVliet |
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| Rok vydání: | 2007 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Databases Factual Heart Diseases Waiting Lists medicine.medical_treatment Economic shortage Kaplan-Meier Estimate Risk Assessment Severity of Illness Index Severity of illness medicine Humans Intensive care medicine Proportional Hazards Models Heart transplantation Transplantation business.industry Proportional hazards model Disease progression Infant Newborn Infant Treatment Outcome Disease Progression Heart Transplantation Surgery Listing (finance) Cardiology and Cardiovascular Medicine business Risk assessment |
| Zdroj: | The Journal of Heart and Lung Transplantation. 26:980-985 |
| ISSN: | 1053-2498 |
| Popis: | Background Neonatal and infant heart transplantation is a therapeutic option for patients with end-stage cardiac lesions, yet infants continue to face a considerable shortage of donor organs. We sought to ascertain outcomes after listing for heart transplantation using a competing outcomes methodology, and to identify factors predicting each outcome. Methods Review of the Toronto cardiac transplant database was undertaken to identify infant patients (≤12 months) wait-listed for heart transplantation. Achievement of one of five possible outcomes was parametrically modeled, including: transplantation; death on the wait-list; delisting: too sick; delisting: clinically improved; and delisting for surgical palliation. Results Forty-three percent (117 of 269) of the total patient listings were infants (26 fetal/63 neonatal). Of the 117 patients, 80 (68%) underwent transplantation, 15 died on the wait-list, 9 were delisted (too sick/no longer eligible for transplant), 9 opted for surgical palliation and 4 were delisted (clinical improvement). Eighty-nine percent of outcomes were achieved by 3 months from listing. Blood group and transplant era predicted achieving transplantation. Factors predicting death on the wait-list included Canadian Status 4 (most urgent), and mechanical support. Status at listing also predicted delisting: too sick. Fetal listing predicted delisting for surgical alternative. Conclusions The first 3 months after listing are critical for achieving an outcome, particularly in higher status patients, affirming the need for timely organ replacement. Strategies such as ABO-incompatible transplantation continue to decrease wait-list mortality; however, these data demonstrate that blood type O and B patients continue to face longer wait-list duration. It is imperative that we continue to seek solutions for the shortage of infant donor organs in order to maximize the utility of heart transplantation as a therapeutic option. |
| Databáze: | OpenAIRE |
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