Outcomes of third heart transplants in pediatric and young adult patients: analysis of the United Network for Organ Sharing database
| Autor: | Joshua M. Friedland-Little, Robert J. Gajarski, Kurt R. Schumacher, Sunkyung Yu, Mary Zamberlan, Janet E. Donohue |
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| Rok vydání: | 2014 |
| Předmět: |
Pulmonary and Respiratory Medicine
United Network for Organ Sharing Graft Rejection Male Reoperation Tissue and Organ Procurement Adolescent Databases Factual Waiting Lists medicine.medical_treatment computer.software_genre Cardiac allograft vasculopathy Elevated serum Young Adult Risk Factors medicine Extracorporeal membrane oxygenation Humans Young adult Child Heart transplantation Mechanical ventilation Heart transplants Heart Failure Transplantation Database business.industry Age Factors Infant Survival Rate Treatment Outcome Case-Control Studies Child Preschool Heart Transplantation Surgery Female Cardiology and Cardiovascular Medicine business computer |
| Zdroj: | The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 33(9) |
| ISSN: | 1557-3117 |
| Popis: | 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 ( 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. |
| Databáze: | OpenAIRE |
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