OUTCOME OF CARDIAC TRANSPLANTATION IN CHILDREN - SURVIVAL IN A CONTEMPORARY MULTIINSTITUTIONAL EXPERIENCE

Background Meaningful analysis of survival and risk factors for death in children who undergo heart transplantation is problematic because o f the small number of heart transplantations performed at individual i nstitutions. Methods and Results To more accurately examine survival a nd risk factors for death in children undergoing heart transplantation , we analyzed 191 patients between 1 and 18 years old who received tra nsplants at 22 centers in the Pediatric Heart Transplant Study between January 1, 1993, and December 31, 1994. Cardiac diagnosis was congeni tal heart disease in 74 patients (39%), dilated cardiomyopathy in 73 ( 38%), and other in 44 (23%). Actuarial survival was 93% at 1 month, 82 % at 1 year, and 81% at 2 years after transplantation. The major cause s of death (n=31) were rejection (29% of deaths), early graft failure (19%), infection (16%), sudden death (13%), and other causes (23%). By multivariate analysis, risk factors for death were assist devices (P= .02), nonidentical ABO blood types (P=.05), and younger age (P=.10). C onclusions Contemporary survival for pediatric heart transplant recipi ents >1 year old is comparable to survival after adult heart transplan tation. Risk factors for death are the need for assist devices, nonide ntical ABO blood types, and younger age. Rejection is the most common cause of death after pediatric heart transplantation.