Effect of oversizing cardiac allografts on survival in pediatric patients with congenital heart disease

• Published in: The Journal of heart and lung transplantation Vol. 24; no. 2; p. 195
• Main Authors: Razzouk, Anees J, Johnston, Joyce K, Larsen, Ranae L, Chinnock, Richard E, Fitts, James A, Bailey, Leonard L
• Format: Journal Article
• Language: English
• Published: United States 01-02-2005
• Subjects: Adolescent; Child; Child, Preschool; Female; Graft Rejection; Heart - anatomy & histology; Heart Defects, Congenital - mortality; Heart Defects, Congenital - pathology; Heart Defects, Congenital - surgery; Heart Transplantation; Humans; Infant; Infant, Newborn; Length of Stay; Male; Organ Size; Reoperation; Retrospective Studies; Survival Analysis; Time; Transplantation, Homologous; Treatment Outcome
• ISSN: 1053-2498
• DOI: 10.1016/j.healun.2003.11.398

There are few published data regarding the long-term outcome of "large" cardiac allografts in children. This study examines the effect of cardiac graft oversizing on the survival of pediatric patients with congenital heart disease (CHD).
Two hundred ninety-one children, age 1 day to 17 years (median 50 days), with CHD underwent primary cardiac transplantation between 1985 and 2002. Patients were analyzed according to donor-recipient weight ratio (D-R): Group (Gp) I (n = 252) with D-R <2.5 (range 0.59 to 2.49, median 1.4), and Gp II (n = 39) with D-R >/=2.5 (range 2.5 to 4.65, median 2.78). CHD diagnoses included hypoplastic left heart syndrome (138 in Gp I, 13 in Gp II), single ventricle (29 in Gp I, 1 in Gp II) and other (85 in Gp I, 13 in Gp II). Patients with cardiomyopathy were excluded. Pre-transplant cardiac palliation was performed in 36% of Gp I and 15% of Gp II patients. The average graft ischemic times (minutes) were 266 +/- 7.5 and 283 +/- 18.9 for Gp I and Gp II, respectively (p < 0.2).
The operative mortality for Gp I was 10.3% and 10.2% for Gp II (p < 0.99). There was no significant difference between the 2 groups in length of hospital stay (p < 0.15) or duration of ventilator support (p < 0.6) post-transplantation. However, the incidence of open chest was higher (p < 0.003) in Gp II (28%) compared with Gp I (8%). The survival rates for Gp I and Gp II were: 82 +/- 2.4% vs 84 +/- 5.7% at 1 year; 71 +/- 2.9% vs 72 +/- 7.2% at 5 years; and 63 +/- 3.2% vs 65% +/- 7.4 at 10 years.
Post-transplant morbidity and short- and long-term survival of pediatric recipients with CHD are not adversely influenced by the use of oversized cardiac allografts.