Abstract 119 Poster Session III, Monday, 5/3 (poster 127)

It has been suggested that the outcome following heart transplantation is worse for pediatric patients with congenital heart disease than for those with cardiomyopathy and structurally normal hearts. However, there are little data describing the morbidity and mortality associated with waiting for a donor organ after the time of listing in these two groups. To address this question, we retrospectively reviewed the experience at a single center regarding pediatric heart transplant candidates between the time of listing and transplantation. Pediatric patients listed for heart transplant at Stanford between 1977 and 1996 were included. Medical records were reviewed for 96 patients, ages 1 day to 19 years (median 3.4 yrs). Major complications were defined as life-threatening dysrhythmia, thromboembolism, or requirement for mechanical circulatory support. Mortality was evaluated by crude mortality, and by Kaplan-Meier survival curves. Patients were categorized as having congenital heart disease (CHD), or cardiomyopathy with no structural disease (CM).

RESULTS: Of the total group of 96 pts, 67 (70%) underwent transplantation, 12 (12%) died while listed, and 17 (18%) either improved, improved and were lost to followup or are currently awaiting transplantation. Median time on the waiting list was 23 days, which remained constant throughout the study period. At time of listing, 64% of CHD pts, and 57% of CM pts were status 1 (p=NS). Overall mortality was 12% in pts with CHD (7/56), and was the same in pts with CM (5/40, 12%). This result was confirmed by Kaplan-Meier analysis, which demonstrated survival to be 93% and 81% at 30 days, and 90 days respectively, with no difference between CHD and CM. There were 27 major complications in 20 pts (15 tachyarrhythmia, 6 thromboemboli, 2 mechanical support, 4 other). Major complications were identified in 38% of pts with CM (15/40), as compared to 9% of pts with CHD (5/56). This difference was statistically significant, p<0.001. Major complications were also significantly more common in pts who were status 1 at time of listing (10/37, 27%) as compared to those who were listed as status 2 candidates (0/22, 0%), p<0.01.

CONCLUSIONS: Although overall mortality is similar, pediatric pts with CM suffer greater morbidity than pts with CHD while awaiting transplantation. The majority of the complications are either arrhythmias or thromboembolic phenomena.