Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115, USA.
J Heart Lung Transplant. 2009 Dec;28(12):1292-8. doi: 10.1016/j.healun.2009.06.013. Epub 2009 Sep 26.
Infants awaiting heart transplantation (HT) face the highest wait-list mortality among all children and adults listed for HT in the USA. We sought to determine the risk of death for infants <12 months old while awaiting HT in the current era, and to identify the principle risk factors associated with wait-list mortality.
We analyzed outcomes for all infants listed for HT in the USA from January 1999 to July 2006, using data reported to the U.S. Scientific Registry of Transplant Recipients.
Of the 1,133 listed infants, 61% were <3 months of age, 80% were listed as Status 1A, 64% had a congenital heart disease (CHD) and 31% had cardiomyopathy. Of 724 infants with CHD, 25% were on prostaglandin (PG) and 27% had a history of prior surgery. By 6 months after listing, 23% died on the wait-list and 54% were transplanted. Multivariate factors associated with wait-list mortality were weight <3 kg (hazard ratio [HR] 1.4, 95% confidence interval [CI] 1.0 to 1.9), extracorporeal membrane oxygenation (ECMO) support (HR 5.6, CI 4.0 to 7.9), ventilator support (HR 2.1, 95% CI 1.6 to 2.8), CHD with PG support (HR 2.8, 95% CI 1.8 to 4.3), CHD without prior surgery (HR 2.8, 95% CI 1.9 to 3.9) and non-white race/ethnicity (HR 1.8, 95% CI 1.4 to 2.3).
One in four infants listed for HT in the USA die before a donor heart can be identified. Wait-list mortality is associated with weight <3 kg, level of invasive support and CHD, but not listing status, which captures medical urgency poorly. Measures to expand infant organ donation, especially among neonates, are urgently needed.
在美国，等待心脏移植（HT）的婴儿面临着所有 HT 患者中最高的等待名单死亡率。我们旨在确定当前时代等待 HT 的 12 个月以下婴儿的死亡风险，并确定与等待名单死亡率相关的主要危险因素。
我们分析了 1999 年 1 月至 2006 年 7 月在美国登记的所有等待 HT 的婴儿的结果，使用向美国移植受者科学注册处报告的数据。
在登记的 1133 名婴儿中，61%的婴儿年龄<3 个月，80%的婴儿登记为状态 1A，64%的婴儿患有先天性心脏病（CHD），31%的婴儿患有心肌病。在 724 名患有 CHD 的婴儿中，25%的婴儿正在使用前列腺素（PG），27%的婴儿有先前手术史。在登记后 6 个月，23%的婴儿在等待名单上死亡，54%的婴儿接受了移植。与等待名单死亡率相关的多变量因素包括体重<3kg（危险比[HR]1.4，95%置信区间[CI]1.0 至 1.9）、体外膜肺氧合（ECMO）支持（HR 5.6，CI 4.0 至 7.9）、呼吸机支持（HR 2.1，95%CI 1.6 至 2.8）、PG 支持的 CHD（HR 2.8，95%CI 1.8 至 4.3）、无先前手术的 CHD（HR 2.8，95%CI 1.9 至 3.9）和非白种人种族/民族（HR 1.8，95%CI 1.4 至 2.3）。
在美国，等待 HT 的婴儿中有四分之一在可以找到供体心脏之前死亡。等待名单死亡率与体重<3kg、侵袭性支持和 CHD 有关，但与列表状态无关，列表状态不能很好地反映医疗紧急情况。迫切需要采取措施扩大婴儿器官捐献，特别是在新生儿中。
