Division of Cardiothoracic Surgery, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, Georgia, USA.
Pediatr Transplant. 2024 Aug;28(5):e14792. doi: 10.1111/petr.14792.
Heart transplantation in the neonatal period is associated with excellent survival. However, outcomes data are scant and have been obtained primarily from two single-center reports within the United States. We sought to analyze the outcomes of all neonatal heart transplants performed in the United States using the United Network for Organ Sharing (UNOS) dataset.
The UNOS dataset was queried for patients who underwent infant heart transplantation from 1987 to 2021. Patients were divided into two groups based on age - neonates (<=31 days), and older infants (32 days-365 days). Demographic and clinical characteristics were analyzed and compared, along with follow up survival data.
Overall, 474 newborns have undergone heart transplantation in the United States since 1987. Freedom from death or re-transplantation for neonates was 63.5%, 58.8% and 51.6% at 5, 10, and 20 years, respectively. Patients in the newborn group had lower unadjusted survival compared to older infants (p < .001), but conditional 1-year survival was higher in neonates (p = .03). On multivariable analysis, there was no significant difference in survival between the two age groups (p = .43). Black race, congenital heart disease diagnosis, earlier surgical era, and preoperative mechanical circulatory support use were associated with lower survival among infant transplants (p < .05).
Neonatal heart transplantation is associated with favorable long-term clinical outcomes. Neonates do not have a significant survival advantage over older infants. Widespread applicability is limited by the small number of available donors. Efforts to expand the donor pool to include non-standard donor populations ought to be considered.
新生儿心脏移植的存活率非常高。然而，目前仅有美国的两项单中心报告提供了相关数据。本研究旨在利用美国器官共享联合网络（UNOS）数据库，分析全美所有新生儿心脏移植的结局。
我们对 1987 年至 2021 年期间接受婴儿心脏移植的患者进行了 UNOS 数据库查询。根据患者年龄将其分为两组：新生儿（<=31 天）和大龄婴儿（32 天至 365 天）。分析并比较了两组患者的人口统计学和临床特征，以及随访生存数据。
自 1987 年以来，全美共有 474 例新生儿接受了心脏移植。新生儿的无死亡或再次移植生存率分别为 5 年 63.5%、10 年 58.8%和 20 年 51.6%。未校正的生存率显示，新生儿组低于大龄婴儿组（p<.001），但新生儿组的 1 年条件生存率更高（p=.03）。多变量分析显示，两组的生存率无显著差异（p=.43）。黑种人、先天性心脏病诊断、手术较早以及术前使用机械循环支持与婴儿心脏移植的生存率较低相关（p<.05）。
新生儿心脏移植具有良好的长期临床结局。新生儿的生存率并不优于大龄婴儿。由于可供选择的供体数量较少，其广泛应用受到限制。应考虑扩大供体库，包括非标准供体人群。
