Hayes Emily A, Koehl Devin, Cantor Ryan, Fisher Lauren A, Azeka Estela, Mokshagundam Deepa, Asante-Korang Alfred, Rusconi Paolo, O'Connor Matthew J, Nandi Deipanjan, Kirklin James K, Boyle Gerard J
Nationwide Children's Hospital, Columbus, Ohio, USA.
Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Pediatr Transplant. 2025 Mar;29(2):e70042. doi: 10.1111/petr.70042.
Short-term outcomes following heart transplantation in children have improved, but comparable improvements in long-term survival continues to have barriers. We sought to investigate long-term outcomes following heart transplantation and to identify protective and risk factors associated with long-term survival in children.
The Pediatric Heart Transplant Society (PHTS) database was queried for heart transplant recipients from 1993 to 2010 who were ≤ 10 years of age at time of transplant. Patients with conditional graft survival > 3 years and at ≥ 10 years were analyzed. Survival and time-to-event were compared using the Kaplan-Meier method with a log-rank test for significance. Factors associated with graft loss were identified using Cox proportional hazard modeling.
There were 1610 patients ≤ 10 year of age who were transplanted between 1993 and 2010 with conditional survival to 3 years post-transplant. Of those patients, there were 1170 with conditional survival to 10 years post-transplant. Patients < 1 year at transplant had improved survival compared to other age groups. Risk factors for graft loss after 3 years post-transplant were malignancy, rejection, cardiac allograft vasculopathy (CAV), age, congenital heart disease, female sex, and Black race (p value for all < 0.05).
Heart transplantation remains an effective therapy in children with a growing number of long-term survivors. Risk factors for mortality in patients ≤ 10 years of age at transplant with conditional survival to 3 years post-transplant include CAV, rejection, malignancy, female sex, and Black race. Further studies are needed to understand the social and biologic causes of racial and sex disparities in pediatric transplant patients.
儿童心脏移植后的短期预后有所改善，但长期生存率的类似改善仍存在障碍。我们试图研究儿童心脏移植后的长期预后，并确定与长期生存相关的保护因素和风险因素。
查询儿科心脏移植协会（PHTS）数据库，获取1993年至2010年期间移植时年龄≤10岁的心脏移植受者。对移植后有条件存活>3年且≥10年的患者进行分析。使用Kaplan-Meier方法和对数秩检验比较生存率和事件发生时间的显著性。使用Cox比例风险模型确定与移植物丢失相关的因素。
1993年至2010年期间，有1610名年龄≤10岁的患者接受了心脏移植，移植后有条件存活至3年。在这些患者中，有1170名有条件存活至移植后10年。与其他年龄组相比，移植时年龄<1岁的患者生存率有所提高。移植后3年移植物丢失的风险因素包括恶性肿瘤、排斥反应、心脏移植血管病变（CAV）、年龄、先天性心脏病、女性和黑人种族（所有p值<0.05）。
心脏移植仍然是儿童的一种有效治疗方法，长期存活者的数量不断增加。移植时年龄≤10岁且移植后有条件存活至3年的患者死亡的风险因素包括CAV、排斥反应、恶性肿瘤、女性和黑人种族。需要进一步研究以了解儿科移植患者种族和性别差异的社会和生物学原因。
