985-64 Impact of Prolonged Waiting Times on Neonatal Heart Transplantation

Abstract

Because of improved survival after infant heart transplantation (HTx) and the proliferation of infant HTx centers, waiting times have increased for infants listed for HTx. The purpose of this study was to analyze the impact of prolonged waiting times on neonates listed for HTx at 2 HTx centers. All patients (pts) at each institution listed for HTx in the first 2 months of life were included. Diagnosis, blood type, waiting time, initial outcome, final outcome, and hospital cost while on the transplant list were recorded. The presence of risk factors was also noted and chi-square analysis was employed to determine which predicted receiving HTx and surviving HTx. Thirty neonates (17 in Utah and 13 in Washington) were listed for HTx beginning in 1991. Twenty eight had hypoplastic left heart syndrome (HLHS) or a variant of HLHS and 2 had complex right sided obstructive lesions. Fifteen of these infants received hearts; there were 5 early deaths and 10 long term (6 months to 3 years) survivors. Seven pts died while on the transplant list and 8 underwent reconstructive surgery (4 early deaths, 3 late deaths, and 1 survivor). Predictors of HTx survival were lack of a central line, no mechanical ventilation, and A–blood type (p < 0.05). Freedom from sepsis predicted receiving HTx (p < 0.01). Morbidity while waiting included 16 episodes of sepsis in 12 pts and necrotizing enterocolitis in 4 pts. Eight interventional catheterizations were needed in 6 pts (3 ductal stents in 2 pts and 5 septostomies in 5 pts). Waiting time (44 ± 6 days) was similar at both institutions and increased from 25 ± 8 days in 1991–92 (n = 13) to 58 ± 7 days in 1993–94 (n = 17; p < 0.01 )). Cost per pt while listed for HTx ($159,000 ± $20,100) was also similar at both institutions and increased from $110,800 ± $28,800 in 1991–92 to $195,900 ± $24,700 in 1993–94 (p < 0.05). Cost per day ($4,200 ± $400), outcome, and morbidity were not different in the two time periods, but the number of pts with restrictive atrial septal defects (a poor prognostic factor in previous reports) increased from 1 to 5. Fifty percent of neonates listed for HTx received a heart. Pts who are free of sepsis, lack a central line, are not mechanically ventilated, and have A–blood type have better outcomes. Waiting times and costs have increased significantly over the last 2 years.