Abstract
Introduction: Waitlist and post-transplant outcomes for heart transplantation (HTx) in infants below 5 kg are not well defined. Hypothesis: We hypothesize that lower listing weight leads to higher waitlist and post-HTx mortality in the smallest infants. Methods: All children <5 kg listed for primary (1°) HTx between 10/87-12/14 were identified in the United Network for Organ Sharing database. Demographic and clinical covariates, along with waitlist and post-HTx survival, were compared between weight groups. Waitlist and post-HTx survival differences were assessed via the Kaplan-Meier method and a Cox proportional hazards model assessed independent risk factors for mortality. Results: Over the 27 year study period, 2,785 infants <5 kg were listed for 1° HTx. Median waiting time was 25 days [IQR 9-57]. The majority had congenital heart disease (79%) and 205 (7%) were <2.5 kg. Waitlist death or removal due to deterioration was more common in infants <2.5 kg (37%), compared to 31% in those 2.5-5 kg (p <0.01). Waitlist survival was worse for patients with progressively lower listing weight (p <0.01; Fig. 1a). In addition, 30-day and 1-year post-HTx survival were worse in the <2.5 kg cohort [77%, 64% (<2.5 kg) vs. 89%, 79% (2.5-5 kg), respectively] (p <0.01; Fig. 1b). However, 1-year conditional survival after HTx was not different between the groups (p=0.82; Fig. 1c). In the <2.5 kg group, pre-HTx ECMO requirement was an independent risk factor for waitlist and post-HTx mortality [waitlist adjusted HR 4.3 (CL 2.0, 9.2), post-HTx adjusted HR 11.3 (CL 4.0, 31.8); p <0.01]. Conclusions: For small infants, lower listing weight is associated with increasing waitlist mortality. Early post-HTx mortality is worse for infants weighing <2.5 kg and the need for ECMO while listed greatly increases these risks. Despite elevated waitlist and early post-HTx mortality, long term conditional survival for infants <2.5 kg is similar to that achieved in patients weighing 2.5-5 kg.
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