Effect of oversizing cardiac allografts on survival in pediatric patients with congenital heart disease

Abstract

Background There are few published data regarding the long-term outcome of “large” cardiac allografts in children. This study examines the effect of cardiac graft oversizing on the survival of pediatric patients with congenital heart disease (CHD). Methods Two hundred ninety-one children, age 1 day to 17 years (median 50 days), with CHD underwent primary cardiac transplantation between 1985 and 2002. Patients were analyzed according to donor-recipient weight ratio (D-R): Group (Gp) I ( n = 252) with D-R <2.5 (range 0.59 to 2.49, median 1.4), and Gp II ( n = 39) with D-R ≥2.5 (range 2.5 to 4.65, median 2.78). CHD diagnoses included hypoplastic left heart syndrome (138 in Gp I, 13 in Gp II), single ventricle (29 in Gp I, 1 in Gp II) and other (85 in Gp I, 13 in Gp II). Patients with cardiomyopathy were excluded. Pre-transplant cardiac palliation was performed in 36% of Gp I and 15% of Gp II patients. The average graft ischemic times (minutes) were 266 ± 7.5 and 283 ± 18.9 for Gp I and Gp II, respectively ( p < 0.2). Results The operative mortality for Gp I was 10.3% and 10.2% for Gp II ( p < 0.99). There was no significant difference between the 2 groups in length of hospital stay ( p < 0.15) or duration of ventilator support ( p < 0.6) post-transplantation. However, the incidence of open chest was higher ( p < 0.003) in Gp II (28%) compared with Gp I (8%). The survival rates for Gp I and Gp II were: 82 ± 2.4% vs 84 ± 5.7% at 1 year; 71 ± 2.9% vs 72 ± 7.2% at 5 years; and 63 ± 3.2% vs 65% ± 7.4 at 10 years. Conclusions Post-transplant morbidity and short- and long-term survival of pediatric recipients with CHD are not adversely influenced by the use of oversized cardiac allografts.