Non-Infant, Single Ventricle Patients Enjoy the Same Post-Transplant Survival as Other Congenital Heart Patients

Abstract

Purpose Prior database studies have grouped pediatric transplant recipients broadly into “congenital heart disease” but have not distinguished between single ventricle (SV) patients and other diagnoses. By combining databases, we investigated whether SV patients could have similar post-transplant survival as biventricular (BiV) patients. Methods The UNOS database, providing patient outcomes, was combined with the Pediatric Hospital Information System (PHIS) database, used to elicit specific congenital diagnosis for patients transplanted at a PHIS hospital from 2006-2018. The most complex or diagnosis indicating SV physiology by ICD-9 diagnostic code was used to establish the primary diagnosis. Diagnoses were described and post-transplant outcomes compared by Kaplan-Meier analysis. Results There were 1,803 patients identified with congenital heart disease undergoing transplantation. Diagnoses were identified 1,031 (57%) identified as SV pathology, 706 (39%) as BiV pathology, and 66 (4%) as indeterminant. Only 78 (4%) patients were >18. Though 1-year survival was worse for SV diagnoses compared to biventricular (84% vs 91%; p-value 0.05. When stratified by age, SV infants (n=402) had worse long-term survival compared to BiV (log-rank p=0.038), however, non-infants (n=629) remained the same (p=0.405) as seen in Figure 1. Conclusion Although early survival is worse, overall SV patients are expected to enjoy equally excellent long-term survival after cardiac transplantation as other congenital heart disease patients. However, long-term survival for infant SV is inferior to infant BiV patients, primarily due to mortality within the six months.