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

Abstract

Purpose: 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 d), with CHD underwent primary cardiac transplantation between 1985 and 2002. This population was analyzed according to the donor-recipient weight ratio (D-R). Group I (n=252) with D-R<2.5 (range, 0.59 to 2.49; median 1.4) and group II (n=39) with D-R>=2.5 (range 2.5 to 4.65; median, 2.78). CHD diagnoses included HLHS (138 in GP I, 25 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. Pretransplant cardiac palliation was performed in 36% of GP I and 15% of GP II patients. The average graft ischemic times (minutes) were 252+/-7.5 and 293.8+/-18.9 for GP I and GP II respectively (p<0.2).Results: The operative mortality for GP I was 11.8% and 10.2% for GP II (p<0.76). There was no significant difference between the two groups in the length of hospital stay (p<0.15) or the duration of ventilator support (p<0.6) post-transplantation. However, the incidence of open chest was higher (p<0.003) in GP II (23%) compared with GP I (8%). The survival 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 69%+/-7.4 at 10 years.Conclusion: Post-transplant morbidity as well as short and long-term survival of pediatric recipients with CHD are not adversely influenced by the use of oversized cardiac allografts.