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TRANSITION TO ADULTHOOD: HEART TRANSPLANT (HT) RECIPIENT OUTCOMES BY AGE GROUP
A897 JACC March 17, 2015 Volume 65, Issue 10S
Heart Failure and Cardiomyopathies Transition to Adulthood: Heart Transplant (HT) Recipient Outcomes by Age Group Poster Contributions Poster Hall B1 Saturday, March 14, 2015, 3:45 p.m.-4:30 p.m. Session Title: Advances in Heart Failure Therapies: From Diuretics to VADs and Transplant Abstract Category: 14. Heart Failure and Cardiomyopathies: Clinical Presentation Number: 1146-227 Authors: Leigh C. Reardon, Eugene DePasquale, UCLA, Los Angeles, CA, USA
Background: Outcomes of post-HT patients in transition (13y to 24y) have not been well described.
Methods: 45213 HT recipients were identified from UNOS (1987-2011) and stratified by age group (pediatric (age 24, n=38322).
Exclusions: re-HT & lost to follow up. Survival was censored at 12y. Multivariate Cox proportional hazard regression analysis was adjusted for sex, DM, race, ischemic time, dialysis, life support, VAD use, wait time & HLA mismatch. Transition and pediatric patients were more likely to be listed status 1 for HT (p < 0.001), receive a younger donor (p<0.001) and have less prior cardiac surgery (p<001) compared to adults. The adult and transition were more likely to have elevated creatinine (p<0.001), to be bridged with VAD (p<0.001) and wait longer for transplant than the pediatric group (p<0.001). There was less cardiovascular death in the adult group (p<0.001) with significantly less graft failure and rejection (Pediatric vs Transition vs Adult: 12 vs 9 vs 6% and 20 vs 23 vs 8%, respectively (p<0.001)). Survival (1, 5 & 10y) was: Pediatric (82, 70, 59%), transition (87, 65, 46%) & adult (86, 71, 50%) (Figure). Unadjusted HR (vs transitional group) for all-cause mortality was: Adult: 0.92 (CI 0.87-0.98) and Pediatric: 0.79 (0.73-0.85). Multivariate analysis yielded a HR of: Adult: 0.88 (CI 0.82-0.95) and Pediatric: 0.71 (0.65-0.78).
Conclusion: Despite better survival early post HT, the transition group survival declines over time and is significantly worse compared to the adult and pediatric group.
Heart Failure and Cardiomyopathies Transition to Adulthood: Heart Transplant (HT) Recipient Outcomes by Age Group Poster Contributions Poster Hall B1 Saturday, March 14, 2015, 3:45 p.m.-4:30 p.m. Session Title: Advances in Heart Failure Therapies: From Diuretics to VADs and Transplant Abstract Category: 14. Heart Failure and Cardiomyopathies: Clinical Presentation Number: 1146-227 Authors: Leigh C. Reardon, Eugene DePasquale, UCLA, Los Angeles, CA, USA
Background: Outcomes of post-HT patients in transition (13y to 24y) have not been well described.
Methods: 45213 HT recipients were identified from UNOS (1987-2011) and stratified by age group (pediatric (age 24, n=38322).
Exclusions: re-HT & lost to follow up. Survival was censored at 12y. Multivariate Cox proportional hazard regression analysis was adjusted for sex, DM, race, ischemic time, dialysis, life support, VAD use, wait time & HLA mismatch. Transition and pediatric patients were more likely to be listed status 1 for HT (p < 0.001), receive a younger donor (p<0.001) and have less prior cardiac surgery (p<001) compared to adults. The adult and transition were more likely to have elevated creatinine (p<0.001), to be bridged with VAD (p<0.001) and wait longer for transplant than the pediatric group (p<0.001). There was less cardiovascular death in the adult group (p<0.001) with significantly less graft failure and rejection (Pediatric vs Transition vs Adult: 12 vs 9 vs 6% and 20 vs 23 vs 8%, respectively (p<0.001)). Survival (1, 5 & 10y) was: Pediatric (82, 70, 59%), transition (87, 65, 46%) & adult (86, 71, 50%) (Figure). Unadjusted HR (vs transitional group) for all-cause mortality was: Adult: 0.92 (CI 0.87-0.98) and Pediatric: 0.79 (0.73-0.85). Multivariate analysis yielded a HR of: Adult: 0.88 (CI 0.82-0.95) and Pediatric: 0.71 (0.65-0.78).
Conclusion: Despite better survival early post HT, the transition group survival declines over time and is significantly worse compared to the adult and pediatric group.