Risk factors for adverse outcomes in pediatric heart transplantation

Heart transplantation (HT) remains the only definitive surgical treatment for end-stage chronic heart failure (CHF).

Objective: to investigate factors associated with adverse immediate outcomes following HT in children.

Materials and methods. Between January 1, 2012, and December 31, 2024, 91 HTs were performed in recipients under 18 years of age at Shumakov National Medical Research Center of Transplantology and Artificial Organs, Moscow. The patients were divided into two groups based on early postoperative outcomes: survivors (n = 79; 86.8%) and non-survivors (n = 12; 13.2%).

Results. Between 2012 and 2024, a total of 2,190 HTs were performed, including 91 (4.2%) in children. Severe early graft dysfunction occurred in 14 pediatric heart recipients (15.4%), and in-hospital mortality was 13.2%. A high recipient urgency status (UNOS), the use of short-term mechanical circulatory support, and clinical manifestations of multiple organ failure necessitated the expansion of donor heart selection criteria. Receiver operating characteristic (ROC) analysis demonstrated that baseline laboratory parameters influenced transplant outcomes. Serum sodium, lactate, and urea levels, as well as hemoglobin levels, red blood cell and platelet counts, showed statistically significant predictive value, as confirmed by area under the curve (AUC) analysis. Donors in the non-survivor group were significantly older than those in the survivor group. The donor-to-recipient weight ratio was higher among recipients who died in the early post-transplant period. In the non-survivor cohort, significantly higher values were observed for the donor-to-recipient height ratio, donorto-recipient body surface area ratio, and durations of graft ischemia, anesthesia, surgery, and cardiopulmonary bypass.

Conclusion. The effectiveness of pediatric HT (hospital survival rate 86.8%) is influenced primarily by recipient urgency status (UNOS). Additional contributing factors include severity of multiple organ dysfunction, donor age, significant donor–recipient anthropometric mismatch, operative time, and intraoperative blood loss. 

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