Fifty-year pediatric heart transplant outcomes: A pediatric-adult center linked analysis.

PURPOSE: Long-term outcomes after pediatric heart transplant (pHT) are rarely reported owing to young programs and loss of follow-up after transition to adult care. We leveraged our program age, center volume, and linked electronic medical record to analyze 50-year outcomes after pHT, including events after adult care transfer.

METHODS

Retrospective review of all pHT over 50 years at Stanford (August 19, 1974 to August 19, 2024). Patient characteristics and posttransplant outcomes, including death, retransplant, and subsequent kidney transplantation, were ascertained from the pediatric and adult electronic medical records, public records, and personal communication with other centers.

RESULTS

There were 567 pHTs in 540 patients. Status as of August 19, 2024 was confirmed for 526 (97%),11 (2%) had partial follow-up, and 3 were missing. Over 1,888,341 follow-up days, 50 (9%) received a second heart transplant (27 pediatric, 23 adult) after a median of 9 (5, 14) years; 3 (1%) received a third heart transplant; 6 (1%) received a subsequent kidney transplant, and 212 (39%) died (172 pediatric, 40 adult). Median survival was 16.7 years; survival improved in successive eras (p<0.001).

CONCLUSION

This linked analysis of pediatric and adult programs shows excellent long-term pHT outcomes with median survival exceeding 15 years and improving. Nearly half of retransplants occur after transfer; subsequent kidney transplant occurs infrequently.