Prevalence and Outcomes of Heart Transplantation in Children With Intellectual Disability
1Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
2Biostatistics, University of Wisconsin School of Medicine and Public Health, Madison, WI
3Pediatrics, University of Washington School of Medicine, Seattle, WA.
Meeting: 2015 American Transplant Congress
Abstract number: B10
Keywords: Ethics, Heart transplant patients, Outcome, Pediatric
Session Information
Session Name: Poster Session B: "A Descent into the Maelstrom": Complications After Heart Transplantation
Session Type: Poster Session
Date: Sunday, May 3, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Background:
Heart transplantation in children with intellectual disability (ID) is a controversial issue. Previous research on this population has been limited to small case reports.
Objective:
To describe the prevalence and outcomes of heart transplantation in children with ID. We hypothesized that recipients with ID have comparable short-term outcomes compared to those without ID.
Design/Methods:
We performed a retrospective cohort analysis of children receiving a first heart-alone transplant in the UNOS STAR dataset from 2008-2013. We defined recipients at listing as definite ID if cognitive development was scored "definitely impaired" or as probable ID if scored as cognitive development "probably impaired/questionably impaired" and either academic activity level "delayed grade level/special education" or academic progress "reduced academic load/unable to participate in academics due to disease." Recipients were compared to children without ID using chi-square tests. Kaplan-Meier curves were constructed for patient and graft survival.
Results:
Over the study period, 312 children with definite (115) or probable (197) ID underwent first heart transplant, accounting for up to 22% of all first pediatric heart transplants (1404). Recipients with definite ID were more likely to have congenital heart disease as an indication for transplant. Recipients with definite or probable ID tended to be younger, have public insurance, were more likely to require a ventilator at time of listing, and have a higher medical urgency status at initial listing and transplant. There was no difference in the incidence of acute rejection between groups in the 1st year after transplant, however recipients with definite or probable ID had more treatment related hospitalizations. Kaplan–Meier curves and log-rank tests did not suggest significant differences in patient or graft survival between those with definite ID and those without ID during the first five years following transplantation.
Conclusions
Children with ID make up a significant portion of total heart transplants with short-term graft and patient survival comparable to children without ID. Further research is needed to examine long-term outcomes of transplant in this population.
To cite this abstract in AMA style:
Wightman A, Bartlett H, Zhao Q, Smith J. Prevalence and Outcomes of Heart Transplantation in Children With Intellectual Disability [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/prevalence-and-outcomes-of-heart-transplantation-in-children-with-intellectual-disability/. Accessed November 24, 2024.« Back to 2015 American Transplant Congress