J Korean Med Sci.  2021 Nov;36(44):e283. 10.3346/jkms.2021.36.e283.

The Waiting List Mortality of Pediatric Heart Transplantation Candidates in Korea before the Pediatric Ventricular Assist Device Era

• Jeung MS
• Kim MJ
• Huh J
• Kang IS
• Kim GB
• Yu JJ
• Song J

• KMID: 2522361
• DOI: http://doi.org/10.3346/jkms.2021.36.e283

Abstract

Background
Despite advancements in heart transplantation for pediatric patients in Korea, the waiting list mortality has not been reported. Therefore, we investigated the waiting list mortality rate and factors associated with patient mortality.
Methods
We reviewed the medical records of pediatric patients who were registered for heart transplantation at three major hospitals in Korea from January 2000 to January 2020. All patients who died while waiting for heart transplantation were investigated, and we identified the waiting list mortality rate, causes of mortality and the median survival periods depending on the variable risk factors.
Results
A total of 145 patients received heart transplantations at the three institutions we surveyed, and the waiting list mortality rate was 26%. The most common underlying diseases were cardiomyopathy (66.7%) and congenital heart disease (30.3%). The leading causes that contributed to death were heart failure (36.3%), multi-organ failure (27.2%), and complications associated with extracorporeal membrane oxygenation (ECMO) (25.7%). The median survival period was 63 days. ECMO was applied in 30 patients. The different waiting list mortality percentages according to age, cardiac diagnosis, use of ECMO, and initial Korean Network of Organ Sharing (KONOS) level were determined using univariate analysis, but age was the only significant factor associated with waiting list mortality based on a multivariate analysis.
Conclusion
The waiting list mortality of pediatric heart transplantation candidates was confirmed to be considerably high, and age, underlying disease, the application of ECMO, and the initial KONOS level were the factors that influenced the survival period.

Keyword

Heart Transplantation; Pediatrics; Waiting Lists; Mortality

Figure

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  Fig. 1 A flow diagram illustrating the patient selection process.HT = heart transplantation, KONOS = Korean Network of Organ Sharing.

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  Fig. 2 The Kaplan-Meier survival curve of the waiting list mortality group.

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  Fig. 3 A comparison of cumulative survival curves depending on various risk factors. (A) By patient age, (B) use of ECMO, (C) the initial KONOS level, (D) cardiac diagnosis.ECMO = extracorporeal membrane oxygenation, KONOS = Korean Network of Organ Sharing, CMP = cardiomyopathy.

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