35 Years of improvement: 2,000 consecutive pediatric solid organ transplants at a single institution
Chun-Sing Huang4, Brian Hickner4, Abbas Rana4, Daniel Leung2, Kathleen Hosek4, Jeffrey Heinle1, William Dreyer1, Iki Adachi1, Christine O'Mahony4, Eileen Brewer3, Tina Melicoff1, Thao Galvan4, John Goss4.
1Cardiothoracic Transplant Surgery, Texas Children's Hospital, Houston, TX, United States; 2Pediatric Hepatology, Texas Children's Hospital, Houston, TX, United States; 3Pediatric Nephrology, Texas Children's Hospital, Houston, TX, United States; 4Abdominal Transplant Surgery, Texas Children's Hospital, Baylor college of Medicine, Houston, TX, United States
Introduction: Our pediatric transplant center began in 1968 and over two thousand solid organ transplants have been performed. In this study, we explore trends and lessons learned in our 35 years of experience.
Methods: A retrospective analysis from UNOS and internal data identified 2006 total pediatric transplants at our program (693 livers, 568 kidneys, 511 hearts, and 234 lungs) from January 8th, 1987 to February 9th, 2022. Univariable and multivariable Cox regression was used to determine if the year of listing for transplant was associated with patient and allograft survival, controlling for various clinical and demographic factors. Survival was also compared across multiple eras for each organ using the Kaplan-Meier method.
Results: The most common indications for transplant included renal hypoplasia (21%) for kidney, biliary atresia (33%) for liver, cystic fibrosis (48%) for lung, and dilated cardiomyopathy (39%) for heart. Of our kidney transplants, 29% were living-related or living unrelated donors. Thirty-one (4%) of our transplants were multi-organ including 7 simultaneous liver and lung transplants and one simultaneous heart, lung, and liver transplant. Significant improvements in patient survival occurred for liver and heart transplants, with mortality decreasing by 3% and 4% each year, respectively. Diagnosis of biliary atresia was associated with nearly 50% improved survival within our liver cohort (HR 0.53, CI 0.31- 0.91). Lung allograft survival demonstrated significant improvement with an 8% yearly reduction in failure even with an increase in listed recipients on life support. Kidney transplant recipient survival improved, although this did not reach significance (HR 0.96, CI 0.91 - 1.01).
Conclusion: There was a steady improvement in survival over 35 years despite liberalized donor and recipient criteria. With short wait times on the list (the median wait time for liver transplants was 79 days), more of our sick patients could be rescued with transplantation. Our data suggests it is safe to consider even more marginal donors and even higher acuity recipients for transplantation.
