Comprehensive Analysis of the First 35 Years of Pediatric Heart Transplantation in Sweden.

IF 1.4 4区医学 Q3 PEDIATRICS

Pediatric Transplantation Pub Date : 2025-09-01 DOI:10.1111/petr.70154

Oscar van der Have, Håkan Wåhlander, Tove Hofbard, Dace Abele, Maria Sjöborg Alpman, Ilse Duus Weinreich, Jens Böhmer, Johan Nilsson, Jan Holgersson, Ann-Sofie Liedberg, Karin Tran-Lundmark, Michal Odermarsky

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Abstract

Background: The first 35 years of pediatric heart transplantation (pHTx) in Sweden were investigated to determine outcomes following listing and transplantation, investigate sub-populations of recipients, and describe the presence of donor-specific antibodies (DSA) in a contemporary cohort.

Methods: Swedish children < 18 years, listed from 1/1/1989 to 31/12/2023, were included. The cohort was split based on the era of transplantation (ERA I: 1989-2008, ERA II: 2009-2023).

Results: A total of 254 children were listed and 185 (72.8%) reached pHTx, with no loss to follow-up. Waiting list duration was 62 days and increased over time, while mortality on the waiting list decreased (30.5% in ERA I, 8.8% in ERA II). Congenital heart disease was the etiology of heart failure in 36.2% of recipients, including 24.9% with univentricular physiology. The frequency of ABO-incompatible transplantations was 9.3% and 8.0% were considered to be at high immunological risk pre-pHTx due to pre-formed HLA-antibodies with mean fluorescence intensity ≥ 5000. Ventricular assist device (VAD) was used in 26.9% of recipients. Long-term survival was not affected by age, heart failure etiology, the use of pre-transplant VAD, or elevated baseline indexed pulmonary vascular resistance. Era of transplantation was a determinant of listing, but not post-pHTx outcome. Survival at 1-, 10-, and 30-year follow-up was 94.5%, 79.4%, and 57.1%, respectively. Of the total de novo DSA burden, 45.9% were HLA-DQ-type specific. Re-transplantation was performed in 5.9% of recipients.

Conclusions: A high quality of care has been achieved in Sweden, despite modest pHTx numbers, in cooperation with the Scandiatransplant organization.

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瑞典前35年儿童心脏移植的综合分析

背景：对瑞典前35年的儿童心脏移植（pHTx）进行了调查，以确定清单和移植后的结果，调查受体亚群，并描述当代队列中供体特异性抗体（DSA）的存在。结果：共纳入254例儿童，185例（72.8%）达到pHTx，随访无损失。等待名单的时间为62天，并且随着时间的推移而增加，而等待名单上的死亡率下降（ERA I为30.5%，ERA II为8.8%）。先天性心脏病是36.2%的受者心力衰竭的病因，其中24.9%为单心室生理。abo血型不相容移植的发生率为9.3%，其中8.0%的患者在phtx前存在较高的免疫风险，因为预形成的hla抗体平均荧光强度≥5000。26.9%的受者使用心室辅助装置（VAD）。长期生存率不受年龄、心力衰竭病因、移植前VAD使用或基线指标肺血管阻力升高的影响。移植时代是上市的决定因素，但不是phtx后的结果。随访1年、10年和30年的生存率分别为94.5%、79.4%和57.1%。在总新发DSA负担中，45.9%是hla - dq型特异性的。5.9%的受者进行了再次移植。结论：在瑞典，尽管pHTx数量不多，但与斯堪的纳维亚移植组织合作，实现了高质量的护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Transplantation 医学-小儿科

CiteScore

2.90

自引率

15.40%

发文量

216

审稿时长

3-8 weeks

期刊介绍： The aim of Pediatric Transplantation is to publish original articles of the highest quality on clinical experience and basic research in transplantation of tissues and solid organs in infants, children and adolescents. The journal seeks to disseminate the latest information widely to all individuals involved in kidney, liver, heart, lung, intestine and stem cell (bone-marrow) transplantation. In addition, the journal publishes focused reviews on topics relevant to pediatric transplantation as well as timely editorial comment on controversial issues.