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Babies put on transplant list before birth get hearts faster
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AHA Scientific Sessions
ORLANDO, Fla. — Listing unborn babies with severe prenatal heart problems results in earlier heart transplants and comparable outcomes when compared with babies added to a transplant list after birth, researchers reported here.
A prospective, multicenter, events-driven data registry was used to determine outcomes of babies listed for heart transplantation before birth. The researchers’ search identified 4,365 children added to a heart transplant list for the study period of 1993 to 2009. Unborn babies comprised 1% and newborns (aged 0 to 30 days) comprised 19.8% of those listed.
The most common indication for fetal listing for heart transplant was congenital heart disease, with left-side obstructive lesions predominating.
Unborn babies were listed for an average 18 days before delivery. About half of the babies listed before birth waited 1 month after birth to receive a transplant while newborn babies waited 3 months, on average. The median wait-list time to heart transplant after birth was 25 days for babies listed before birth vs. 39 days for newborns.
Survival did not differ for babies listed before or after birth (P=.2). Multisystem failure was the most common cause of wait-list death among babies listed before birth and cardiac failure was the most common cause among babies listed after birth.
Of those who survived the heart transplant, mean age at transplant (50 days vs. 66 days), sex (78% vs. 62% male) and race (89% vs. 79% white) were not different between the unborn and newborn listed groups.
“Babies continue to have the highest chance of dying while waiting for a heart transplant due to the shortage of donor organs. Listing a fetus with severe heart disease is one way to try to deal with this shortage, although only a few patients were actually delivered early after receiving a donor offer while in utero. This strategy does not apply to most fetuses but can be considered in specific types of cases because the outcomes after transplant are good,” Jennifer Conway, MD, from the Hospital for Sick Children, Toronto, told Cardiology Today.
“Our hope would be that studies such as this can contribute to increasing community awareness about the difficult outcomes for babies in need of heart transplants and underscore the importance of organ donation,” Conway said. Future research may focus on which fetuses would benefit most from early transplant listing and how to determine whether a fetus should undergo surgery after birth, she added. – by Katie Kalvaitis
For more information:
- Conway J. Abstract #11335. Presented at: American Heart Association Scientific Sessions 2011; Nov. 12-16, 2011; Orlando, Fla.
Disclosure: Dr. Conway reports no relevant financial disclosures.
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