A United Network for Organ Sharing analysis of heart transplantation in adults with congenital heart disease: Outcomes and factors associated with mortality.

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A United Network for Organ Sharing analysis of heart transplantation in adults with congenital heart disease: Outcomes and factors associated with mortality and retransplantation Tara Karamlou, MD, MSc, Jennifer Hirsch, MD, MS, Karl Welke, MD, MS, Richard G. Ohye, MD, Edward L. Bove, MD, Eric J. Devaney, MD, Robert J. Gajarski, MD The Journal of Thoracic and Cardiovascular Surgery Volume 140, Issue 1, Pages 161-168 (July 2010) DOI: 10.1016/j.jtcvs.2010.03.036 Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Immunosuppression trends over time among patients with adult congenital heart disease (ACHD) and adult recipients (ARs). In era 1 patients with ACHD significantly received less aggressive induction than ARs. In era 2, although the induction gap decreased among groups, the prevalence of steroid maintenance was still significantly lower in patients with ACHD compared with that seen in ARs. AI, Any induction with standard agents excluding steroids; SI, steroid induction; SM, steroid maintenance. *P < .05. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 161-168DOI: (10.1016/j.jtcvs.2010.03.036) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Overall risk-unadjusted freedom from death after transplantation. Numbers at bottom inset show the number of patients remaining at risk. Dashed lines enclose 95% confidence intervals. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 161-168DOI: (10.1016/j.jtcvs.2010.03.036) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A, Risk-unadjusted freedom from death for adult recipients stratified by eras demonstrates an improvement in mortality over time, especially within midterm survival. Note the areas of the curves between years 4 and 7 in which the confidence limits do not overlap. Era 1 (1990–1998) is depicted in red, and era 2 (1999–2008) is depicted in blue. Solid circles represent censored patients. Numbers at inset show the number of patients remaining at risk. Dashed lines enclose 95% confidence intervals. B, Risk-unadjusted freedom from death for patients with adult congenital heart disease was equivalent in both eras. Era 1 (1990–1998) is depicted in red, and era 2 (1999–2008) is depicted in blue. Solid circles represent censored patients. Numbers at inset show the number of patients remaining at risk. Dashed lines enclose 95% confidence intervals. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 161-168DOI: (10.1016/j.jtcvs.2010.03.036) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Risk-unadjusted freedom from death stratified by underlying diagnosis, either patients with adult congenital heart disease (ACHD) or adult recipients (ARs). The blue line depicts ARs, and the red line depicts patients with ACHD. Survival is significantly better for ARs than for patients with ACHD, mainly because of an early hazard phase representing increased postoperative mortality for patients with ACHD that persists to 2.5 years after transplantation. Numbers at inset show the patients remaining at risk. Dashed lines enclose 95% confidence intervals. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 161-168DOI: (10.1016/j.jtcvs.2010.03.036) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Risk-unadjusted freedom from retransplantation stratified by underlying diagnosis, either patients with adult congenital heart disease (ACHD) or adult recipients (AR). The blue line depicts ARs, and the red line depicts patients with ACHD. Although the difference is small, note the nearly overlapping confidence intervals, the retransplantation rate is significantly higher for patients with ACHD than for ARs. Dashed lines enclose 95% confidence intervals. The Journal of Thoracic and Cardiovascular Surgery 2010 140, 161-168DOI: (10.1016/j.jtcvs.2010.03.036) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions