Article Impact Level: HIGH Data Quality: STRONG Summary of The Journal of Heart and Lung Transplantation, S1053249825020248. https://doi.org/10.1016/j.healun.2025.05.020 Dr. Oscar van der Have et al.
Points
- Over 38 years, 597 children in the Nordic countries were listed for heart transplantation, with 461 ultimately receiving a new organ, demonstrating a high rate of successful transplantation.
- Waiting list mortality for pediatric heart transplant candidates has impressively decreased from 22.8% in the earliest era to just 6.8% in the most recent period studied.
- Technological advances like VADs are credited with improving survival to transplant, even as the median waiting time for a donor heart nearly doubled from 38 to 63 days.
- Long-term post-transplant survival is excellent, with 78% of recipients alive after 10 years and over half surviving for 30 years, although these rates have not shown significant improvement over time.
- Patients with congenital heart disease face worse survival outcomes compared to those with cardiomyopathies, highlighting a key area for future research and improved clinical management strategies.
Summary
A retrospective analysis of the Scandiatransplant registry from January 1, 1986, to December 31, 2023, evaluated 38 years of pediatric heart transplantation (pHTx) outcomes. The cohort included 597 children (<18 years) listed for pHTx, of whom 461 (77.2%) received a transplant. The regional incidence was 4.0 pHTx per 100,000 live births, with centers performing a median of fewer than four procedures annually. The study divided the cohort into three eras—ERA I (1986-1998), ERA II (1999-2011), and ERA III (2012-2023)—to assess temporal trends. While the distribution of primary diagnoses, such as congenital heart disease (CHD) and cardiomyopathy (CM), did not differ between eras, significant practice changes were observed.
The analysis revealed a marked decrease in waiting list mortality, which fell from 22.8% in ERA I to 6.8% in ERA III. This improvement occurred despite an increase in the median duration of the waiting list. The use of advanced technologies as a bridge to transplant increased substantially; ventricular assist device (VAD) support rose from 6.6% in ERA I to 19.9% in ERA III. Concurrently, the frequency of ABO-incompatible (ABOi) transplants increased from 1.0% to 8.8% over the same period, expanding the donor pool for the youngest recipients. The era of listing was identified as a significant determinant of listing mortality, but not of post-transplant survival.
Post-transplant survival was robust, with rates of 78.0% at 10 years and 51.4% at 30 years. However, these long-term outcomes did not show significant improvement across the eras, a finding attributed to the already excellent short-term survival achieved in early recipients. Survival was significantly worse for patients with a primary diagnosis of CHD compared to those with cardiomyopathies. The study concludes that while advancements in pre-transplant care have dramatically reduced waiting list mortality, future efforts must focus on improving long-term graft survival and managing post-transplant complications.
Link to the article: https://www.jhltonline.org/article/S1053-2498(25)02024-8/fulltext
References
Van Der Have, O., Tran-Lundmark, K., Wåhlander, H., Kaskinen, A. K., Möller, T., Juul, K., Jahnukainen, T., Weinreich, I. D., Sarkola, T., Nilsson, J., & Odermarsky, M. (2025). Pediatric heart transplantation within the Scandiatransplant region—A multinational observational study spanning 38 years. The Journal of Heart and Lung Transplantation, S1053249825020248. https://doi.org/10.1016/j.healun.2025.05.020
