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

van der Have, Oscar LU orcid ; Wåhlander, Håkan ; Hofbard, Tove ; Abele, Dace ; Alpman, Maria Sjöborg ; Weinreich, Ilse Duus ; Böhmer, Jens ; Nilsson, Johan LU orcid ; Holgersson, Jan and Liedberg, Ann-Sofie LU , et al. (2025) In Pediatric Transplantation 29(6).
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... (More)

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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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Pediatric Transplantation
volume
29
issue
6
article number
e70154
publisher
Wiley-Blackwell
external identifiers
  • pmid:40820386
ISSN
1399-3046
DOI
10.1111/petr.70154
language
English
LU publication?
yes
additional info
© 2025 The Author(s). Pediatric Transplantation published by Wiley Periodicals LLC.
id
86c21c1a-975e-4416-864c-17a9794ea68e
date added to LUP
2025-08-18 15:36:15
date last changed
2025-08-18 16:18:01
@article{86c21c1a-975e-4416-864c-17a9794ea68e,
  abstract     = {{<p>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.</p><p>METHODS: Swedish children &lt; 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).</p><p>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.</p><p>CONCLUSIONS: A high quality of care has been achieved in Sweden, despite modest pHTx numbers, in cooperation with the Scandiatransplant organization.</p>}},
  author       = {{van der Have, Oscar and Wåhlander, Håkan and Hofbard, Tove and Abele, Dace and Alpman, Maria Sjöborg and Weinreich, Ilse Duus and Böhmer, Jens and Nilsson, Johan and Holgersson, Jan and Liedberg, Ann-Sofie and Tran-Lundmark, Karin and Odermarsky, Michal}},
  issn         = {{1399-3046}},
  language     = {{eng}},
  number       = {{6}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Pediatric Transplantation}},
  title        = {{Comprehensive Analysis of the First 35 Years of Pediatric Heart Transplantation in Sweden}},
  url          = {{http://dx.doi.org/10.1111/petr.70154}},
  doi          = {{10.1111/petr.70154}},
  volume       = {{29}},
  year         = {{2025}},
}