Objective: To determine neurodevelopmental outcomes and their predictors in children after cardiac transplantation.

Methods: Children <6yrs having cardiac transplant between 2000-2008 had demographic, preoperative recipient and donor, operative, and postoperative variables recorded. The association of variables with outcomes >6mos post-transplant were determined by univariate and multiple regression analyses.

Results: Thirty-seven children (25 [65%] male) had transplantation at age 268 [IQR 82-820] days, with 4 (11%) deaths. Twenty-nine (88%) of survivors had neuro-developmental assessment 19±8mos after transplantation (age 32±13mos). Between the congenital heart disease (CHD)(15) and non-CHD(14) groups there was no difference in pre-transplant days ventilated, highest creatinine, lactate, inotrope score, time to transplant, urgency of transplant, age or size at transplant, panel reactive antibodies, ischemic time, or donor weight (p>0.05). Patients with CHD had longer cardiopulmonary-bypass times, more hypothermic circulatory-arrest, and higher post-operative inotrope scores, lactate, and days of ventilation (p<0.05). Thirteen (45%) had disability: cerebral palsy (3), visual impairment (3), sensorineural hearing loss (2), epilepsy (1), isolated mental delay (6) [total mental delay 11 (38%)]. The Adaptive Behaviour Assessment System-General Adaptive Composite was 74±20 (normative mean 100±15) and Motor Score was 6.5±4.3 (normative mean 10±3). On multivariate logistic regression only year of transplant predicted death (OR 0.28; 95% CI .09-0.91); and CHD predicted disability (OR 14.3; 95% CI 1.4-143.7).

Conclusion: A significant proportion of children after cardiac transplantation have disability and below-average developmental scores. Patients with CHD are more likely to have disability. These data should help to appropriately counsel parents prior to proceeding with transplantation.