Purpose: To profile the waitlist time and mortality in pediatric patients, and to assess risk factors for longer waiting times and for waitlist mortality.

Institutional review of patients listed for HTx (1990-2008). Competing risk analysis to model survival to HTx, death on waitlist, delisting, or improvement. Associated factors sought in multivariable parametric survival models.

308 listings in 280 patients (2 in 18; 3 in 5 patients). Median age at listing was 1.6y (0-17.9y). Competing risk analysis: 1 month after listing 47% remained listed (transplanted at 1 month: 33%; deceased/delisted at 1 month: 15%); 5 months later 11% remained listed (transplanted at 6 months: 62%; deceased/delisted at 6 months: 19%). Younger patients had the highest waitlist mortality: n=72 age 0-1 month (54% transplanted at 6 months;28% deceased/delisted at 6 months), n=63 age 1-12 months (67%;20%), n=55 age 1-5 years (53%;25%) and n=128 age >5 years (69%;10%). Diagnosis was associated with differing waitlist mortality: congenital heart disease, n=179 (53%;22%); cardiomyopathy, n=107 (73%;15%); allograft vasculopathy, n=12 (58%;8%); primary graft failure, n=10 (70%;30%). Blood group: O, n=149 (52%;19%); A, n=105 (77%;14%); B, n=41 (63%;27%); AB, n=13 (46%;38%). 38 were on a VAD(24 ECMO, 14 Berlin), waitlist mortality of 38% on ECMO; 14% on Berlin Heart.

Blood groups O/B, younger patients and patients with congenital heart disease waited the longest. Higher status patients and those on mechanical support had the shortest wait times but the highest mortality. Berlin heart reduced mortality by more than half. These need to be considered when listing for HTx.