Abstract 16940: Heart Transplant After Failed Single Ventricle Palliation in Young Infants Carries Excess Mortality Risk: A Multi-Institutional Study
Bibliographic record
Abstract
BACKGROUND: Infant heart transplant (HT) recipients have the best long term survival of any age group, but small donor pool and high early mortality limit the therapeutic efficacy. We aimed to determine the relationship between pre-HT diagnosis and early HT outcome to identify infants most likely to benefit from HT. METHODS: The Pediatric Heart Transplant Study (PHTS) database was used to identify 739 infants s/p HT at age ≤6 mths between 1993-2008 divided into the following etiologic groups: cardiomyopathy (CM: 132, 18%); hypoplastic left heart syndrome without prior surgery (HLHS_WOS: 303, 41%); HLHS with surgery (HLHS_WS: 69, 9%); other congenital heart disease without surgery (CHD_WOS: 121, 16%; and other congenital heart disease with surgery (CHD_WS: 114, 15%). Severity of illness at HT, post HT survival, and era effects were compared among the 4 groups. RESULTS: The 1 yr survival for HLHS_WOS (79%) was similar to CHD_WOS (79%) and CHD_WS (82%) but worse than CM (89%). HLHS_WS had the highest mortality w 1 yr survival of 70%, p=0.03. Hazard function analysis showed the difference occurred within the 1st 6 mths after HT. Survival remained poor in the current surgical era for HLHS_WS, 71% (1993-1998) v 70% (1999-2008). Risk factors at HT associated w mortality included age <1 mth (OR 2.5; CI 1.3-4.7, p=0.01), ECMO (OR 3.7; CI 2-6.8, p<0.01), ventilator use (OR 1.8; CI 1-3.2, p=0.04), and HLHS_WS (OR 2.3; CI 1.3-4.1, p<0.01). After adjusting for illness severity, differences in mortality risk persisted across etiologic groups. HLHS_WS (HR 2.3, CI 1.3-4, P<0.01), CHD_WOS (HR 1.8, 1.1-3.1, P= 0.03), and HLHS_WOS (HR 1.7, 1.1-2.8, P=0.02) had significantly higher risk for mortality compared to CM. CONCLUSIONS: Infant HT recipients with different pre-HT diagnoses have strikingly different outcomes after HT that are unchanged over time and seem unrelated to clinical acuity at HT. CM infants have excellent survival, but HLHS_WS represent a high risk group for early mortality after HT.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".