Contemporary Waitlist and Post-Heart Transplant Outcomes for Fontan patients: An International Multi-Institutional Analysis.
Document Type
Article
Publication Date
2-2026
Identifier
DOI: 10.1016/j.cardfail.2025.08.028
Abstract
BACKGROUND: Pediatric patients with Fontan circulation represent a growing, high-risk cohort of heart transplant (HT) candidates. However, contemporary multi-institutional data on their waitlist and post-transplant outcomes are limited.
METHODS: We conducted a retrospective analysis of children aged 2 to < 18 years listed for HT in the Pediatric Heart Transplant Society database from 1993 to 2023. Patients were categorized as having Fontan circulation, non-Fontan congenital heart disease (CHD), or cardiomyopathy (CMP). Outcomes were analyzed across early (1993-2014) and current (2015-2023) eras. Cox proportional hazards models identified risk factors for waitlist mortality and post-transplant graft loss.
RESULTS: Among 6061 listed patients, 22.3% had Fontan circulation, 24.1% non-Fontan CHD, and 53.6% CMP. In the current era, 54.6% of CHD listings are Fontan patients. Fontan patients were significantly less likely to receive ventricular assist device (VAD) support at listing (2.6%) or transplant (4.7%) compared to CMP (16.4%, 29.5%; P < .001). Waitlist survival has improved significantly, with no differences among diagnostic groups in the current era (P = .109). However, Fontan patients had a 2-fold higher risk of post-transplant graft loss compared to CMP (HR 1.99, P < .0001) and experienced higher rates of post-transplant infection and malignancy (P < .05). Among Fontan patients, VAD-supported individuals had similar post-transplant survival to those without mechanical support and significantly better survival than those supported with extracorporeal membrane oxygenation (P < .0001).
CONCLUSIONS: Fontan patients now represent the largest CHD subgroup listed for HT. While waitlist outcomes have improved, posttransplant outcomes remain inferior. Selective and timely use of VAD support may improve survival in this high-risk population.
Journal Title
Journal of cardiac failure
Volume
32
Issue
2
First Page
430
Last Page
438
MeSH Keywords
Humans; Heart Transplantation; Retrospective Studies; Fontan Procedure; Waiting Lists; Female; Child; Male; Child, Preschool; Adolescent; Heart Defects, Congenital; Treatment Outcome; Risk Factors; Follow-Up Studies; Infant; Survival Rate
PubMed ID
41224169
Keywords
Fontan; Pediatric; cardiomyopathy; congenital heart disease; graft loss; heart transplant; transplant outcomes; waitlist outcomes
Recommended Citation
Amdani S, Bedzra E, Koehl D, et al. Contemporary Waitlist and Post-Heart Transplant Outcomes for Fontan patients: An International Multi-Institutional Analysis. J Card Fail. 2026;32(2):430-438. doi:10.1016/j.cardfail.2025.08.028
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