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Extracorporeal membrane oxygenation support after pediatric orthotopic heart transplantation
Jennifer A Su1, Robert B Kelly, Tristan Grogan
1Department of Pediatrics, Mattel Children's Hospital UCLA, Los Angeles, CA, USA.
Insights
Extracorporeal membrane oxygenation (ECMO) successfully supports pediatric heart transplant patients with graft dysfunction or rejection. This mechanical circulatory support demonstrates a 62% survival rate to hospital discharge in critically ill children.
Area of Science:
- Pediatric Cardiology
- Cardiothoracic Surgery
- Critical Care Medicine
Background:
- Mechanical circulatory support (MCS) aids cardiac recovery from ischemia and injury.
- Limited pediatric data exist on extracorporeal membrane oxygenation (ECMO) for post-heart transplant complications.
- Primary graft dysfunction and rejection are significant concerns after pediatric heart transplantation (OHT).
Purpose of the Study:
- To evaluate the efficacy of ECMO in pediatric patients following OHT.
- To assess ECMO's role in managing primary graft dysfunction and rejection post-OHT.
- To determine survival rates associated with ECMO use in this specific pediatric population.
Main Methods:
- Retrospective analysis of pediatric OHT patients requiring ECMO support between 1998 and 2010.
- Inclusion criteria: OHT recipients at a tertiary care children's hospital needing ECMO for post-transplantation cardiac failure.
- Primary outcome: Survival to hospital discharge.
Main Results:
- Out of 203 pediatric OHT patients, 29 required ECMO for post-transplantation cardiac failure.
- Overall survival to hospital discharge was 62% (18 out of 29 patients).
- Survival rates varied: 75% for rejection/allograft vasculopathy and 53% for primary graft failure (p=0.273).
Conclusions:
- ECMO is a viable hemodynamic support option for pediatric OHT recipients.
- Successful application of ECMO in primary graft dysfunction and rejection cases is demonstrated.
- Survival outcomes were not significantly influenced by ischemic time or ECMO duration.
Abstract:
Mechanical circulatory support has been used for more than 30 yr to allow the heart to recover from ischemia and injury. There are limited pediatric data, however, on the efficacy of ECMO in the setting of post-transplantation support for primary graft dysfunction or rejection. Data from all patients at our university-affiliated, tertiary care children's hospital who underwent OHT between 1998 and 2010 and required subsequent ECMO support were analyzed. The primary outcome measure was survival to hospital discharge. Two hundred and three pediatric patients underwent OHT between 1998 and 2010 at our institution. Twenty-nine of these patients experienced post-transplantation cardiac failure requiring ECMO support, 18 of whom survived to hospital discharge (62%). Survival in the rejection and allograft vasculopathy group was 75%, and survival in patients with primary graft failure was 53% after ECMO support (p = 0.273). Patient survival to hospital discharge was not associated with ischemic time or duration of ECMO. ECMO provides hemodynamic support in the setting of cardiac failure and can be used successfully after pediatric OHT for primary graft dysfunction or rejection.
