The impact of cognitive delay on pediatric heart transplant outcomes

Area of Science:

• Pediatric Cardiology
• Transplant Surgery
• Developmental Pediatrics

Background:

• Congenital defects (CD) are a relative contraindication for pediatric heart transplantation (HTx).
• The impact of CD on pediatric HTx outcomes, particularly cognitive performance, is not well understood.
• Academic progress serves as a surrogate measure for cognitive function in pediatric patients.

Purpose of the Study:

• To evaluate the effect of CD on pediatric HTx outcomes.
• To assess the association between developmental learning (DL) delays and the need for special education (SE) with post-HTx graft survival.
• To identify factors influencing long-term graft survival in pediatric HTx recipients with CD.

Main Methods:

• Utilized the Organ Procurement and Transplantation Network (OPTN) database for pediatric HTx recipients from 2004-2014.
• Included patients with reported academic progress data.
• Employed multivariable analysis to determine the impact of DL and SE on post-HTx graft survival.

Main Results:

• A total of 2245 children were analyzed: 76% within grade level, 12% with DL, and 12% requiring SE.
• The need for SE was not a significant risk factor for post-HTx mortality.
• Developmental learning delays (DGL) independently predicted worse post-HTx outcomes (AHR 1.4, P=.03).

Conclusions:

• Pediatric HTx recipients requiring SE demonstrated similar outcomes to those without CD, potentially due to enhanced parental involvement.
• Children with DL exhibited poorer post-HTx survival, possibly linked to reduced parental oversight.
• Enhanced social support for pediatric HTx patients with CD may improve graft survival and overall outcomes.