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Post-transplant outcomes in pediatric ventricular assist device patients: A PediMACS-Pediatric Heart Transplant Study

David L Sutcliffe1, Elizabeth Pruitt2, Ryan S Cantor2

  • 1Department of Pediatric Cardiology, Children's Health Dallas, UT Southwestern, Dallas, Texas, USA.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|January 27, 2018
PubMed

Insights

Pediatric ventricular assist device (VAD) support improves waitlist survival for children needing heart transplants. Post-transplant outcomes, including survival and rejection rates, are similar to those without VAD support, indicating VADs mitigate pre-implant illness severity.

Area of Science:

  • Pediatric cardiology
  • Transplant medicine
  • Mechanical circulatory support

Background:

  • Pediatric ventricular assist device (VAD) use as a bridge to heart transplantation has improved survival on the waitlist.
  • The impact of pre-implant status and VAD-related events on post-transplant outcomes remains understudied.

Purpose of the Study:

  • To determine the effects of pre-implant status and VAD course on post-transplant outcomes in pediatric heart transplant recipients.
  • To link PediMACS and Pediatric Heart Transplant Study (PHTS) databases for comprehensive analysis.

Main Methods:

  • A linkage analysis was performed between the PediMACS and PHTS databases.
  • 147 pediatric patients who received a VAD and subsequently underwent heart transplantation between October 2012 and December 2015 were analyzed.
  • A comparison cohort of 630 PHTS patients without pre-transplant VAD support was used.

Main Results:

  • The VAD cohort exhibited greater pre-implant illness severity, including higher requirements for inotropic and ventilator support, and increased liver and renal dysfunction.
  • Despite this, post-transplant outcomes were comparable between the VAD and non-VAD cohorts.
  • Specifically, 1-year post-transplant survival (96% vs 93%), freedom from infection (81% vs 79%), and freedom from rejection (71% vs 74%) showed no significant differences.

Conclusions:

  • Pediatric patients supported with VADs as a bridge to transplant achieve post-transplant outcomes comparable to those supported medically.
  • Pre-implant illness severity and VAD-related complications did not negatively impact post-transplant survival, length of stay, infection, or rejection rates.
  • VAD support effectively mitigates the severity of illness in children awaiting heart transplantation.
Abstract

Keywords:
PHTSPediMACSPediatric Heart Transplant StudyVADheart transplantpediatricventricular assist device

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