Children who stroke on VAD support: When is it safe to transplant and what are their outcomes?

Area of Science:

• Pediatric Cardiology
• Transplantation Medicine
• Neurology

Background:

• Ventricular assist devices (VADs) improve survival for pediatric heart transplant candidates.
• Stroke remains a significant risk for patients on VAD support.
• Understanding the impact of pre-transplant stroke on post-transplant outcomes is crucial.

Purpose of the Study:

• To analyze the impact of strokes occurring during VAD support on post-heart transplant outcomes in children.
• To compare survival rates and other outcomes between pediatric patients with and without pre-transplant strokes on VADs.

Main Methods:

• A retrospective analysis of 520 pediatric heart transplant candidates (<18 years) who received a VAD between January 2011 and April 2018.
• Data were matched between the United Network of Organ Sharing and Pediatric Health Information System databases.
• Patients were categorized into pre-transplant stroke and no-stroke cohorts.

Main Results:

• 81% of patients were transplanted; 28% experienced a pre-transplant stroke.
• Patients with stroke were transplanted later (median 57 days) compared to the no-stroke cohort (significantly higher transplant rate in no-stroke group).
• No significant difference in post-transplant survival was observed between the stroke and no-stroke groups (p=0.440). Patients transplanted >60 days post-stroke had comparable survival to no-stroke patients.

Conclusions:

• Pediatric patients transplanted after experiencing a stroke on VAD support demonstrate similar long-term survival to those without a stroke.
• Allowing a longer recovery period after stroke before transplantation may potentially improve outcomes, though optimal timing remains undetermined.
• Larger, more detailed studies are required to establish the ideal interval between stroke and heart transplantation.