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Deficits in Pre- and Post-transplant Functional, Motor, and Cognitive Deficits Associated With Graft Failure and
Conor Donnelly1, Suhani S Patel1, Teresa Po-Yu Chiang1
1Department of Surgery, Transplant Institute, NYU Langone Health, New York, New York, USA.
Insights
Pediatric heart transplant recipients often have pre-existing functional deficits that persist post-transplant. These deficits significantly increase the risk of graft failure and mortality, highlighting the need for early interventions.
Area of Science:
- Pediatric Cardiology
- Transplant Medicine
- Quality of Life Research
Background:
- Pretransplant functional, motor, cognitive, and academic deficits are prevalent in pediatric heart transplant (HT) candidates.
- These deficits can persist after heart transplantation, impacting long-term outcomes.
- Quality of life (QoL) impairments are a significant concern in this patient population.
Purpose of the Study:
- To assess the association between pre- and post-transplant QoL deficits and outcomes in pediatric heart transplant recipients.
- To evaluate the impact of functional, motor, cognitive, and academic status on graft survival and patient mortality.
- To identify potential targets for intervention to improve post-HT QoL and outcomes.
Main Methods:
- Utilized data from the SRTR (2008-2023) for pediatric HT recipients.
- Evaluated functional, motor, cognitive, and academic status from listing up to 15 years post-HT.
- Employed Cox regression models to compare all-cause graft survival and analyzed associations with graft failure.
Main Results:
- A high percentage of patients (85.3%) had pre-HT functional status ≤80%; 53.1% had academic limitations, decreasing to 15.2% postoperatively.
- Cognitive deficits (17.4%) and motor delays (18.6%) were observed pre-HT and remained stable post-HT.
- Both pre- and post-HT functional deficits were associated with worse graft survival, with post-HT status showing a stronger association (aHR=1.18).
Conclusions:
- Decreased functional status in pediatric HT recipients is linked to increased risk of graft failure and mortality.
- Early intervention strategies targeting functional status improvement may benefit these patients.
- Addressing pre- and post-transplant QoL deficits is crucial for optimizing long-term outcomes in pediatric heart transplantation.
Background:
Pretransplant functional, motor, cognitive, and academic deficits are common in pediatric patients requiring heart transplantation (HT); some persist post-HT. We assessed the association between these quality of life (QoL) deficits and post-HT outcomes.
Methods:
Using SRTR data 2008-2023, we evaluated the functional, motor, cognitive, and academic status of pediatric HT recipients from listing to 15 years post-HT. We compared all-cause graft survival among patients with vs. without pre-HT deficits using Cox regressions. Among patients with a functioning graft at 1 year, we assessed the association between deficits at that time and subsequent graft failure.
Results:
In 6153 HT recipients, 85.3% had pre-HT functional status ≤ 80%, 53.1% of patients could not tolerate a full academic load; this decreased to 15.2% and 15.0% postoperatively, and was sustained. Definite or probable cognitive deficits were seen in 17.4% of patients and motor delays in 18.6%; both remained stable post-HT at 18.0% and 16.4%, respectively. Graft survival was worse in those with either pre- or post-HT deficits in functional status. Worse pre-HT functional status was associated with risk of graft failure (adjusted hazard ratio [aHR] per 10% decrease = 1.03 1.06 1.08, p < 0.001); worse 1-year post-HT functional status was much more strongly associated with risk of graft failure (aHR = 1.13 1.18 1.23, p < 0.001).
Conclusion:
Pediatric HT recipients with decreased functional status are at higher risk for graft failure and mortality. These patients may benefit from early intervention aimed at improving functional status.
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