Trends in Survival on the Pediatric Heart Transplant Waiting List

Area of Science:

• Pediatric Cardiology
• Transplant Surgery
• Medical Device Technology

Background:

• Pediatric heart failure management has advanced, necessitating updated survival outcome evaluations for children on the heart transplant waiting list.
• Mechanical circulatory support devices are increasingly used in pediatric patients, impacting waitlist survival.
• Understanding long-term survival trends is crucial for optimizing care for pediatric heart transplant candidates.

Purpose of the Study:

• To examine survival rates of pediatric patients (ages 0-18) on the heart transplant waiting list between 1987 and 2023.
• To identify factors influencing survival outcomes in this population.
• To assess the impact of advancements in medical care and policy on pediatric heart transplant waitlist survival.

Main Methods:

• Retrospective analysis of the United Network for Organ Sharing (UNOS) database.
• Inclusion of 18,536 pediatric candidates (ages 0-18) listed for heart transplant from 1987-2023, excluding those over 18 and combined transplant candidates.
• Kaplan-Meier survival curves and competing risk analysis models were used to assess survival, with waitlist mortality as the primary outcome.

Main Results:

• One-year survival for pediatric waitlist candidates significantly improved from 21.1% (1987-1990) to 70.5% (2021-2023) (P < .05).
• Adjusted analyses demonstrated a consistent reduction in mortality risk across different time eras.
• Key variables analyzed included BMI, dialysis, ECMO, VADs, and functional status at listing.

Conclusions:

• Survival for pediatric heart transplant candidates has markedly improved over the study period.
• Advancements in mechanical support devices and changes in organ allocation policies have contributed to better outcomes.
• Future research should focus on refining pediatric transplant criteria and further exploring the role of assist devices in enhancing waitlist survival.