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Current availability and status of paediatric cardiac transplantation and mechanical circulatory support in
Oscar van der Have1,2, Esme Dunne3, Karin Tran-Lundmark1,2
1Department of Experimental Medical Science and Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.
Insights
Paediatric heart transplantation (HTx) and mechanical circulatory support (MCS) availability varies significantly across Europe. Standardisation of HTx listing and VAD criteria is challenging, necessitating greater cross-national collaboration to improve outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Pediatric Healthcare
Background:
- Paediatric heart transplantation (HTx) and mechanical circulatory support (MCS) care exhibits significant variation across European nations.
- Existing knowledge highlights differences in transplant service organization and patient care for HTx and MCS patients within Europe.
Purpose of the Study:
- To investigate inter- and intra-country variations in paediatric HTx and MCS availability and practice across Europe.
- To identify factors contributing to heterogeneity in paediatric HTx and MCS services and outcomes.
Main Methods:
- A survey was distributed to paediatric transplant cardiologists across 28 European countries between November 2022 and March 2023.
- Data collection focused on centre density, organ allocation protocols, transplant volumes, VAD program status, resource allocation, and post-transplant care protocols.
Main Results:
- Paediatric HTx centre density varied widely (0.00–5.35 per 10 million inhabitants), with 59% of countries reporting low annual paediatric HTx volumes (<4).
- Ventricular assist device (VAD) programs were operational in 79% of countries, but only 38% had dedicated hospital budget resources for HTx.
- Significant heterogeneity was observed in organ allocation protocols, post-HTx care standardization (44% had national protocols), and intensive care unit bed availability (78% reported limitations).
Conclusions:
- Substantial variation exists in paediatric HTx centre density, VAD availability, listing protocols, and post-HTx management across European countries.
- This heterogeneity complicates the standardization of HTx listing and VAD criteria.
- Enhanced cross-national collaboration is recommended to strengthen HTx and MCS availability and improve patient outcomes, particularly in regions with smaller, neighboring countries.
Abstract:
We sought to investigate the inter- and intra-country variation in paediatric heart transplantation (HTx) and mechanical circulatory support (MCS) availability and practice in Europe. Data was obtained through a survey circulated to paediatric transplant cardiologists identified through the Association of European Paediatric and Congenital Cardiology between November 2022 and March 2023. Twenty-eight respondents from twenty-eight European countries completed the survey. Twenty-four (86%) had paediatric and 25 (89%) had adult congenital HTx services. National paediatric HTx centre density ranged from 0.00 to 5.35 per 10 million inhabitants. Eighteen (64%) countries followed either Eurotransplant or Scandiatransplant protocols for organ allocation and 59% of the surveyed countries had low HTx volumes (< 4 paediatric HTx annually), based on the self-reported numbers. A ventricular assist device (VAD) programme was operational in 22 (79%) countries. In only 9 countries (38%), there were dedicated resources for HTx as part of the hospital budget; however, a vast majority (77%) reported that families suffered no cost when a VAD was utilised. Twenty-one countries (78%) reported limited intensive care unit beds and 14 (54%) reported that HTx impacted on congenital heart surgery cases. Only 12 of 27 countries (44%) had a standardised national protocol for post-HTx care. There was no correlation between paediatric HTx centre density, population or GDP per capita.
Conclusion:
There is a high degree of variation both within and between the surveyed European countries with regard to paediatric HTx centre density, VAD availability, listing protocols, and post-HTx management. Multiple factors contribute to this heterogeneity, which makes standardisation of HTx listing and VAD criteria challenging. Increased cross-national collaborative efforts between European countries may strengthen both HTx and MCS availability and outcomes, especially in regions with several smaller neighbouring countries.
What Is Known:
• The care of paediatric heart transplant (HTx) and mechanical support (MCS) patients varies across Europe.
What Is New:
• This paper elucidates the differences in transplant service organisation and the care of transplant and MCS patients in twenty-eight European countries. • These findings could potentially encourage broader open dialogue and facilitate collaboration across European paediatric HTx centres with development of standardised listing criteria, improved collective European registry data and creation of standards for screening post-HTx patients.
