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

David L Sutcliffe; Elizabeth Pruitt; Ryan S Cantor; Justin Godown; John Lane; Mark W Turrentine; Sabrina P Law; Jodie L Lantz; James K Kirklin; Daniel Bernstein; Elizabeth D Blume

doi:10.1016/j.healun.2017.12.004

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

J Heart Lung Transplant. 2018 Jun;37(6):715-722. doi: 10.1016/j.healun.2017.12.004. Epub 2017 Dec 13.

Authors

Affiliations

¹ Department of Pediatric Cardiology, Children's Health Dallas, UT Southwestern, Dallas, Texas, USA. Electronic address: davidsutcliffemd@gmail.com.
² Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama, USA.
³ Department of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital of the Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ Department of Pediatric Critical Care, Phoenix Children's Hospital, Phoenix, Arizona, USA.
⁵ Department of Cardiac Surgery, Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana, USA.
⁶ Department of Pediatric Cardiology, Columbia University-Morgan Stanley Children's Hospital of New York Presbyterian, New York, New York, USA.
⁷ Department of Pediatric Cardiology, Children's Health Dallas, Dallas, Texas, USA.
⁸ Department of Pediatric Cardiology, Lucile Packard Children's Hospital of Stanford University, Palo Alto, California, USA.
⁹ Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

PMID: 29373179
DOI: 10.1016/j.healun.2017.12.004

Abstract

Background: Pediatric ventricular assist device (VAD) support as bridge to transplant has improved waitlist survival, but the effects of pre-implant status and VAD-related events on post-transplant outcomes have not been assessed. This study is a linkage analysis between the PediMACS and Pediatric Heart Transplant Study databases to determine the effects of VAD course on post-transplant outcomes.

Methods: Database linkage between October 1, 2012 and December 31, 2015 identified 147 transplanted VAD patients, the primary study group. The comparison cohort was composed of 630 PHTS patients without pre-transplant VAD support. The primary outcome was post-transplant survival, with secondary outcomes of post-transplant length of stay, freedom from infection and freedom from rejection.

Results: At implant, the VAD cohort was INTERMACS Profile 1 in 33 (23%), Profile 2 in 89 (63%) and Profile 3 in 14 (10%) patients. The VAD cohort was older, larger, and less likely to have congenital heart disease (p < 0.0001). However, they had greater requirements for inotrope and ventilator support and increased liver and renal dysfunction (p < 0.0001), both of which normalized at transplant after device support. Importantly, there were no differences in 1-year post-transplant survival (96% vs 93%, p = 0.3), freedom from infection (81% vs 79%, p = 0.9) or freedom from rejection (71% vs 74%, p = 0.87) between cohorts.

Conclusions: Pediatric VAD patients have post-transplant outcomes equal to that of medically supported patients, despite greater pre-implant illness severity. Post-transplant survival, hospital length of stay, infection and rejection were not affected by patient acuity at VAD implantation or VAD-related complications. Therefore, VAD as bridge to transplant mitigates severity of illness in children.

Keywords: PHTS; PediMACS; Pediatric Heart Transplant Study; VAD; heart transplant; pediatric; ventricular assist device.

MeSH terms

Adolescent
Child
Child, Preschool
Combined Modality Therapy
Databases, Factual
Female
Heart Failure / surgery*
Heart Transplantation*
Heart-Assist Devices*
Humans
Infant
Male
Postoperative Complications / epidemiology
Registries
Retrospective Studies
Treatment Outcome
United States