Mechanical Support Before Transplantation Improves Survival for Pediatric Heart Failure Patients
Published April 2022 | ASAIO Journal
Data from children with end-stage heart failure shows that pediatric ventricular assist devices (VADs) make many patients better transplant candidates, improves their endorgan function at transplantation and significantly improves post-transplant survival. The study, based on the first 1,200 children to receive VADs as bridges to transplantation, was led by Cincinnati Children’s cardiothoracic surgery research fellow Karthik Thangappan, MD, and David Morales, MD. Without mechanical circulatory support (MCS), pediatric patients often do not survive their time on organ waiting lists.
“This was the largest ever report of pediatric VAD patients from the U.S.,” Morales says. “In 2004, only four VADs had been placed in the U.S. This shows what our field has achieved together, with cooperation.”
Researchers identified pediatric MCS patients from the vast United Network for Organ Sharing database, then divided the data into three eras: first (2005-2009), second (2010-2014) and third (2015-2019). Findings include:
More MCS patients were successfully bridged to transplantation in the third era (28%) compared to the first era (16%) and second era (24%).
The proportion of patients discharged on VAD healthy enough to wait at home for a possible transplant increased from 3% to 22%.
One-year survival post-transplant reached 96% in the third era and three-year survival reached 89%, both improvements compared to the previous eras.
Renal dysfunction, ventilator dependence, inotrope use and functional status all improved for patients on MCS while waiting for transplantation. Now with a large database, researchers plan to focus future studies on more specific questions and larger goals.
“This is the first step toward our ultimate goal of creating a predictive tool on an AI platform to inform clinicians and families about the outcomes they can expect after VAD implantation,” Morales says.
More than 1,200 Children BTT with MCS
MCS Bridge vs. No-MCS Bridge to Transplant
The proportion of pediatric heart transplant recipients bridged to transplant over the years. Stacked bar plot denoted the yearly proportion of pediatric heart transplants using and not using mechanical circulatory support to bridge to transplantation (BTT) over the 15-year study period.
Numbers on top of bars denote the total number of pediatric heart transplantations in the given year.
*The 2019 total reflects only the first three months of the year. Censored events are standard for Kaplan-Meier analysis: only account for any lack of post-transplant follow-up survival data.
