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 Turrentine, Sabrina P. Law, Jodie L. Lantz, James K. Kirklin, Daniel Bernstein, Elizabeth D. Blume

Research output: Contribution to journalArticle

6 Citations (Scopus)

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.

Original languageEnglish (US)
JournalJournal of Heart and Lung Transplantation
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Heart-Assist Devices
Pediatrics
Transplants
Length of Stay
Infection
Databases
Patient Acuity
Mechanical Ventilators
Liver Diseases
Heart Diseases

Keywords

  • Heart transplant
  • Pediatric
  • Pediatric Heart Transplant Study
  • PediMACS
  • PHTS
  • VAD
  • Ventricular assist device

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Post-transplant outcomes in pediatric ventricular assist device patients : A PediMACS-Pediatric Heart Transplant Study linkage analysis. / Sutcliffe, David L.; Pruitt, Elizabeth; Cantor, Ryan S.; Godown, Justin; Lane, John; Turrentine, Mark; Law, Sabrina P.; Lantz, Jodie L.; Kirklin, James K.; Bernstein, Daniel; Blume, Elizabeth D.

In: Journal of Heart and Lung Transplantation, 01.01.2018.

Research output: Contribution to journalArticle

Sutcliffe, David L. ; Pruitt, Elizabeth ; Cantor, Ryan S. ; Godown, Justin ; Lane, John ; Turrentine, Mark ; Law, Sabrina P. ; Lantz, Jodie L. ; Kirklin, James K. ; Bernstein, Daniel ; Blume, Elizabeth D. / Post-transplant outcomes in pediatric ventricular assist device patients : A PediMACS-Pediatric Heart Transplant Study linkage analysis. In: Journal of Heart and Lung Transplantation. 2018.
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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.",
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T2 - A PediMACS-Pediatric Heart Transplant Study linkage analysis

AU - Sutcliffe, David L.

AU - Pruitt, Elizabeth

AU - Cantor, Ryan S.

AU - Godown, Justin

AU - Lane, John

AU - Turrentine, Mark

AU - Law, Sabrina P.

AU - Lantz, Jodie L.

AU - Kirklin, James K.

AU - Bernstein, Daniel

AU - Blume, Elizabeth D.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - Heart transplant

KW - Pediatric

KW - Pediatric Heart Transplant Study

KW - PediMACS

KW - PHTS

KW - VAD

KW - Ventricular assist device

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