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 language | English (US) |
|---|---|
| Journal | Journal of Heart and Lung Transplantation |
| DOIs | |
| State | Accepted/In press - Jan 1 2018 |
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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 journal › Article
}
TY - JOUR
T1 - Post-transplant outcomes in pediatric ventricular assist device patients
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
UR - http://www.scopus.com/inward/record.url?scp=85040617128&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85040617128&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2017.12.004
DO - 10.1016/j.healun.2017.12.004
M3 - Article
AN - SCOPUS:85040617128
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
SN - 1053-2498
ER -