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

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:37

Article

Sutcliffe, David L.¹  Pruitt, Elizabeth²  Cantor, Ryan S.²  Godown, Justin³  Lane, John⁴  Turrentine, Mark W.⁵  Law, Sabrina P.⁶  Lantz, Jodie L.⁷  Kirklin, James K.²  Bernstein, Daniel⁸  Blume, Elizabeth D.⁹ 

[1] UT Southwestern, Childrens Hlth Dallas, Dept Pediat Cardiol, 1935 Med Dist Dr, Dallas, TX 75235 USA

[2] Univ Alabama Birmingham, Kirklin Inst Res Surg Outcomes, Birmingham, AL USA

[3] Vanderbilt Univ, Med Ctr, Monroe Carell Jr Childrens Hosp, Dept Pediat Cardiol, Nashville, TN USA

[4] Phoenix Childrens Hosp, Dept Pediat Crit Care, Phoenix, AZ USA

[5] Indiana Univ Hlth, Riley Hosp Children, Dept Cardiac Surg, Indianapolis, IN USA

[6] Columbia Univ, Morgan Stanley Childrens Hosp New York Presbyteri, Dept Pediat Cardiol, New York, NY USA

[7] Childrens Hlth Dallas, Dept Pediat Cardiol, Dallas, TX USA

[8] Stanford Univ, Lucile Packard Childrens Hosp, Dept Pediat Cardiol, Palo Alto, CA 94304 USA

[9] Harvard Med Sch, Boston Childrens Hosp, Dept Cardiol, Boston, MA USA

关键词: pediatric;    ventricular assist;    device;    VAD;    heart transplant;    PediMACS;    Pediatric Heart Transplant Study;    PHTS;   

DOI  :  10.1016/j.healun.2017.12.004

来源: Elsevier

【 摘 要 】

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 (C) 2017 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

Free