BACKGROUND: Earlier reviews have reported unacceptably high incidence of pediatric heart transplant (PHT) waiting list mortality. An increase in ventricular assist devices (VAD) suggests a potential positive effect. This study evaluated PHT waiting list mortality in the era of pediatric VADs. METHODS: United Network of Organ Sharing (UNOS) database from 1999 to 2012 showed 5,532 pediatric candidates (aged ≤ 18 years) actively listed for PHT: 2,191 were listed in 1999 to 2004 (Era 1) and 3,341 were listed in 2005 to 2012 (Era 2). RESULTS: Waiting list mortality was lower in Era 2 (8%) vs Era 1 (16%; p < 0.001). VAD therapy was used more frequently in Era 2 (16%) than in Era 1 (6%; p < 0.001) and was associated with better waiting list survival (p < 0.001). There were more UNOS Status 1A patients in Era 2 (80%) vs Era 1 (68%; p < 0.001). Independent predictors of waiting list mortality included weight < 10 kg (odds ratio [OR], 2.7 95% confidence interval [CI], 1.1-6.9), congenital heart disease diagnosis (OR, 2.4; 95% CI, 1.9-3.0), blood type O (OR, 2.2; 95% CI, 1.8-2.8)], extracorporeal membrane oxygenation (OR, 1.5; 95% CI, 1.1-2.2), mechanical ventilation (OR, 1.8; 95% CI, 1.4-2.3), and renal dysfunction (OR 1.6; 95% CI, 1.2-2.0). Independent predictors of survival on the waiting list included VAD therapy (OR 4.2; 95% CI, 2.4-7.6), cardiomyopathy diagnosis (OR 3.3; 95% CI, 2.4-4.6), blood type A (OR, 2.2; 95% CI, 1.8-2.8), UNOS list Status 1B (OR, 1.9; 95% CI, 1.2-3.0), listed in Era 2 (OR 1.8; 95% CI, 1.4-2.2), and white race (OR 1.3; 95% CI, 1.1-1.6). CONCLUSIONS: Despite an increase in the number of children listed as Status 1A, there was more than a 50% reduction in waiting list mortality in the new era. Irrespective of other factors, patients supported with a VAD were 4 times more likely to survive to transplant.
BACKGROUND: Earlier reviews have reported unacceptably high incidence of pediatric heart transplant (PHT) waiting list mortality. An increase in ventricular assist devices (VAD) suggests a potential positive effect. This study evaluated PHT waiting list mortality in the era of pediatric VADs. METHODS: United Network of Organ Sharing (UNOS) database from 1999 to 2012 showed 5,532 pediatric candidates (aged ≤ 18 years) actively listed for PHT: 2,191 were listed in 1999 to 2004 (Era 1) and 3,341 were listed in 2005 to 2012 (Era 2). RESULTS: Waiting list mortality was lower in Era 2 (8%) vs Era 1 (16%; p < 0.001). VAD therapy was used more frequently in Era 2 (16%) than in Era 1 (6%; p < 0.001) and was associated with better waiting list survival (p < 0.001). There were more UNOS Status 1A patients in Era 2 (80%) vs Era 1 (68%; p < 0.001). Independent predictors of waiting list mortality included weight < 10 kg (odds ratio [OR], 2.7 95% confidence interval [CI], 1.1-6.9), congenital heart disease diagnosis (OR, 2.4; 95% CI, 1.9-3.0), blood type O (OR, 2.2; 95% CI, 1.8-2.8)], extracorporeal membrane oxygenation (OR, 1.5; 95% CI, 1.1-2.2), mechanical ventilation (OR, 1.8; 95% CI, 1.4-2.3), and renal dysfunction (OR 1.6; 95% CI, 1.2-2.0). Independent predictors of survival on the waiting list included VAD therapy (OR 4.2; 95% CI, 2.4-7.6), cardiomyopathy diagnosis (OR 3.3; 95% CI, 2.4-4.6), blood type A (OR, 2.2; 95% CI, 1.8-2.8), UNOS list Status 1B (OR, 1.9; 95% CI, 1.2-3.0), listed in Era 2 (OR 1.8; 95% CI, 1.4-2.2), and white race (OR 1.3; 95% CI, 1.1-1.6). CONCLUSIONS: Despite an increase in the number of children listed as Status 1A, there was more than a 50% reduction in waiting list mortality in the new era. Irrespective of other factors, patients supported with a VAD were 4 times more likely to survive to transplant.
Authors: Brody Wehman; Kristen A Stafford; Gregory J Bittle; Zachary N Kon; Charles F Evans; Keshava Rajagopal; Nicholas Pietris; Sunjay Kaushal; Bartley P Griffith Journal: Ann Thorac Surg Date: 2016-02-22 Impact factor: 4.330
Authors: J Timothy Baldwin; Iki Adachi; John Teal; Christopher A Almond; Robert D Jaquiss; M Patricia Massicotte; Kurt Dasse; Flora S Siami; Victor Zak; Jonathan R Kaltman; William T Mahle; Robert Jarvik Journal: Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu Date: 2017-01
Authors: Rakesh K Singh; Charles E Canter; Ling Shi; Steven D Colan; Debra A Dodd; Melanie D Everitt; Daphne T Hsu; John L Jefferies; Paul F Kantor; Elfriede Pahl; Joseph W Rossano; Jeffrey A Towbin; James D Wilkinson; Steven E Lipshultz Journal: J Am Coll Cardiol Date: 2017-11-28 Impact factor: 24.094
Authors: Melissa K Cousino; Victoria A Miller; Cynthia Smith; Karen Uzark; Ray Lowery; Nichole Rottach; Elizabeth D Blume; Kurt R Schumacher Journal: Palliat Med Date: 2019-10-24 Impact factor: 4.762
Authors: David M Peng; Devin A Koehl; Ryan S Cantor; Kristen N McMillan; Aliessa P Barnes; Patrick I McConnell; Jessica Jordan; Nicholas D Andersen; James D St Louis; Katsuhide Maeda; James K Kirklin; Steven J Kindel Journal: J Heart Lung Transplant Date: 2018-10-31 Impact factor: 10.247
Authors: Amit Iyengar; Matthew L Hung; Kian Asanad; Oh Jin Kwon; Nicholas J Jackson; Brian L Reemtsen; Myke D Federman; Reshma M Biniwale Journal: Pediatr Cardiol Date: 2017-02-10 Impact factor: 1.655