Background

There is wide variability in the timing of heart transplant (HTx) after pediatric VAD implant. While some centers wait months before listing for HTx, others accept donor heart offers within days of VAD surgery. We sought to determine if HTx within 30 days versus ≥ 30 after VAD impacts post-HTx outcomes.

Methods

Children on VAD pre-HTx were extracted from the Pediatric Heart Transplant Study database. The primary endpoints were post-HTx length of hospital stay (LOS) and one-year survival. Confounding was addressed by propensity score weighting using inverse probability of treatment. Propensity scores were calculated based on age, blood type, primary cardiac diagnosis, decade, VAD type, and allosensitization status.

Results

A total of 1064 children underwent VAD prior to HTx between 2000 to 2018. Most underwent HTx ≥ 30 days post-VAD (70%). Infants made up 22% of both groups. Patients ≥ 12 years old were 42% of the < 30 days group and children 1 to 11 years comprised 47% of the ≥ 30 days group (p < 0.001). There was no difference in the prevalence of congenital heart disease vs. cardiomyopathy (p = 0.8) or high allosensitization status (p = 0.9) between groups. Post-HTx LOS was similar between groups (p = 0.11). One-year survival was lower in the < 30 days group (adjusted mortality HR 1.76, 95% CI 1.11-2.78, p = 0.016).

Conclusions

A longer duration of VAD support prior to HTx is associated with a one-year survival benefit in children, although questions of patient complexity, post-VAD complications and the impact on causality remain. Additional studies using linked databases to understand these factors will be needed to fully assess the optimal timing for post-VAD HTx.

中文翻译：

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心室辅助装置支持持续时间与儿科心脏移植结果的关系

背景

儿童VAD 植入后心脏移植 (HTx) 的时间差异很大。虽然一些中心在 HTx 上市前等待数月，但其他中心在 VAD 手术后几天内接受捐赠心脏报价。我们试图确定 HTx 是否在 30 天内与 VAD 后 ≥ 30 天影响 HTx 后的结果。

方法

从儿科心脏移植研究数据库中提取 VAD pre-HTx 的儿童。主要终点是 HTx 后的住院时间 (LOS) 和一年生存期。通过使用逆治疗概率的倾向评分加权来解决混杂问题。根据年龄、血型、原发性心脏病诊断、十年、VAD 类型和同种异体致敏状态计算倾向评分。

结果

2000 年至 2018 年间，共有 1064 名儿童在 HTx 前接受了 VAD。大多数儿童在 VAD 后 30 天以上接受了 HTx（70%）。婴儿占两组的 22%。≥ 12 岁的患者占 < 30 天组的 42%，1 至 11 岁的儿童占 ≥ 30 天组的 47% ( p < 0.001)。组间先天性心脏病与心肌病 ( p  = 0.8) 或高同种异体致敏状态 ( p  = 0.9) 的患病率没有差异。各组之间的 HTx 后 LOS 相似（p  = 0.11）。< 30 天组的一年生存率较低（调整后死亡率 HR 1.76，95% CI 1.11-2.78，p  = 0.016）。

结论

尽管患者复杂性、VAD 后并发症和对因果关系的影响等问题仍然存在，但 HTx 之前较长时间的 VAD 支持与儿童一年的生存获益相关。需要使用链接数据库进行更多研究以了解这些因素，以全面评估 VAD 后 HTx 的最佳时机。