Impact of ventricular assist device use on pediatric heart transplant waitlist mortality: Analysis of the scientific registry of transplant recipients database

• Published in: Pediatric transplantation 2024-06, Vol.28 (4), p.e14787-n/a
• Main Authors: Butto, Arene, Wright, Lydia K., Dyal, Jameson, Mao, Chad Y., Garcia, Richard, Mahle, William T.
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Databases, Factual; Female; Heart diseases; Heart Failure - mortality; Heart Failure - surgery; Heart Failure - therapy; Heart Transplantation; Heart transplants; Heart-Assist Devices; Humans; Infant; Male; Mechanical ventilation; Mortality; outcomes; Pediatrics; Proportional Hazards Models; Registries; Retrospective Studies; Risk Factors; United States - epidemiology; Ventilation; Ventricle; ventricular assist device; Waiting Lists - mortality
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/petr.14787

Background Children awaiting heart transplant (Tx) have a high risk of death due to donor organ scarcity. Historically, ventricular assist devices (VADs) reduced waitlist mortality, prompting increased VAD use. We sought to determine whether the VAD survival benefit persists in the current era. Methods Using the Scientific Registry of Transplant Recipients, we identified patients listed for Tx between 3/22/2016 and 9/1/2020. We compared characteristics of VAD and non‐VAD groups at Tx listing. Cox proportional hazards models were used to identify risk factors for 1‐year waitlist mortality. Results Among 5054 patients, 764 (15%) had a VAD at Tx listing. The VAD group was older with more mechanical ventilation and renal impairment. Unadjusted waitlist mortality was similar between groups; the curves crossed ~90 days after listing (p = .55). In multivariable analysis, infant age (HR 2.77, 95%CI 2.13–3.60), Black race (HR 1.57, 95%CI 1.31–1.88), congenital heart disease (HR 1.23, 95%CI 1.04–1.46), renal impairment (HR 2.67, 95%CI 2.19–3.26), inotropes (HR 1.28, 95%CI 1.09–1.52), and mechanical ventilation (HR 2.23, 95%CI 1.84–2.70) were associated with 1‐year waitlist mortality. VADs were not associated with mortality in the first 90 waitlist days but were protective for those waiting ≥90 days (HR 0.43, 95%CI 0.26–0.71). Conclusions In the current era, VADs reduce waitlist mortality, but only for those waitlisted ≥90 days. The differential effect by race, size, and VAD type is less clear. These findings suggest that Tx listing without VAD may be reasonable if a short waitlist time is anticipated, but VADs may benefit those expected to wait >90 days. In the current era, VADs reduce waitlist mortality in children who wait ≥90 days for a heart transplant, but there may be differential effects based on race, size, and VAD type.