Long-Term Outcome following Pediatric Heart Transplantation with and without Mechanical Circulatory Support as Bridge to Transplantation: Eight Patient-Years on Assist and 1,480 Patient-Years following Transplantation

Background: In Germany, an increasing number of children require ventricular assist device (VAD) implantation as bridge to transplantation (HTX) due to donor organ shortage. We sought to evaluate the outcome following HTX with and without prior VAD support at a single center.

Method: All consecutive patients who underwent HTX between 1988 and 2020 below the age of 18 years were included into this retrospective follow-up study. The patients were divided into groups with (VAD) and without VAD support (no VAD) prior to HTX. The following potential influencing factors for transplant free survival were analyzed for differences between groups and for potential impact on outcome. Sex, sex mismatch, body mass index (BMI) mismatch (donor/recipient BMI < 0.8 or > 1.2), previous operation (VAD prior to HTX not counted), weight, age, waiting time, indication (cardiomyopathy or congenital heart disease), and ischemic time. Freedom from events was calculated with the Kaplan–Meier method, and differences between freedom from event curves were analyzed using the log-rank test.

Results: The data from 131 patients (33 VAD, 98 no VAD) were eligible for analyzes. Mean age at HTX was 9.0 ± 6.5 years. Mean waiting time was 49 ± 58 d, 67 ± 85 d and 131 ± 136 d for the decades prior to 2000, 2000 to 2010, and after 2010, respectively (p < 0.001, first vs. last decade). Mean waiting time on VAD was 6 ± 7 d (n = 3), 37 ± 58 d (n = 10) and 129 ± 152 d (n = 20) for the decades prior to 2000, 2000 to 2010, and after 2010, respectively (p = 0.002, first vs. last decade). There was no significant difference among potential influencing factors for transplant-free survival between the groups with and without VAD. Cause of death was graft failure (n = 33), lymphoma (n = 4), multi-organ failure (n = 2), and transplant vasculopathy (n = 1). Transplant-free survival at 5 and 15 years was 90.2 ± 5.4% and 66.2.6 ± 14.1%, respectively, in patients with VAD support and 81.5 ± 3.9% and 56.0 ± 5.6%, respectively, in patients without VAD support (p = 0.398). There was no significant influence of any potential risk factor for shorter time to death or HTX.

Conclusion: The number of children who require VAD support as bridge to HTX increased significantly over time as well as the waiting time for HTX with and without VAD support. More than half of all patients survive for more than 15 years without requiring a second HTX. Previous VAD support and longer waiting time does not affect transplant-free survival.

Publication History

Article published online:
03 February 2022