ECMO at Heart Transplant Listing: Has Waitlist Survival Improved in the Era of Pediatric VAD Support?

• Published in: The Journal of heart and lung transplantation Vol. 32; no. 4; pp. S35 - S36
• Main Authors: Almond, C.S, Singh, T.P, Daly, K.P, VanderPluym, C, Smoot, L.B, Kehoe, E, Rosenthal, D
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-04-2013
• Subjects: Surgery
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2013.01.891

Purpose As pediatric VAD use in the US has grown, wait-list mortality for children listed for heart transplant (HT) has decreased. It is unclear whether this decrease applies to children at highest risk of waitlist mortality, specifically children supported on ECMO or a ventilator at listing. Methods and Materials All patients <18 yrs of age listed for HT from 2001-2011 were identified using Organ Procurement and Transplant Network (OPTN) data. Waitlist mortality was defined as death while waiting or delisting due to clinical deterioration. Results Of 5,430 children listed for HT, 647 children were listed for HT while on ECMO. The number of patients (average 59 per year) and baseline characteristics of patient on ECMO at listing did not change appreciably over the 10-year period. For all patients, overall waitlist mortality declined 44% from 25% in 2001 to 14% (P<0.01) in 2011. For patients not on invasive support at listing, waitlist mortality declined by 61% percent from 18% to 7% (P<0.01). By contrast, for patients listed from ECMO support, overall waitlist mortality did not change significantly (45% versus 41%, P=0.89, test of trend) whereas patients listed from a ventilator (exclusive of ECMO) had a non-statistically significant decrease in mortality (33% versus 26%, P=0.15. [ figure 1 ] Conclusions While overall pediatric heart transplant waitlist mortality has improved significantly for US children in the past decade, waitlist mortality for the sickest children listed from ECMO or mechanical ventilation has not changed. Further research is needed to understand why the sickest patients do not appear to be benefiting from recent advances in circulatory support and refinements in organ allocation.