Abstract 2553: Effect of Pre-Transplant Extracorporeal Membrane Oxygenation on Pediatric Heart Transplantation Outcomes: An Analysis of the United Network for Organ Sharing Database
Introduction: Extracorporeal membrane oxygenation (ECMO) has been used as salvage therapy in children with intractable heart failure as a bridge to transplantation, but outcomes have not been examined in a large pediatric transplant database.
Methods: All pediatric (<18 years of age) primary heart transplant recipients reported to the United Network for Organ Sharing database from 1999 –2007 were reviewed and segregated according to need for pre-transplant ECMO. Survival was estimated by Kaplan-Meier method before and after propensity match analysis. Propensity-adjusted Cox regression modeling was used to identify predictors of mortality.
Results: During the study period, 2141 children underwent first time heart transplantation: 154 (7%) were on ECMO. On univariate analysis, children bridged to heart transplant with ECMO had lower weight at operation (15 vs 27 kg; p<0.0001), shorter time on the organ waitlist (31 vs 92 days; p=0.0002), longer post-transplant length of stay (40 vs 24 days; p<0.0001), and higher incidence of stroke (5% vs 2%, p=0.02), reoperation (16% vs 8%; p=0.002), and infection (50% vs 25%; p<0.0001). Kaplan-Meier 5-year survival was inferior for the pre-transplant ECMO group (55% vs 73%) (Figure⇓), both before and after propensity matching (p<0.0001). After propensity score adjustment, pre-transplant ECMO was a significant predictor of mortality (HR 2.7; 95% CI 1.8 – 4.1; p<0.001).
Conclusion: Patients on ECMO before heart transplant have inferior outcomes, even after adjustment for propensity scores, but still have acceptable 5-year survival. Improvement in survival will likely require refinement in mechanical support technology and practice.