Abstract 2579: Does Mechanical Circulatory Support work as a Safety Net for Adult and Pediatric Heart Transplant Candidates in Eurotransplant Urgent Status?
Background Listing for urgent donor heart allocation in candidates for heart transplantation (HTx) remains in force until ventricular assist device (VAD) implantation, due to Eurotransplant (ET) organ allocation policy. We studied the prognosis of patients after failed donor heart allocation in urgent status without mechanical circulatory support.
Methods We studied all adult and pediatric (< 18 years) HTx candidates who underwent primary HTx after ET urgency listing between January 2001 and December 2006 (Group A(dults)-u(rgent)HTx, n=99; Group P(ediatric)-uHTx, n=24), those to whom donor heart was not urgently allocated before VAD implantation or death in the same period (Group A - f(ailed) H(eart) A(llocation), n=21, Group P-fHA, n=10), and those with primary VAD implantation without ET urgency listing in the same period (Group A-primVAD, n=142, Group P-primVAD, n=17). Mortality rate after urgency listing or primary VAD implantation was studied in each group.
Results In adult patients, 1-year mortality rate after urgency listing in Group A-fHA was 56.8% and significantly higher than that in Group A-uHTx (30.6%, p < 0.001, log-rank test) and that after primary VAD implantation in Group A-primVAD (36.2%, p < 0.01). After failed urgent heart allocation, 15 out of 21 patients in Group A-fHA had VAD implantation and 2 patients (9.5%) underwent HTx after VAD implantation. In pediatric patients, 1-year mortality rate in Group P-fHA was 40.0% and significantly higher than that in Group P-uHTx (8.5%, p < 0.05) and also higher than that in Group P-primVAD (5.9%). In Group P-fHA, all 10 patients underwent VAD implantation after failed urgent heart allocation and 6 patients (60.0%, p<0.01 versus Group A-fHA, Fisher’s exact test) underwent HTx after VAD implantation.
Conclusion After failed urgent donor heart allocation, pediatric HTx candidates seem to profit more from mechanical circulatory support than adults.