Abstract 4953: The Impact of Heart Failure Severity at Time of Listing for Cardiac Transplantation on Short and Long Term Stability with Pediatric Cardiomyopathy
Background: Limited donors, risks of heart transplantation (HTx) and uncertain course of pediatric cardiomyopathy (CM) make the decision to list pts not needing inotropic or mechanical ventilatory/circulatory support (UNOS Status 2) for HTx difficult. Stability of Status 2 CM pts listed for HTx, compared to those who require such support at listing (Status 1), is unknown.
Methods: We queried the merged Pediatric Cardiomyopathy Registry/Pediatric Heart Transplant Study databases to determine presenting characteristics and outcomes of CM pts listed initially as Status 1 (n=242) vs Status 2 (n=81).
Results: Mortality 6 and 12 mos after listing was > in pts initially listed as Status 1 (11%) vs Status 2 (4%) (p=0.04). However, within 4 mos of listing, 48% of Status 2 pts required HTx or died (events) - after clinical worsening and change to Status 1. Most Status 2 pts remained stable thereafter. (Figure⇓) No pt died awaiting HTx as Status 2. Demographic and clinical characteristics at time of CM presentation including echo parameters and severity of CHF did not identify future stable vs unstable pts. A trend (p=0.09) to shorter interval between presentation and listing was observed in pts who deteriorated.
Inferences: Half of pediatric CM patient initially listed as Status 2 deteriorate to Status 1 shortly after listing. Those who remain without inotropic or mechanical support >4 months after listing may represent a subgroup not requiring HTx. Routine clinical parameters at presentation do not predict those at risk for deterioration.