Abstract 16269: ECMO as a Bridge to Pediatric Heart Transplantation: Impact on Post-Listing and Post-Transplantation Outcomes
Background: Current organ allocation algorithms have been developed to direct hearts to the sickest recipients to mitigate death whilst waiting. Such a strategy may reduce post-transplant (Tx) survival for certain high risk candidates, including those on ECMO. In the evolving era of mechanical support, outcomes must be closely examined to determine the appropriateness of different technologies as a bridge to Tx.
Methods: The prospective, multi-institutional, event-driven Pediatric Heart Transplant Study database was used for patients (<18y old) listed for heart Tx between Jan 1993 and Dec 2009 to analyze the impact of ECMO support at the time of listing and Tx on waitlist mortality and post-Tx outcomes.
Results: At the time of listing, 408/4,365 patients (9%) were on ECMO at the ages of <1 m (117; 29%), 1m-1y (120; 29%), 1-5y (91; 22%), 5-10y (44; 11%), and >10y (36; 9%). For ECMO patients, at 12 months after listing, 48% had been Tx, 36% were delisted (worse) or deceased, 9% delisted (better) and 7% were alive waiting. Survival after listing was significantly worse in patients listed on ECMO. [Fig] At Tx, there were 203/3132 (6.5%) patients on ECMO. Of patients undergoing Tx, 148 (73%) had been on ECMO since the time of listing, and 55 (27%) had deteriorated to ECMO support whilst waiting. Survival after Tx was significantly worse in patients Tx from ECMO. [Fig] There was no difference in survival outcomes for patients on VAD or not on VAD/ECMO at the time of listing or Tx. Patients Tx from ECMO at an age <1year had the worst survival.
Conclusions: Pediatric patients requiring ECMO support prior to heart Tx have poor outcomes. Serious consideration needs to be given to the candidacy of these patients, especially in light of the evolving and improving results utilizing VAD support as a bridge to Tx. Urgent prioritization of donor hearts to children waitlisted on ECMO on an unselected basis may not be associated with a net Tx benefit in overall patient survival due to ECMO's high post-Tx mortality.
- © 2011 by American Heart Association, Inc.