Abstract
Background
Functional status predicts waitlist survival in adult heart transplantation and is
an independent predictor of outcomes in pediatric liver transplantation. This has
not been studied in pediatric heart transplantation. Study aims were to determine
the association of: 1) functional status at listing with waitlist and post-transplant outcomes, and 2) functional status at transplant with post-transplant outcomes in pediatric heart transplantation.
Methods
Retrospective United Network of Organ Sharing database study of pediatric patients
listed for heart transplant between 2005 and 2019 with Lansky Play Performance Scale
(LPPS) scores at listing. Standard statistical methods were used to assess relationships
between LPPS and outcomes (waitlist and post-transplant). Negative waitlist outcome
was defined as death or removal from waitlist due to clinical deterioration.
Results
There were 4,169 patients identified, including 1,080 with LPPS 80-100 (normal activity),
1,603 with LPPS 50-70 (mild limitations), and 1,486 with LPPS 10-40 (severe limitations).
LPPS 10-40 correlated with negative waitlist outcomes (HR 1.69, CI 1.59-1.80, p<0.0001).
While LLPS at listing had no association with post-transplant survival, those with LPPS 10-40 at transplant had inferior 1-year post-transplant survival compared to those with LPPS ≥ 50 (92%
vs. 95-96%, p=0.0011). Functional status was an independent predictor of post-transplant
outcomes in patients with cardiomyopathy. A functional improvement of ≥20 points between
listing and transplant (N=770, 24%) was associated with higher 1-year post-transplant
survival (HR 1.63, 95% CI 1.10-2.41, p=0.018).
Conclusions
Functional status is associated with waitlist and post-transplant outcomes. Interventions
targeting functional impairment may improve pediatric heart transplantation outcomes.
Keywords
Abbreviations:
CDC (Center for Disease Control), CHD (congenital heart disease), CI (confidence interval), ECMO (extracorporeal membrane oxygenation), FS (functional status), GFR (glomerular filtration rate), HR (hazard ratio), HTx (heart transplant), IV (intravenous), OPTN (Organ Procurement and Transplant Network), PCW (pulmonary capillary wedge), LPPS (Lansky Play-Performance Scale), UNOS (United Network for Organ Sharing), VAD (ventricular assist device)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Heart and Lung TransplantationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Frailty in the End-Stage Lung Disease or Heart Failure Patient: Implications for the Perioperative Transplant Clinician.J Cardiothorac Vasc Anesth. 2019; 33: 1382-1392
- Pretransplant frailty is associated with decreased survival after lung transplantation.J Heart Lung Transplant. 2016; 35: 173-178
- Frailty predicts waitlist mortality in liver transplant candidates.Am J Transplant. 2014; 14: 1870-1879
- Functional status at listing predicts waitlist and posttransplant mortality in pediatric liver transplant candidates.Am J Transplant. 2019; 19: 1388-1396
- The measurement of performance in childhood cancer patients.Cancer. 1987; 60: 1651-1656
- Impact of Heart Transplantation on the Functional Status of US Children With End-Stage Heart Failure.Circulation. 2017; 135: 939-950
- Functional status of United States children supported with a left ventricular assist device at heart transplantation.J Heart Lung Transplant. 2017; 36: 890-896
- Pediatric heart transplant waiting list mortality in the era of ventricular assist devices.J Heart Lung Transplant. 2015; 34: 82-88
- The impact of frailty on mortality after heart transplantation.J Heart Lung Transplant. 2021; 40: 87-94
- Frailty in heart transplantation: Report from the heart workgroup of a consensus conference on frailty.Am J Transplant. 2021; 21: 636-644
- The Prevalence and Prognostic Significance of Frailty in Patients With Advanced Heart Failure Referred for Heart Transplantation.Transplantation. 2016; 100: 429-436
- Frailty Screening Tool for Patients Undergoing Orthotopic Heart Transplant.Ann Thorac Surg. 2021; 111: 586-593
- Ventricular assist devices in a contemporary pediatric cohort: Morbidity, functional recovery, and survival.J Heart Lung Transplant. 2016; 35: 92-98
- Optimal timing of cardiac transplantation after ventricular assist device implantation.J Thorac Cardiovasc Surg. 2004; 127: 1789-1799
- Optimal Timing of Heart Transplant After HeartMate II Left Ventricular Assist Device Implantation.Ann Thorac Surg. 2017; 104: 1569-1576
- Optimizing Postcardiac Transplantation Outcomes in Children with Ventricular Assist Devices: How Long Should the Bridge Be?.ASAIO J. 2020; 66: 787-795
- Variation in Cardiac Rehabilitation for Pediatric Ventricular Assist Device Recipients Across North America.ASAIO J. 2021; 67: 1045-1050
Article info
Publication history
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation.
