Impact of ventricular assist device use on pediatric heart transplant waitlist mortality: Analysis of the scientific registry of transplant recipients database

Abstract

AbstractBackgroundChildren awaiting heart transplant (Tx) have a high risk of death due to donor organ scarcity. Historically, ventricular assist devices (VADs) reduced waitlist mortality, prompting increased VAD use. We sought to determine whether the VAD survival benefit persists in the current era.MethodsUsing the Scientific Registry of Transplant Recipients, we identified patients listed for Tx between 3/22/2016 and 9/1/2020. We compared characteristics of VAD and non‐VAD groups at Tx listing. Cox proportional hazards models were used to identify risk factors for 1‐year waitlist mortality.ResultsAmong 5054 patients, 764 (15%) had a VAD at Tx listing. The VAD group was older with more mechanical ventilation and renal impairment. Unadjusted waitlist mortality was similar between groups; the curves crossed ~90 days after listing (p = .55). In multivariable analysis, infant age (HR 2.77, 95%CI 2.13–3.60), Black race (HR 1.57, 95%CI 1.31–1.88), congenital heart disease (HR 1.23, 95%CI 1.04–1.46), renal impairment (HR 2.67, 95%CI 2.19–3.26), inotropes (HR 1.28, 95%CI 1.09–1.52), and mechanical ventilation (HR 2.23, 95%CI 1.84–2.70) were associated with 1‐year waitlist mortality. VADs were not associated with mortality in the first 90 waitlist days but were protective for those waiting ≥90 days (HR 0.43, 95%CI 0.26–0.71).ConclusionsIn the current era, VADs reduce waitlist mortality, but only for those waitlisted ≥90 days. The differential effect by race, size, and VAD type is less clear. These findings suggest that Tx listing without VAD may be reasonable if a short waitlist time is anticipated, but VADs may benefit those expected to wait >90 days.