Sickest Children Not Benefiting from Recent Advances in Heart Transplant Therapy
Research indicates an overall decrease in pediatric waitlist mortality by 44 percent
MONTREAL, April 25, 2013 – The latest research on children awaiting heart transplant will be presented today at the International Society for Heart and Lung Transplantation (ISHLT) 33rd Annual Meeting and Scientific Sessions in Montreal, Canada. The study set out to determine if waitlist survival has improved for children (under the age of 18) in the era of greater pediatric ventricular assist device (VAD) utilization using data from the Organ Procurement and Transplant Network (OPTN) . Results show over a 10-year period waitlist mortality has decreased by 44 percent (25 percent in 2001 to 14 percent in 2011) overall. However, the data demonstrates that the sickest children, those who are on ECMO (extracorporeal membrane oxygenation) or a ventilator at listing, have not seen dramatic declines in waitlist mortality.
Today’s research indicates patients not on ECMO or a ventilator at the time of being placed on the heart transplant list saw waitlist mortality decline by 61 percent, from 18 percent to seven percent. In contrast, pediatric patients on ECMO did not see a significant change in waitlist mortality. The study revealed patients on a ventilator at the time of listing may be starting to experience improved waitlist survival, but the difference, 21 percent, has not yet achieved significant change.
“The advances in VAD technology has contributed significantly to improving the overall pediatric heart transplant waitlist mortality in the U.S. however, waitlist mortality for children listed from ECMO has not changed,” said Christopher S. Almond, M.D., Associate in Cardiology at Boston Children’s Hospital and Assistant Professor at Harvard Medical School. “The bigger question is why are the sickest children clearly not benefitting from recent technology advances? This emphasizes the challenges of patient selection.”
VADs have become an effective way to treat patients awaiting heart transplant. VADs work by being implanted into the chest to assist a damaged or weakened heart by pumping blood. VADs have come a long way in the past 10 years as a bridge to heart transplantation. Most devices are developed for adults and it wasn’t until the past two years that an FDA-approved pediatric VAD was available.
ECMO is a system that provides both cardiac and respiratory support oxygen to patients whose heart and lungs are so severely diseased or damaged that the organs can no longer serve their function.
Similarly a ventilator is designed to move breathable air in and out of the lungs, to facilitate the breathing for a patient who is physically unable to breathe, or breathing insufficiently because of the build-up of lung water caused by heart failure.
In the heart transplant timeline a patient being placed on a ventilator is the second to last stage followed by ECMO. While patients can recover enough to be removed from ECMO it is typically the final stage where a heart transplant is the only therapy. Although the waitlist mortality for children has decreased, a call for additional research will be made at the ISHLT Annual Meeting to determine why patients on ECMO and ventilators are not benefitting from the same dramatic reductions in waitlist mortality as other patients.
The International Society for Heart and Lung Transplantation (ISHLT) is a not-for-profit professional organization with more than 2,700 members from over 45 countries dedicated to improving the care of patients with advanced heart or lung disease through transplantation, mechanical support and innovative therapies via research, education and advocacy. For more information, visit www.ishlt.org .
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