Analysis of United Network for Organ Sharing: Neurodevelopmental Outcomes of Mechanical Circulatory Support as a Bridge-to-Transplantation in Pediatric Heart Transplant Recipients

Abstract

Background: This analysis evaluates the longitudinal impact of extracorporeal membrane oxygenation (ECMO) and ventricular assist device (VAD) on the progression of motor delay and cognitive delay in pediatric heart transplant recipients. Methods: The United Network for Organ Sharing Registry was queried for pediatric patients (<18 years) who received a heart transplant between 2008 and 2022 and were bridged-to-transplantation with either ECMO or VAD. Patients were further stratified based on the progression of delay status pretransplant to post-transplant. Results: A total of 827 patients were included in the final VAD cohort and 68 in the final ECMO cohort with 187/827 (22.6%) and 20/68 (29.4%) having progression of delay, respectively. Patients with progression of delay were more likely than those without progression of delay to have had a stroke prior to discharge (VAD: 14/187 (7.5%) vs. 16/640 (2.5%), P = .003; ECMO: 5/20 (25%) vs. 3/48 (6.25%), P = .043). VAD patients more often developed isolated delays (motor or cognitive only), whereas patients bridged-to-transplantation on ECMO more often had combined delays, with a cumulative incidence of combined delay at 3-years of 20.0% (95% CI = 8.94–34.20). Among VAD supported patients, those with progression of delay had worse 3-year survival compared with those without (91.20% [95% CI = 87.04–95.57%] vs. 94.97% [95% CI = 93.19–96.78], log-rank P = .04). Postoperative stroke was associated with an increased risk of progression of delay (OR = 2.39 [95% CI = 1.13–5.02] P = .021), and progression of delay was found to be an independent predictor of mortality (HR = 2.10 [95% CI = 1.35–3.25], P < .001). Conclusions: While overall rates of neurodevelopmental delay are similar between those bridged-to-transplantation with ECMO or VAD, the type of delay and associated survival varies.