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Inferior Transplant Outcomes of Adolescents and Young Adults Bridged with a Ventricular Assist Device

Rizwan, Raheel; Bryant, Roosevelt, III; Zafar, Farhan; Villa, Chet, R.; Lorts, Angela; Morales, David, L.

doi: 10.1097/MAT.0000000000000685
Adult Circulatory Support
Conference Article

Adolescents, who are thought to have compliance issues, are well known to have poor heart transplant (HTx) outcomes. This “effect” has recently been demonstrated to extend to age 29. The study sought to investigate whether the poor outcomes for HTx related to adolescent age are also observed in recipients who are bridged to transplant (BTT) with a ventricular assist device (VAD) and whether this effect extends beyond the standard definition of adolescent age 12–18 years. All HTx BTT with a VAD in recipients 8–39 years were identified in the United States Organ Sharing (UNOS) database (1 January 2005 to 30 June 2016). Based on the Kaplan-Meier survival comparison for age year, patients were divided into three groups: Group 1 (8–14 years), group 2 (15–29 years), and group 3 (30–39 years). A total of 1,848 HTx were bridged with a VAD. A decline in post-HTx 5 years survival was noted after 14 years of age, which improved at around 30 years of age. Group 1 had 237 (13%) HTx, group 2 had 787 (43%) HTx, and group 3 had 823 (44%) HTx. Group 2 (15–29 years) had worse post-HTx survival compared with group 1 (p < 0.001) and group 3 (p = 0.005). On subdividing group 2 (15–29 years) into “older adolescents” (15–17 years) and “young adults” (18–29 years), post-HTx survival was similar between the two subgroups (p = 0.353). In conclusion, older adolescents and young adults, both, have similarly poor post-HTx survival when BTT with a VAD compared with other age groups. These groups are generally categorized into different broad pediatric and adult age groups; however, these similarities should be carefully considered when formulating treatment protocols for older adolescents and young adults.

From the Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio.

Submitted for consideration June 2017; accepted for publication in revised form August 2017.

Presentation: Top Abstract Award recipient for the 63rd annual ASAIO conference, 2017.

Disclosure: David L. Morales, Berlin Heart: PAS clinical events committee, moderator/presenter in Berlin Heart, Inc. academic activities, Consultant for Berlin Heart EXCOR, Cincinnati Children’s Hospital Medical Center is a training center for Berlin Heart. HeartWare, Inc.: Consultant. Syncardia: Proctor and consultant for SynCardia Total Artificial Heart (TAH) training, national PI for the 50/50cc TAH FDA Trial. Oregon Heart: Medical Advisory Board. The other authors have no conflicts of interest to report.

Correspondence: Raheel Rizwan, MD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, S4.200AI, Cincinnati, OH 45229. Email: Raheel.Rizwan@cchmc.org.

Copyright © 2018 by the American Society for Artificial Internal Organs