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Determinates of Non-Utilization in Pediatric Heart Donors
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The Journal of Heart and Lung Transplantation, Vol 34, No 4S, April 2015
HRQOL-related treatment options after implant. These comparative QOL studies will play an important role in the evaluation of smaller devices that are potentially better suited to females and other smaller patients. 1( 86) Factors Influencing Gains in Six Minute Walk Distance After Continuous Flow Ventricular Assist Device Placement S.V. Pamboukian ,1 F.D. Pagani,2 D.C. Naftel,1 S.L. Myers,1 K.A. Hollifield,1 J.K. Kirklin.1 1University of Alabama at Birmingham, Birmingham, AL; 2Cardiac Surgery, University of Michigan, Ann Arbor, MI. Purpose: Continuous flow left ventricular assist devices (CF-LVAD) improve functional capacity as measured by six minute walk distance (6MWD). This study examines the influence of baseline characteristics and the effect of major post CF-LVAD complications on 6MWD at 12 months post-implantation. Methods: INTERMACS includes 9689 patients with CF-LVAD implanted at 143 institutions between April 2008 and March 2014. Of these, 1331 patients had pre-implant and 12 month post-implant 6MWD data and were included. A multivariable regression analysis sought to identify factors affecting functional performance. Results: The influence of various factors on post CF-LVAD 6MWD at 12 months are shown in table 1. Pre-implant comorbidities including dialysis within 48 hours of implantation, severe diabetes (figure 1), coronary artery disease and peripheral vascular disease attenuated observed improvements in 6MWD. Concomitant surgery at implantation and presence of intra-aortic balloon pump pre-op favorably impacted 6MWD. Post CF-LVAD adverse events including bleeding, infection, neurological dysfunction and re-hospitalization were detrimental to 6MWD at 12 months. Conclusion: Presence of pre-implant comorbidities and adverse events post CF-LVAD adversely influenced gains in functional capacity in patients receiving CF-LVAD. These findings underscore the importance of reducing serious adverse events if the full benefit of these devices is to be realized.
1( 87) Determinates of Non-Utilization in Pediatric Heart Donors C. Castleberry ,1 M. Khan,1 F. Zafar,1 S. Shugh,2 I. Wilmot,1 T.D. Ryan,1 C. Chin,1 J.L. Jefferies,1 A. Lorts,1 D. Morales.1 1Heart Institute, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH; 2Pediatrics, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH. Purpose: Improved survival while waiting for transplant has increased the demand for donor hearts, but there are no standardized guidelines for donor selection. The objective was to analyze pediatric cardiac donor utilization across eras and determine factors associated with non-utilization. Methods: United Network of Organ Sharing database was used to identify all pediatric donors (age < 18 years) who were offered for heart transplant from 2000-2012. Modern era was defined as 2007-2012. Cohort was divided based on utilization of donor heart. Multivariable logistic regression was used to identify factors of non-utilization. Results: Of 11,944 donors, there were 5,838 (49%) hearts that were unutilized. Non-utilization decreased from 51% in old era to 47% in modern era (p less than 0.001). Overall, unutilized donor hearts were highest amongst children (1-10 years) (57%). There has been an increase in unutilized donors who were on inotropes, had CPR greater than 20 minutes, clinical infection, anoxia as the cause of death, or considered CDC High Risk (Table 1). Anoxia, head injury and modern era were donor factors that predicted utilization while cardiopulmonary resuscitation, CDC high risk, liver dysfunction, age 1-10 years, greater than 3 inotropes, and abnormal left ventricular ejection all predicted non-utilization (Table 2). Conclusion: Despite improvement in pediatric cardiac donor utilization in the modern era, a substantial number of organs are still unutilized. Increased use of donors with less desirable characteristics could improve patient outcomes.
1( 88) Do the Duration Between Donor Brain Death and Heart Harvest or Administration of Thyroxine (T4) Affect Allograft Function After Pediatric Heart Transplantation? F.I. Lunze , K. Gauvreau, S.I. Colan, R. Narciso, F. Costantino, H. Bastardi, E.D. Blume, T.P. Singh. Cardiology, Boston Chilren’s Hospital, Boston, MA. Purpose: Despite surgical efforts to minimize ischemic time, early allograft dysfunction is common. We hypothesized that a longer duration between
The Journal of Heart and Lung Transplantation, Vol 34, No 4S, April 2015
HRQOL-related treatment options after implant. These comparative QOL studies will play an important role in the evaluation of smaller devices that are potentially better suited to females and other smaller patients. 1( 86) Factors Influencing Gains in Six Minute Walk Distance After Continuous Flow Ventricular Assist Device Placement S.V. Pamboukian ,1 F.D. Pagani,2 D.C. Naftel,1 S.L. Myers,1 K.A. Hollifield,1 J.K. Kirklin.1 1University of Alabama at Birmingham, Birmingham, AL; 2Cardiac Surgery, University of Michigan, Ann Arbor, MI. Purpose: Continuous flow left ventricular assist devices (CF-LVAD) improve functional capacity as measured by six minute walk distance (6MWD). This study examines the influence of baseline characteristics and the effect of major post CF-LVAD complications on 6MWD at 12 months post-implantation. Methods: INTERMACS includes 9689 patients with CF-LVAD implanted at 143 institutions between April 2008 and March 2014. Of these, 1331 patients had pre-implant and 12 month post-implant 6MWD data and were included. A multivariable regression analysis sought to identify factors affecting functional performance. Results: The influence of various factors on post CF-LVAD 6MWD at 12 months are shown in table 1. Pre-implant comorbidities including dialysis within 48 hours of implantation, severe diabetes (figure 1), coronary artery disease and peripheral vascular disease attenuated observed improvements in 6MWD. Concomitant surgery at implantation and presence of intra-aortic balloon pump pre-op favorably impacted 6MWD. Post CF-LVAD adverse events including bleeding, infection, neurological dysfunction and re-hospitalization were detrimental to 6MWD at 12 months. Conclusion: Presence of pre-implant comorbidities and adverse events post CF-LVAD adversely influenced gains in functional capacity in patients receiving CF-LVAD. These findings underscore the importance of reducing serious adverse events if the full benefit of these devices is to be realized.
1( 87) Determinates of Non-Utilization in Pediatric Heart Donors C. Castleberry ,1 M. Khan,1 F. Zafar,1 S. Shugh,2 I. Wilmot,1 T.D. Ryan,1 C. Chin,1 J.L. Jefferies,1 A. Lorts,1 D. Morales.1 1Heart Institute, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH; 2Pediatrics, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH. Purpose: Improved survival while waiting for transplant has increased the demand for donor hearts, but there are no standardized guidelines for donor selection. The objective was to analyze pediatric cardiac donor utilization across eras and determine factors associated with non-utilization. Methods: United Network of Organ Sharing database was used to identify all pediatric donors (age < 18 years) who were offered for heart transplant from 2000-2012. Modern era was defined as 2007-2012. Cohort was divided based on utilization of donor heart. Multivariable logistic regression was used to identify factors of non-utilization. Results: Of 11,944 donors, there were 5,838 (49%) hearts that were unutilized. Non-utilization decreased from 51% in old era to 47% in modern era (p less than 0.001). Overall, unutilized donor hearts were highest amongst children (1-10 years) (57%). There has been an increase in unutilized donors who were on inotropes, had CPR greater than 20 minutes, clinical infection, anoxia as the cause of death, or considered CDC High Risk (Table 1). Anoxia, head injury and modern era were donor factors that predicted utilization while cardiopulmonary resuscitation, CDC high risk, liver dysfunction, age 1-10 years, greater than 3 inotropes, and abnormal left ventricular ejection all predicted non-utilization (Table 2). Conclusion: Despite improvement in pediatric cardiac donor utilization in the modern era, a substantial number of organs are still unutilized. Increased use of donors with less desirable characteristics could improve patient outcomes.
1( 88) Do the Duration Between Donor Brain Death and Heart Harvest or Administration of Thyroxine (T4) Affect Allograft Function After Pediatric Heart Transplantation? F.I. Lunze , K. Gauvreau, S.I. Colan, R. Narciso, F. Costantino, H. Bastardi, E.D. Blume, T.P. Singh. Cardiology, Boston Chilren’s Hospital, Boston, MA. Purpose: Despite surgical efforts to minimize ischemic time, early allograft dysfunction is common. We hypothesized that a longer duration between