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Functional Status as a Predictor of Pediatric Heart Transplant Outcomes
Abstract   Open access   Peer reviewed

Functional Status as a Predictor of Pediatric Heart Transplant Outcomes

R.S. Khan, P. Khoury, F. Zafar, D.L. Morales, C. Chin and S.G. Wittekind
The Journal of heart and lung transplantation, Vol.40(4), pp.S244-S244
04/2021
DOI: 10.1016/j.healun.2021.01.700
url
https://doi.org/10.1016/j.healun.2021.01.700View
Published (Version of record) Open Access

Abstract

Functional status at listing predicts waitlist survival in adult heart transplant candidates including those on mechanical circulatory support. This has not been studied in pediatric heart transplantation although it is an independent predictor of outcomes in pediatric liver transplantation. We aimed to determine the association of: 1) functional status at listing with waitlist and post-transplant outcomes, and 2) functional status at transplant with post-transplant outcomes in pediatric heart transplant candidates. Retrospective registry study of 5754 patients ≤18 years old listed for heart transplant between 1995 and 2019 with Lansky/Karnofsky Play Performance Scale (LPPS) scores in the UNOS database. Standard statistical methods were used to assess relationships of LPPS scores at listing and transplant with waitlist and post-transplant outcomes. A positive waitlist outcome was defined as transplantation, removal from waitlist due to clinical improvement, or remaining on waitlist. At listing, 1463 patients had the ability to carry out normal activities (LPPS 80-100), 2338 had mild-moderate restriction in functional status (LPPS 50-70), and 1953 had moderate-severe restriction (LPPS 10-40). Normal activity and mild-moderate restriction at listing were associated with a higher positive waitlist outcome rate compared with moderate-severe restriction (90% vs 80%, p<0.0001). While LPPS at listing had no association with 1-year survival post-transplant (p=0.13), patients with moderate-severe restriction at transplant had inferior 1-year post-transplant survival (78%) compared to those with normal activity (81%) and mild-moderate restriction (82%) (p=0.04). Improvement in LPPS score by ≥20 points between listing and transplant was associated with 8% improvement in 1-year post-transplant survival for patients with baseline moderate-severe restriction (p=0.0002) and 3% improvement in survival in those with mild-moderate restriction (p=0.23). Candidate functional status is associated with waitlist as well as post-transplant outcomes. Improvement in functional status between listing and transplant is associated with better outcomes 1-year post-transplant. These data suggest that interventions targeting functional impairment (e.g. physical rehabilitation) have the potential to improve pediatric heart transplant outcomes.

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