Should We Be Bridging More VAD Patients To Transplant At Home?
Jason W. Greenberg, MD, Alia Dani, MD, MPH, Kyle W. Riggs, MD, Farhan Zafar, MD, MS, David L. S. Morales, MD.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Purpose: Children bridged to heart transplant (BTT) on VADs as outpatients have superior quality of life and comparable pre-transplant cost to inpatients. The present study sought to determine the current rate of outpatient BTT and whether outpatient BTT patients achieve similar post-transplant outcomes as inpatients.
Methods: Data from 2013-2020 were merged between UNOS and PHIS. The proportion of patients on intracorporeal VAD BTT as outpatients was calculated. A 2:1 propensity-score match was performed between outpatients and non-ICU inpatients by listing status (functional limitation, renal and hepatic dysfunction, inotrope requirement). Post-transplant outcomes and survival were compared.
Results: 240 non-ICU patients from 28 centers received VADs, 71% of whom were BTT outpatient. Ninety-six patients were matched: n=64 outpatient, n=32 inpatient (Table). Post-transplant outcomes were uniformly equivalent between groups, with comparable post-transplant ICU and hospital lengths of stay, post-transplant mechanical ventilatory days, post-transplant clinical charges, dialysis requirements, and incidence of acute rejection (all p>0.1; Table). Post-transplant survival at 1-, 3-, and 5-years was equivalent (p=0.820).
Conclusions: As demonstrated in the literature, outpatient BTT has multiple social, emotional, and practical benefits, yet nearly 30% of non-ICU patients BTT on intracorporeal VADs remain hospitalized until transplant (significantly different than in adults). For stable patients, the fact that post-transplant outcomes and costs are equivalent suggests that more patients may benefit from outpatient BTT.
Back to 2022 Abstracts