Abstract 19118: Motor and Cognitive Impairment Following Pediatric Heart Transplantation in the US Analysis of Organ Procurement and Transplant Network Data

Abstract

BACKGROUND: Studies suggest the cognitive and motor performance of pediatric heart transplant (HT) recipients falls below population norms; though the incidence and risk factors for these observations are not well characterized. We sought to identify independent predictors of cognitive and motor impairment after HT based on predictors recorded at the time of HT. METHODS: OPTN data were used to identify all children <18 years of age with a post-HT neurodevelopmental screen available between 2007 and 2010, when the screen was mandatory for all children. Logistic regression was used to identify independent risk factors for definite or probable cognitive and motor impairment, respectively, as reported by transplant centers using a standardized screen. RESULTS: Of 1999 children with a cognitive screen available and 2048 children with a motor screen available, the median age at HT was 6 years, the median weight was 19.1 kg, 57% were white, 37% had congenital heart disease (CHD), 59% were listed UNOS status 1A at HT, 12% were ventilated, 11% were on VAD support, 43% had renal dysfunction, and 44% had Medicaid Insurance. Patients without screening data available were more likely to be younger at transplant but were otherwise similar. Overall, 15% of HT recipients were categorized as having definite (10%) or probable (5%) cognitive impairment; 7% had questionable impairment and 79% had no impairment. By contrast 10% were categorized as having definite (8%) or probable (2%) motor impairment; 5% had questionable impairment and 85% had no impairment. Multivariable risk factors for cognitive and motor impairment are summarized below. CONCLUSION: An important fraction of children demonstrate cognitive or motor impairment after HT. Younger age at HT, congenital diagnosis and invasive hemodynamic support were associated with impairments in both cognitive and motor performance. Hispanic race, renal dysfunction and Medicaid insurance were associated with cognitive impairment.