Children who stroke on VAD support: When is it safe to transplant and what are their outcomes?

Abstract

Ventricular assist devices (VADs) increase waitlist survival, yet the risk of stroke remains notable. The purpose of this study was to analyze how strokes on VAD support impact post-transplant (post-Tx) outcomes in children. About 520 pediatric (<18years) heart transplant candidates listed from January 2011 to April 2018 with a VAD implant date were matched between the United Network of Organ Sharing and Pediatric Health Information System databases. Patients were divided into pre-Tx Stroke and No Stroke cohorts. About 81% of the 520 patients were transplanted; 28% (n=146) had a pre-Tx Stroke; and 59% (n=89) of the Stroke patients were transplanted at a median of 57 (IQR 17-102) days from stroke. Significantly more No Stroke cohort (90%) were transplanted (p<0.001). There was no difference in post-Tx survival between the Stroke and No Stroke cohorts (p=0.440). Time between stroke and transplant for patients who died within 1year of transplant was 32.0days (median) compared to 60.5days for those alive >1year (p=0.18). Regarding patients in whom time from stroke to transplant was more than 60days, one-year survival of Stroke vs. No Stroke patients was 96% vs. 95% (p=0.811), respectively. Patients with stroke during VAD support, once transplanted, enjoy similar survival compared to No Stroke patients. We hypothesize that allowing Stroke patients more time to recover could improve post-Tx outcomes. Unfortunately, the ideal duration of time between stroke and safe transplantation could not be determined and will require more detailed and larger studies in the future.