Functional status predicts pediatric heart transplant outcomes: A united network for organ sharing (UNOS) database study

BACKGROUND: Functional status predicts waitlist survival in adult heart transplantation and is an inde-pendent predictor of outcomes in pediatric liver transplantation. This has not been studied in pediatric heart transplantation. Study aims were 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 transplantation.METHODS: Retrospective United Network of Organ Sharing database study of pediatric patients listed for heart transplant between 2005 and 2019 with Lansky Play Performance Scale (LPPS) scores at list -ing. Standard statistical methods were used to assess relationships between LPPS and outcomes (wait-list and post-transplant). Negative waitlist outcome was defined as death or removal from waitlist due to clinical deterioration.RESULTS: There were 4,169 patients identified, including 1,080 with LPPS 80-100 (normal activity), 1,603 with LPPS 50-70 (mild limitations), and 1,486 with LPPS 10-40 (severe limitations). LPPS 10-40 correlated with negative waitlist outcomes (HR 1.69, CI 1.59-1.80, p < 0.0001). While LLPS at list -ing had no association with post-transplant survival, those with LPPS 10-40 at transplant had inferior 1-year post-transplant survival compared to those with LPPS & GE;50 (92% vs 95%-96%, p = 0.0011). Functional status was an independent predictor of post-transplant outcomes in patients with cardiomy-opathy. A functional improvement of & GE;20 points between listing and transplant (N = 770, 24%) was associated with higher 1-year post-transplant survival (HR 1.63, 95% CI: 1.10-2.41, p = 0.018).CONCLUSIONS: Functional status is associated with waitlist and post-transplant outcomes. Interventions targeting functional impairment may improve pediatric heart transplantation outcomes. J Heart Lung Transplant 2023;42:964-973 & COPY; 2023 International Society for Heart and Lung Transplantation. All rights reserved.