Heart Transplants Delayed During COVID-19 Pandemic for Pediatric Patients

Children with end-stage heart failure (HF) had to remain on the wait list longer for a pediatric heart transplant (PHT) in the United States during the COVID-19 pandemic, according to new research, which emphasizes the importance of sustaining care delivery among a vulnerable patient population for whom donor organs are already in limited supply.

Findings were published recently online in JAMA Network Open, and they detail the results of an analysis that compared data from the United Network for Organ Sharing on patients younger than 18 years from 2 periods. The prepandemic period was November 1, 2018, to February 28, 2020 (non-PHT; n = 626; mean [SD] age, 6.74 [6.2] years), and the pandemic period was March 1, 2020, to June 30, 2021 (PHT; n = 610; mean age, 6.93 [6.2] years), with corresponding data analyzation periods of November 1, 2018, to February 30, 2020, and March 1, 2020, to June 30, 2021.

“Transplant disciplines have faced considerable challenges in maintaining allocation and sustaining delivery of care during the COVID-19 pandemic,” the study authors wrote.

Overall, 82% of the non-PHT group and 80% of the PHT group had a waiting list status of 1A, indicating likely hospitalization to support their heart function. Further, 50% of the patients in the non-PHT group and 48% were in the intensive care unit. And at the time of their transplant, fewer patients in the PHT group were on ventilatory support compared with the non-PHT group: 7% vs 12%.

Data also show that those in the PHT group had a wait list time that was 31.4% longer compared with the non-PHT group: 157.4 (272) vs 126 (293) days (95% CI, 0.3-63 days; P = .05). Recipient and graft survival rates, however, remained similar between the groups, and most patients in each cohort received an organ with an identical blood type (non-PHT group, 66%; PHT group, 67%).

There was also a significant difference in postop hospital stay, with the PHT group having a mean stay that decreased by 31 (32) days compared with 40 (57) days in the non-PHT group (95% CI, –15 to –4 days; P = .001).

Most study participants in each group were male (non-PHT, 54%; PHT, 58%); White, Hispanic, or Black, respectively (non-PHT: 54%, 20%, 18%; PHT: 52%, 18%, 23%); had type O blood (44% and 45%, respectively); and congenital heart disease was the most common disease type (51% and 49%).

“The findings of this cohort study suggest that the COVID-19 pandemic was associated with increased waiting list times among pediatric patients awaiting a heart transplant in the United States, while graft and recipient survival were maintained and waiting list mortality remained unchanged,” the study authors concluded. “These findings are a testament to multidisciplinary initiatives to sustain delivery of care among this vulnerable patient population.”

Still, they emphasize the need for further collaborative efforts that focus on ensuring optimal donor heart utilization and waiting list and transplant survival. Four important areas of future research are donor and recipient screening protocols, time-to-listing practices, acceptance

standards for COVID-19–positive donors, and surveillance statistics for case positivity after transplant, the authors wrote.

Reference

Inguidbashian J, Yoeli D, Everitt MD, et al. Pediatric heart transplant waiting list times in the us during the COVID-19 pandemic. JAMA Netw Open. Published online October 7, 2022. doi:10.1001/jamanetworkopen.2022.34874