Abstract
BACKGROUND: Mechanical ventilation prior to pediatric heart transplantation predicts inferior post-transplant survival, but the impact of ventilation duration on survival is unclear. METHODS: Data from the United Network for Organ Sharing and Pediatric Health Information System were used to identify pediatric (<18 years) heart transplant recipients from 2003 to 2020. patients ventilated pretransplant were first compared to no ventilation, then ventilation durations were compared across quartiles of ventilation (≤1 week, 8 days-5 weeks,>5 weeks). RESULTS: At transplant, 11% (511/4506) of patients required ventilation. Ventilated patients were younger, had more congenital heart disease, more urgent listing-status, and greater rates of nephropathy, TPN-dependence, and inotrope and ECMO requirements (p < .001 for all). post-transplant, previously ventilated patients experienced longer ventilation durations, icu and hospital stays, and inferior survival (all p >< .001). hospital outcomes and survival worsened with longer pretransplant ventilation. one-year and overall survival were similar between the no-ventilation and ≤1 week groups (p =" .703" & p =" .433," respectively) but were significantly worse for ventilation durations>1 week (p < .001). on multivariable analysis, ventilation ≤1 week did not predict mortality (hr 0.98 [95% ci 0.85-1.43]), whereas ventilation>1 week did (HR: 1.18 [1.01-1.39]). CONCLUSIONS: Longer pretransplant ventilation portends worse outcomes, although only ventilation >1 week predicts mortality. These findings can inform pretransplant prognostication.
