The waiting game: bridging to paediatric heart transplantation.
BACKGROUND
Although mechanical circulatory support might not increase the number of adults surviving to transplantation, because of the shortage of donor organs, the situation might be different for children. Our aim was to assess the effect of mechanical assist devices to bridge children with end-stage cardiomyopathy to heart transplantation.


METHODS
A 5-year retrospective review was undertaken with data from the UK paediatric transplant programme and from bridging to transplant done at two paediatric transplant centres in the UK.


RESULTS
Between Jan 1, 1998 and Dec 31, 2002, 22 children with end-stage cardiomyopathy, median age 5.7 years (range 1.2-17), were supported by a mechanical assist device as a bridge to first heart transplantation, with a 77% survival rate to hospital discharge. Nine were supported by a paracorporeal ventricular assist device, six received transplantation, five survived to discharge (55%), with one late death. 13 were supported by extra-corporeal membrane oxygenation, and 12 were transplanted and survived to discharge (92%) with one late death. With urgent listing, the median waiting time for a heart was 7.5 days (range 1.5-22 days). The correlation between the proportion of patients bridged to transplantation and the proportion of patients dying while on the transplant waiting list was r=-0.93, p=0.02.


CONCLUSIONS
Our findings lend support to the hypothesis that a national mechanical assist programme to bridge children to transplantation can minimise the number dying while on the heart transplant waiting list. In the context of urgent listing and a short waiting time, extra-corporeal membrane oxygenation seems to provide the safest form of support.
Goldman
Allan P
AP
Great Ormond Street Children's Hospital, Great Ormond Street, WC1N 3JY, London, UK. goldma1@gosh.nhs.uk
Cassidy
Jane
J
de Leval
Marc
M
Haynes
Simon
S
Brown
Katherine
K
Whitmore
Pauline
P
Cohen
Gordon
G
Tsang
Victor
V
Elliott
Martin
M
Davison
Anne
A
Hamilton
Leslie
L
Bolton
David
D
Wray
Jo
J
Hasan
Asif
A
Radley-Smith
Rosemary
R
Macrae
Duncan
D
Smith
Jon
J
D000293:Adolescent; D001243:Assisted Circulation / Q000379:methods* / Q000706:statistics & numerical data; D009202:Cardiomyopathies / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods / Q000706:statistics & numerical data; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D006113:United Kingdom; D014850:Waiting Lists