• Anne I Dipchand, William T Mahle, Margaret Tresler, David C Naftel, Christopher Almond, James K Kirklin, Elizabeth Pruitt, Steven A Webber, and Pediatric Heart Transplant Study Investigators.
• From the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (A.I.D.); Children's Healthcare of Atlanta, GA (W.T.M.); University of Alabama at Birmingham (M.T., D.C.N., J.K.K., E.P.); Stanford University, Palo Alto, CA (C.A.); and Vanderbilt University School of Medicine, Nashville, TN (S.A.W.). anne.dipchand@sickkids.ca.
• Circ Heart Fail. 2015 Sep 1;8(5):960-9.

BackgroundCurrent organ allocation algorithms direct hearts to the sickest recipients to mitigate death while waiting. This may result in lower post-transplant (Tx) survival for high-risk candidates mandating close examination to determine the appropriateness of different technologies as a bridge to Tx.Methods And ResultsWe analyzed all patients (<18 years old) from the Pediatric Heart Transplant Study (PHTS) database listed for heart Tx (1993-2013) to determine the effect of extracorporeal membrane oxygenation (ECMO) support at the time of listing and the time of Tx on waitlist mortality and post-Tx outcomes. Eight percent of patients were listed on ECMO, and within 12 months, 49% had undergone Tx, 35% were deceased, and 16% were alive waiting. Survival at 12 months after listing (censored at Tx) was worse in patients on ECMO at listing (50%) compared with ventricular assist device at listing (76%) or not on ECMO or ventricular assist device at listing (76%; P<0.0001). Two hundred three (5%) patients underwent Tx from ECMO; 135 (67%) had been on ECMO since listing, and 67 (33%) had deteriorated to ECMO support while waiting. Survival after Tx was worse in patients who underwent Tx from ECMO (3 years: 64%) versus on ventricular assist device at Tx (3 years: 84%) or not on ECMO/ventricular assist device at Tx (3 years: 85%; P<0.0001). Patients transplanted from ECMO at age <1 year had the worst survival.ConclusionsPediatric patients requiring ECMO support before heart Tx have poor outcomes. Prioritization of donor hearts to children waitlisted on ECMO warrants careful consideration because of ECMO's high pre- and post-Tx mortality.© 2015 American Heart Association, Inc.

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