Functional Status as a Predictor of Pediatric Heart Transplant Outcomes

Purpose Functional status at listing predicts waitlist survival in adult heart transplant candidates including those on mechanical circulatory support. This has not been studied in pediatric heart transplantation although it is an independent predictor of outcomes in pediatric liver transplantation. We aimed 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 transplant candidates. Methods Retrospective registry study of 5754 patients ≤18 years old listed for heart transplant between 1995 and 2019 with Lansky/Karnofsky Play Performance Scale (LPPS) scores in the UNOS database. Standard statistical methods were used to assess relationships of LPPS scores at listing and transplant with waitlist and post-transplant outcomes. A positive waitlist outcome was defined as transplantation, removal from waitlist due to clinical improvement, or remaining on waitlist. Results At listing, 1463 patients had the ability to carry out normal activities (LPPS 80-100), 2338 had mild-moderate restriction in functional status (LPPS 50-70), and 1953 had moderate-severe restriction (LPPS 10-40). Normal activity and mild-moderate restriction at listing were associated with a higher positive waitlist outcome rate compared with moderate-severe restriction (90% vs 80%, p Conclusion Candidate functional status is associated with waitlist as well as post-transplant outcomes. Improvement in functional status between listing and transplant is associated with better outcomes 1-year post-transplant. These data suggest that interventions targeting functional impairment (e.g. physical rehabilitation) have the potential to improve pediatric heart transplant outcomes.