Analysis of UNOS: Longitudinal Cognitive and Motor Delay After Pediatric Heart Transplantation and Associated Survival.

Abstract

Background: We investigated factors associated with the longitudinal presence of neurodevelopmental delays in pediatric heart transplant recipients.

Methods: The United Network for Organ Sharing Registry was queried for patients aged <18 years who received a first-time isolated heart transplant between March 2008 and December 2022. Two patient cohorts were developed, those with and without (1) definitive motor delay (MD) and (2) definitive cognitive delay (CD).

Results: The MD cohort was comprised of 3847 patients (n = 3267 [no MD], n = 580 [definitive MD]) and the CD cohort was comprised of 3446 patients (n = 2689 [no CD], n = 757 [definitive CD]). The MD cohort and the CD cohort shared 3189 patients. Compared with the intracohort nondelayed patients, definitive MD and CD cohorts each independently had higher rates of congenital heart disease, ventilator support at transplant, and stroke before discharge (P < .001 for all). Patients with a definitive delay at follow-up had worse longitudinal survival, with hazard ratios of 2.82 (95% CI, 2.32-3.44; P < .001) for the MD cohort and 1.67 (95% CI, 1.32-2.05; P < .001) for the CD cohort. Stroke before discharge and symptomatic cerebrovascular disease at listing were both predictors of CD and MD at follow-up. The definitive MD and CD cohorts each independently had higher rates of stroke before discharge (MD cohort, 57 of 580 [9.8%] vs 48 of 3267 [1.5%]; CD cohort, 53 of 757 [7.0%] vs 42 of 2689 [1.6%]; P < .001 for both), and symptomatic cerebrovascular disease at listing was a predictor of CD (odds ratio, 4.16; 95% CI, 2.62-6.58) and MD (odds ratio, 3.30; 95% CI, 2.06-5.22) at follow-up.

Conclusions: Patients with MD and/or CD after receiving a heart transplant share several characteristics, including increased stroke before discharge, and have decreased longitudinal survival compared with their nondelayed counterparts.