Deliberate bridging to transplantation in the paediatric age group: initial UK results

Introduction

In the paediatric age group in the UK, there is an excess of donor organs over recipients. There are still deaths while waiting for transplantation. In an effort to extend the survival of children with dilated cardiomyopathy, we have employed a paracorporeal ventricular assist device (Medos HIA Assist, Medos, Stolberg, Germany) in patients who we felt were dying. We report our results here.

Method

We considered children who were admitted to our intensive care units (ICUs) with a diagnosis of dilated cardiomyopathy of such severity that they were ventilated. If listed for transplantation, they were considered for a mechanical assist device. Our threshold for this was the scenario detailed above, with the addition of incipient renal failure and escalation in the doses of the inotropes being used.

Results

The results are presented in Table 1.

Table 1 Patient characteristics, treatment details, complications and outcomes

Conclusion

A bridge to transplantation is feasible. There are complications and 50% mortality. The criteria for support in this group need to be defined better. The benefit of such a costly programme alongside a transplant programme remains to be established.