Marc Anders, MD,
Associate Professor
Texas Childrens Hospital
Houston, Texas
Disclosure information not submitted.
Title: Phosphodiesterase 5 inhibitor use after pediatric heart transplantation, is it making a difference?
INTRODUCTION/HYPOTHESIS: This study aims to describe the trend of phosphodiesterase 5 inhibitor (PDE5i) use in the post-operative period after pediatric heart transplantation (HTx) and compare the post-operative outcomes of pediatric HTx patients based on their PDE5i use.
Methods: Retrospective study including all pediatric heart transplant recipient patients ≤17 y/o from 2010-2019 using the Pediatric Health Information System database. HTx patients were analyzed as only transplant (OHT), pre-transplant extracorporeal membrane oxygenator support and OHT (ECMO+OHT), pre-transplant ventricular assist device and OHT (VAD+OHT), and ECMO with VAD support before OHT (ECMO+VAD+OHT). Univariate/multivariate analysis was performed.
Results: We included 2,386 HTx patients, subdivided into OHT (n:1,999), ECMO+OHT (n:130), VAD+OHT (n:185), ECMO+VAD+OHT (n:72). PDE5i were used in 791 (33%) of the patients. There has been an increase of PDE5i use after HT procedure in OHT (2010 vs.2019, 18% vs.45%, p < 0.001), ECMO+OHT (2010 vs.2019, 36% vs.58%, p =0.008), VAD+OHT (2010 vs.2019, 25% vs. 65%, p < 0.001) and ECMO+VAD+OHT (2010 vs.2019, 13% vs. 40%, p =0.11) patients. In the OHT group, PDE5i was used in 637 (32%) patients, p< 0.05. When comparing PDE5i vs. non-PDE5i patients within the OHT group, PDE5i subjects were older (median 7 vs. 5 years), had more frequent congenital heart disease (68% vs. 57%), had higher mortality (3% vs. 1%), longer hospital length of stay (LOS) (median 52 vs. 45 days), and ICU LOS (median 19 vs. 15 days) compared to the non-PDE5i OHT group, all p < 0.05. Comparison of PDE5i use within the VAD+OHT group, 49% of the subjects used PDE5i (p < 0.05); and there was no difference in age, sex, hospital or ICU LOS or mortality when comparing it to the VAD+OHT non-PDE5i patients. ECMO+OHT patients used less frequent PDE5i (29%), and those who received PDE5i had longer hospital (PDE5i vs. non-PDE5i, 131 vs. 93 median in days, p =0.001) and ICU LOS (PDE5i vs. non-PDE5i, 103 vs. 54 median in days, p < 0.001). ECMO+VAD+OHT patients’ comparison based on their PDE5i use did not differ in outcomes (mortality, hospital, or ICU LOS).
Conclusions: There has been an increase in the use of PDE5i after pediatric heart transplantation procedures; however, it has not been associated with a significant improvement in outcomes.