An aggressive transplant strategy plus exceptional post-transplant care equals better outcomes for even the most fragile children.
Seattle Children’s performed 21 heart transplants in 2015, making its heart center one of the busiest in the country. More important for the children who received those grafts, Seattle Children’s outcomes are among the best in the nation, with a three-year survival rate of 92.31%.
These outcomes are especially remarkable because many of the children successfully transplanted in Seattle would have been turned down by other centers.
“Our program has become the point of last resort for kids who couldn’t be transplanted otherwise: HLA-sensitized children, kids with extremely complex congenital abnormalities, neonates,” says Dr. Jonathan Chen, the Heart Center’s surgical director. “Because of the depth of our experience and the breadth of our team, we’re able to mitigate the risks associated with transplanting complicated patients.”
Cutting wait time in half
Nationally, 17% of children listed for transplant will die waiting for a donor heart. Seattle Children’s has one of the lowest waitlist mortality rates in the U.S. One reason for this is that the Heart Center combines excellent medical management of heart failure with a comprehensive Extracorporeal Life Support Program, including ECMO, mobile ECMO, VAD and total artificial heart.
And, because Seattle Children’s accepts and successfully transplants a wider range of donor hearts – larger or smaller, or coming from further away – than most other centers, the average wait time is half the national average (three and a half months as opposed to seven).
ABO-mismatch transplants (something many centers don’t do, despite the clear evidence for their safety) account for about 9% of the transplant volume at Seattle Children’s. If a child has type O blood, some centers will only transplant a donor heart that’s also type O. Seattle Children’s will accept O, AB, A or B for children younger than 2 (who typically wait the longest for a donor heart). That increases donor availability dramatically.
Seattle Children’s outcomes for ABO-incompatible transplants are just as excellent as ABO-compatible transplants.
“In collaboration with our blood bank, we carefully prepare our patients so they are able to receive an ABO-incompatible transplant,” explains Dr. Yuk Law, medical director of the transplant/heart failure service. “Our methods minimize the number of antibodies that might attack the new heart.”
Continuity of care is key
One of the distinguishing characteristics of Seattle Children’s program is that patients are cared for by the same cardiologists, nurse coordinators and other specialists from diagnosis through transplant and post-transplant, including the transition to adult cardiac care.
“If you want your outcomes to go from the 90th percentile to the 99th percentile,” says Law, “the key is continuity and integration. Our team includes specialized heart failure/ICU and transplant pharmacists, heart failure/transplant nutritionists, a clinical psychologist, infectious disease experts, and other transplant related specialists.”
Likewise, in Seattle Children’s dedicated, 16-bed Cardiac Intensive Care Unit, the transplant team doesn’t just consult – they work side-by-side with the intensivists and provide patient care around the clock.
Typically, 85% of U.S. transplant programs perform five or fewer each year with a narrow patient profile that excludes children who, after multiple surgeries, have developed antibodies to certain human leukocyte antigens (HLAs).
HLA-sensitized patients not only face longer wait times for an acceptable organ, they are at higher risk for rejecting their new heart. Through state-of-the art tissue typing, blood banking and immunological treatment, Seattle Children’s has a compelling record of successfully transplanting these children. The process involves a virtual crossmatch to determine the best donor match for each individual candidate, and advanced B-cell targeted immunosuppression therapy post-transplant.
“We push the envelope in terms of what we’re willing to do,” says Chen. “And our survival rates attest to the fact that our approach benefits the children who need it most.”
Because of the depth of our experience and the breadth of our team, we’re able to mitigate the risks associated with transplanting complicated patients.
– Dr. Jonathan Chen