PEDIATRIC TRANSPLANTATION Use of Extracorporeal Life Support as a Bridge to Pediatric Cardiac Transplantation Robert J. Gajarski, MD, a Ralph S. Mosca, MD, c Richard G. Ohye, MD, b Edward L. Bove, MD, b Dennis C. Crowley, MD, a Joseph R. Custer, MD, a Frank W. Moler, MD, a Alicia Valentini, RN, CPNP, b and Thomas J. Kulik, MD a Background: Extracorporeal life support (ECLS) has been used for post-cardiotomy rescue, but its use as a bridge to heart transplantation (OHT) in patients with post- surgical or end-stage ventricular failure remains controversial. Methods: Records were reviewed for patients receiving ECLS for ventricular failure from January 1991 to August 2001. Patients listed for OHT were analyzed separately. Listing for OHT requirements were improbable myocardial recovery, absence of contraindications (central nervous system damage, high pulmonary resistance, ongoing infection, etc.), and parental consent. Outcome variables included patient demographics, diagnosis, days from ECLS initiation to United Network for Organ Sharing (UNOS) listing (latency), list time, renal function, and survival to discharge. Results: Of 145 patients with ventricular failure who received ECLS, 21 pediatric patients were UNOS listed. Of 124 non-listed patients, 57 (46%) survived to discharge. All but 3 survivors were separated from ECLS in 7 days. Twelve underwent OHT and 10 survived to discharge (list time, 6 days; median ECLS time, 14 days). Five had ECLS discontinued without undergoing OHT (1 later underwent OHT, 2 survived to discharge). Five experienced complications while receiving ECLS and died without undergoing OHT. Six of 9 patients who required dialysis for renal failure died. Of 11 infants listed, 4 were weaned from ECLS without undergoing OHT (2 survived to discharge), 5 had OHT (ECLS support, 4 days; 4 survived to discharge) and 2 died (ECLS support, 16 and 47 days). Conclusions: (1) Extracorporeal life support can be used as a bridge to OHT (even among the infant population) for at least 2 weeks with acceptable survival and hospital discharge rates, and (2) renal insufficiency with the concomitant requirement for dialysis decreases the likelihood of survival before and after OHT. J Heart Lung Transplant 2003;22:28 –34. From the a Division of Pediatric Cardiology, Department of Pediatrics and b Section of Cardiac Surgery, Department of Surgery, University of Michigan, C. S. Mott Children’s Hospi- tal, Ann Arbor, Michigan; and c Department of Cardiothoracic Surgery, Babies and Children’s Hospital of New York, Colum- bia University, New York, New York. Submitted January 14, 2002; revised April 22, 2002; accepted May 15, 2002. Reprint requests: Dr. Robert J. Gajarski, Division of Pediatric Cardiology, L1242 Women’s, Box 0204, 1500 E Medical Center Drive, Ann Arbor, Michigan 48109-0204. Telephone: 734-936- 9114. Fax: 734-936-9470. E-mail: rjgaj@umich.edu Copyright © 2003 by the International Society for Heart and Lung Transplantation. 1053-2498/03/$–see front matter PII S1053-2498(02)00476-X 28