(207) Erythropoietin-Stimulating Agents to Prevent Blood Transfusion in Children Awaiting Heart Transplant

Introduction: Children awaiting heart transplant often require blood transfusions to optimize cardiac output, which contributes to an elevated panel reactive antibody (PRA) that may cause significant morbidity and mortality pre and post-transplant. Erythropoietin stimulating agent (ESA) utilization is associated with rises in hemoglobin (Hgb) and hematocrit (Hct) which may decrease the number of blood transfusions administered. However, there is a lack of evidence to support these claims and ESA therapy has been associated with increased risk for thrombotic events. The purpose of this project is to determine if ESA therapy reduces the number of blood transfusions in children awaiting heart transplant.

Methods: This retrospective cohort study included pediatric patients admitted to UF Health Shands Hospital from January 1st, 2010 to June 30th, 2023 who were listed for heart transplant and divided into ESA therapy or control groups. Patients with end stage renal disease (ESRD) were excluded. The primary outcome of this project was the number of blood transfusions after ESA therapy initiation for the treatment group and the date after being listed for heart transplant for the control group. Secondary outcomes included ESA dose and duration of therapy, change in hematologic labs, pre-transplant PRA, time to transplant, hospital and ICU length of stay, anticoagulation method, and adverse effects.

Results: There were 142 patients included in this analysis; 90 in the control group, 52 in the treatment group. In the treatment group there were younger, smaller patients included, p < 0.0001; higher incidence of VAD implantation, p < 0.001; and increased hospital and ICU length of stay, p < 0.0001. Higher incidence of blood transfusions were administered, p = 0.01; and increased incidence of bleeding events in the treatment group, p = 0.0077. In a subgroup analysis of patients with mechanical circulatory support, additional blood transfusions were administered regardless of ESA therapy, p < 0.0001.

Conclusions: Utilization of ESA therapy may not reduce the number of blood transfusions administered to pediatric patients awaiting heart transplantation. Further studies evaluating the role of confounding variables is necessary to characterize the risk-benefit of ESA therapy.