Add like
Add dislike
Add to saved papers

Waitlist Mortality in US Children Listed for Heart Transplant - Where are We Now?

PURPOSE: Studies suggest that pediatric heart transplant (HT) waitlist mortality has declined. The impact of factors such as heart allocation system refinements, patient selection, greater ABO incompatible (ABOI) HT, and rise in VAD use are unknown. We examined the 20-year trend in waitlist mortality to identify factors associated with declining mortality and whether allocational inefficiencies persist.

METHODS: All children <18 years listed for isolated HT from 1999-2019 were identified using OPTN data and grouped into 3 eras (Era 1: 1999-2006; Era 2: 2006-2016; Era 3: 2016-2019) based on when UNOS revised the heart allocation system. Cox proportional hazards modeling was used to identify factors associated with death/deterioration.

RESULTS: Overall, 10,730 patients met inclusion criteria (3,397 in Era 1; 5,359 in Era 2; 1,974 in Era 3). Waitlist mortality declined significantly across eras (22%, 17%, 14%, P<0.001). The prevalence at listing of major risk factors for mortality declined across eras including a reduction by 50% in ECMO use (12%, 9%, 6%, P<0.001), by 32% in ventilator use (28%, 22%, 19%, P<0.001), by 38% in dialysis use (2.4%, 2.0%, 1.5%, P<0.001), while VAD use at listing increased 8-fold (2%, 8%, 14%, P<0.001). Infant mortality declined significantly (27%, 25%, 21%, P<0.001) with a 40% decline in mortality unique to blood group O patients (relative to background decline for all blood groups); infant VAD mortality declined by 36% (P<0.01). In Era 3, RCM and re-transplant patients not eligible for status 1A without exception have higher mortality than 1A DCM patients on LVAD support (12% vs. 4.3%, P<0.01).

CONCLUSION: Pediatric HT waitlist mortality has declined significantly over the past 20 years. There is evidence to suggest that greater VAD use, revisions to organ allocation, refinements in patient selection, and ABO-I transplant may all contribute. Organ allocation inefficiencies persist under the current allocation system, suggesting opportunities for allocation improvement may still exist.

Full text links

We have located links that may give you full text access.
Can't access the paper?
Try logging in through your university/institutional subscription. For a smoother one-click institutional access experience, please use our mobile app.

For the best experience, use the Read mobile app

Mobile app image

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app

All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

By using this service, you agree to our terms of use and privacy policy.

Your Privacy Choices Toggle icon

You can now claim free CME credits for this literature searchClaim now

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app