Should status II patients be removed from the pediatric heart transplant waiting list? A multi-institutional study

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
James K KirklinBlair Robinson

Abstract

The survival benefit of cardiac transplantation (CTx) among Status 2 (stable outpatient) adult recipients has been questioned, but few studies have addressed this issue in pediatric patients. This study examined the following hypothesis: "Status 2 pediatric recipients have a survival benefit with CTx." Between 1993 and 2003, 2,375 patients were listed for CTx at 24 institutions; 614 (26%) of these patients were Status 2. By multivariate competing outcomes hazard function analysis, death after listing and post-transplant survival were analyzed. A single-phase hazard function described the risk of death after listing, with 20% actual mortality within 2 months after Status 1 listing. The "natural history" of Status 2-listed patients was estimated by the risk of death, whereas waiting and risk of deterioration to Status 1 at CTx (weighted by the probability of death at 3 months after Status 1 listing). At 4 months after CTx, survival with CTx exceeded the predicted "natural Hx" survival in all diagnostic categories out to 4 years of follow-up. Pediatric patients currently listed as Status 2 have a survival benefit with transplant out to at least 4 years. A pediatric allocation system restricted to Status 1 patients could only be ju...Continue Reading

References

Feb 13, 2003·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Mario C DengJames B Young
Feb 13, 2003·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Seema MitalDaphne T Hsu
Apr 12, 2003·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Mehmet C OzJames B Young
Oct 11, 2003·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Linda R PetersonJoseph G Rogers
Apr 6, 2004·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Shrikanth UpadyaStuart D Katz
Feb 11, 2005·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Javier JimenezStephen Mallon

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Citations

Apr 24, 2014·The Journal of Thoracic and Cardiovascular Surgery·Rachel D VanderlaanAnne I Dipchand
Sep 15, 2014·The Annals of Thoracic Surgery·Alexis E ShafiiEugene H Blackstone
Feb 15, 2013·Expert Review of Cardiovascular Therapy·Mona Parikh Kinkhabwala, Donna Mancini
Feb 25, 2014·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Adriana Luk, Heather J Ross
Mar 23, 2011·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Ranae L LarsenStephen E Lipshultz
Sep 28, 2010·Heart Failure Clinics·Elfriede PahlMichael Burch
Aug 28, 2010·Journal of Cardiac Failure·Brian FeingoldKenneth J Smith
Feb 28, 2013·Pediatric Transplantation·Anne I DipchandJames K Kirklin
Sep 29, 2009·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Richard KirkUNKNOWN Pediatric Heart Transplant Study Investigators
Sep 18, 2015·Cardiology in the Young·Yuk M Law
Jul 14, 2010·Circulation·Donna Mancini, Katherine Lietz

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