Heart failure & cardiomyopathiesCohort study
Contemporary Pediatric Heart Transplant Waitlist Mortality
- Retrospective cohort study
- registry-based (OPTN data)
- competing risks (Fine-Gray) and fixed-effects analysis
Authors' conclusion
The 2016 allocation revisions were not independently associated with the decline in pediatric HT waitlist mortality. The 3-tier classification system fails to adequately capture patient-specific risks.
Study context
- Population
- Children listed for heart transplant in the US (OPTN data), 1999–2023
- Exposure
- Era 3 vs earlier eras
- Outcome
- Waitlist mortality (death or delisting for deterioration)
Main finding
Waitlist mortality
Absolute difference
8 percentage points
P < 0.01
By group
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | absolute difference (percentage points) | P value |
|---|---|---|
| Illness severity at listing, era 3 vs era 1 — Era 3 vs Era 1 · less ECMO use | 6 | P < 0.01 |
| Illness severity at listing, era 3 vs era 1 — Era 3 vs Era 1 · less ventilator use | 11 | P < 0.01 |
| Illness severity at listing, era 3 vs era 1 — Era 3 vs Era 1 · less dialysis use | 1 | P < 0.01 |
Ventricular assist device (VAD) use and VAD mortality
- VAD use higher (percentage points (PP))
- 13
- VAD mortality decrease (PP)
- 9
- P < 0.01
Non-White mortality
- Decline (PP)
- 10
- P < 0.01
ABO-incompatible listings and blood group O infant mortality
- ABO-incompatible listings increase (PP)
- 27
- Blood group O infant mortality decrease (PP)
- 13
- P < 0.01
Match-run analyses
- Poor correlation between individual waitlist mortality risk and match-run order
Original publication
Contemporary Pediatric Heart Transplant Waitlist Mortality. J Am Coll Cardiol. Published 13 August 2024. doi:10.1016/j.jacc.2024.05.049
Summarised from the published abstract; every number is checked against it