Cohort study
Impact of Heart Transplant Allocation Changes on Waitlist Mortality and Clinical Practice in Pediatric and Adult Patients With Congenital Heart Disease and Cardiomyopathy
- Retrospective cohort study
- registry (UNOS database)
- competing risk models
Authors' conclusion
The recent allocation changes of the Organ Procurement and Transplantation Network associations with waitlist duration and outcome were not uniform across pediatric and adult cohorts with CHD or those with cardiomyopathy. Children with cardiomyopathy and adults with CHD did not experience the mortality benefits experienced by adults with cardiomyopathy and children with CHD.
Study context
- Population
- Pediatric (<18 years) and adult (18–50 years) patients with congenital heart disease (CHD) or cardiomyopathy listed for heart transplantation, UNOS database
- Participants
- 11,637 participants
- Exposure
- Postallocation change era vs preallocation change era
- Outcome
- Death or waitlist removal because of clinical deterioration from heart transplantation listing
- Follow-up
- Within 1 year of listing
Main finding
As reported in the abstract
Infants with CHD: allocation changes associated with lower death or waitlist removal
HR 0.75 (95% CI 0.57-0.99); P=0.04
Children with CHD: allocation changes associated with lower death or waitlist removal
HR 0.61 (95% CI 0.43-0.86); P=0.005
Adults with cardiomyopathy: allocation changes associated with lower death or waitlist removal
HR 0.60 (95% CI 0.44-0.81); P=0.001
Observational data: associations, not effects.
Original publication
Summarised from the published abstract; every number is checked against it