Heart failure & cardiomyopathiesCohort study
Status Exceptions and Misalignment of Medical Urgency in U.S. Pediatric Heart Transplantation
- Retrospective cohort study
- registry-based (OPTN)
- mixed-effects Cox models
Authors' conclusion
Pediatric heart transplant candidates granted status exceptions have significantly lower medical urgency than those meeting standard criteria. Implementation of a national review board did not result in improved alignment between waitlist mortality and listing status.
Study context
- Population
- Pediatric heart transplant candidates listed March 2016 through March 2025, US OPTN data
- Participants
- 6,026 candidates
- Exposure
- Status exception vs standard criteria
- Exception recipientsn = 1,668
- Outcome
- Waitlist mortality (death or deterioration)
Main finding
Waitlist mortality
Hazard ratio
0.41
95% CI 0.31–0.55
P < 0.001
Exception recipients vs Standard criteria
HR 0.41 (95% CI 0.31–0.55); P < 0.001
As reported in the abstract
- National Heart Review Board (NHRB) impact on this association nonsignificant
- P = 0.62
Observational data: associations, not effects.
Further findings
| Outcome | With exceptions | Without exceptions (hypothetical) |
|---|---|---|
| Concordance index for waitlist mortality, with vs without exceptions | 0.694 (95% CI 0.682–0.706) | 0.713 (95% CI 0.700–0.724) |
- Concordance index for waitlist mortality, with vs without exceptions — Concordance improved without exceptions
- P < 0.001
Waitlist mortality within status 1A
- Significant heterogeneity, exception recipients having the highest survival
Original publication
Status Exceptions and Misalignment of Medical Urgency in U.S. Pediatric Heart Transplantation. J Am Coll Cardiol. Published 4 March 2026. doi:10.1016/j.jacc.2026.01.052
Summarised from the published abstract; every number is checked against it