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Pediatric Heart Allocation Policy No Better for Waitlist Mortality

THURSDAY, Sept. 26, 2019 -- The current pediatric heart allocation policy has increased congenital heart disease (CHD) status 1A representation but has not improved waitlist mortality, according to a study published online Sept. 23 in the American Journal of Transplantation.

Defne A. Magnetta, M.D., from the UPMC Children's Hospital of Pittsburgh, and colleagues compared waitlist characteristics and mortality around the revision in U.S. pediatric heart allocation policy, which deprioritized cardiomyopathy candidates while maintaining status 1A eligibility for CHD candidates on high-dose inotropes.

The researchers found a decrease in status 1A listings (70 to 56 percent) and an increase in CHD representation among status 1A listings (48 versus 64 percent). There was no change in waitlist mortality overall (subdistribution hazard ratio [SHR], 0.96; 95 percent confidence interval [CI], 0.80 to 1.14; P = 0.63) or among status 1A candidates (SHR, 1.16; 95 percent CI, 0.95 to 1.41; P = 0.14). There was also no change in waitlist mortality for CHD candidates (SHR, 0.82; 95 percent CI, 0.66 to 1.01; P = 0.06) or status 1A-listed CHD candidates (SHR, 0.92; 95 percent CI, 0.73 to 1.15; P = 0.47). There were twofold to threefold increases in status 1A listing exceptions among hypertrophic and restrictive cardiomyopathy candidates and a 13.5-fold increase among dilated cardiomyopathy candidates. Increased waitlist mortality was seen for hypertrophic (SHR, 6.25; 95 percent CI, 1.81 to 21.65; P = 0.004) and restrictive (SHR, 3.87; 95 percent CI, 1.18 to 12.68; P = 0.03) cardiomyopathy candidates without status 1A exceptions.

"We can't prove causality here, but it would seem that restrictive and hypertrophic cardiomyopathy patients have been disadvantaged by the criteria change," a coauthor said in a statement.

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Posted: September 2019

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