New Listing Criteria For Pediatric Heart Transplantation: The Effect On Congenital Heart Patients
Kyle W. Riggs, MD1, Clifford W. Chin, Jr, BS2, Farhan Zafar, MD1, Clifford Chin, Sr, MD1, Angela Lorts, MD1, Chet R. Villa, MD1, David L. S. Morales, MD1.
1Cincinnati Children's Hospital, Cincinnati, OH, USA, 2Vanderbilt University, Nashville, TN, USA.
Introduction: The 2016 listing criteria revision for pediatric heart transplantation improved waitlist survival, but its impact is unclear across different diagnoses. We analyzed waitlist and post-transplant survival for dilated cardiomyopathy (DCM) and congenital heart disease (CHD) patients since then. Methods: All children <18 years-of-age listed Status 1A for first-time heart transplantation in UNOS between 2006-2019 with DCM or CHD were included for 1-year waitlist and post-transplant outcomes. Early (2006-2016) and recent (2017-2019) eras were based on revision date for Status 1A criteria. Results: 4,052 children were listed (59.7% with CHD). VAD support was 8.1% (CHD) vs 41.8% (DCM); p<0.001. One-year survival for CHD in the recent era was significantly improved over the early era but lower than cardiomyopathy in either era, all p<0.001(Figure 1). Multivariable predictors of waitlist mortality in the recent era included ECMO (HR:1.84, 95% CI:1.23-2.75), mechanical ventilation (HR:2.13, 95% CI:1.55-2.93), and CHD (HR:1.80, 95% CI:1.08-2.98), all p<0.05.VAD support was protective overall (HR:0.33, 95% CI:0.19-0.57) and within the CHD population (HR:0.40, 95% CI:0.21-0.76). One-year post-transplant survival improved for CHD (85% vs 89%, p=0.025) and was unchanged for DCM (97% vs 95%, p=0.240). Conclusion: Changes to the pediatric listing criteria improved CHD waitlist outcome with better post-transplant survival. However, waitlist mortality remains higher for CHD patients. VAD use, which is protective, is underutilized in CHD patients.
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