Should status II patients be removed from the pediatric heart transplant waiting list? A multi-institutional study

Area of Science:

• Pediatric Cardiology
• Transplantation Medicine
• Outcomes Research

Background:

• The survival benefit of cardiac transplantation (CTx) in stable outpatient (Status 2) adult recipients is debated.
• Few studies have evaluated this benefit specifically in pediatric patients.
• This study investigated the survival advantage of CTx for Status 2 pediatric recipients.

Purpose of the Study:

• To determine if Status 2 pediatric heart transplant recipients experience a survival benefit.
• To compare the survival of Status 2 patients receiving CTx with their predicted survival without transplant.

Main Methods:

• Analysis of 2,375 patients listed for CTx between 1993-2003 across 24 institutions.
• Focus on 614 Status 2 pediatric patients (26% of total).
• Multivariate competing risks hazard function analysis to assess post-listing mortality and post-transplant survival.

Main Results:

• The risk of death after listing was modeled using a hazard function.
• The natural history survival for Status 2 patients was estimated, accounting for waiting time and risk of deterioration.
• Survival post-CTx exceeded predicted natural history survival for all diagnostic categories up to 4 years.

Conclusions:

• Pediatric patients listed as Status 2 gain a significant survival benefit from cardiac transplantation, lasting at least four years.
• Restricting allocation to only Status 1 patients would require near-immediate transplantation (1-2 months) for most to be justifiable.