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. 2022 Mar;22(3):833-842.
doi: 10.1111/ajt.16921. Epub 2022 Feb 8.

Pediatric heart transplant waiting times in the United States since the 2016 allocation policy change

Ryan J Williams  1 , Minmin Lu  2 , Lynn A Sleeper  2   3 , Elizabeth D Blume  2   3 , Paul Esteso  2   3 , Francis Fynn-Thompson  4   5 , Christina J Vanderpluym  2   3 , Simone Urbach  2 , Kevin P Daly  2   3
Affiliations

Pediatric heart transplant waiting times in the United States since the 2016 allocation policy change

Ryan J Williams et al. Am J Transplant. 2022 Mar.

Abstract

We describe waiting times for pediatric heart transplant (HT) candidates after the 2016 revision to the US allocation policy. The OPTN database was queried for pediatric HT candidates listed between 7/2016 and 4/2019. Of the 1789 included candidates, 65% underwent HT, 14% died/deteriorated, 8% were removed for improvement, and 13% were still waiting at the end of follow-up. Most candidates were status 1A at HT (81%). Median wait times differ substantially by listing status, blood type, and recipient weight. The likelihood of HT was lower in candidates <25 kg and in those with blood type O; The <25 kg, blood type O subgroup experiences longer wait times and higher wait list mortality. For status 1A candidates, median wait times were 108 days (≤25 kg, blood type O), 80 days (≤25 kg, non-O), 47 days (>25 kg, O), and 24 days (>25 kg, non-O). We found that centers with more selective organ acceptance practices, based on a lower median Pediatric Heart Donor Assessment Tool (PH-DAT) score for completed transplants, experience longer status 1A wait times for their listed patients. These data can be used to counsel families and to select appropriate advanced heart failure therapies to support patients to transplant.

Keywords: Organ Procurement and Transplantation Network (OPTN); organ allocation; waitlist management.

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Conflict of interest statement

Disclosures

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1:
Figure 1:
The wait time for each patient was analyzed according to days spent at each listing status. Three sample patients, Infant A, Child B and Child C, demonstrate the methodology. Candidates were classified as achieving a wait list outcome (transplant, death, or removal) with respect to their final active listing status, and censored in the analysis for any other statuses in which they spent time as of the last active day in that status. Since Status 7 (inactive) time does not contribute to calculated waiting time, it was ignored in the analysis. If a patient achieved a wait list outcome while listed as Status 7, then the event was assigned to the final day of their last active listing status.
Figure 1:
Figure 1:
The wait time for each patient was analyzed according to days spent at each listing status. Three sample patients, Infant A, Child B and Child C, demonstrate the methodology. Candidates were classified as achieving a wait list outcome (transplant, death, or removal) with respect to their final active listing status, and censored in the analysis for any other statuses in which they spent time as of the last active day in that status. Since Status 7 (inactive) time does not contribute to calculated waiting time, it was ignored in the analysis. If a patient achieved a wait list outcome while listed as Status 7, then the event was assigned to the final day of their last active listing status.
Figure 2:
Figure 2:
Competing risks models showing wait list outcome over time for pediatric heart transplant candidates in (A) the overall cohort, and by (B) UNOS Status 1A, (C) UNOS Status 1B, (D) UNOS Status 2.
Figure 3:
Figure 3:
Cumulative incidence of heart transplantation over time by recipient blood type for pediatric UNOS (A) Status 1A, (B) Status 1B, and (C) Status 2 listed patients.
Figure 4:
Figure 4:
Cumulative incidence of heart transplantation by recipient weight for pediatric UNOS (A) Status 1A; (B) Status 1B; and (C) Status 2 listed patients.
Figure 5:
Figure 5:
Instantaneous hazard rate for heart transplant by time listed UNOS Pediatric Status 1A stratified by recipient blood type and weight group.
Figure 6.
Figure 6.
Proportion of pediatric Status 1A candidates undergoing HT stratified by transplant center donor selectivity. Intermediate centers experience shorter wait times compared to highly selective centers (HR 1.22, 95% CI 1.08–1.55).
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References

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