ISHLT Annual Meeting PapersAssociation of high-priority exceptions with waitlist mortality among heart transplant candidates
Section snippets
Data source and study population
This study used data from the Scientific Registry of Transplant Recipients (SRTR). The SRTR data system includes data on all donor, waitlisted candidates, and transplant recipients in the US, submitted by the members of the OPTN. The Health Resources and Services Administration, US Department of Health and Human Services provides oversight to the activities of the OPTN and SRTR contractors. This study was a secondary analysis of deidentified data and was granted exemption status by the
Overall study population characteristics by exception
A total of 12,776 active adult heart transplant candidates were added to the transplant waitlist between October 18, 2018, and December 1, 2021 (Figure S1). Among this sample, 318 candidates were excluded for listing as permanently inactive (n = 59), listing at a low-volume center (n = 62), or listing using the previous allocation system (n = 197). The final sample included 12,458 candidates listed at 112 transplant centers, including 2273 candidates (18.2%) who received an exception at initial
Discussion
In this longitudinal study of the waitlist history of 12,458 heart transplant candidates, we found that 30% and 40% of candidates listed at Statuses 1 and 2 received exceptions, respectively, and the proportion of exception candidates at each status remained approximately the same over time. Adjusted for status, candidates listed for high-priority heart transplant statuses with an exception had a 45% lower risk of dying on the waitlist than candidates meeting standard criteria. This association
Conclusion
Adult heart transplant candidates granted exceptions under the new heart allocation policy were significantly less likely to die on the waitlist than candidates who met the standard criteria. A substantial proportion of candidates received high-priority Status 1 and 2 designations through exceptions, counteracting the efforts of the new heart allocation policy to reduce the number of exceptions. Further work is needed to ensure equitable allocation of donor hearts while simultaneously reducing
Author Contributions
Johnson and Parker developed the study design, performed all data analyses, and drafted the manuscript. Ahn, Lazenby, Zeng, and Zhang contributed to data analysis. All co-authors interpreted data and revised the manuscript for important intellectual content.
Disclosure statement
W.F. Parker was funded by National Institutes of Health grant K08HL150291, K.K. Khush was funded by National Institutes of Health grant R01HL125303 and D.Y. Johnson was funded by National Institutes of Health National Heart, Lung, and Blood Institute grant #5R25HL096383-12. All other authors have nothing to disclose.
Acknowledgments
The data reported here have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government.
References (23)
- et al.
A change of heart: preliminary results of the US 2018 adult heart allocation revision
Am J Transpl
(2020) - et al.
Practice changes at U.S. transplant centers after the new adult heart allocation policy
J Am Coll Cardiol
(2020) - et al.
Between-center variation in high-priority listing status under the new heart allocation policy
Am J Transpl
(2021) - et al.
Heart waitlist survival in adults with an intra-aortic balloon pump relative to other Status 2, Status 1, and inotrope Status 3 patients
J Heart Lung Transplant
(2023) - et al.
Changes in use of left ventricular assist devices as bridge to transplantation with new heart allocation policy
JACC Heart Fail
(2021) - et al.
Variables of importance in the Scientific Registry of Transplant Recipients database predictive of heart transplant waitlist mortality
Am J Transpl
(2019) - et al.
Continuously updated estimation of heart transplant waitlist mortality
J Am Coll Cardiol
(2018) - et al.
External validation of the estimated posttransplant survival score for allocation of deceased donor kidneys in the United States
Am J Transpl
(2014) - et al.
The MELD score in patients awaiting liver transplant: strengths and weaknesses
J Hepatol
(2011) - All-time records again set in 2021 for organ transplants, organ donation from deceased donors. UNOS. Published January...