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

Academic Article

Abstract

  • Background: The survival benefit of cardiac transplantation (CTx) among Status 2 (stable outpatient) adult recipients has been questioned, but few studies have addressed this issue in pediatric patients. This study examined the following hypothesis: "Status 2 pediatric recipients have a survival benefit with CTx." Methods: Between 1993 and 2003, 2,375 patients were listed for CTx at 24 institutions; 614 (26%) of these patients were Status 2. By multivariate competing outcomes hazard function analysis, death after listing and post-transplant survival were analyzed. Results: A single-phase hazard function described the risk of death after listing, with 20% actual mortality within 2 months after Status 1 listing. The "natural history" of Status 2-listed patients was estimated by the risk of death, whereas waiting and risk of deterioration to Status 1 at CTx (weighted by the probability of death at 3 months after Status 1 listing). At 4 months after CTx, survival with CTx exceeded the predicted "natural Hx" survival in all diagnostic categories out to 4 years of follow-up. Conclusions: Pediatric patients currently listed as Status 2 have a survival benefit with transplant out to at least 4 years. A pediatric allocation system restricted to Status 1 patients could only be justified if the vast majority of such patients could be transplanted within 1 to 2 months. Copyright © 2006 by the International Society for Heart and Lung Transplantation.
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    Digital Object Identifier (doi)

    Author List

  • Kirklin JK; Naftel DC; Caldwell RL; Pearce FB; Bartlett H; Rusconi P; White-Williams C; Robinson BV
  • Start Page

  • 271
  • End Page

  • 275
  • Volume

  • 25
  • Issue

  • 3