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Impact of 2016 UNOS pediatric heart allocation policy changes on VAD utilization, waitlist, and post-transplant survival outcomes in children with CHD versus Non-CHD.
Das, Bibhuti B; Blackshear, Chad T; Lirette, Seth T; Slaughter, Mark S; Ghaleb, Stephanie; Moskowitz, William; Ghanamah, Mohammad; Burch, Phillip T.
Afiliação
  • Das BB; Heart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, Jackson, Mississippi, USA.
  • Blackshear CT; Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA.
  • Lirette ST; Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA.
  • Slaughter MS; Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky, USA.
  • Ghaleb S; Heart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, Jackson, Mississippi, USA.
  • Moskowitz W; Heart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, Jackson, Mississippi, USA.
  • Ghanamah M; Heart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, Jackson, Mississippi, USA.
  • Burch PT; Heart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Clin Transplant ; 37(3): e14843, 2023 03.
Article em En | MEDLINE | ID: mdl-36494889
AIMS: We analyzed the impact of the revised pediatric heart allocation policy on types of ventricular assist device (VAD) utilization, and waitlist (WL) and post-heart transplant (HT) survival outcomes in congenital heart disease (CHD) versus non-CHD patients before (Era-1) and after (Era-2) pediatric heart allocation policy implementation. METHODS: We retrospectively reviewed the UNOS database from December 16, 2011, through March 31, 2021, for patients < 18 years old and listed for primary HT. We compared the differences observed between Era-1 and Era-2. RESULTS: 5551 patients were listed for HT, of whom 2447(44%) were in Era-1 and 3104(56%) were in Era-2. CHD patients were listed as status 1A unchanged, but the number of patients listed as status 1B decreased in Era-2, whereas the number of non-CHD patients listed as status 1A decreased, but status 1B increased. In Era-2 compared to Era-1, both temporary (1% to 4%, p < .001) and durable VAD (13.6% to 17.8%, p < .001) utilization increased, and the transplantation rate per 100-patient years increased in both groups. The median WL period for CHD patients increased marginally from 70 to 71 days (p = .06), whereas for non-CHD patients it decreased from 61 to 54 days (p < .001). Adjusted 90-day WL survival increased from 84% to 88%, p = .016 in CHD, but there was no significant change in non-CHD patients (p = .57). There was no significant difference in 1-year post-HT survival in CHD and non-CHD patients between Era-1 and Era-2. CONCLUSIONS: In summary, after the revised heart allocation policy implementation, temporary and durable VAD support increased, HT rate increased, waitlist duration marginally increased in the CHD cohort and decreased in the non-CHD cohort, and 90-day WL survival probability improved in children with CHD without significant change in 1-year post-HT outcomes. Future studies are needed to identify changes to the policy that may further improve the listing criteria to improve WL duration and post-HT survival.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Coração Auxiliar / Transplante de Coração / Cardiopatias Congênitas / Insuficiência Cardíaca Tipo de estudo: Prognostic_studies Limite: Adolescent / Child / Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Coração Auxiliar / Transplante de Coração / Cardiopatias Congênitas / Insuficiência Cardíaca Tipo de estudo: Prognostic_studies Limite: Adolescent / Child / Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article