2021
DOI: 10.1111/ctr.14205
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Increased frequency of heart transplantation, shortened waitlist time and preserved post‐transplant survival in adults with congenital heart disease, on the new heart transplant allocation system

Abstract: Congenital heart disease is the most prevalent birth defect with an estimated incidence of 8 per 1000 live births in the United States. 1 As a result of improvements in surgical interventions and medical therapies, an estimated 90% of congenital patients survive to adulthood. 2 However, approximately 40% of adult CHD (ACHD) patients die due to heart failure (HF). 3,4 End-stage heart failure ACHD patients may benefit from heart transplantation (HT). 5 The proportion of ACHD who receive HT has nearly doubled ove… Show more

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Cited by 12 publications
(10 citation statements)
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“…Compared to others who needed transplants, ACHD patients had no difference in waiting list mortality or being delisted, although ACHD patients still received organs at a slower rate. As in previous reports 13,17 these changes did not appear to adversely affect early OHT outcomes, given comparable short-term mortality rates in ACHD patients receiving OHT before and after the policy changes.…”
Section: Discussionsupporting
confidence: 74%
See 1 more Smart Citation
“…Compared to others who needed transplants, ACHD patients had no difference in waiting list mortality or being delisted, although ACHD patients still received organs at a slower rate. As in previous reports 13,17 these changes did not appear to adversely affect early OHT outcomes, given comparable short-term mortality rates in ACHD patients receiving OHT before and after the policy changes.…”
Section: Discussionsupporting
confidence: 74%
“…We estimated survival curves using competing outcomes methodology to test the time-related probability of mutually exclusive 1year outcomes on the transplant waitlist (death, delisted, or alive on waitlist). 12,13 Competing outcome curves were compared using log-…”
Section: Discussionmentioning
confidence: 99%
“…Our study has significant strengths, including the inclusion of the totality of patients listed for OHT in the United States as well as complete ascertainment of vital status. Our methods differed from a previously published analysis, 38 where including those listed under the old allocation system and transplanted in the new system could have introduced reclassification bias and having unequal duration of periods [old era: November 1, 2015 to October 17, 2018 (1081 days) and new era: October 18, 2018 to September 30, 2019 (348 days)] could have biased results away from the null. Additionally, we differentiate from other publications 39 by including data from SRTR as well as a comparison between ACHD with non‐ACHD patients.…”
Section: Discussionmentioning
confidence: 87%
“…Our study has significant strengths, including the inclusion of the totality of patients listed for OHT in the United States as well as complete ascertainment of vital status. Our methods differed from a previously published analysis, 38 where including those listed under the old allocation system and transplanted in the…”
Section: Discussionmentioning
confidence: 99%
“…In the new US system, patients with CHD are listed as status 4 but may also be elevated to status 1, 2, or 3 as specific exceptions, when meeting particular clinical and therapeutic criteria. 23 Although the 1-year cumulative incidence of HT among US patients with CHD was higher in the new versus old system, the 1-year cumulative incidence of HT remained lower in CHD than non-CHD candidates in the new system. The increased cumulative incidence of HT among patients with CHD in the new system was associated with an increased proportion of patients undergoing HT with status 1 to 3 (74.2%), which may have been related to an increased use of exceptions.…”
Section: Discussionmentioning
confidence: 88%