1. Should Status II Patients Be Removed From the Pediatric Heart Transplant Waiting List? A Multi-institutional Study
- Author
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Kirklin, J.K., Naftel, D.C., Caldwell, R.L., Pearce, F.B., Bartlett, H., Rusconi, P., White-Williams, C., and Robinson, B.V.
- Subjects
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HEART transplantation , *PEDIATRIC surgery , *TRANSPLANTATION of organs, tissues, etc. , *MORTALITY ,CARDIAC surgery patients - 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 &y& Elsevier]
- Published
- 2006
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