Should status II patients be removed from the pediatric heart transplant waiting list? A multi-institutional study.
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.
Kirklin
J K
JK
University of Alabama at Birmingham, Birmingham, Alabama 35294, USA. jkirklin@uab.edu
Naftel
D C
DC
Caldwell
R L
RL
Pearce
F B
FB
Bartlett
H
H
Rusconi
P
P
White-Williams
C
C
Robinson
B V
BV
D000293:Adolescent; D009202:Cardiomyopathies / Q000145:classification / Q000401:mortality / Q000601:surgery; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D006330:Heart Defects, Congenital / Q000145:classification / Q000401:mortality / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D015233:Models, Statistical; D018579:Patient Selection; D014850:Waiting Lists