Organ allocation in adults with congenital heart disease listed for heart transplant: impact of ventricular assist devices.
BACKGROUND
Adults with congenital heart disease (CHD) listed for heart transplantation are rarely supported by ventricular assist devices (VADs). This may be a disadvantage to their priority for organ allocation. We sought to determine the relationship between VAD implantation and successful transplantation among patients listed for heart transplant.


METHODS
Adults with CHD patients (N = 1,250) were identified from the United Network for Organ Sharing (UNOS) database from 1985 to 2010 and compared to patients without congenital etiology for heart failure (N = 59,606). VAD use at listing, listing status, status upgrades and reasons for upgrade prior to transplant were trended at 5-year intervals and appropriate statistical comparisons were made between groups.


RESULTS
Since 1985, VAD use prior to transplant has increased significantly in patients without CHD, but not in CHD patients (17% vs 3% in 2006 to 2010, p < 0.0001). CHD patients were more likely to be listed as Status 2, compared to those without (66% vs 40%, p < 0.001 for 2006 to 2010), and less likely to be upgraded to Status 1 after listing (43% vs 55%, p = 0.03). Among those upgraded to Status 1, CHD patients were less likely to have a VAD at transplant than those without (3% vs 18%, p = 0.005). VAD use was more likely to result in death in CHD patients.


CONCLUSIONS
VAD use is less common in CHD patients than in patients without CHD, both at the time of listing and transplantation. Reduced VAD use appears to contribute to lower listing status and organ allocation. These differences have grown more disparate over time. Separate criteria for organ allocation for CHD patients may be justified.
Heart Failure Transplant Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon.
Jill M
JM
Gelow
Howard K
HK
Song
Joseph B
JB
Weiss
James O
JO
Mudd
Craig S
CS
Broberg
D000328:Adult; D019468:Disease Management; D005260:Female; D006331:Heart Diseases / Q000401:mortality / Q000628:therapy*; D006333:Heart Failure / Q000401:mortality / Q000628:therapy; D016027:Heart Transplantation / Q000706:statistics & numerical data / Q000639:trends*; D006353:Heart-Assist Devices / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012042:Registries; D040841:Resource Allocation / Q000706:statistics & numerical data / Q000639:trends*; D012189:Retrospective Studies; D015996:Survival Rate; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data / Q000639:trends*; D016896:Treatment Outcome; D014850:Waiting Lists
congenital; heart defects; heart failure; heart transplantation; transplant organ allocation; ventricular assist device