Organ allocation in adults with congenital heart disease listed for heart transplant: Impact of ventricular assist devices

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    Abstract

    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.

    Original languageEnglish (US)
    Pages (from-to)1059-1064
    Number of pages6
    JournalJournal of Heart and Lung Transplantation
    Volume32
    Issue number11
    DOIs
    StatePublished - Nov 2013

    Fingerprint

    Heart-Assist Devices
    Heart Diseases
    Transplants
    Transplantation
    Heart Transplantation
    Heart Failure
    Databases

    Keywords

    • congenital
    • heart defects
    • heart failure
    • heart transplantation
    • transplant organ allocation
    • ventricular assist device

    ASJC Scopus subject areas

    • Transplantation
    • Cardiology and Cardiovascular Medicine
    • Pulmonary and Respiratory Medicine
    • Surgery

    Cite this

    @article{a3022268c17d41539bc23993dd411c82,
    title = "Organ allocation in adults with congenital heart disease listed for heart transplant: Impact of ventricular assist devices",
    abstract = "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.",
    keywords = "congenital, heart defects, heart failure, heart transplantation, transplant organ allocation, ventricular assist device",
    author = "Jill Gelow and Howard Song and Weiss, {Joseph B.} and James Mudd and Craig Broberg",
    year = "2013",
    month = "11",
    doi = "10.1016/j.healun.2013.06.024",
    language = "English (US)",
    volume = "32",
    pages = "1059--1064",
    journal = "Journal of Heart and Lung Transplantation",
    issn = "1053-2498",
    publisher = "Elsevier USA",
    number = "11",

    }

    TY - JOUR

    T1 - Organ allocation in adults with congenital heart disease listed for heart transplant

    T2 - Impact of ventricular assist devices

    AU - Gelow, Jill

    AU - Song, Howard

    AU - Weiss, Joseph B.

    AU - Mudd, James

    AU - Broberg, Craig

    PY - 2013/11

    Y1 - 2013/11

    N2 - 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.

    AB - 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.

    KW - congenital

    KW - heart defects

    KW - heart failure

    KW - heart transplantation

    KW - transplant organ allocation

    KW - ventricular assist device

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    U2 - 10.1016/j.healun.2013.06.024

    DO - 10.1016/j.healun.2013.06.024

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    C2 - 23921356

    AN - SCOPUS:84885954547

    VL - 32

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    EP - 1064

    JO - Journal of Heart and Lung Transplantation

    JF - Journal of Heart and Lung Transplantation

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