WEDNESDAY, Aug. 7, 2024 (HealthDay News) — Mortality on the pediatric heart transplant (HT) waiting list has declined, but changes to pediatric HT allocation guidelines in 2016 do not appear to be the reason, according to a study published in the Aug. 13 issue of Journal of the American College of Cardiology.

Alyssa Power, MD, of Stanford University School of Medicine in Palo Alto, California, and colleagues investigated whether changes in pediatric HT allocation policy made in 2016 by the United Network for Organ Sharing were associated with lower waitlist mortality. Children listed for HT from 1999 to 2023 were identified and grouped by era (1999 to 2006 (Epoch 1); 2006 to 2016 (Epoch 2); 2016 to 2023 (Epoch 3)).

The researchers found that waitlist mortality decreased by 8 percentage points across all eras (21, 17, and 13 percent, respectively). At waitlist entry, children in Era 3 were less sick than in Era 1, with 6, 11, and 1 percentage point less use of extracorporeal membrane oxygenation, ventilation, and dialysis, respectively. Ventricular assist device (VAD) use was 13 percentage points higher, and VAD mortality decreased by 9 percentage points. The 2016 revisions were not associated with lower waitlist mortality in multivariable analyses, but they were associated with the use of VADs (in Era 3), ABO-incompatible transplants, improved patient selection, and a reduction in racial disparities.

“The waitlist mortality rate has gone down, which is a very good thing, but based on our analysis, it doesn’t look like the allocation changes made the difference,” lead author Christopher S. Almond, MD, MPH, also of Stanford University School of Medicine, said in a statement.

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