Evidence map›Paper›PMID 36494889›Full record

ArticleClinical transplantation2023

Impact of 2016 UNOS pediatric heart allocation policy changes on VAD utilization, waitlist, and post-transplant survival outcomes in children with CHD versus Non-CHD.

Bibhuti B Das, Chad T Blackshear, Seth T Lirette, Mark S Slaughter, Stephanie Ghaleb, William Moskowitz, Mohammad Ghanamah, Phillip T Burch

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical transplantation, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.7field-weighted citation impact, top 34% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 9 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Bibhuti B DasHeart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, Jackson, Mississippi, USA.ORCID 0000-0001-9530-8785
Chad T BlackshearDepartment of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Seth T LiretteDepartment of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Mark S SlaughterDepartment of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky, USA.
Stephanie GhalebHeart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, Jackson, Mississippi, USA.
William MoskowitzHeart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Mohammad GhanamahHeart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Phillip T BurchHeart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Jackson Memorial Hospital · USUniversity of Louisville · US

Funding

Tracking and Evaluation CoreU54GM115428 · NIGMS · UNIVERSITY OF MISSISSIPPI MED CTR · PI HALL, JOHN E · 2016 to 2025
$38.2M
NIGMS NIH HHS U54 GM115428
6 · The paper itself

Abstract

aimsWe analyzed the impact of the revised pediatric heart allocation policy on types of ventricular assist device (VAD) utilization, and waitlist (WL) and post-heart transplant (HT) survival outcomes in congenital heart disease (CHD) versus non-CHD patients before (Era-1) and after (Era-2) pediatric heart allocation policy implementation.

methodsWe retrospectively reviewed the UNOS database from December 16, 2011, through March 31, 2021, for patients < 18 years old and listed for primary HT. We compared the differences observed between Era-1 and Era-2.

results5551 patients were listed for HT, of whom 2447(44%) were in Era-1 and 3104(56%) were in Era-2. CHD patients were listed as status 1A unchanged, but the number of patients listed as status 1B decreased in Era-2, whereas the number of non-CHD patients listed as status 1A decreased, but status 1B increased. In Era-2 compared to Era-1, both temporary (1% to 4%, p < .001) and durable VAD (13.6% to 17.8%, p < .001) utilization increased, and the transplantation rate per 100-patient years increased in both groups. The median WL period for CHD patients increased marginally from 70 to 71 days (p = .06), whereas for non-CHD patients it decreased from 61 to 54 days (p < .001). Adjusted 90-day WL survival increased from 84% to 88%, p = .016 in CHD, but there was no significant change in non-CHD patients (p = .57). There was no significant difference in 1-year post-HT survival in CHD and non-CHD patients between Era-1 and Era-2.

conclusionsIn summary, after the revised heart allocation policy implementation, temporary and durable VAD support increased, HT rate increased, waitlist duration marginally increased in the CHD cohort and decreased in the non-CHD cohort, and 90-day WL survival probability improved in children with CHD without significant change in 1-year post-HT outcomes. Future studies are needed to identify changes to the policy that may further improve the listing criteria to improve WL duration and post-HT survival.

Indexed as

Heart-Assist DevicesHeart Defects, CongenitalHeart FailureHeart TransplantationAdolescentChildHumansPolicyRetrospective StudiesWaiting ListsCHDchildrenheart transplanttransplant outcomesUNOS policyVAD

Identifiers

PMID36494889
PMCPMC10278055
OpenAlexW4311025548

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.