Evidence map›Paper›PMID 42263896›Full record

ArticleThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation2026

Artifactual declines in durable LVAD utilization among heart transplant candidates: Selection bias in transplant registries.

Daniel J Ahn, Grace R Lyden, Antony Attia, Toshihiro Nakayama, Nikhil Narang, Kazunari Sasaki, William F Parker, Kiran K Khush

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
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

2 citing papers in PubMed.

  1. Article
  2. 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.

Daniel J AhnDepartment of Surgery, Stanford University, Stanford, California; Stanford Transplant Outcomes Research Center, Stanford University, Stanford, California; Stanford Cardiovascular Institute, Stanford University, Stanford, California; Department of Epidemiology and Population Health, Stanford University, Stanford, California. Electronic address: djahn@stanford.edu.
Grace R LydenHennepin Healthcare Research Institute, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Antony AttiaDepartment of Surgery, Stanford University, Stanford, California; Stanford Transplant Outcomes Research Center, Stanford University, Stanford, California.
Toshihiro NakayamaDepartment of Surgery, Stanford University, Stanford, California; Stanford Transplant Outcomes Research Center, Stanford University, Stanford, California.
Nikhil NarangDepartment of Medicine, University of Chicago, Chicago, Illinois.
Kazunari SasakiDepartment of Surgery, Stanford University, Stanford, California; Stanford Transplant Outcomes Research Center, Stanford University, Stanford, California.
William F ParkerDepartment of Medicine, University of Chicago, Chicago, Illinois; Department of Public Health Sciences, University of Chicago, Chicago, Illinois; MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois.
Kiran K KhushStanford Cardiovascular Institute, Stanford University, Stanford, California; Department of Medicine, Stanford University, Stanford, California.

Funding

Stanford Integrated Cardiovascular/Pulmonary Residency Research Training ProgramR38HL143615 · NHLBI · STANFORD UNIVERSITY · PI Michael Peter Fischbein, Marlene Rabinovitch · 2020 to 2026
$2.2M
Improving the efficiency and equity of critical care allocation during a crisis with place-based disadvantage indicesR01LM014263 · NLM · UNIVERSITY OF CHICAGO · PI William F Parker · 2023 to 2026
$2.0M
NHLBI NIH HHS R38 HL143615NLM NIH HHS R01 LM014263
6 · The paper itself

Abstract

backgroundThe Organ Procurement and Transplantation Network (OPTN) Standard Transplant Analysis and Research (STAR) files are commonly used to study use of mechanical circulatory support (MCS) among heart transplant candidates. However, the STAR MCS file reports devices only for candidates removed from the waitlist, whereas the Scientific Registry of Transplant Recipients (SRTR) MCS file includes devices for all candidates. We compared the STAR and SRTR MCS files in estimating trends in LVAD support and waitlist outcomes among heart transplant candidates with durable LVADs.

methodsWe identified adult heart transplant candidates who obtained durable LVADs between October 18, 2018 and December 31, 2024 using MCS files from STAR (N = 4182) and SRTR (N = 4919). We estimated the cumulative incidence of transplantation and death/deterioration in both cohorts and analyzed LVAD prevalence at bimonthly intervals from October 2018 to April 2025.

resultsThe SRTR cohort showed stable LVAD prevalence (30.7% to 37.4%). In contrast, the STAR cohort constructed from the MCS file showed a 92.5% decline in LVAD prevalence (1740 to 131 candidates), despite 971 candidates listed with status 4 for LVAD support on April 30, 2025. The STAR cohort demonstrated higher 3-year cumulative incidence of transplantation (66.7% vs 54.4%) and death/deterioration (10.1% vs 4.5%) after LVAD implantation. When we reran STAR-based analyses with both MCS and status justification files, prevalence and outcomes matched SRTR estimates.

conclusionsThe STAR MCS file excludes LVADs among currently listed candidates, producing artifactual declines in LVAD prevalence and incidence and inflated waitlist outcomes. Awareness of registry construction is essential for accurate interpretation of LVAD-related outcomes.

Indexed as

Heart-Assist DevicesHeart FailureHeart TransplantationRegistriesTissue and Organ ProcurementAdultFemaleHumansMaleMiddle AgedRetrospective StudiesSelection BiasUnited StatesWaiting Listsadult heart transplantationdurable LVADOPTNSRTRSTAR

Identifiers

PMID42263896
PMCPMC13354525

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

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.