ArticleJHLT open2026
Association of hemodynamics at listing with waitlist deterioration in pediatric heart transplant candidates across United States heart allocation eras.
Article in JHLT open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Many children experience death or require mechanical circulatory support (MCS) while listed for heart transplant (HT). The prognostic relevance of hemodynamic measures for waitlist deterioration, particularly across allocation eras, remains incompletely defined. Methods: In a single-center retrospective cohort study of patients <21 years with biventricular circulation listed for HT during 1999-2024, we assessed associations between hemodynamic measures at listing and risk of death or initiation of MCS using a Cox model. Results: Among 210 patients (median age 10 years), 174 (83%) had cardiomyopathy and 36 (17%) had congenital heart disease. Median cardiac index (CI) was 2.7 L/min/m² (IQR 2.2, 3.3), pulmonary capillary wedge pressure (PCWP) was 18 mmHg (IQR 14, 23), and right atrial pressure (RAP) to PCWP ratio was 0.50 (IQR 0.36, 0.67). Baseline characteristics were similar before and after the 2016 allocation change, however waitlist trajectories differed with significantly longer waitlist time for HT after 2016. Patients with both markedly elevated PCWP (>21 mmHg) and low CI (<2.1 L/min/m Conclusions: Low cardiac index and elevated left-sided filling pressures at listing are associated with increased risk of death or deterioration in pediatric biventricular HT candidates. The RAP/PCWP ratio may provide prognostic insight in patients with low PCWP. These findings support hemodynamic risk stratification and anticipatory counseling at listing.
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