Journal Article10.1016/j.cardfail.2024.04.001
The impact of local programmatic decisions on outcomes in transplant-listed adults with congenital heart disease.
Armaan F. Akbar,Benjamin L. Shou,Ahmet Kilic,A.M. Cedars +3 more
4
TL;DR: ACHD candidates have longer waitlist times, lower priority status at initial listing, wait longer for upgrade, and have higher mortality at the same final status as non-ACHD candidates, suggesting that they are being upgraded too late.
read more
Abstract: We investigated variables impacting waitlist time and negative waitlist outcomes in adult congenital heart disease (ACHD) orthotopic heart transplant (OHT) candidates following the 2018 allocation change.Adult OHT candidates listed between 10/18/2018-12/31/2022 in the United Network for Organ Sharing database were categorized as ACHD vs. non-ACHD. Waitlist time and time to upgrade for those upgraded into status 1-3 were compared using rank-sum tests. Death/delisting for deterioration was assessed using Fine-Gray sub-distribution hazard ratios (SHRs).Of 15,424 OHT candidates, 589 (3.8%) were ACHD. ACHD vs. non-ACHD candidates had less urgent status at initial listing (4.2% vs. 4.7% listed at status 1; 17.2% vs. 23.7% listed at status 2, p<0.001), but not final listing (5.9% vs. 7.6% final status 1; 35.6% vs. 36.8% final status 2, p<0.001). ACHD vs. non-ACHD candidates upgraded into status 1 (65.0 vs. 30.0 days, p=0.09) and status 2 (113.0 vs. 64.0 days, p=0.003) spent longer on the waitlist. ACHD vs. non-ACHD candidates spent longer waiting for an upgrade into status 1 (51.4 vs. 17.6 days, p=0.027) and status 2 (76.7 vs. 34.7 days, p=0.003). Once upgraded, there was no difference between groups in waitlist time as status 1 (9.7 vs. 5.5 days, p=0.66). ACHD vs. non-ACHD candidates with a final status of 1 (20.0% vs. 8.6%; SHR 2.47 [95%CI=1.19-5.16], p=0.02) and 2 (8.9% vs. 2.3%; SHR 3.59 [95%CI=2.18-5.91], p<0.001) experienced higher death/deterioration.ACHD candidates have longer waitlist times, lower priority status at initial listing, wait longer for upgrade, and have higher mortality at the same final status as non-ACHD candidates, suggesting that they are being upgraded too late.
read more
Chat with Paper
AI Agents for this Paper
Find similar papers on Google Scholar, PubMed and Arxiv
Write a critical review of this paper
Analyze citations of this paper to find unaddressed research gaps
Citations
Collaborative care models in adult congenital heart disease transplant
K. Kearney,Michael McDonald,S. Lucy Roche +2 more
TL;DR: This review challenges traditional transplant processes for adult congenital heart disease patients, advocating for tailored collaborative care models to improve transplant volumes and outcomes, leveraging expert partnerships and patient-centered teams.
Medium to Long-Term Ventricular Assist Device Support in Adults with Congenital Heart Disease
Ryan Byrne,William C. Frankel,Ajith Nair,Hari Tunuguntla,Swati Choudhry,Iki Adachi,Edward Hickey,Andrew B. Civitello,Christopher R. Broda +8 more
TL;DR: Medium to long-term ventricular assist device therapy is a viable solution for adults with congenital heart disease, providing durable support for up to 4.2 years, with successful bridging to transplant and low device-related complications.
Heart Failure Management in the Adult Congenital Heart Disease Patient: Part II: Non-Pharmacologic Therapies
Juan M Ortega-Legaspi,Arwa Saidi,Fred H. Rodriguez,Wilson W. Lam,Andrew Pistner,Leigh C. Reardon,Christopher E Mascio,Allison L. Tsao,Karen Stout,Sumeet S. Vaikunth +9 more
- 01 Nov 2025
Closing the Gaps in Cardiac Transplantation for Adult Congenital Heart Disease: The Importance of Early Referral to Heart Failure
Alice Vinogradsky,Jonathan N. Menachem,Tripti Gupta,Koji Takeda +3 more
References
A Proportional Hazards Model for the Subdistribution of a Competing Risk
Jason P. Fine,Robert Gray +1 more
TL;DR: This article proposes methods for combining estimates of the cause-specific hazard functions under the proportional hazards formulation, but these methods do not allow the analyst to directly assess the effect of a covariate on the marginal probability function.
13.1K
Temporal Trends in Survival to Adulthood Among Patients Born With Congenital Heart Disease From 1970 to 1992 in Belgium
TL;DR: Almost 90% of children with CHD have the prospect of surviving into adulthood, and analysis per heart defect confirmed that patients with univentricular heart and hypoplastic left heart syndrome had the poorest survival rate.
732
Chronic Heart Failure in Congenital Heart Disease A Scientific Statement From the American Heart Association
Karen K. Stout,Craig S. Broberg,Wendy Book,Frank Cecchin,Jonathan M. Chen,Konstantinos Dimopoulos,Melanie D. Everitt,Michael A. Gatzoulis,Louise Harris,Daphne T. Hsu,Jeffrey T. Kuvin,Yuk M. Law,Cindy M. Martin,Anne M. Murphy,Heather J. Ross,Gautam K. Singh,Thomas L. Spray +16 more
TL;DR: The purposes of this statement are to review the literature pertaining to chronic HF in CHD and to elucidate important gaps in knowledge, emphasizing the need for specific studies of HF mechanisms and improving outcomes for those with HF.
325
Treatment of heart failure in adult congenital heart disease: a position paper of the Working Group of Grown-Up Congenital Heart Disease and the Heart Failure Association of the European Society of Cardiology.
Werner Budts,Jolien W. Roos-Hesselink,Tanja Rädle-Hurst,Andreas Eicken,Theresa McDonagh,Ekaterini Lambrinou,María G. Crespo-Leiro,Fiona Walker,Alexandra Frogoudaki +8 more
TL;DR: The growing number and aging of ACHD patients led to an overall increase in hospitalizations over the last decade and a substantial increase in patients presenting with heart failure (HF) (∼20%), which was summarized in Table 1.
A United Network for Organ Sharing analysis of heart transplantation in adults with congenital heart disease: outcomes and factors associated with mortality and retransplantation.
Tara Karamlou,Tara Karamlou,Jennifer C. Hirsch,Karl F. Welke,Richard G. Ohye,Edward L. Bove,Eric J. Devaney,Robert J. Gajarski +7 more
TL;DR: Compared with adult recipients, patients with adult congenital heart disease experience higher post-heart transplantation mortality and retransplantation and any induction therapy and steroid maintenance was associated with improved survival for all recipients.
145