| Autor: |
Aaron M. Wolfson, Eugene C. DePasquale, Michael W. Fong, Kruti Pandya, Leon Zhou, Eric S. Kawaguchi, Sunu S. Thomas, Ajay S. Vaidya |
| Rok vydání: |
2022 |
| Předmět: |
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| Zdroj: |
American Journal of Transplantation. 22:2931-2941 |
| ISSN: |
1600-6135 |
| DOI: |
10.1111/ajt.17173 |
| Popis: |
The heart transplantation policy change (PC) has improved outcomes in high-acuity (Old 1A, New 1-3) patients, but the effect on low-priority (Old 1B/2, New 4-6) patients is unknown. We sought to determine if low-priority patient outcomes were compromised by benefits to high-priority patients by evaluating for interaction between PC and priority status (PS). We included adult first-time heart transplant candidates and recipients from the UNOS registry during a 19-month period before and after the PC. We compared clinical characteristics and performed competing risks and survival analyses stratified by PC and PS. There was a dependence of PC and PS on waitlist death/deterioration with an interaction sub-distribution hazard ratio (adjusted sdHR) of 0.59 (0.45-0.78), p-value .001. There was a trend toward a benefit of PC on waitlist death/deterioration (adjusted sdHR: 0.86 [0.73-1.01]; p = .07) and an increase in heart transplantation (adjusted sdHR: 1.08 [1.02-1.14], p = .007) for low-priority patients. There was no difference in 1-year post-transplant survival (log-rank p = .22) when stratifying by PC and PS. PC did not negatively affect waitlisted or transplanted low-priority patients. High-priority, post-PC patients had a targeted reduction in waitlist death/deterioration and did not come at the expense of worse post-transplant survival. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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