Should status II patients be removed from the pediatric heart transplant waiting list? A multi-institutional study

J Heart Lung Transplant. 2006 Mar;25(3):271-5. doi: 10.1016/j.healun.2005.10.003. Epub 2006 Jan 18.


Background: The survival benefit of cardiac transplantation (CTx) among Status 2 (stable outpatient) adult recipients has been questioned, but few studies have addressed this issue in pediatric patients. This study examined the following hypothesis: "Status 2 pediatric recipients have a survival benefit with CTx."

Methods: Between 1993 and 2003, 2,375 patients were listed for CTx at 24 institutions; 614 (26%) of these patients were Status 2. By multivariate competing outcomes hazard function analysis, death after listing and post-transplant survival were analyzed.

Results: A single-phase hazard function described the risk of death after listing, with 20% actual mortality within 2 months after Status 1 listing. The "natural history" of Status 2-listed patients was estimated by the risk of death, whereas waiting and risk of deterioration to Status 1 at CTx (weighted by the probability of death at 3 months after Status 1 listing). At 4 months after CTx, survival with CTx exceeded the predicted "natural Hx" survival in all diagnostic categories out to 4 years of follow-up.

Conclusions: Pediatric patients currently listed as Status 2 have a survival benefit with transplant out to at least 4 years. A pediatric allocation system restricted to Status 1 patients could only be justified if the vast majority of such patients could be transplanted within 1 to 2 months.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Cardiomyopathies / classification
  • Cardiomyopathies / mortality
  • Cardiomyopathies / surgery
  • Cause of Death
  • Child
  • Child, Preschool
  • Heart Defects, Congenital / classification
  • Heart Defects, Congenital / mortality
  • Heart Defects, Congenital / surgery
  • Heart Transplantation*
  • Humans
  • Infant
  • Models, Statistical
  • Patient Selection*
  • Waiting Lists*