Insights Into the Revision of Heart Transplant Allocation Criteria　- Analysis of Waitlist Mortality and Transplant Probability for Adult Heart Transplant Candidates in the Nationwide Registry Data of Japan.

BACKGROUND

Using the Japan Organ Transplant Network national waitlist, this study investigated confounding factors for waitlist mortality and transplant probability among adult heart transplant candidates, focusing on heart disease and change in status (from registration to observation on June 30, 2024), to provide insights into the use of underlying heart disease or severity in the current revision of the heart transplant allocation criteria.

METHODS AND

RESULTS

All-cause waitlist mortality and heart transplantation probability were assessed using Gray's test, as well as univariate and multivariate Fine-Gray subdistribution hazard regression models. After excluding heart-lung transplantation candidates, patients with missing data, patients who were never on the waitlist after revision of the Organ Transplant Act, and patients aged <18 and ≥60 years at the time of registration, 1,522 patients were included in the final cohort. Heart transplant candidates with congenital heart disease had a higher risk of mortality, whereas patients waiting for retransplantation had no chance of transplantation and all died. The mortality rate was significantly higher for patients listed as Status 2 (unchanged) at observation than those listed as Status 1 (unchanged).

CONCLUSIONS

Prioritization of candidates with congenital heart disease should be considered to reduce the risk of mortality while patients are on the transplant waitlist.