BACKGROUND In the 2018 Organ Procurement and Transplantation Network donor heart allocation system, patients listed for re-transplantation due to cardiac allograft vasculopathy (CAV) are assigned to Status 4 unless hemodynamic criteria are met. We aim to examine waitlist outcomes of CAV patients among adult heart transplant candidates. METHODS We examined waitlist mortality stratified by CAV and waitlist status among adult heart transplant candidates using Scientific Registry of Transplant Recipients data from 10/1/2018-11/1/2023. We analyzed waitlist mortality using Kaplan-Meier curves and doubly-robust Cox regressions adjusted for age, gender, sex, race, and dialysis. We compared CAV to non-CAV patients by initial waitlist status, first status of interest, and time-dependent status. RESULTS Of 21,586 listed patients, 368 were listed for CAV. CAV patients were most often listed at Status 4 with lower proportions at Status 3/2/1 compared with non-CAV patients. Status 4 and Status 3 CAV candidates demonstrated higher than expected waitlist mortality compared to non-CAV counterparts (Status 4: HR 0.51, 95% CI 0.31-0.84; p < 0.01; Status 3: HR 0.61, 95% CI 0.23-1.64; p = 0.33) with similar mortality to non-CAV patients in Status 3 and 2, respectively (Status 4: HR 0.80, 95% CI 0.48-1.35; p = 0.4; Status 3: HR 1.07, 95% CI 0.40-2.86; p = 0.89). When stratifying by status tier, CAV waitlist patients ever listed at Status 4 and 3 had a higher probability of death compared to their non-CAV counterparts (Status 4: HR 1.99, 95% CI 1.20-3.31, p < 0.01; Status 3: HR 3.06, 95% CI 1.06-8.87, p = 0.04). CONCLUSIONS After 2018, CAV patients had a higher risk of waitlist mortality at Status 4 and 3 compared to non-CAV patients. These results suggest that CAV patients are underprioritized in the current allocation system.

中文翻译：

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2018 年 OPTN 供体心脏分配系统下同种异体移植血管病变患者的候补名单死亡率。


背景 在 2018 年器官获取和移植网络供体心脏分配系统中，除非满足血流动力学标准，否则因心脏同种异体移植血管病变 （CAV） 而被列入再移植名单的患者被分配到状态 4。我们旨在检查成人心脏移植候选人中 CAV 患者的候补名单结果。方法 我们使用 2018 年 10 月 1 日至 2023 年 11 月 1 日的移植受者科学登记数据检查了按 CAV 分层的候补名单死亡率和成人心脏移植候选人的候补名单状态。我们使用 Kaplan-Meier 曲线和针对年龄、性别、性别、种族和透析调整的双稳健 Cox 回归分析了候补名单死亡率。我们通过初始候补名单状态、首次感兴趣的状态和时间依赖性状态将 CAV 与非 CAV 患者进行了比较。结果 在 21,586 名列出的患者中，有 368 名被列为 CAV。与非 CAV 患者相比，CAV 患者最常被列为状态 4，处于状态 3/2/1 的比例较低。与非 CAV 对应物相比，状态 4 和状态 3 CAV 候选者表现出高于预期的候补名单死亡率（状态 4：HR 0.51,95% CI 0.31-0.84;p < 0.01;状态 3：HR 0.61,95% CI 0.23-1.64;p = 0.33），死亡率分别与状态 3 和 2 的非 CAV 患者相似（状态 4：HR 0.80,95% CI 0.48-1.35;p = 0.4;状态 3：HR 1.07,95% CI 0.40-2.86;p = 0.89）。按状态等级分层时，与非 CAV 患者相比，处于状态 4 和 3 的 CAV 候补名单患者死亡概率更高（状态 4：HR 1.99,95% CI 1.20-3.31，p < 0.01;状态 3：HR 3.06,95% CI 1.06-8.87，p = 0.04）。结论 2018 年后，与非 CAV 患者相比，CAV 患者在状态 4 和 3 的候补名单死亡风险更高。 这些结果表明，在当前的分配系统中，CAV 患者的优先级被低估了。