BACKGROUND A pediatric national heart review board (NHRB) and exception guidance document to standardize decision-making were implemented in 2021 to reduce variability and ensure equity in status exceptions for pediatric candidates. We evaluated the hypothesis that these changes decreased center variability and racial disparities within the granted exceptions. METHODS Guidance document and pediatric NHRB were operational by February and June 2021, respectively. Candidates were stratified by listing date into: Era 1, pre-policy changes (July 2018 - June 2020) and Era 2, post-policy changes (July 2021 - June 2023). Mixed effects logistic regression models evaluated individual and center-level predictors of receiving status 1A and 1B exceptions (E) pre- and post-policy implementation. RESULTS Of 1,275 Era 1 listees, 15% received a 1A(E), with significant center variation. Black listees had lower likelihood of receiving 1A(E) (OR 0.57 [95% CI 0.34 - 0.94]), controlling for age, diagnosis, and center effects. Among 1,369 Era 2 listees, 14% received status 1A(E). Race was not associated with 1A(E), when controlling for the same variables, and center effect was not significant. While children listed 1B(E) increased from 12% to 16% from Era 1 to Era 2, in both eras, Black children were less likely to receive 1B(E) (OR 0.56 [95% CI 0.33 - 0.94) in Era 1, and 0.56 [0.34 - 0.91]) in Era 2). Center effect was significant in both eras. CONCLUSIONS Since implementing exception guidance and a pediatric review board, variation by center and patient race/ethnicity in 1A exceptions has been reduced. Center variation and racial disparities persist among 1B exceptions.

中文翻译：

---

自儿科审查委员会实施以来，儿科心脏移植候选者上市状态例外的公平性和中心差异。


背景 2021 年实施了儿科国家心脏审查委员会 （NHRB） 和例外指导文件，以标准化决策，以减少可变性并确保儿科候选人状态例外的公平性。我们评估了这些变化在授予的例外中降低了中心变异性和种族差异的假设。方法 指导文件和儿科 NHRB 分别于 2021 年 2 月和 6 月开始运行。候选人按上市日期分为：时代 1，政策变更前（2018 年 7 月至 2020 年 6 月）和时代 2，政策变更后（2021 年 7 月至 2023 年 6 月）。混合效应 logistic 回归模型评估了政策实施前后接收状态 1A 和 1B 异常 （E） 的个体和中心级预测因子。结果在 1,275 名时代 1 名单中，15% 获得 1A（E），中心差异显著。在控制年龄、诊断和中心效应的情况下，黑名单患者接受 1A（E） 的可能性较低 （OR 0.57 [95% CI 0.34 - 0.94]）。在 1,369 名时代 2 名单中，14% 获得了 1A（E） 状态。当控制相同的变量时，种族与 1A（E） 无关，中心效应不显著。虽然从时代 1 到时代 2，列出的 1B（E） 儿童从 12% 增加到 16%，但在这两个时代，黑人儿童在时代 1 中接受 1B（E） （OR 0.56 [95% CI 0.33 - 0.94]）的可能性较小，在时代 2 中接受 0.56 [0.34 - 0.91]）。中心效应在两个时代都显著。结论 自从实施例外指南和儿科审查委员会以来，1A 例外中不同中心和患者种族/民族的差异已经减少。在 1B 例外中，中心差异和种族差异仍然存在。