Ahmanson/UCLA Adult Congenital Heart Disease Center, Division of Cardiology, University of California Los Angeles, Los Angeles, California, USA.
Columbia University Irving Medical Center, New York, New York, USA.
Am J Transplant. 2022 Apr;22(4):1123-1132. doi: 10.1111/ajt.16900. Epub 2021 Dec 23.
Adults with congenital heart disease (ACHD) experience worse waitlist outcomes and higher early posttransplant mortality compared to non-ACHD patients. On October 18, 2018; the UNOS donor heart allocation system was redesigned giving unique listing status to ACHD patients. The impact of this change on outcomes in transplant-listed patients is unstudied. Using the Scientific Registry of Transplant Recipients (SRTR) we compared ACHD patients listed for the first-time for heart transplantation from two eras of equal duration. We analyzed waitlist outcomes, posttransplant mortality and length of stay among ACHD patients in both eras and between ACHD and non-ACHD patients in the new era. Of 12 723 listed patients, 535 had ACHD (293 in the new era) and 12 188 did not (6258 in the new era). A total of 163 (56%) ACHD patients in the new era versus 150 (62%) in the prior era were transplanted; 11 (3.8%) versus 15 (6.2%) died on the waitlist; 32 (11%) versus 35 (14%) were delisted and 15 (9.2%) versus 19 (12.7%) died within 30 days of transplant, respectively. The new UNOS donor heart allocation system improved waitlist time and decreased the proportion not transplanted during the first 300 days after listing among ACHD patients without altering early posttransplant outcomes or significantly changing the gap in outcomes compared to non-ACHD patients.
成人先天性心脏病（ACHD）患者的等待名单结果比非 ACHD 患者差，并且早期移植后死亡率更高。2018 年 10 月 18 日，UNOS 供体心脏分配系统进行了重新设计，为 ACHD 患者提供了独特的列表状态。这种变化对移植患者的结果的影响尚未研究。使用 Scientific Registry of Transplant Recipients（SRTR），我们比较了两个相等时间段内首次列出心脏移植的 ACHD 患者。我们分析了两个时期的 ACHD 患者的等待名单结果、移植后死亡率和住院时间，以及新时期 ACHD 患者与非 ACHD 患者之间的差异。在 12723 名列出的患者中，有 535 名患有 ACHD（新时期有 293 名），12188 名没有（新时期有 6258 名）。在新时期，共有 163 名（56%）ACH 患者接受了移植，而在前一个时期有 150 名（62%）；11 名（3.8%）在等待名单上死亡，而在前一个时期有 15 名（6.2%）；32 名（11%）被取消名单，而在前一个时期有 35 名（14%）；15 名（9.2%）在移植后 30 天内死亡，而在前一个时期有 19 名（12.7%）。新的 UNOS 供体心脏分配系统改善了等待名单时间，并减少了 ACHD 患者在列出后的前 300 天内未移植的比例，而不会改变早期移植后结果，也不会显著改变与非 ACHD 患者相比的结果差距。
