ArticleThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation2023
Association of high-priority exceptions with waitlist mortality among heart transplant candidates.
Article in The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- High Rate of Transplantation Before Review of Status Exception Requests Among Adult Heart Transplant Candidates.Circulation. Heart failure · 2026Article
- Potential Impact of the OPTN Status Escalation Policy for Adult Heart Transplant Candidates With Durable LVADs.Circulation. Heart failure · 2026Article
- Status Exceptions and Misalignment of Medical Urgency in U.S. Pediatric Heart Transplantation.Journal of the American College of Cardiology · 2026Article
- Management of Ischemic Heart Disease in Patients With Heart Failure: JACC: Heart Failure Position Statement.JACC. Heart failure · 2025Review
- Modernizing the national transplant database.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2025Review
- Complications and Status Upgrades among Adult Heart Transplant Candidates with Durable LVADs: Waiting 6 to 8 Years for Status Escalation Is Too Long.medRxiv : the preprint server for health sciences · 2025Article
- High Rate of Transplantation Prior to Review of Status Exception Requests among Adult Heart Transplant Candidates.medRxiv : the preprint server for health sciences · 2025Article
- Association of nonstandardized model for end-stage liver disease score exceptions with waitlist mortality in adult liver transplant candidates.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2025Article
- Article
- Best practices for statistical analysis of pretransplant medical urgency.The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2024Article
- Observational
- Are exceptions justified in the current heart allocation system?JHLT open · 2023Article
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8 authors.
Funding
Abstract
backgroundThe US heart allocation system ranks candidates using six categorical status levels. Transplant programs can request exceptions to increase a candidate's status level if they believe their candidate has the same medical urgency as candidates who meet the standard criteria for that level. We aimed to determine if exception candidates have the same medical urgency as standard candidates.
methodsUsing the Scientific Registry of Transplant Recipients, we constructed a longitudinal waitlist history dataset of adult heart-only transplant candidates listed between October 18, 2018 and December 1, 2021. We estimated the association between exceptions and waitlist mortality with a mixed-effects Cox proportional hazards model that treated status and exceptions as time-dependent covariates.
resultsOut of 12,458 candidates listed during the study period, 2273 (18.2%) received an exception at listing and 1957 (15.7%) received an exception after listing. After controlling for status, exception candidates had approximately half the risk of waitlist mortality as standard candidates (hazard ratio [HR] 0.55, 95% confidence interval [CI] [0.41, 0.73], p < .001). Exceptions were associated with a 51% lower risk of waitlist mortality among Status 1 candidates (HR 0.49, 95% CI [0.27, 0.91], p = .023) and a 61% lower risk among Status 2 candidates (HR 0.39, 95% CI [0.24, 0.62], p < .001).
conclusionsUnder the new heart allocation policy, exception candidates had significantly lower waitlist mortality than standard candidates, including exceptions for the highest priority statuses. These results suggest that candidates with exceptions, on average, have a lower level of medical urgency than candidates who meet standard criteria.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.