Exception-Status Listing: A Critical Pathway to Heart Transplantation for Adults With Congenital Heart Diseases

ANIKET S. Rali; SAGAR RANKA; JEREMY A. MAZUREK; MARSHALL D. BRINKLEY; ARI CEDARS; DANIEL CLARK; NHUE DO; GINA E. LAZZARA; LYNN PUNNOOSE; EMILY SANDHAUS; ASHISH SHAH; SIVA TADURU; MARK WIGGER; SANDIP ZALAWADIYA; JOSEPH ROGERS; JOANN LINDENFELD; KELLY SCHLENDORF; JONATHAN N. MENACHEM

doi:10.1016/j.cardfail.2021.10.004

Research Article| Volume 28, ISSUE 3, P415-421, March 2022

Exception-Status Listing: A Critical Pathway to Heart Transplantation for Adults With Congenital Heart Diseases

ANIKET S. Rali, MD *
Author Footnotes
⁎ Both authors contributed equally to the study.
ANIKET S. Rali
Footnotes
⁎ Both authors contributed equally to the study.
Affiliations
From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Search for articles by this author
SAGAR RANKA, MD *
Author Footnotes
⁎ Both authors contributed equally to the study.
SAGAR RANKA
Footnotes
⁎ Both authors contributed equally to the study.
Affiliations
Department of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
Search for articles by this author
JEREMY A. MAZUREK, MD
JEREMY A. MAZUREK
Affiliations
Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Search for articles by this author
MARSHALL D. BRINKLEY, MD
MARSHALL D. BRINKLEY
Affiliations
From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Search for articles by this author
ARI CEDARS, MD
ARI CEDARS
Affiliations
Departments of Medicine and Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
Search for articles by this author
DANIEL CLARK, MD
DANIEL CLARK
Affiliations
From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Search for articles by this author
NHUE DO, MD
NHUE DO
Affiliations
Division of Pediatric Cardiac Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
Search for articles by this author
GINA E. LAZZARA, MD
GINA E. LAZZARA
Affiliations
Departments of Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
Search for articles by this author
LYNN PUNNOOSE, MD
LYNN PUNNOOSE
Affiliations
From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Search for articles by this author
EMILY SANDHAUS, MD
EMILY SANDHAUS
Affiliations
From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Search for articles by this author
ASHISH SHAH, MD
ASHISH SHAH
Affiliations
Division of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
Search for articles by this author
SIVA TADURU, MD
SIVA TADURU
Affiliations
Department of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas
Search for articles by this author
MARK WIGGER, MD
MARK WIGGER
Affiliations
From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Search for articles by this author
SANDIP ZALAWADIYA, MBBS
SANDIP ZALAWADIYA
Affiliations
From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Search for articles by this author
JOSEPH ROGERS, MD
JOSEPH ROGERS
Affiliations
Texas Heart Institute, Houston, Texas
Search for articles by this author
JOANN LINDENFELD, MD
JOANN LINDENFELD
Affiliations
From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Search for articles by this author
KELLY SCHLENDORF, MD
KELLY SCHLENDORF
Affiliations
From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Search for articles by this author
JONATHAN N. MENACHEM, MD
JONATHAN N. MENACHEM
Correspondence
Reprint requests: Jonathan N. Menachem, MD, 1215 21st Avenue South, Suite 5209, Nashville, TN 37232, Ph.: 6153222318, Fax: 6159362815
Contact
Affiliations
From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Search for articles by this author
Show footnotesHide footnotes
Author Footnotes
⁎ Both authors contributed equally to the study.

Published:October 17, 2021DOI:https://doi.org/10.1016/j.cardfail.2021.10.004

Abstract

Adults with congenital heart diseases may not be candidates for conventional therapies to control ventricular systolic dysfunction, including mechanical circulatory support, which moves potential heart-transplantation recipients to a listing status of higher priority. This results in longer waitlist times and greater mortality rates. Exception-status listing allows a pathway for this complex and anatomically heterogenous group of patients to be listed for heart transplantation at appropriately high listing status. Our study queried the United Network for Organ Sharing registry to evaluate trends in the use of exception-status listing among adults with congenital heart diseases awaiting heart transplantation. Uptrend in the use of exception-status listing precedes the new allocation system, but it has been greatest since changes were made in the allocation system. It continues to remain a vital pathway for adults with congenital heart disease (whose waitlist mortality rates are often not characterized adequately by using the waitlist-status criteria) timely access to heart transplantation.

Key Words

To read this article in full you will need to make a payment

Purchase one-time access:

One-time access price info

For academic or personal research use, select 'Academic and Personal'
For corporate R&D use, select 'Corporate R&D Professionals'

Subscribe:

Already a print subscriber? Claim online access

Already an online subscriber? Sign in

Register: Create an account

Institutional Access: Sign in to ScienceDirect

References

Organ Procurement and Transplantation Network/United Network for Organ Sharing Thoracic Organ Transplantation Committee. Proposal to Modify the Adult Heart Allocation System. [accessed March 20, 2021]. Available from: https://optn.transplant.hrsa.gov/media/2006/thoracic_brief_201612.pdf.
View in Article
- Google Scholar
Electronic Code of Federal Regulations. Title 42: Public Health. Part 121: Organ Procurement and Transplantation Network. [accessed March 20, 2021]. Available from: http://www.ecfr.gov/cgi-bin/text-idx?SID=bb60e0a7222f4086a88c31211cac77d1&mc=true&node=pt42.1.121&rgn=div5#se42.1.121_18.
View in Article
- Google Scholar
- Colvin M
- Smith JM
- Hadley N
- Skeans MA
- Carrico R
- Uccellini K
- et al.
OPTN/SRTR 2016 Annual Data Report: Heart.
Am J Transplant. 2018;; 18: 291-362
View in Article
- Google Scholar
Organ Procurememt and Transplantation Network. Modify Adult Heart Allocation 2016 2nd Round. [accessed March 20, 2021]. Available from: https://optn.transplant.hrsa.gov/governance/public-comment/modify-adult-heart-allocation-2016-2nd-round/.
View in Article
- Google Scholar
- Goldberg SW
- Fisher SA
- Wehman B
- Mehra MR
- et al.
Adults with congenital heart disease and heart transplantation: optimizing outcomes.
J Heart Lung Transplant. 2014; 33: 873-877
View in Article
- Google Scholar
- Alshawabkeh LI
- Hu N
- Carter KD
- Opotowsky AR
- Light-McGroary K
- Cavanaugh JE
- et al.
Wait-list outcomes for adults with congenital heart disease listed for heart transplantation in the U.S.
J Am Coll Cardiol. 2016; 68: 908-917
View in Article
- Google Scholar
- Karamlou T
- Hirsch J
- Welke K
- Ohye RG
- Bove EL
- Devaney EJ
- et al.
A united network for organ sharing analysis of heart transplantation in adults with congenital heart disease: outcomes and factors associated with mortality and retransplantation.
J Thorac Cardiovasc Surg. 2010; 140: 161-168
View in Article
- Google Scholar
- Davies RR
- Russo MJ
- Yang J
- Quaegebeur JM
- Mosca RS
- Chen JM
- et al.
Listing and transplanting adults with congenital heart disease.
Circulation. 2011; 123: 759-767
View in Article
- Google Scholar
- Chouairi F
- Mullan CW
- Sen S
- Mori M
- Fuery M
- Elder RW
- et al.
Impact of the new heart allocation policy on patients with restrictive, hypertrophic, or congenital cardiomyopathies.
PLoS One. 2021; 16e0247789
View in Article
- Google Scholar
- Menachem JN
- Schlendorf KH
- Mazurek JA
- Bichell DP
- Brinkley DM
- Frischhertz BP
- et al.
Advanced heart failure in adults with congenital heart disease.
JACC Heart Fail. 2020; 8: 87-99
View in Article
- Google Scholar
Review board (RB) guidance for adult congenital heart disease (chd) exception requests. [accessed March 20, 2021]. Available from: https://optn.transplant.hrsa.gov/media/2349/thoracic_guidance_201712.pdf.
View in Article
- Google Scholar
- Kovach JR
- Naftel DC
- Pearce FB
- Tresler MA
- Edens RE
- Shuhaiber JH
- et al.
Comparison of risk factors and outcomes for pediatric patients listed for heart transplantation after bidirectional Glenn and after Fontan: an analysis from the Pediatric Heart Transplant Study.
J Heart Lung Transplant. 2012; 31: 133-139
View in Article
- Google Scholar
- John AS
- Johnson JA
- Khan M
- Driscoll DJ
- Warnes CA
- Cetta F
- et al.
Clinical outcomes and improved survival in patients with protein-losing enteropathy after the Fontan operation.
J Am Coll Cardiol. 2014; 64: 54-62
View in Article
- Google Scholar
- Griffiths ER
- Kaza AK
- Wyler von Ballmoos MC
- Loyola H
- Valente AM
- Blume ED
- et al.
Evaluating failing Fontans for heart transplantation: predictors of death.
Ann Thorac Surg. 2009; 88 (discussion 563–4): 558-563
View in Article
- Google Scholar
- Gewillig M
- Brown SC
The Fontan circulation after 45 years: update in physiology.
Heart. 2016;; 102: 1081-1086
View in Article
- Google Scholar

Article info

Publication history

Published online: October 17, 2021

Accepted: October 2, 2021

Received in revised form: September 30, 2021

Received: June 10, 2021

Identification

DOI: https://doi.org/10.1016/j.cardfail.2021.10.004

Copyright

ScienceDirect

Access this article on ScienceDirect

Property	Value
Status
Version
Ad File
Disable Ads Flag
Environment
Moat Init
Moat Ready
Contextual Ready
Contextual URL
Contextual Initial Segments
Contextual Used Segments
AdUnit
SubAdUnit
Custom Targeting
Ad Events
Invalid Ad Sizes

Exception-Status Listing: A Critical Pathway to Heart Transplantation for Adults With Congenital Heart Diseases

Abstract

Key Words

Purchase one-time access:

Subscribe:

References

Article info

Publication history

Identification

Copyright

ScienceDirect

Related Articles