Background. On March 22, 2016, changes to the definitions of pediatric Status 1A and 1 B criteria were implemented in the US. These changes were implemented to emphasize medical urgency over waiting time in heart allocation for children and therefore to increase access to transplant (tx) by better prioritizing pediatric candidates based on medical urgency. The current analysis was conducted as policy evaluation for the OPTN Pediatric Transplantation Committee.

Data and Methods. OPTN database was used for pediatric heart additions and txs during pre-policy period (12/7/15–3/21/16) and post-policy period (3/22/16–7/6/16). Additions and txs were tabulated by policy period and status/criteria at listing or tx.

Results. The number of pediatric additions was almost identical in the two policy periods (174 and 175, respectively). The percent of additions in Status 1A decreased from 72% pre-policy to 51% post-policy, whereas the percent of Status 1B and Status 2 additions increased from 14% to 27% and from 14% to 22%, respectively. Overall number of pediatric txs increased from 119 to 138. The percent of Status 1A txs dropped from 88% to 77%, while percent of Status 1B txs increased from 8% to 20%. The most commonly reported Status 1A criteria during pre-policy period was high dose inotropes for both listings and txs (in over 60%). During post-policy period, congenital heart disease with high dose inotropes was the most common Status 1A criteria for both listings and txs (in about 30%). Growth failure was the most common Status 1B criteria pre-policy for both listings and txs (in 63% and 40%, respectively). During the post-policy period, high dose inotrope was the most common Status 1B criteria at listing (81%) and exception was the most common Status 1B criteria at tx (46%). The percent of listings with exceptions doubled for both Status 1A (from 5% to 10%) and Status 1B (from 8% to 19%). The percent of txs with exceptions almost quadrupled for Status 1A (from 5% to 19%) and increased from 30% to 46% for Status 1B.

Conclusions. Early results of the policy change showed a decrease in Status 1A listings and transplants, which was an intended goal of the policy. However, early data also showed a marked increase in percent of listings and transplants with exceptions after the policy change, a trend that needs to be monitored closely as more data are available.

CITATION INFORMATION: Cherikh W, Davies R, Cheng Y, Mahle W. Redefining Pediatric Heart Status 1A and 1B Criteria: Results of Early Policy Evaluation. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress